Having Obsessive Compulsive Disorder (OCD) is sort of like having the person who is supposed to be your best friend turn into the enemy, or is that a frenemy? (Part of the problem for many with OCD is that they have trouble making this distinction, and their progress is often impeded until they do; this is especially an issue for children and adolescents.) Persons with OCD often report feeling as if their own mind (or body) has betrayed them, but because they are so doubtful, they’re not even sure about this!
Those with OCD need to be 100% certain that their thoughts are exactly what they need them to be which, of course is futile, since thoughts cannot be controlled, predicted, or “on demand”; nor should they be, since this would make us more like machines than human beings. Individuals with OCD seek “guarantees” that their mind, not to mention life itself, cannot deliver.
And that is the essence of the majority of obsessions: thoughts, feelings, or sensations that feel like they either shouldn’t be in one’s mind or just are “wrong” (as in what is called “just right” OCD), or create even the slightest smidgen of “doubt.”
The content of an obsession can be anything the mind can conjure, but some common themes are:
Being contaminated or dirty—literally, or morally.
“What if” cognitions about losing control and causing harm to self or others, explicit violent or sexual images or thoughts.
“Feeling” that an item is in the wrong place or in the wrong order, or not symmetrical, as it should be.
Thoughts that something “bad” might happen that only they and they alone will be responsible for not preventing, even if they realize this is irrational or “magical.” In clinical terms, such features of OCD are called “inflated sense of responsibility” and “thought-behavior fusion.”
Obsessions make even the most simple decisions feel as if the fate of the world, or at least one’s own fate or that of a loved one—or perhaps even a stranger—depends on each and every choice that is made. Or, obsessions can feel like an “urge” that dominates one’s mind and body like severe pain might—nothing else matters until it is satisfied—which brings us to compulsions.
First, a word about what is called Pure Obsessional OCD (Pure "O”). Some individuals have obsessional content that seems unrelated to anything else. It could be words of a song on a constant replay loop, or a recurrent image that seems as if it is floating in one’s mind. It could also be an intense thought about a somatic function like blinking or swallowing, almost like a “tic of the mind.” But Pure "O' is not that common and easy to confuse with mental rituals - if you are performing anything neutralizing with your mind, it's likely a mental ritual not Pure
Back to compulsions, which are functionally similar to avoidance behaviors in that they serve a “function” to neutralize, lessen, or “get away from” obsessional content or “urges.” Similar to how obsessional content is extremely diverse, so too are compulsions; that is, just about anything that can “move” (or be stopped, even briefly from moving) could become a compulsion. In very real sense, such actions, whether mental:
Reviewing conversations or repeating prayers precisely over and over, or “counting.”
Or physical:
Excessively checking the stove or hand washing, or turning light switches on and off)
Or interpersonal:
Seeking unnecessary reassurances
Are just like providing OCD with fuel—or food
Compulsions and avoidance behaviors are “negative reinforcers,” which means that they provide the reward of reducing fear or other mental or physiological discomfort. But this is a very dubious reward because it is actually “rewarding obsessions” and also bit by bit lowering the bar for obsessions to be troubling as opposed to easily dismissed. It can’t be emphasized enough that the vicious cycle of obsessions followed by compulsions and avoidance behaviors and back again in an ever-worsening circle is inevitable; thus, in OCD there is no such thing as a “good” compulsion. Like an extortionist, it will always come back for more.
Anyone can talk tough, and say if they were being extorted they wouldn’t give in, no matter what. But, as we all know, it’s not that simple. That is why no one who is not in the shoes of someone who is struggling with OCD should judge them too harshly, and no one who has OCD should really feel embarrassed or ashamed of “giving in.” It’s totally understandable why OCD is so daunting, which is not to say that it can’t be fought or overcome. With the right motivation, treatment strategies or “tools,” the evidence that OCD can be dealt with effectively is unquestionable.
As with any other hard challenge, the initial steps are:
Admit there is a problem.
Work to understand the nature of the problem.
Make a plan to tackle the problem.
Often, this means accepting the need for help, and although you might think “I should be able to do it on my own,” when you think about it, could any individual build a city or get to walk on the moon on their own?
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