The Three Tricks Your OCD Plays on You.
Recently, I’ve begun working with individuals who have OCD using Exposure and Response Prevention (ERP), the gold standard of treatment for OCD. As a sufferer myself, I have an intimate relationship with this doubting disease and can tell you that it knows no limits.
A typical OCD spike looks something like this: You get triggered. An intrusive thought just popped into your head causing you to feel significant anxiety or guilt. You try to withstand it, try to ignore what it’s saying, but it gets louder. Suddenly, you are flooded with a fear so great that you feel you have no other choice but to engage in a compulsion. You do the compulsion, maybe you undo the mental thought or image that came up with a “positive one”, you counted a certain number of times, said a safe word, washed your hands, repeated your actions several times, sought reassurance, confessed, removed dangerous objects, prayed, and then…relief. The fear abates and you return to homeostasis. For now.
Of course, anyone with OCD knows that giving into a compulsion is what reaffirms the disorder. It tells the brain, “Yep! This thought, image, sensation, urge, was dangerous and this compulsion was necessary”. But trying to respond to OCD using logic is about as useless as using scotch tape to fix a broken bone. It doesn’t do much of anything. We have use an approach that feels counterintuitive and outright scary as hell. The approach can be defined in three ways:
1. Do nothing.
Yep, that’s right. Do absolutely nothing in response to your anxiety. Don’t do a compulsion, don’t seek out relief or reassurance, and instead, sit in it. The reason why you do this is so that your brain learns, through your lack of response, that the thought, feeling, or sensation is not a threat. When we sit with our anxiety, we’re telling our brain that we can handle it. And naturally, the anxiety starts to subside. It’s not an immediate thing, but eventually, our body relaxes just enough and our thoughts move on to something else. And when they can’t, we might do step two.
2. Agree with the obsession.
Oh boy, this one is tough. I don’t care what theme your OCD takes, this one is downright scary. This is usually the last thing I want to do when my thoughts are full of fear and doubt. But what I’ve learned through my own experiences is that you have to one up the OCD bully by showing it who’s boss. Think of an actual bully for a moment. This bully wants to get you to cower in fear and do what it tells you. But what happens when you agree with the bully? Well, he might try harder, using scarier threats, trying to overpower you with fear. But what happens if you keep agreeing with him? Eventually, he’ll lose steam and move on. Bullies don’t know what to do in the face of confidence, so you have to show your OCD that you truly are not afraid of what it’s telling you by agreeing with it. Once you get a sense of confidence around this, it grows and grows.
3. Accept that you’ll never know for sure.
OCD wants absolute certainty that you would never hurt someone, steal something, act out sexually or violently, contaminate yourself or those you love, insult God, or be morally dubious. And honestly, the list could go on. OCD is called the doubting disease for a reason and we play right into its doubting trap when we go looking for certainty. The only way out of this is to accept that we cannot ever achieve total certainty. Sure, a violent thought may occur in my mind and my OCD may start to wonder, “are you really capable of doing that? Perhaps you had this thought because you actually want to stab that person?” and I have to reply with, “maybe, maybe not. I guess I’ll never know”. And it doesn’t mean I have to like saying that! But if I want a path out of OCD, then accepting uncertainty is the trailhead.
Considering how powerful OCD is, I’d like to share the top three tricks that your OCD will play on you and invite you to use one of the three responses above.
Trick number one: Your thoughts have meaning (spoiler alert: they don’t).
I’ll use hit-and-run themed OCD for this example.
Maybe you’re driving on a winding road and for a minute, you glance down as something on the floor caught your eye. You have the intrusive thought, “In that moment I wasn’t paying attention. What if I hit someone and didn’t realize it? They could be bleeding and hurt!”. The compulsion then would be to either live in rumination, call local hospitals to see if anyone had been hit by a car, or turn the car around to go inspecting. If you suffer from hit-and-run themed OCD, you know how tedious this one can be. Despite not having any indication that you’ve hit someone, the doubt persists. Because OCD is so thoughtful, it will takes the doubt up another notch, further making you “remember” feeling a bump in the road or believing that you saw someone on the road. It starts to say, “are you sure there was no one on that road? I’m almost certain that there was someone there.” And round and round we go.
OCD tricks us into thinking we’ve done something or could do something by assigning meaning to what we’re thinking or doing. For hit-and-run OCD, it assigns meaning to the act of looking away from the road temporarily. If you looked away, you probably hit someone. In non-OCD individuals, they likely don’t even register when they’ve looked away from the road, and if they do, quickly come back and remind themselves to pay attention. But in OCD, this innocuous act gets registered as a crime.
