Are OCD compulsions always detrimental? Yes. The end.
Well actually, it seems this is a much more complex question than I first thought.
OCD Compulsions and Covid-19
There have been many conversations floating around about OCD and coronavirus lately, with a lot of people stating that OCD compulsions have been useful (I wrote about this here). These are not just ignorant comments by non sufferers. I am seeing people with OCD stating that their OCD is now useful, and almost writing as if they feel a sense of vindication. Most with OCD seem to argue against this viewpoint, holding the opinion that OCD is never beneficial, and if it was, it wouldn’t be OCD. I would lean towards this view also, but on reflection I can see where the other OCD sufferers are coming from even if I don’t agree.
Here are a few examples taken from an OCD forum to demonstrate what I am talking about (such exclamations are not uncommon):
- “It’s the OCD superbowl, guys! We’ve been preparing for years!”
- “My therapist just told me that it’s weird times that we’re living, because OCD symptoms are pretty much accepted by society and considered the norm…It’s not that we’re right, it’s that now what we do is accepted.”
- “My therpaist told me “You were right”
If an act is based on evidence and no longer excessive, can it be considered an OCD compulsion
Are they right? Is what could have been considered abnormal and compulsive a couple of months ago now actually useful? Well, assuming their previous compulsions were similar to what most people are recommended to do now, then in a sense, yes. However, if an act is based on evidence and no longer excessive, can it be considered an OCD compulsion any more?
What are compulsions anyway?
As stand alone acts, many individual OCD compulsions resemble “normal” behaviour. Praying, washing hands, researching symptoms, checking the switch is turned off or asking your spouse for reassurance about something. All these actions are common and perfectly healthy in the right context. However, for an OCD compulsion to be labelled as such, my understanding is that it must feel urgent, be excessive and with the purpose to reduce the obsessive thoughts. The key word here is excessive.
The OCD Cycle
When you are caught in the OCD cycle you are essentially chasing your own tail. Obsessions, which causes anxiety or distress, fuel the intensity of compulsions and compulsions, because they tell the brain this is a valid concern, fuel the intensity of obsessions. This is a simple description of how OCD works. In reality OCD feels more like a complex web of cause and effect involving physiology and environmental stimuli, hence why, for example, some people need medication and why OCD symptoms can fluctuate. But in terms of compulsions, this is pretty much how it works.
So why claim compulsions to be helpful?
I think the reason why this discussion has become so prominent with coronavirus is because the goalposts have shifted so fast. Social distancing (as standard) two months ago was excessive and a clear OCD compulsion (in relation to contamination) in most cases. Now it is scientifically recommended to slow the spread of the virus. But again I would argue, surely any action that is no longer excessive, or is actually (now) helpful in any given context is no longer an OCD compulsion?
For example, when I obsessed about testicular cancer (read about this here) I would often perform the self checking method as a compulsion; I also sought expert advice when there was no evidence to do so, another compulsion. However, if I noticed a massive swelling on one of my testicles during the time I had the obsession, and then I went to the doctor, this wouldn’t be a compulsion. This would be an act based on reality, even if it would have been considered a compulsion the week before. This is the last time I will mention my balls, apologies.
Can OCD compulsions be clearly differentiated?
Deep down I know when I’m doing something compulsive
My view is that a compulsion, or action, is either detrimental (or potentially detrimental) or it’s not. It is either part of the OCD cycle, or it isn’t. If it is not detrimental or not part of the OCD cycle then it cannot be an OCD compulsion. This is just a separate action or behaviour that you do.
In my experience as an OCD sufferer, deep down I know when I’m doing something compulsive which feeds into the OCD cycle. It takes a lot of reflection and self honesty to weed out all the compulsions, and a therapist can only guide you in this quest. Even the most skilled expert probably won’t be able to uncover the whole web of compulsions your OCD spider has weaved. We often fool ourselves and justify our compulsive behaviours, we can lie to ourselves that some actions are okay and not actually a compulsion. But in my experience, when I am truly open and honest, I mostly know the difference. Self deception and an unwillingness to relinquish certain compulsions, especially the more subtle ones can make relapse more likely.
I could be guilty of black and white thinking here. Afterall, if OCD is on a kind of spectrum (as some argue), can we ever clearly differentiate and highlight when an action crosses the line from useful to harmful? Probably not. I’ve always been taught that if it feels like an obsessive thought then treat it as one. I’ve found the same technique often works with compulsions. That said, during this pandemic I can empathise with those that cannot tell the difference between what is now compulsive and what isn’t. With such a rapid shift with reality, I would almost certainly be in the same boat if I was in the midst of contamination OCD before the Covid-19 crisis.
Why does it even matter?
I think my major concern with all this isn’t whether compulsions are “useful” or not. Perhaps I’m wrong about this in an absolute sense. My major worry is that people who are currently proclaiming their compulsions to be useful, are, in reality still being excessive and thus feeding their OCD cycle (only they can know). OCD is a shrewd opponent, and during this pandemic it’s a perfect breeding ground for trying to justify excessive behaviours. Even people without OCD are being excessive. But for those without OCD they will most likely resort back to default naturally. The stakes are much higher for those with OCD.
Afterall, the guidelines aren’t exactly overly specific in certain areas. In the UK it suggests washing your hands for at least 20 seconds. Well what on earth does that mean for someone with contamination OCD? 21, 30, 45, an hour, maybe two hours? And how many times are we supposed to wash our hands? Doesn’t say. Let’s stick with the usual 50+ times a day shall we. Also, even if current compulsions are exactly in keeping with recommended guidelines during this pandemic, do you really think OCD will be satisfied with this? Highly doubtful. I know mine wouldn’t.
If it was me, and I had contamination OCD during this pandemic, I would agree a set of actions based on evidence and reputable sources to ensure I was keeping safe, but also ensuring OCD doesn’t get a free reign. For example, 20 seconds handwashing and no more and I’d specify the situations when hands can be washed, whilst at the same time trying to make sure the intervention doesn’t become compulsive in itself, there has to be some uncertainty. Otherwise it could quickly spiral out of control and what might be considered “helpful” now might grow into an even bigger monster. Then where would that leave people once the pandemic is over?
Ultimately, this is a major challenge for all those with OCD affected by coronavirus, there are no easy solutions and people are struggling. My heart goes out to all of them.