The Four Basic Types of OCD, Part 2 - Checking

I hope this weeks post finds you all having a good start to the new year (decade!). It’s not too early to begin thinking about planning to attend the International OCD Foundation meeting July 31 - August 2, 2020 in Seattle at the Hyatt Regency. If you have, or a loved one has, OCD you would likely benefit from attending. This conference is unique in that it is very welcoming of anyone attending. There are presentations/programs for professionals, individuals with OCD, the family/loved ones of individuals with OCD, adults, teens, children, etc. The program isn’t quite set yet, but will be published sometime in March.

Did I Actually Lock the Door?

Besides contamination, checking is probably one of the most recognizable versions of OCD. Though there are many versions of checking, one common example of things that individuals with this kind of OCD frequently check are doors and windows to make sure they have been properly closed and locked.  When most people close and lock a door, they walk away with little doubt that the door/window behind them has been properly closed and locked. With OCD that sense of confidence that the door/window was properly closed and locked is difficult to achieve. As with virtually every type of OCD, uncertainty and doubt arise and the person feels compelled to go back and be sure that the door/window was closed and locked properly.  OCD prevents people from feeling sure that they actually closed and locked the door. 

The checking can be physical such as walking back and pulling on the door, twisting the doorknob, double checking the window latch, etc., to be sure that the door/window was closed and locked or the checking can also be mental in that the individual will carefully mentally review what they did to make sure that they remember doing exactly what was required. If they can’t recall doing exactly what they think they should have done then they often assume they didn’t close and lock the door/window properly. And for many individuals with OCD checking once often isn’t sufficient and they will feel compelled to go back and check multiple times in an effort to get a feeling of certainty that the door was closed and locked. For example, it’s not uncommon for people to drive their car out of the garage, close the garage door, drive away and be so troubled by a sense of uncertainty about having closed the garage door properly that they will go back and double, triple or quadruple check the garage door. The concern is often that if they do not close and lock the doors/windows properly somebody will break into their home and steal their belongings.

What If It’s My Fault?

Although I used the example of doors and windows, checking can occur with anything about which the individual feels a sense of responsibility. Another frequent type of checking is household appliances of any kind that they fear could cause a fire if not properly unplugged or at least turned off. Household items such as stoves, toasters, coffee pots, hairdryers, hair straighteners, washing machines, clothes dryers, etc. are all carefully checked and/or touched to be sure there they’ve cooled down, or unplugged. And as with the checking of the doors and windows, often one check isn’t sufficient and these items must be checked multiple times and even after walking away will still compel the person to come back and check once again (and again!). It’s not unusual for this, checking to become a morning routine and is almost like a “circuit” the individual will go through in the morning (or any time they leave their home) before they can leave the house. There are times, even, where this routine will become so ingrained that the person simply feels unable to leave the house unless the routine is completed. In another rather odd aspect of OCD, if the individual has an appointment at a specific time, this often leads to even more checking than usual and they are frequently late for their appointment. If they do not have an appointment the checking will be a more routine kind of circuit but when they have an appointment the circuit is often repeated multiple times, often in a vain attempt to “feel” certain that everything is safe. The checking is also often more extensive when the individual is leaving for an extended period of time, such as a weekend trip or vacation.

Underlying checking of any kind is a heightened sense of responsibility that is very common within OCD. One of the ways that this sense of responsibility plays out when checking doors or household appliances is that if the individual with OCD is the last person to leave the home the need to check is greater than if somebody else was the last person to leave. This is because if they are the last person to leave they feel more responsible for making sure that the doors and windows were closed and locked properly and all the appliances have been secured. Checking isn’t limited to home, but can extend to vehicles and also often their place of employment.

I’m Not Sure I Can Trust My Memory

Another, often very frustrating, aspect of checking OCD is that the person has trouble trusting their memory. It’s as if unless they can recall every detail of closing and locking the door or turning off the appliance, they fear that they are remembering it incorrectly and will go back to check. They even may have a sense that on the one hand they “know” that they closed and locked the door, but yet the sense of doubt is so great that they still go back and check anyway.

There Is a Solution

Treatment for this kind of OCD is the usual Cognitive Behavioral Therapy technique of exposure with response prevention (ERP). When it comes to door locks, for example, the goal is to first of all recognize that the OCD has driven them to do more checking than is required and commit to reducing the excessive checking. The target is then to close and lock the door, walk away and no matter how much doubt then appears, to keep walking. We do allow our clients to do what we call “one mindful check” which means that after the initial check, they can take a moment to look carefully to make sure it has been done properly before walking away, but once they walk away they cannot go back and check again. This, of course, will initially lead to experiencing considerable anxiety/worry, but as they continue with the  ERP, this anxiety will gradually fade. Accepting this initial anxiety/worry and not going back to check is the hard part of the ERP process. I covered some of the basic principles of how to do ERP correctly in a previous blog post.

I hope you all have a good week and, as always, let me know if you have any questions you’d like me to address in future posts.

Dr Bob