Beating obsessive compulsive disorder

You “obsess” over obsessing and find yourself doing unnecessary things over and over again, completing them just because the anxiety won’t go away unless they’re done.  A quick visit to your doctor’s office clarifies everything: you’ve got Obsessive Compulsive Disorder (OCD).  Now you have to figure out what to do about it.

OCD is marked by obsessions and compulsions.  Below you’ll find information about both symptom clusters along with methods for overcoming them.  But, quickly, before we get into the specifics, here are some tips to remember:

• Don’t forget the usual:  get enough sleep, eat healthy, talk to someone, reduce stress in your life, and get enough exercise.
• Learn self-soothing strategies and practice them.  Try relaxation, meditation or mindfulness, muscle relaxation, abdominal breathing, journaling, and other coping skills. 
• It’s a good idea to have a friend at the ready for moral support.  If you prefer, connect with a therapist.
• Take it very slowly. Whether you need three weeks or ten months, be patient with yourself and go at your own pace.

Dealing with obsessions

Understanding obsessions

An obsession is an unwanted, intrusive thought that won’t go away.  The thinker is frightened or disturbed by the obsession, so much so that they decide to AVOID the thought.  Ever try NOT thinking about something?  For example, don’t think about a VW bug.

Any luck?  Chances are, despite your best efforts, you thought about a VW bug.  Why is that?  The picture didn’t help.  Now cover the cartoon and again try not to think about a VW bug.  Still too hard?  Turns out that avoiding a thought, especially a bad one, just makes it harder to get rid of.  By trying to bury the obsession, it intensifies and gains importance.  It can’t be ignored.  And when the target of the obsession is right there (like the VW bug), it seems to leap out at you.

A closer look at obsessions  

Imagine thinking, “What if I stabbed that person with a knife?”  Most people would follow that up with, “What an awful thought!  But it doesn’t mean anything, and I wouldn’t ever do it.”  A person with OCD might respond differently: “I should feel awful for thinking that.  What kind of person am I?  Is that something I’d actually do?  How can I be sure I wouldn’t?  Having these thoughts means I’m an evil person.  Really, I shouldn’t think that sort of thing.”  Soon the cognition spirals out of control, and the individual tries to abort the thought.  But the obsession refuses to be forgotten.  Each time the person tries to block it, it gains power.  Next thing, alarm bells sound every time the thought goes off.  It’s a difficult cycle.

There are many types of obsessions.  Often they’re direct opposite to a person’s belief system, but not always.  Examples include:

• Fear of losing control and harming self or others. “If I accidentally leave the stove on, the whole neighborhood might burn down.”
• Mental images of getting hurt or witnessing others getting hurt.  For example, intrusive statements like “I hope I get hurt,” or forceful images of one’s wife getting raped or killed.
• Forbidden, intrusive sexual thoughts.  This might include incestuous or other inappropriate relationships.
• Blasphemous thoughts that go against one’s religion or values.  Common obsessions include “I hate God” or sexual imagery mixed with faith.
• Fear of being contaminated or dirty.  “I didn’t clean the counter off properly, so my family is going to get sick and die, and it’ll all be my fault.”
• Feeling extremely uncomfortable when something isn’t balanced.  “If my shoes aren’t arranged properly, I’ll fail my exam.”
• Excessive attention to something lucky or unlucky (superstition).  “If I don’t get a six when I roll the dice, it means I’ll never find true love.”
• A need for perfection.  For example, a teenager can’t study until her room is organized perfectly, her books ordered and arranged in alphabetical order.

In addition to being distressing, obsessions are time-consuming and problematic.  They take up at least an hour each day, usually more, and knock down quality of life.

Certain “obsessions” aren’t obsessions

A man might be “obsessed” with gambling, but his dysfunctional passion for something he enjoys isn’t really an obsession.  He likes gambling.  By definition, OCD means you’re stuck with a thought or mental image you don’t want.

A student might be “obsessed” with her studies and therefore make great grades; her drive to study is based on positive consequences.  Unless it causes her problems, this 100% focus on her books is healthy.  On the other hand, OCD is never beneficial.

