Know Your Enemy
The first step in recovery is to know that you even have a problem in the first place. It seems silly, but in my experience, Obsessive Compulsive Disorder (OCD) is a sneaky disorder and many people suffering from it probably don’t even know they have it. It doesn’t help that in pop culture and social media, OCD is often stereotyped as people who are obsessed with being clean or tidy. Of course, this could be a symptom of one’s OCD, but it is only scratching the tip of the iceberg. Oftentimes, OCD will get misdiagnosed as generalized anxiety, or depression, or any other number of mental health disorders, as the symptoms of OCD can be tricky to identify (especially if the sufferer only has mental compulsions, often called “Pure O”) and many doctors, psychologists, and psychiatrists do not have much experience in diagnosing and treating OCD patients.
As a result, many people (myself included) have spent years of their lives living with OCD, not understanding what they have or why it makes them act the way they do. At its core, OCD is a mental disorder characterized by an obsessive need to complete “compulsions” or “rituals,” which are repetitive actions driven by an almost uncontrollable, compulsive urge. Failure to complete these rituals results in severe anxiety and fear in those suffering from OCD, and often they will continue to be paralyzed with these feelings until they successfully complete a given compulsion, which will temporarily “relieve” their anxiety. It is important to note that compulsions are not always physical, but can be mental as well (repetitive thoughts, mental images, excessive worrying, etc…).
Some examples of OCD compulsions that I myself have struggled with throughout my life (and the associated fears behind it) include:
Excessive hand-washing and cleanliness (fear of germs - what if I poison myself?)
Constantly hammering the “save” button in a video game (what if I lose all my progress?)
Checking that the door is closed and locked, sometimes up to 15 or 20 times (what if someone breaks into my house?)
Re-reading what I wrote in emails at work (what if I typed something wrong and get fired?)
Re-playing conversations in my head constantly (what if I said something offensive to that person?)
Restarting or completely redoing something (because it didn’t “feel right” the first time)
Asking friends if I did anything stupid after a night out at the bars (what if I drunkenly did something awful?)
And some other OCD compulsions and fears that I’ve read or heard about other people struggling with:
Checking their car tires after a drive or going back to a certain street to check if they had accidentally hit someone
Constantly ruminating / wondering if they really love their spouse or significant other, or if it’s just a temporary feeling
Repeating an activity a certain number of times (e.g. tying and untying their shoelaces 5 times because it feels “lucky”)
Constantly praying to God (or some other religious figure) for hours each day because they were afraid they had sinned or had not “prayed correctly” the first time
Checking the oven constantly to make sure it’s truly turned off and won’t burn the house down
Repeating a word or phrase constantly like a mantra, whether mentally or verbally, in order to provide a feeling of reassurance
Fear that they are attracted to people of the same sex (if they are heterosexual) or fear that they are attracted to people of the opposite sex (if they are homosexual)
Of course, the above compulsions and fears are just scratching the surface. Your particular fear or compulsion may not be listed but that doesn’t mean it’s not OCD - as I stated in the second paragraph, if you are driven to repeat certain actions in a compulsive urge in order to avoid feelings of anxiety and fear, then odds are pretty likely that you are suffering from OCD.
As you can see from my examples, OCD is much more varied than the stereotypical “he likes to clean his desk a lot” portrayal that it is often portrayed as in pop culture. It can range from “serious” fears (what if I killed someone by running them over in my car?) to “sillier” ones (my example with constantly saving when I play video games because I was afraid to lose progress). OCD compulsions can be physical (constantly washing your hands) or mental (repeating conversations in your head or ruminating on how certain things may have occurred). Regardless, the fears and compulsions all have the same effect: the sufferer ends up wracked in anxiety (or guilt, or fear, or doubt) over what “might” happen, and ends up wasting significant time and energy (sometimes hours or even days) performing compulsions to “prove” with absolute certainty that their worst fears will not come true. Then, after performing the compulsions, the sufferer is temporarily “relieved” of the feeling of anxiety, only for OCD to return in full force again once the next trigger occurs. And then the cycle repeats all over again.
That last sentence is extremely important. OCD feeds and sustains itself in a cycle. Fear leads to the sufferer doing compulsions, and acting out the compulsions temporarily relieves the anxiety, which teaches the brain: “If I do this compulsion, the anxiety will go away, and I will feel better again!” This then results in a cycle where everytime the sufferer is faced with the trigger or fear, the urge to do the compulsions only grows stronger, as do the feelings of anxiety if the compulsions are not performed. This eventually becomes crippling if OCD is not treated properly, as sufferers can end up spending days or weeks in a constant anxiety-fueled state of performing illogical compulsions, or upending their lives to avoid all triggers and fears which might set them off.
This cycle is what is most often misunderstood about OCD, both by people suffering from it, and by medical professionals. Of course it seems logical to say: “If I do this compulsion, the anxiety goes away, so therefore I should always do this compulsion whenever I get triggered.” But this only exacerbates the issue. Rather than training the brain to jump at OCD’s every command, we need to teach the brain to ignore the compulsions and accept our worst fears and uncertainties.
Let me repeat that, because it is key to recovery: we need to teach the brain to ignore the compulsions and accept our worst fears and uncertainties.
