At the time my son Dan’s obsessive-compulsive disorder (OCD) was at its worst, he had not eaten in over a week. I flew down to be with him at his college, and though he was only two weeks away from completing his freshman year, he knew he would have to leave school if he couldn’t eat. He desperately wanted to complete the semester, and though it was torturous for him, he somehow mustered the courage to consume a meal. I was so relieved. Now he could eat; he was on his way to recovery!
Unfortunately that’s not how obsessive-compulsive disorder works. Instead, when I brought him some breakfast the next morning, we were back to square one. He could not eat. I remember saying to him, “But you just ate yesterday! Nothing bad happened, so why can’t you eat now?” This is a common reaction from people who do not have OCD. We can’t understand. “You did it before, why can’t you do it again?”
The problem with this thought process is that it is logical. Most of us can relate to overcoming obstacles: We climb our mountains and work through our fears. For those of us without OCD, that is often the end of it. We have conquered our demons, or at least quieted them. We move on.
But OCD is not logical. If you have the disorder, one day you might easily be able to drive 500 miles and feel fine, yet the next day you can’t drive around the block without getting out of the car five times to see if you hit someone. There is no linear progression here; no predictable course. If you think this is hard for those of us without OCD to cope with, imagine being the one with the disorder! In addition to their own frustration, OCD sufferers might also have to deal with their annoyed friends and impatient families, who just don’t get it, or even worse, think they’re faking.
The intensity of OCD is not the only part of the disorder that can vary on a daily basis. Obsessions and compulsions can change also, at any time. An OCD sufferer who fears he might harm someone while driving might be convinced the next day that he should stay away from knives because he might stab someone. Or someone whose compulsions revolve around cleaning might expectedly develop the need to check things (such as checking to make sure the stove is off, or checking to make sure doors are locked). There is no rhyme or reason when it comes to any aspect of OCD, and it’s not hard to understand how troubling this can be for OCD sufferers and their loved ones.
For me, what really helps in grasping the unpredictability of obsessive-compulsive disorder is personifying the disorder. This technique is often used to help children better understand what is going on with them, and it can even be helpful to name their OCD. Maybe it’s The Enemy, or The Bully. Separating OCD from the person who is suffering from the disorder drives home the fact that OCD is something the person has, not who the person is. In our situation, once I was able to envision Dan’s OCD as separate from himself, it was actually quite simple to comprehend why he couldn’t eat breakfast that day. It was Dan against his OCD. Two powerful forces at odds.
Sometimes the OCD was just too strong, or too tricky, to contend with; other times he was able to stand up to it. Thankfully, as Dan progressed with his Exposure and Response Prevention (ERP) therapy he was able to prevail more often, until he got to the point where he almost always now wins his run-ins with the disorder. When you get right down to it, however, I think what is most important is not necessarily who wins each battle, but that all those with OCD just continue to fight.