How to deal with obsessions

Okay, here we are: how to overcome obsessions.  There are different schools of thought when it comes to treating OCD.

The long version: Some therapists favor cognitive therapy, or interpreting the meaning behind obsessions (this link leads to anxietybc.com, which opens in a new window). Others bypass interpretation and focus instead on a person’s actions, called behavioral therapy.  Behavioral therapy for OCD usually involves exposure to the thing that’s causing distress.   That is, you face the obsession until it stops bothering you.  “Doing the opposite” is an example of behavioral or exposure therapy.

The short version: You can overcome obsessions by changing the way you react to them. Just do the opposite.  Keep reading to make sense out of this.

A thought is just a thought

First, it’s important to remember that a thought is just a thought.  If I think, “Today is the day I die” or “Today I’m going to win the lottery,” these outcomes aren’t more likely just because I’m thinking about them.

A thought doesn’t determine your identity either.   The obsession, “I’m going to stab my wife,” might leave you feeling lousy, but having the thought doesn’t mean you’re a lousy person.  You don’t want to do it.  You don’t plan on doing it.  It’s a thought, not an action.  It carries as much weight as “I’m going to give my wife a hundred million dollars and ten new cars.”  A thought, that’s it.

As you fight your OCD, keep this in mind. An obsession, no matter how disturbing, is just a thought.

We’re back to “do the opposite”

So you’re dealing with an obsession. The natural tendency is to try to ignore it, which gives it power.  (Alternatively, people do things to “neutralize” obsessions, but we’ll take that on a little later). The trick then is to stare the obsession down full-throttle until it stops bothering you.

Next time you have an obsession, stay with it.  Study it from different angles, listen to it, imagine it, stand next to it, repeat it, imagine it again, embrace it, and accept it.  If it’s a statement, repeat the statement as many times as you need.  If it’s an image, focus on that image.   If it’s a situation, find every opportunity you can to face that situation.

You’ll find at first the anxiety worsens.  That’s okay, hang in there.  Stay with it and you’ll eventually see something miraculous: what goes up must come down.  The anxiety backs off.  Stay with it even longer, and you’ll feel your muscles relax, your mind relax, and the obsession… well, it loses its power.  Progress can be immediate, or it can take a few months, but it happens.

Examples of “doing the opposite”

Example 1.  If your obsession is the thought “Today I’m going to trip down the stairs” or “I want to fall down the stairs,” the natural tendency is to avoid the stairs.  Instead, take the stairs!  Each time you change floors, take the stairs and imagine yourself falling.  Exaggerated “hit the ground and roll” falling.  Focus on the image as much as you can, and do so over and over until the thought loses its hold on you.

Example 2: If your obsession is an inappropriate sexual image, something that really bothers you, you probably distract yourself and think of something else each time it comes up.  Instead, purposefully focus on the image and stay with it.  Study it repeatedly until it isn’t a big deal.  No matter how crude, obscene, or offensive it is, it’s just a thought.

Example 3: Your obsession is about dirt.  The idea of a soiled hand sends you into a panic.  Next thing, you’re washing your hands dozens of times/hour trying to keep it clean.  How do you deal with your OCD?  First, deal with the obsession. Your first job is to immerse yourself in the world of contamination.  That’s easier than it sounds: simply imagine your hand covered with filth, the worst you can imagine, and focus on the poorest case outcome.  Does your hand get blistery?  Painful?  Does it turn lime green and fall off?  Stay with this image.  You’ll feel the anxiety worsen, then improve.

What obsessions like the least is when we purposefully focus on them.  Do the opposite to what you’d usually do, stick with the obsession and connect with the moment, and you’re getting there!

Trouble-shooting obsessions

Too many obsessions, too much work.  A lone obsession can knock the wind out of you, but sometimes there can be dozens at the same time.  If this is the case, expose yourself to the thoughts little by little.  If there’s more than one obsession, focus on one at a time.  If two or more hit you at once, take a deep breath, relax, put the extra obsessions aside, and go back to the first one.  You can deal with the others when you’re ready.  If needed, jot them down to remember them.

