OCD Tricks and Distortions #1
YOU CAN’T CONTROL YOUR THOUGHTS YOU CAN ONLY CONTROL HOW YOU JUDGE THEM
OCD can be a difficult disorder to manage because it is full of tricks and unless you understand these tricks and learn how to play the game to win, then OCD has the upper hand. It's almost as if the OCD has a tenth degree black belt in karate and you are just beginning. In this blog post I will list four of the more common tricks that OCD uses to "trick" people into doing compulsions (see next weeks post for the next three). Understanding and recognizing some of the tricks and distortions that OCD uses can be helpful when seeking to manage OCD.
1) Maybe this isn’t OCD
This may be one of the more troublesome tricks up OCD’s sleeve. It amounts to obsessing about obsessing. “This isn't OCD, this is real and you better take it seriously”. The higher the stakes the more important it will feel to get this right. For example, a young mother who has postpartum OCD and is having harming thoughts about her new baby will be very reluctant to take the chance that her harming thoughts about her baby are harmless and can be ignored. “What if I really do want to hurt my baby?” Another example might be someone with contamination fears worries who that the yogurt has turned bad because it is one day past the expiration date and fears that if anyone was to eat this yogurt they would be poisoned and could get sick or die. “Why should I take the chance that this yogurt is bad? It’s just easier to throw it away and not take the chance.” To not be "tricked" by these kinds of thoughts the person with OCD must recognize these thoughts as OCD thoughts and not take them seriously.
An example of this type of trick that one of my clients (a phlebotomist at a local hospital) recently struggled with was wondering whether or not he had inadvertently transferred blood to a roll of cotton which other phlebotomists would be using to dab future patients' injection sites. He, of course, feared that the blood he had transferred might be infected and would cause the next patient to become ill and, in the worst case scenario, even die. He indicated that if he was sure that this concern was OCD he could use our previous work to stop doing his checking, stop seeking reassurance from his wife and family about what he had done and resist confessing his “errors” to his employer. He had become entangled in the web of seeking certainty around whether this was OCD. After much discussion we agreed that the best way out of his entanglement with this question was to accept the uncertainty and commit to stopping all of his compulsions. The minute he turns back to seeking certainty about whether or not this is OCD he has once again become entangled in the OCD web. Seeking to find "the answer" "to know for sure" or anything like that just further deepens the entanglement with the OCD web and will never result in any type of lasting solution. He must surrender the need for certainty if he wishes to free himself from the OCD.
A related concern that often comes up when discussing this issue with my clients is that they often have lost track of what is appropriate or “normal” to do. For example, how often do people without contamination OCD wash their hands, how careful should I be about hypodermic needles having been discarded the park when I take my children there to play, is it safe/okay to hold the handrails on escalators?, etc. Where does being appropriately cautious and reasonable end and and being unreasonable, and overly cautious begin? What is normal and what is OCD?
2) The more you think, the deeper you sink
OCD often invites you to figure something out, analyze something and to dig deeper into the meaning behind something etc. And all of these are done with the false promise that if I can just get to the bottom of this, then I'll understand and it'll be okay. In over 30 years of practice seeing OCD clients I have never once had a client "figure it out“ in such a way that led to relief from their OCD. In fact, just the opposite is true. The more you try to analyze, figure something out, etc. the deeper you sink into the quicksand of OCD only to emerge on the other side of this process more frustrated, confused and afraid than ever. OCD appears to offer the tantalizing possibility that if I can just figure this out this time then I'll be okay, but it never works out that way.
A recent client of mine feared he had inadvertently looked at some child pornogrphy several years ago and feared there was now some type of online record of his misdeed. He had, for years, tried to figure out if he had actually looked at child porn, but it actually seemed that the more he tried to figure it out, the less certain he became of what he had actually done.
3) Guilty until proven innocent
Most people assume that we are innocent until proven guilty, but with OCD the opposite seems to be the case. For example, a person with OCD might worry that they did something inappropriate at a party last night after having had a drink or two. They will review their actions throughout the entire party and if there are some (understandable) gaps in their memory, they will assume that during those "gaps" they indeed did the inappropriate thing they were afraid of. It's as if unless they can prove their innocence beyond a shadow of a doubt then they must be guilty. In an attempt to “prove” their innocence they will attempt to recall every detail of what happened last night, ask people who were there if anything happened, return to where they were looking for evidence of what they fear could have happened, etc. I have even had clients who will still be “reviewing” events that happened years earlier in a vain attempt to be sure they didn’t do what they fear they might have done. To make it even worse OCD has a way of making people start to have false memories where they start to “remember” events that never really happened.
4) If a thought doesn't bother me (enough) then I must like and want that thought
When dealing with intrusive thought OCD - having harming thoughts towards a loved one or thoughts of doing something inappropriate sexually - one of the primary goals is to treat these kinds of thoughts just like any other kind of thought and not take them seriously (more about this kind of OCD in future blog posts). However, as the person with OCD goes from being terrified by these thoughts to not taking them seriously, they often encounter some bumps in the road. One of those bumps is the "trick"/belief that "If a thought doesn't bother me then I must like and want that thought." It's easy to see how this would be very disturbing to the person with OCD and would reignite their anxiety. A closely related idea is that "Certain thoughts should scare/bother me or I'm not normal." Clients will get caught “testing” themselves to see how they respond to a particular thought and in most cases they will “fail” this test which, of course, then causes more anxiety. More about these types of beliefs in future blog posts.