Of course, this is much easier said than done, and for someone in the throes of an OCD panic attack, accepting that they may have killed someone, or burned their house down, or ate poisoned food, is not an easy thing to do. Trust me, I have been there many, many times in the nearly three decades that I have suffered from OCD. But in order to dig ourselves out of the OCD hole and get on the path to recovery, we absolutely need to begin re-training our brain to accept fear and uncertainty, and disregarding the illogical signals that OCD throws at us. In order to beat OCD, you need to understand how it works.
Think of your brain like a puppy dog. Much like a puppy, it reacts and responds instinctively from learned behaviors that you teach it. If you are triggered by a fear (or uncertainty, or doubt, or “what if…?” question) which causes a feeling of anxiety, your OCD wants you to do a compulsion (such as ruminating on the thought, or physically checking, etc…) in order to relieve that anxiety and make you feel “good” again. By doing the compulsion, you may temporarily soothe the anxiety, but you are only making OCD worse in the long run by reinforcing negative behavior. When you respond to feelings of anxiety by doing compulsions, you are inadvertently teaching your puppy-dog brain that the feelings/fears are valid, so whenever that trigger occurs again, the brain will send more and increasing levels of anxiety in order to get you to perform more compulsions so that you can get that brief feeling of reassurance to feel good. Think of it like a drug: that sense of temporary relief is the “high” and your OCD will do anything to trick your brain into getting more of it.
Understanding this feedback cycle is critical for recovery, and something that even people who have been suffering for years with OCD can find difficult to grasp. What I want to emphasize is that in order to beat OCD and recover, you need to train that puppy in your head with the correct behavior.
How do you do this? It’s quite simple on paper, but difficult in practice. OCD is fueled by compulsions - so naturally, the best way to “beat” it is to stop doing the compulsions (which is the core principle that Exposure Responsive Prevention is based upon). The “correct” behavior you need to be teaching your brain is that whenever a trigger appears which causes anxiety, OCD will want you to perform the compulsion. Instead, choose not to do the compulsion. Sit there with the feeling of anxiety and actively refuse to do things like checking, ruminating, etc… no matter how bad the anxiety or fear gets. By consistently refusing compulsions and learning to accept the feelings of anxiety, you gradually teach your brain that these fears are not valid, and the compulsions are not required. As a result, you retrain your brain - quite literally - by teaching it to not throw up false alarms or feelings of anxiety whenever a trigger happens. However, it is important to note: this process is not necessarily fast nor is it easy. It can take months of proper ERP therapy to re-condition your brain and oftentimes it will feel like a torturous experience for the person undergoing therapy, as they are depriving themselves of the only things (acting on the compulsions) which provided any sense of relief to their anxiety.
I’m not writing this to scare you, or to cause despair, but to help set some context. The feeling that I get from talking to many OCD sufferers is that they hate their obsessions and feelings of anxiety and want an immediate, easy fix. And the unfortunate truth is - you may have to suffer a little in the short term. ERP therapy is not easy and it demands that you cut out your addiction to performing compulsions. Similar to how a drug addict or an alcoholic going through rehab may experience withdrawal from being deprived of their favorite vice, OCD sufferers will have to deal with bouts of anxiety when going through ERP. There is no way around it and the sooner you can accept that fact, the faster your recovery will be.
Your OCD recovery journey is completely in your hands - it can be as fast or as slow as you make it. I find that people with the mindset of saying: “This may be terrible for a couple months, but I will grit my teeth and wholeheartedly commit to ERP and eliminating compulsions no matter how much anxiety I feel” will recover quite quickly, often faster than they were expecting. And that really is key - in order to recover from OCD, you must make peace with that feeling of anxiety (or guilt, or doubt, or fear, or whatever emotion your brain is throwing at you) and learn that you can still live your life and do things that you enjoy. When it comes to OCD recovery, your feelings are a lie. I’ve had people ask me: “I’ve been doing ERP for X amount of time and I still feel anxious. Does this mean I’m not recovering?” My only response is this: “Your feelings are irrelevant for gauging progress. If you are always checking how anxious you feel, you will only get stuck in that rut. Instead, gauge progress by actions - am I doing less compulsions today than I did yesterday? Did I go to work, or do the dishes, or exercise for 30 min, or watch a movie I enjoy, instead of spending that time ruminating?”
The anxiety, obsessions, and intrusive thoughts will not last forever, but in order to free yourself from OCD, you need to understand how it works so that you can break the cycle. Cognitive Behavioral Therapy (CBT) techniques like ERP and Acceptance Commitment Therapy (ACT) will help you in the recovery process, but you must understand and accept that these treatments can be difficult and will force you to face your worst fears. But when you realize that your options are either a short period of struggle undergoing CBT treatment, or a lifetime of suffering and being OCD’s slave, it really doesn’t become a choice at all.
I hope this blog post helped in explaining two things: what OCD is, and how it works. This is foundational knowledge because in order to beat OCD (and also appreciate the techniques and approaches taught in ERP and ACT), you need to truly understand what you’re fighting and how it feeds off of your compulsions.
In my next blog post, I’ll start to dive more into the gold standard for treating OCD - Exposure Response Prevention (ERP) and outlining some high level ideas about the framework, as well as techniques that you can employ by yourself even without a therapist. As usual, please feel free to message me with questions or leave a comment below!
Eric