Making a date.  Obsessions need attention and time.  If needed (and this might sound ridiculous, but give it a try), set up an “obsession schedule” to get the work done.  Arrange a time that works for you, preferably every day — and engross yourself in the obsession.  You can use written scripts, self-made audio recordings, and other material to remind yourself of the thought and keep you on track.  Some therapists recommend an hour/day

When the obsessions seem real.  Sometimes the obsession is based on a legitimate catastrophe.  Your obsession might be a fear of falling down the stairs.  The possibility of falling is real.  This might make the obsession harder to drop.  No problem.  Two things come into play: (1) People don’t fall down the stairs often enough to worry about it so much. The catastrophe is unlikely to happen.  (2) Remember, you’re not battling the catastrophe depicted in the obsession. You’re up against a thought, not the threat behind the thought.  You’re goal is to get used to the thought, i.e. desensitize yourself to thoughts about falling down the stairs.  Less anxiety would help you better handle the threat should it happen.

Self-help: dealing with compulsions

Understanding compulsions

We’ve all done it.  We check to see that the door is locked, but fifteen minutes later (usually as we’re sliding into bed) we hear a little voice in our head: “Did you really check the door?  Are you sure?  Did you check it properly? You’d better check again.”  So we climb out of bed, walk down the stairs and check the lock on the door one more time, and usually that’s it.  We’re satisfied with our door-checking ability and go back to bed, satisfied the world is safe.

When it comes to OCD, the world isn’t safe.  Door-checking can be an arduous affair, taking up one or more hours/day and causing problems in a person’s life, like interfering with their ability to sleep or leave the house.    The obsession is an uncomfortable feeling that something was missed: “You didn’t check the door correctly, it’s hanging wide open.  If you don’t go check, something horrible is going to happen.  It would be all your fault.  There’s only one way to make sure everything’s safe…”  So the person performs a ritual to make things right.  Sometimes it’s a number: they have to check the door 10 times to ensure safety, or there’s a need to click the latch 6 times on 6 occasions…

Compulsions are repetitive, often senseless rituals performed to avoid a feeling that something bad is going to happen. That is, they’re driven by anxiety.

Usually the person with OCD is overpowered by an obsession and feels anxious until they “undo” it by performing a specific ritual.  They give into the compulsion.  Once the ritual is complete, the anxiety goes away for a short period but returns soon after, making the individual repeat the ritual again.  This is a cycle.  The affected person keeps repeating the compulsion until they don’t have time for anything else.

Examples of compulsions

• A man with intrusive images about killing his wife (an image that distresses him) must tell his wife “I love you” thirty times/day to make sure it doesn’t happen.  If he doesn’t get to say the phrase enough times, he feels tense and frightened. The need to say “I love you” is a compulsion.
• A college student obsessed with order arranges her pencils in a perfect row, making sure they’re all the same distance from the end of the table.  She does this with her books, binders, and papers too.  She can’t study until everything is perfect.  The student’s need for order upsets her, but she can’t help it.  Her organizing behaviors are compulsions.
• A child who obsesses about getting dirty hands washes them more than a hundred times/day.  She’s afraid to touch things, for fear of getting contaminated.  Her hand-washing and avoidance of touching things are compulsions.  When she doesn’t give into this ritual, the child feels so dirty she can hardly move.

Compulsions by definition take up at least an hour/day, usually more, and interfere with a person’s ability to enjoy life.  They’re negative experiences.  The affected individual doesn’t want to give into the ritual but can’t help it.

Dealing with compulsions

What’s a good way to deal with compulsions?

The long version: psychotherapists use “exposure and response prevention” (ERP) to help their clients overcome OCD.  Exposure involves facing obsession head-on, and response prevention means not engaging in the compulsion that follows.

The short version: we’re back to “do the opposite” once again.

Resist the urge.

