Most people with OCD are probably aware of most if not all on this list. However, before I started my recovery I didn’t know about any of the below. And actually, If I’m being honest I still succumb to some of them today even though I know better.
There are probably loads more I have missed, but these ones are the most sneaky I have dealt with since having OCD. See how many you can relate to?
1. Social media: reassurance central
Social media can be both a blessing and a curse for OCD. There are some amazing people helping others and I have met many on Twitter since rejoining for this blog. On the other hand however, it can be reassurance central at times (Reddit and Facebook seem to be the worst for it). Of course I know people mean well when they reassure others about obsessions, but more often than not this is adding wood to the fire. I’m not talking about healthy reassurance and support here, I’m talking specifically about reassurance regarding specific obsessional thoughts. It might not be overtly obvious in the text, as reassurance can be so hidden and nuanced.
2. Saying thoughts out loud
Not sure everyone will relate to this one, but I suspect many will. Saying thoughts out loud can be a way to test our reaction to them. For example, with religious obsessions I used to say feared bible passages or “blasphemous” statements out loud to see how I reacted to it emotionally. Then I would berate myself and worry I committed a sin and then do it again to reassure myself that my reaction to the words was not “enjoyment”. Or was it? Let’s say it out loud again to be sure.
3. Confessing to minor things
It’s often said that people with OCD are overly scrupulous by nature. The standards of moral perfection we often set ourselves transcend that of any major religion (not that hard most of the time but you get my point). Having an urge to confess, especially when relating to religious, moral or harm obsessions can become highly compulsive. Even to the point of owning up to the most minor issues to relieve guilt.
4. Recalling facts and figures
It is quite common for people to have statistics held in mind for reassurance. But probabilities and facts don’t help with obsessions. This type of approach is still used surprisingly often with OCD treatment and whilst reassessing risk might be a helpful approach for general anxiety, for OCD it often makes things worse and can quickly become compulsive.
Do you know what the probability of HIV contraction from an accidental needle stick injury is? How about a splash of blood to the mouth? Do you know the % of people in the UK with HIV? No, of course you don’t, unless a) you have/had this obsession or b) you’re an HIV expert. The answers are at the bottom of the page.
5. Avoiding “triggers”
Let me be clear on this one. I am not talking about triggers that could amplify trauma or cause severe distress. I am also not talking about triggers in an OCD context that would be overwhelming at whatever point of recovery a person is at.
I am talking about those triggers which are unhealthy avoidance and can make OCD worse. These are often small things which in and of themselves might appear harmless, but they can add up, and they grow. For example, one day you might avoid BBC on a Sunday morning in case you see a carol service and it spikes blasphemous thoughts. The week after you hide the bible in a box. The next month you are avoiding walking outside in case you come across 2 sticks overlapping that look like a cross in case you stand on them.
In OCD support groups online in the past I have seen it be made a “rule” for people to put “trigger warning” before any posts to ensure people don’t get spiked. In my opinion, this is, for the most part, unhelpful and encourages compulsive behaviour in the form of avoidance. Whilst many people might need support with facing various triggers with therapy (that’s absolutely fine) you cannot look to avoid everything that might spike your OCD if you are to live with some kind of normality. The more you avoid, the more sensitive you become to potential stimuli that will cause a spike.
6. Labelling the thought as OCD
Okay this one can be both useful and not so useful. I’ve experienced both versions.
There is absolutely nothing wrong with saying “I have OCD”, then refocusing your attention. However, whilst saying “this is an OCD thought” can start off positively, it can very quickly turn compulsive. How do I know its OCD? How can I be sure? You can’t and that’s the point. There always has to be an element of uncertainty.
By simply rephrasing and saying “I have OCD” you are acknowledging that you have a disorder, but you don’t reassure yourself that this particular thought(s) is OCD. It is “likely to be OCD” might be a better choice, but absolute statements can be manipulated easily by the OCD. This is the same when agreeing with your thoughts (a useful technique with practice). For example, I used to say to myself “Ok fine I have committed the unpardonable sin” which actually troubled me less than “Ok fine, I might have committed the unpardonable sin”. The second one was like holy water being thrown on the devil of OCD.
