Solving for X: A brief dive into OCD and how OCD can look different to different people

‘I just really like things organized- it’s my OCD.’

Hearing this as a Psychologist, I have to be honest… it can be hard not to roll my eyes sometimes.

We all have funny little quirks, ways of doing things, cultural, religious and superstitious thoughts that we probably engage with without giving it too much thought.

There’s nothing wrong with being neat and tidy, washing your hands, checking that the door is locked, touching wood, keeping a horseshoe above a door, making the sign of the cross, refraining from opening your umbrella inside, or being weary of Friday the 13th. There are times, though, when one can develop such a severe preoccupation and fixation with such behaviors that failure to do certain things can cause severe distress.  

That being the case, the colloquial use of the word OCD doesn’t reflect what the condition can be like for people who struggle and suffer with it.

Obsessive-compulsive disorder (OCD) refers to a severe preoccupation a person can develop in experiencing obsessive thoughts and compulsive behaviors. Obsessive thoughts are unwanted, recurring, and sometimes disturbing thoughts or images that come to mind- sometimes for no apparent reason. Compulsive behaviors refer to things we do, either physically (externally) or in our own heads (internally) to attempt to quiet a specific thought or worry.

In my clinical practice, I have seen different variations of OCD- some of which are more ‘classic’ in nature and some which are or can be quite nuanced, complex, and sometimes disturbing in nature.

In his seminal book Brain Lock, Jeffrey Schwartz, M.D., identifies the following a number of obsessive thoughts and compulsive behaviors- many of which are not always commonly known by the majority of the population:

• Obsessions with dirt and contamination- obsessive concern about dirt, cleanliness, infection, etc.

• Obsessions with order and/or symmetry- obsessive concern about order and presentation

• Obsessive hoarding/saving- obsessively needing to keep things ‘in case I ever need it!’

• Obsessions with sexual content- sexual thoughts that one views as being wrong or unacceptable

• Nonsensical doubts- fears of one’s forgetting to complete routine tasks (paying bills)

• Religious obsessions (scrupulosity)- excessive concern of right and wrong

• Obsessions with aggressive content- obsessively worrying about causing someone harm (images/thoughts of violence to others)

• Compulsively needing to do something ‘just right’- needing to do specific behaviours (putting objects down a certain) to prevent something bad from happening

• Compulsive checking- repeatedly checking that door is locked, hob is turned off, even if this means returning home to check

• Asking for reassurance- asking others if they have wronged them in any way

While some of these are examples are more common than others, what is not as commonly discussed or acknowledged is the why and the what part to the obsessive thought. For example, why did I think (fill in the blank) and what does that say about me for having thought (fill in the blank).

Someone who has thoughts about causing someone harm (although objectively knows they would never do this) could be terrified about a thought of this nature having even come to mind- why would I think that?!? What does that say about me?

Quite often a person would feel a severe guilt and shame for their thoughts and might be afraid to speak to the person who, in their mind, they caused harm to- people might also be afraid to discuss such thoughts with doctors or other medical professionals fearing some other consequence (mandatory hospitalization, losing their jobs/family, etc.). That being the case, this person would want to do whatever was needed to mitigate this from actually happening. As outlined above, the compulsive behavior could include asking for reassurance, telling someone that they thought this (so that it doesn’t come true), or checking (making sure I didn’t do the thing I was worried about).

Generally speaking, and for most people, this could be satisfactory and can help someone move on from the issue. For people with OCD, this only gets the party started.

Relief is a natural byproduct of engaging in a compulsive behavior. The problem is that isn’t a total relief… it’s more of a temporary relief. A temporary relief until the obsessive thought returns… or another takes its place.

The thing about OCD is that it’s not actually the thought that’s the problem, it’s more about the process.

Thinking about basic algebra, our obsessive thoughts can be like solving x (if you remember your algebra, x being a representation of a number that can be changeable depending on the specific equation). We tend to focus on the x rather than looking at the rest of the equation (a + b = x). To treat OCD, we need to move away from solving for x and focus on disrupting the equation (a + b ).

Obsessive thought(s). This isn’t good.

These can include thoughts/worries about leaving something on (the oven on, the front door unlocked), causing harm to others, sending inappropriate messages/photos, etc.

A fixation develops about the thought. This can provoke stress, fear, worry, and anxiety.

If the nature of the thought is particularly upsetting or taboo, a second thought can develop- ‘Why did I think that? What does that say about me?’

Engage in compulsive behavior- the thing that seems like a good idea!

This the part where we go back home to check and see if the oven was still on or if the front door was left unlocked.

This is the part where we go back through our messages to see if we did send an inappropriate message or photo.

This is the part where we tell a friend or family member that we had thoughts of hurting them (so they know what to look out for to ensure it doesn’t happen).

Relief.

Well that’s better… isn’t it?

Probably not. We might get some comfort from the worry thought… but it’s more than likely to be a very specific kind of comfort- temporary comfort. Temporary relief.

Obsessive thought(s). You again?!?

What if didn’t I actually turn the oven off? What if didn’t I actually lock the door?

Did I actually check all my messages? What if I did send someone something inappropriate?

What if the bad thing still happens? How will I be able to live with myself knowing that I wished harm to friends and family?

OCD can have a significant impact on wellbeing and general functioning. OCD can contribute to poor quality sleep, diminished appetite, low/depressed mood, general anxiety, avoidance (in some cases an inability to leave the house, two to three hour long showers), physical health concerns (excessive hand washing, for example), can sometimes have financial ramifications (excessive money spent with cleaning products or missing work), and can lead to lead to concerns for personal safety (self-harm and suicidality).

Through psychological counselling, we can start to unpack specific thoughts and worries, and try to understand and appreciate how they might have developed in the first place.

We would then turn to understand what can be done about it: (1) how can I cope with such thoughts as they emerge and (2) how can I refrain from engaging in the process that continues the process (a + b = x).

OCD can be quite a nuanced and specific experience for people. It can cause severe distress but it can be managed through psychological counselling.

If you would like to understand if difficulties you might be experiencing are reflective of OCD (as well as what you can do to manage), get in touch. At MAPP Psychology, we can pair you with one of Psychologists who can help you understand and manage your specific difficulties.

-Dr. Adam Lorenzen