Imagine as you drive to work every day you struggle with the obsession, “something bad is going to happen to my kid.”  The thought upsets you.  Like many people, you neutralize the obsession with a compulsion: you drive around the block ten times before parking.  This action negates the obsession, meaning your child will be okay.  Unfortunately you’re always late for work.  Your boss is getting on your case about it.  What do you do?

Yep, do the opposite.  Think about the obsession until it stops bothering you — and avoid giving into the compulsion.

You resist the urge.  In this case, you park your car without doing laps.  At first the anxiety will intensify.  Remember to relax, meditate, be mindful, journal, talk to someone, do what you need NOT to give into the compulsion.  In time you notice the bad feeling coming down.  The more you resist the urge, the easier it gets.

Here are some more examples of doing the opposite:

Example 1: A man must say “I love my wife” thirty times/day to counter the intrusive, distressing image of his wife dying by his hand.  He deals with his OCD by repeatedly picturing himself killing his wife (facing the obsession head on) while not giving into the compulsion to say “I love my wife” (not giving into the compulsion).  The thought of his wife dying is scary, but it’s just a thought; thinking about it doesn’t make it more likely to happen, and it doesn’t make him a bad person.

Example 2: A child who worries about contamination washes her hands hundreds of times/day.  Her hands are chapped and red.  Her therapist encourages her to think about having dirty hands (facing the obsession) while refraining from washing them (not giving into the compulsion).  She does this every day for an hour, then gradually increases the time.

Example 3: A woman’s obsession is the statement “something bad will happen today,” with the need to say the Hail Mary fifty times to neutralize it.  To overcome her OCD, she needs to revisit the obsession repeatedly until it stops bothering her (facing the obsession) — and not allow herself to pray (not giving into the compulsion).

Compulsion trouble-shooting

Can’t resist the urge.  Some compulsions are deeply ingrained.  No worries, it doesn’t have to be all or nothing.  Instead of resisting the urge altogether, delay giving into it for a minute.  Next time, two minutes, then three minutes.  Keep expanding your delay until you can resist the compulsion altogether.  Go at your own pace.

Situation is too scary.  If a situation or trigger is too difficult to face, consider breaking the situation down into smaller steps and focusing on one piece at a time.  For example, if the obsession is “I hate God,” and the compulsion is to pray ten hours/day, a sudden about-face change might be too much.  Instead, divide the task into small steps.  First, focus on the obsession ten minutes/day, reminding yourself that a thought is just a thought.  You can have an obsession about hating God when in truth you love him.  When ready, advance to twenty minutes, thirty minutes, and so on.  Next, identify for yourself what is “healthy” prayer and what isn’t.  Adjust your prayer time gradually, and cut back at a comfortable pace.  Take as much time as you need.

Can’t face without compulsion.  Often OCD has been around so long that a person forgets how to face a trigger without acting on a compulsion.  If that’s the case, ask someone you trust to show you how they deal with the trigger.  Either copy what they do, or ask them to guide you through it.  For example, a person with OCD might have a compulsion to scrub their hands for five minutes after touching a doorknob; a friend could show them how to wash their hands quickly.  As you take on the compulsion, remember to use anxiety-busting measures to calm yourself down.

Too many compulsions.  If you find your life is overrun with obsessions and rituals, so many you don’t know which way to turn, grab a piece of paper and jot them all down.  List all obsessions and compulsions you’re dealing with.  Next, put them in order from least to most bothersome.  (The least concerning should be at the top, the scariest at the bottom). Finally, pick the first one on the list and work on it.  Check out anxietybc.com’s example of a OCD list, also called a fear ladder (link opens in a new window).

Final message

Beating OCD isn’t easy.  It takes time, practice, and self-kindness.  Give yourself credit for every step in the right direction, no matter how small, and don’t give up.  If, despite weeks of effort, you find you’re not making headway, please connect with a psychiatrist or psychotherapist.  A psychiatrist can prescribe medications.  A psychotherapist can guide you through exposure/response prevention or help with alternative approaches.