Know your OCD

This week, several members asked for strategies that help them decide whether or not they were experiencing OCD. Put another way, the topic is: “When I know it’s OCD, I know what to do. What do I do when I don’t know whether I’m bothered by a real problem or it’s OCD?”

Let’s come back to this topic this week in Community Time. Here are some ideas to get us started:

  • Is it a real problem? If the thought that you are bothered by hadn’t arrived in your mind, would you still have an issue? 
  • You won’t always know that you are experiencing OCD when you decide to act as though you are. The nature of OCD is that you feel uncertain about something that is not a threat. When you decide to treat your thought as though it is OCD, you are saying, “The uncertainty I feel about this does not mean that there is something wrong. I’m going to act as though there is nothing wrong even though it feels like there is something wrong.” 
  • Try using urgency as a cue for OCD. Real problems are still real problems regardless of when you think about them. If you have a medical illness, you will also have it tonight and tomorrow. If you offended someone, you can make amends tomorrow, too. The urgency tells you that some part of what you’re experiencing is uncertainty. Try committing to relating effectively to the uncertainty, even if there is also a real problem. 
  • Remember that everyone else is also uncertain about whatever makes you feel uncertain. Welcome to humanity! We are all uncertain about whether we or our loved ones will become sick and what will cause it. None of us know exactly how others are perceiving us. Everyone in any romantic relationship doesn’t have certainty whether they made a good choice, what their feelings and actions will be in the future, or how their partner will feel and act towards them in the future. No one knows whether or not they are cursed by God or have some other terrible flaw that makes them a bad person. No one has absolute certainty about these things but some people don’t constantly feel uncertain about them. People that don’t feel uncertain don’t brace against the uncertainty of these possibilities. The bracing is the problem, not the uncertainty. 

All this said, OCD feels like an issue when it shows up. You can’t know with certainty that you’re experiencing OCD in any given moment, but you can get to know your OCD so that you can take an educated guess about it when you feel distress. If you know your OCD well, when it shows up, you’ll be able to guess what’s happening faster. It will become less frequent, quicker, less distressing, and less impairing. It might become funny. You might come to appreciate your own process. 

To know your OCD:

  • Become familiar with what sensitizes you. When your body is under stress, your mind is more likely to be sticky. Bodily states that makes sensitization more likely include being hungry, tired, illness, and stressed. Hormonal fluctuations can be sensitizing. Emotional states like loneliness, anger, irritability, excitement, and arousal are also sensitizing. Healthy lifestyle behaviors will likely reduce your level of sensitization, but they won’t prevent your mind from ever being sticky again. Use your awareness of sensitization to inform thinking like, “This thought might feel like a threat because I am sensitized, rather than because it is an issue.” 
  • Observe your content. OCD content areas commonly include fears about health, fears about contamination, fears about sexuality, fears about harm to self or others, fears about relationships, and excessive concern with right and wrong. You may have variations of these content areas. To get to know what your feared content typically include try self-monitoring on a daily basis. 
  • Learn what maintains fear of your content. We discuss these in small groups. Cognitive and behavioral mechanisms that maintain fear of your content include anxiety sensitivity, intolerance of uncertainty, clinical perfectionism, fear of evaluation, inflated responsibility, pervasive negative beliefs, experiential avoidance, repetitive negative thinking, and fixed attentional focus
  • Get ready for your triggers. Once you understand what sensitizes you, what content areas bother you, and what cognitive and behavioral patterns maintains those content areas, try to get out in front of your triggers. This concept is also known as exposure and response prevention. You’ll need both formal, planned exposure and response prevention to triggering situations, as well as a plan for when you are accidentally exposed to a trigger. Both are opportunities. Plan to talk more in small groups about your exposure and response prevention plan. 
  • Surrender to the hopelessness of perfect recovery. Your OCD is as smart as you are. No matter how hard you work at this, you are going to get re-sensitized. It’s really important to accept this as part of the condition of OCD, rather than a character flaw, moral failing, or something wrong with your approach. You’ll get a handle on some content areas and then you will develop another content area. Or, it will be the same content area with a slightly different, seemingly important, twist. It’s okay. Once you notice, you can use the same strategies. It can even become funny if you let it.