Another way it assigns meaning is in how it interprets our thoughts or sensations. If you have the thought, “I could kill for a chocolate sundae right now”, OCD might wonder, “why did you say the word kill? Is that what you really want to do?”. Or perhaps you look at the opposite or same sex and notice how attractive that person is. If you have sexual orientation themed OCD, this natural reaction to someone’s beauty, whether they are same or opposite sex, gets interpreted as you possibly being gay or straight. Then the doubt comes in. You start to wonder why you had that thought, or why you found it so easy to be attracted to that person? The compulsion then would be to get total certainty that you’re not attracted to that person so that you can know for sure whether your gay or straight.
Trick number two: Do a compulsion, just in case.
I’ve had instances in my OCD recovery where I am an utter BADASS and feel like I can withstand whatever OCD throws at me. In those moments, I feel like I’ve got this OCD recovered mindset down and I feel like the victor. And then there are days when I cannot STAND what it’s throwing at me and I do a compulsion just in case. Just in case I didn’t actually lock the door, I’ll go double check or just in case I forgot to turn the stove off (even though I literally did not use it once that week), I’ll go make sure it says “off”. And this sneaky little just-in-case is just enough to get my OCD back into high gear. Before I know it, I’m counting, repeating certain phrases, mentally reviewing, undoing “negative” thoughts and bam! I’m caught back in the OCD cycle I fought so hard to get out of.
Cue self-compassion.
OCD is a chronic, lifelong condition that has to be managed. Just like anything else, there will be days where you feel on top of it and days when you fall back into the pit. This is all part of recovery. There will be times when we get knocked down by our OCD and times when we rise up, stronger than before.
Just in case is a “technique” our OCD uses to get us back into doing compulsions. I make it sound like the OCD is a sentient being that is trying to lure us into compulsions, and on some days it really feels like it. When it’s doing the “just in case” technique, I try to show myself compassion because my brain is responding to a perceived threat and it believes that a compulsion will help me. I have learned to treat this just in case compulsion the way I treat any other compulsion. I use one of the three strategies above. Typically, I go towards accepting the uncertainty when this worry comes up. Yep, it’s possible that in a haze I turned my stove on and forgot to turn it off, but if I give into this compulsion to go and check, I’m telling my brain that compulsions are necessary.
I know it probably seems so dangerous to accept uncertainty when we’re talking about a stove being on, but OCD tries to convince us that we cannot be trusted. I know it’s an OCD fear operating because of the level of urgency I feel. This level of urgency is different from responding to fear adaptively. If I’m hiking and I see a bear cross my path, my fear will light up and I won’t even need to think about what to do because my nervous system will take over. However, if I’m hiking and an image of a bear comes to my mind, then my response will look differently. With OCD, an image of a bear gets conflated to an actual bear being present. We have to learn to relate to our thoughts and random fears (a la, “what if I left the stove on?’) with a lot more patience, courage, and willingness to be uncertain.
Trick number three: You cannot tolerate uncertainty (Spoiler alert: You can).
Similar to the above, this trick shows up everywhere. OCD demands that we know for sure whether or not something bad will happen. If there’s even an inkling of doubt, OCD demands that we spend the rest of our day (more like life) making sure that doubt gets extinguished. Our compulsions offer the illusion of certainty. If I just pray the right way, then my cat won’t die. Or if I can remember exactly what I said in that conversation, then I’ll know if what I said was mean or nice. OCD does not rest until it gets what it wants. Much like Verruca Salt in Willy Wonka, she will stop at nothing to get what she wants and everyone else has to pay the price for it.
We have to stop needing certainty. Easier said than done, but take a minute to register all the ways in which you naturally live with uncertainty on a daily basis. You could get hit by a car every time you venture out to the grocery store, a meteorite could strike earth at any moment, you could get sick and accidentally spread it to your spouse, there could be an earthquake and your house could get severely damaged, hell you could even win the lottery! There’s uncertainty everywhere, but our OCD doesn’t target all of these possibilities. It just goes after what you value and demands that you keep yourself and others “safe”, even at the expense of you living a full and meaningful life.
But guess what? You can tolerate uncertainty. You do it every day without realizing it. Your OCD will try to convince you that you cannot be uncertain about “this one thing”, but your job is to remind yourself that gaining total certainty is not possible. Imagine getting to the end of your life and realizing that all you did was try to gain certainty, not allowing yourself to embrace the fullness of life? Would you want your eulogy to say something like, “She spent all of her time trying to avoid catastrophe and gain certainty. She feared her thoughts and made sure that she never contaminated anyone”? Hell no! You’d probably want it to read like, “She lived courageously and rose above the chatter in her mind. She faced her fears and learned to flow with the rhythms of life.”
You don’t need certainty, and you won’t get it anyway. So, can you lean in?