Obsessive-Compulsive Disorder and Uncertainty
Obsessive-compulsive disorder (OCD) is a neurologically-based anxiety disorder characterized by intrusive, unwanted thoughts (obsessions) and repetitive behaviors or thoughts (compulsions) that the sufferer feels compelled to perform. OCD often is called “the doubting disease.” But what does doubt have to do with obsessions and compulsions?
A lot. Doubt is what fuels the fire for OCD, as sufferers feel the need to have total control over everything in their lives. There is no room for doubt or uncertainty. The irony is this quest for control inevitably leads to just the opposite — loss of control over one’s life.
When my son Dan was dealing with severe OCD, he was unable to drive. He wasn’t afraid of getting hurt; he was worried about hurting someone else. Avoiding driving was his way of making certain that he didn’t hit anyone. But this avoidance limited his world, fostered his fears, and resulted in him having even less control of his life.
The possibility of causing harm to others is not an uncommon obsession for those with OCD. Let’s say that Dan had been able to muster the courage to drive. He would have returned home after driving around town and thought, “Good, I didn’t hit anyone.” But then the doubt would have kicked in. “Well, I don’t think I hit anyone, but maybe I did. What if I hit someone? I probably should go back and check. What if I hit someone and they are lying in the road right now? I need to go check.”
And so Dan, like others with this harm obsession, would go back to the scene of the (nonexistent) crime, just to double-check that he didn’t hurt anyone. This checking could take hours; OCD sufferers continually wrestle with the feeling of incompleteness. Compulsions need to be repeated constantly, “just to be sure.” To complicate matters more, Dan might have thought, “What if I hit someone on my way back to check if I hit someone?” As you can imagine, performing these compulsions could take all day. The OCD sufferer becomes imprisoned by this insidious disorder.
The goal of this checking compulsion is to make absolutely sure that everyone and everything is okay. Once this is verified, there may be some relief for the OCD sufferer, but it is fleeting. The need for reassurance returns even more strongly, and the vicious cycle begins again.
This continuous need for certainty can infiltrate its way into every aspect of an OCD sufferer’s life. It is this same doubt that causes those with germ obsessions to wash their hands until they bleed, the same doubt that may compel another sufferer to reread a page in a book over and over again, the same doubt that makes another person with OCD continually ask for reassurance. Though OCD sufferers realize their rituals are not rational, they are not able to stop themselves from performing them. The need for certainty is too great.
The problem is that life is filled with uncertainty, and there is no way to change that fact. This is true for all of us, not just those who suffer from OCD. In the course of our lifetimes, good things will happen and bad things will happen and we can never be sure, from one day to the next, what awaits us. Whether we suffer from OCD or not, there are bound to be challenges and surprises for all of us, and we need to be able to cope with them.
One of the best ways for those with obsessive-compulsive disorder to learn to deal with these challenges is through therapy. Cognitive-behavioral therapy (CBT), specifically exposure response prevention (ERP) therapy not only helps sufferers face their fears, but also gives them the tools needed to learn to live with uncertainty. Though this therapy can initially be anxiety-provoking, the payoff is huge, as being able to live with uncertainty allows them to let go of the “what ifs” of the past and future and just live mindfully in the present. And with that comes a newfound freedom for those with obsessive-compulsive disorder.