OCD can look very different from one individual to the next. When our clients start treatment, we take the time to understand the unique intrusive thoughts, fears, and compulsions they are experiencing. Yet there are common areas of struggle that seem to be present across most types of OCD, regardless of theme or symptom severity. We help our clients to recognize how these struggles show up for them and hold them back. See if you identify with any of these four common features of OCD below:
You have difficulty tolerating uncertainty.
Many of us struggle with uncertainty. We like knowing what is going to happen, when something good is going to start, or when something bad is going to end. We like to be prepared and to feel competent and safe. At the same time, life is a near-constant stream of “tolerating uncertainty.” Most of us accept some degree of uncertainty daily. We leave our homes (will I be hit by a falling air conditioning unit?), we drive or take public transportation (will I get into an accident?), we eat food (is this food contaminated?), we manage our health (is this a cold or something more serious?) and we interact with unpredictable people (what does my boss think of me today?)
OCD involves difficulty tolerating uncertainty and efforts to eliminate uncertainty. When we say “tolerating uncertainty,” we simply mean, acknowledging and accepting that 100% certainty is impossible and sitting with that fact. When we leave our homes without double-checking the locks, we are tolerating the possibility that we may have improperly locked them, while moving forward with our day. When we choose a partner to commit to, we are tolerating uncertainties around what the future may hold in our relationship or if there could be another relationship out there that might be a better fit.
OCD sufferers will either avoid situations or engage in compulsions in an effort to feel more safe and certain. Because certainty is unattainable, sufferers become stuck in endless loops of doubting, problem-solving, and fear. We often like to show our clients that they tolerate uncertainty in so many other areas of life, and can learn to apply these skills to their core fears. One goal of treatment is to move from “I can not and should not rest until I am certain” to “I can tolerate not knowing for certain, I can continue to move forward with the things in life that I deeply care about, and I don’t have to invest all my time and energy into seeking answers.”
You are constantly doubting.
OCD is sometimes called the “doubting disease” because it seems like there is always a new doubt just around the corner. One of the most frustrating parts of trying to resolve an OCD-related doubt is that a new doubt often pops up to take its place. It can almost feel like a bottomless pit or like trying to keep a beach ball under water. For instance, a client with health-related OCD may feel relief after a doctor examines him and deems him physically healthy. Yet, mere minutes after leaving the office, the doubts start to gear up again—“What if the doctor missed something? I should probably get a second opinion. Doctors miss things all the time. He didn’t do a very thorough exam.” This can be so demoralizing, especially when the relief is so short-lived.
In OCD treatment, there is so much freedom in recognizing that no amount of talking the problem through, rationalizing, or reassurance is going to resolve doubt. We have to respond to doubt in a completely different way. We can’t use the same problem-solving skills that work so well in other situations.
You often assume that there is the perfect outcome if you can only just find it.
OCD often has the sufferer convinced that the perfect answer or outcome is just outside of their grasp, and they just have to try a little harder to obtain it. For instance, OCD sufferers may find themselves thinking, “if I just analyze this a little deeper, I will solve the problem and find certainty.” This can manifest in many ways: “if I get this paper exactly right, I will get the perfect grade” or “if I ask my therapist just the right question, I will know I have made the right choice” or “if I do this mental ritual just right, I can feel free of worry about my loved ones for the rest of the afternoon.”
These high standards for certainty are often unattainable, because OCD will always find new seeds of doubt, new standards by which to judge oneself, or new questions to ask. This can be an incredibly frustrating cycle of searching, yearning, analyzing and then feeling exhausted, paralyzed, or like a failure. Part of the work in OCD treatment involves accepting that perfection is an illusion. We work to free our clients from unrealistic expectations of “rightness” and “certainty” to turn toward engaging with deeply held values.
You avoid and procrastinate more than you would like.
Avoidance is a core feature of anxiety and OCD. Understandably, high anxiety and unrelenting intrusive thoughts lead those struggling with OCD to avoid people, places, and things. Sufferers may cancel or decline commitments to avoid having to struggle through hours of compulsions or waves of anxiety. Avoidance can be external, as when clients tell us “I’ve stopped going to places where children might be because of my intrusive thoughts” or “I’ve stopped watching movies about relationships because I’ll spend hours questioning my own.” Avoidance can also be internal, as in, “I try to block these thoughts when they show up” or “I quickly distract myself when ‘bad’ thoughts come to mind.” In treatment, we team up to understand what is being avoided and work to help our clients confront feared situations with compassion and support.
Procrastination is, similarly, a response to the tremendous anxiety and paralysis OCD sufferers often feel when faced with decisions, choices, and tasks. Some examples of procrastination might include putting off important decisions due to fear of making the wrong one or writing, re-writing, and over-researching a paper to make sure that the paper is done “right” or “perfectly.” Choices can feel especially fraught and fear of regret can keep our clients stuck in place. Unfortunately, procrastination can end up leading to the outcomes our clients most fear, such as losing out on important opportunities or poor work and school performance due to missed deadlines. We work with clients to help them practice taking small risks, tolerate making decisions without absolute certainty, and challenge the illusion of the “right” or “perfect” choice.
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