Obsessive Compulsive Disorder: The Doubting Disease
Obsessive Compulsive Disorder (OCD) is an extremely painful and debilitating disorder that impacts the sufferer in ways unimaginable to those unaffected. If you are experiencing OCD, know that you are so not alone and there is effective treatment for it!
The biggest misconception I see folks having about OCD is believing it’s only about excessive cleanliness and symmetry. While that is absolutely one subtype of OCD, there are many other subtypes that make up the disorder. It’s important to understand that the hallmark of OCD is the presence of doubt. Perhaps you can relate to some of these doubting questions that OCD asks below:
What if I didn’t lock the front door?
What if I accidentally stab my mother?
What if I do something inappropriate?
What if I’m not even real?
What if I said something horrible to that person?
What if I ran over someone on the way to the grocery store?
What if I had a blasphemous thought against god?
What if I’m actually gay/straight?
What if my partner isn’t the right one for me? Do I even love them?
What if I don’t have OCD and I’m really just a monster?
There are way more “what if’s” that OCD can conjure up beyond the ones listed above, but you get the gist. Essentially, doubt clouds everything. Doubt can be so severe that you can even find yourself questioning reality as you are seeing it. For instance, you might look at your front door, see that it’s locked, but doubt that you are seeing it correctly.
In actuality, it’s not the thoughts in OCD that are the problem, but the distress that the thoughts produce. The distress may look like experiencing significant anxiety, worry that your thoughts mean something, shame and profound guilt. So, one part of treatment is actually learning to tolerate the distressing feeling that the thought creates. The O in OCD is the obsession, which then leads to the distressing feeling and the need to engage in a compulsion to neutralize the feeling.
The C in OCD
What truly makes OCD a disorder is the C, or the compulsion. The compulsion is what keeps suffers stuck on a hamster wheel, going round and round but getting nowhere. When folks who are not affected by OCD experience an intrusive thought, they generally shrug it off and move forward. In most cases, they’re probably not even aware of it, and if they are, it does not generate any anxiety.
For folks with OCD, an intrusive thought gets “caught” in the mind. Due to the nature of OCD, an intrusive thought gets marked as a problem to be solved. Suffers might wonder, “what does it mean about me that I had this thought?” or think that their thought is an important sign to pay attention to.
For instance, an individual distressed by the thought of contamination, might suddenly have a memory pop into their mind where they shook hands with someone and begin to doubt if that person’s hands were clean or not. From that point forward, the compulsion may look like excessive washing, mental reviewing, getting reassurance from others, or even going to the doctor.
The individual who experiences mental compulsions, may find themselves doing something similar to the hand washer, except they are predominantly engaging in mental compulsions such as mental reviewing, undoing negative thoughts with positive thoughts, saying certain words or phrases, or engaging in prayer. Essentially, a mental compulsion is geared towards “undoing” a negative thought, image, memory, to return to a “clean” mental state.
Here are some examples of what compulsions can look like:
Confessing to someone every “bad” thought you’re having
Excessive cleaning and avoidance of public places, touching certain things that may be contaminated.
Prayer or focusing on “undoing” a negative thought with a positive thought
Repeating certain words, phrases, or bodily movements to undo negative thoughts
Mentally reviewing events to check to make sure you didn’t do something “bad”
Checking the news to make sure you didn’t accidentally murder someone
Trying to prove if your gay or straight by checking to make sure you’re not attracted to the same or opposite sex
Excessive re-reading of emails, texts and phone records to make sure you didn’t say anything in appropriate or call anyone that you feel you “shouldn’t have”
Rearranging items in your vicinity or touching something for a certain amount of times until it feels “just right”
The Treatment
If you are suffering from OCD, I want you to know that there is hope for recovery. OCD is a chronic condition, which means recovery is about learning new and more effective ways of living with it. The treatment I use for OCD is called Exposure and Response Prevention (ERP) which essentially boils down to two things:
1. Purposefully exposing oneself to the feared thought, image, worry, or belief
2. Not engaging in a compulsion (i.e. Response prevention).
The reason why ERP is utilized for OCD treatment is because it effectively works to extinguish the cycle of OCD. Sufferers learn to tolerate discomfort and uncertainty without engaging in a compulsion, which retrains the brain to cease misfiring unnecessarily. When you stop yourself from engaging in a compulsion, you are telling your brain “this is not important” and eventually the brain stops associating certain mental events or experiences with “danger”.
ERP is an evidenced-based treatment for OCD and is considered the gold standard for treatment. The practice of ERP can eventually become fun when you gain confidence in your ability to tolerate distress. Eventually you may find yourself saying, “bring it on, brain!” and marveling in your ability to withstand and tolerate discomfort. Learning to live with uncertainty and disengaging in the compulsions that pretend to offer certainty is the end goal of ERP.
I’m excited to help you learn new and effective ways of dealing with your OCD so that you can return to your life fully. You are stronger than you think!
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