7. Scanning body language
This one I rarely see spoken about, but it’s a sneaky one and I don’t think most of us realise when we are doing it. Asking for reassurance whether online or in person is well known and common. However, a sneaky way of getting reassurance is to say something to a person or group and then scan their body language. A look, movement of the mouth, a gasp; anything that might give information about the obsession is useful. For example, someone might pretend they had a dream about them doing something related to their obsessions and check to see how people react: “I had a weird dream last night that I ran someone over and didn’t even know I did it?”….
8. Distraction over refocusing
Admittedly this one is likely semantics most of the time, but I have found there to be a key subtle difference between the two which is important for recovery. Distraction often implies rejection of the thoughts and avoidance. Whilst refocusing (from an ACT perspective) allows the thoughts to be there, you are just calmly telling your brain you are focusing on something else. The difference is minimal, but important. In my opinion distraction can become compulsive because you do it to reduce or remove the obsessions. On the other hand refocusing moves you on to something aligned to your values, but the thoughts are given permission to be. Whilst the activity you do might be the same such as getting on with a work assignment, the driving force behind the decision can make all the difference.
9. Exposures become compulsions
ERP is essential for recovery in my opinion. It’s like basic training giving you the core skills you need to get in shape and tackle future OCD problems. Sometimes ERP needs to be repeated. In fact, some form of ERP is probably needed for most people at some level throughout their lives. I have certainly found this to be true.
However, I have noticed in the past that sometimes I was repeating exposures, not to then practice non response and mindfulness; rather, I was doing them to prove to myself that they were not dangerous. For example, if I did a contamination exposure in a bathroom, I would later get a thought “how do I know the exposure was safe, surely my therapist wouldn’t put me in danger or lie to me?”. So then I would do the exposure again, and again, to reassure myself that it wasn’t as bad as my brain was telling me it was. The whole point of exposures is to sit with the uncertainty, even when it is the exposure itself that becomes the main spike.
10. Giving meaning to thoughts
It’s important to remember that where OCD is concerned, there is no logic. A particular fear, thought or image gets stuck, or you get “Brain lock” as Jeffrey Schwartz called it. Trying to work out why you get a particular obsession is, more often than not, compulsive in itself. My understanding is that this is what psychoanalysis proposes to treat OCD: to look at the root cause(s) of particular obsessions and compulsions. According to the psychoanalytic view, OCD is a maladaptive coping mechanism to deal with unresolved issues as a child. Thus, suggesting the root cause to be where the problem needs addressing. There is very little evidence to support this view, and whilst environmental factors almost certainly play a part (don’t they always with everything?), personally I think this approach plays right into the hands of OCD.
If we take the view that there is some kind of logical causation behind obsessions and compulsions then we are trying to find meaning. And finding meaning behind the thoughts is the exact opposite of what effective and evidence based OCD therapy advocates. Thus, if the problem was some kind of unresolved issue, then how would ERP and ACT help people recover so effectively? Surely the unresolved causative issue from the past would remain? I have read countless stories of people who still receive this type of approach for OCD. Most experts, if not all I’ve read, would reject this approach.
A somewhat nuanced example is when we say OCD “goes after what we care about”. Whilst this is almost certainly true for many themes, attributing such meaning can become a type of reassurance, especially with harm or religious OCD themes. For example:“it wouldn’t bother me if I really meant it” or “these are just thoughts, I love my family”. Like with all OCD treatment approaches, a degree of uncertainty must remain. At least that is what I have found effective anyway.
Thank you all for reading, make sure to leave a comment if you feel like it. Or follow me on Twitter @OCDphilosophy where I check in most days. Take care
*the answers are: do your own bloody research (no pun intended), unless of course you have blood contamination obsessions, you should already know this! I’m not reassuring you here if you don’t! 😉 Now please get back up to no.5 and finish reading 😀