When OCD itself becomes the theme behind your OCD symptoms, you may be experiencing what some people call “meta” OCD.
Obsessive-compulsive disorder (OCD) can present challenges related to persistent, intrusive thoughts known as obsessions. These obsessions often require ritual habits — compulsions — to alleviate them.
For many people, these patterns take on a common theme, such as hygiene or safety. For other people living with OCD, however, OCD itself can be the theme behind symptoms.
This “meta” OCD can mean that your thoughts swirl around having OCD, solving OCD, and how OCD presents itself in your life.
Meta OCD is the term used to describe a kind of OCD in which obsessions and compulsions are based on having OCD.
It’s not a diagnostic term, meaning it’s not an OCD condition formally recognized in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).
Despite its exclusion from the DSM-5, a small number of experts suggest that meta OCD is a manifestation of OCD.
“Meta OCD is a relatively new term that describes being obsessed with OCD and OCD obsessions,” explains Melissa Hunter, a licensed professional counselor out of Aurora, Colorado. “While not recognized as a diagnostic term, it certainly explains some of the spiral thinking that people with OCD get trapped in.”
Hunter adds, “Meta OCD enters in when that individual also obsesses on their OCD with thoughts like, ‘What if I don’t actually have OCD?’”
Symptoms of OCD often relate to these four common categories:
- harmful thoughts or taboo impulses
Meta OCD may be considered a less common symptom type of OCD.
“Going back to the example of contamination OCD, the outward symptoms of it may include excessive washing of hands or sanitizing of surfaces, or the need to put on clean clothes after being outside,” says Hunter. “Meta OCD is then the endless questioning of these behaviors as being compulsions or not.”
What is metacognition in OCD?
Metacognitions aren’t specific to mental health disorders. Metacognition, by definition, is the process of thinking about your thinking.
It’s an awareness of your thought patterns and a desire to know why you think the way you do.
In OCD, this translates into a focus on OCD thoughts. You may wonder whether you really have OCD or whether a repetitive thought you’re experiencing is reflective of your OCD.
Meta OCD in clinical practice is derived from the Adrian Wells model of metacognition in OCD, which suggests that meta OCD occurs when metacognitive beliefs fuse with OCD’s intrusive thoughts and feelings.
How is meta OCD related to the ‘solving ritual’?
The “solving ritual” in OCD is not an established concept in the field of mental health. It was proposed by Stacey Kuhl Wochner, LCSW, and refers to the compulsion to solve or “fix” OCD.
Because meta OCD involves obsessions about life with OCD — do you have it, is it real, can you control it — Kuhl Wochner suggests that it’s natural that compulsions may involve rituals to manage or “solve” OCD.
Kuhl Wochner argues that this may mean that you seek OCD treatment out of compulsion, and when a treatment doesn’t work quickly enough, you question whether it’s the right option.
Doubting and being hypercritical of attempts to “solve” OCD
Still, keep in mind that most behavioral scientists and clinicians would argue that there are many motivations for seeking treatment.
Some may not agree that the desire to seek treatment is a compulsion, especially as compulsions are typically specific and short-term behaviors or thoughts.
In general, OCD is defined by two types of symptoms:
- Obsessions: uncontrollable, recurring, intrusive thoughts or urges
- Compulsions: ritual behaviors used to counteract or respond to obsessions
According to Cameron Murphey, a licensed marriage and family therapist in Oakland, California, meta OCD symptoms maintain the theme of OCD fixation and frequently include obsessions such as:
- wondering whether you really live with OCD
- doubting that obsessions will ever end
- discovering the best treatment option
- worrying about whether you’re doing exposures or therapy correctly
- questioning whether you’re faking or lying about OCD
Compulsions related to these obsessions may include:
- making multiple therapy appointments
- attempting at-home treatment
- taking online quizzes or questionnaires about OCD
- stockpiling literature on OCD
Hunter adds that sometimes meta OCD may show up as reassurance seeking with questions like, “Do you think I have OCD?” or “A lot of people worry about germs, so it’s not OCD, right?”
In rare cases, OCD symptoms may present after certain medical conditions, like streptococcal infection.
“Meta OCD often appears once a person has been diagnosed with OCD and started receiving treatment for it,” says Murphey, though he adds that the exact causes of meta OCD and other manifestations are unknown.
Meta OCD is a relatively new concept that’s not well established and not researched. Therefore, it’s unclear how it’s best treated.
The nature of meta OCD may make its treatment more challenging, as treatment may increase the fixation on OCD and may even become a compulsion in meta OCD.
Murphey and Hunter suggest that, like other manifestations of OCD, meta OCD may respond to exposure and response prevention (ERP) therapy.
“While meta OCD can seem more challenging to treat, the same treatment principles of exposure and response prevention still apply,” says Murphey. “Clients are encouraged to accept uncertainty, face their fears, and take steps toward what matters to them in life.”
ERP is a form of cognitive behavioral therapy (CBT) that uses gradual exposure to situations, thoughts, or images that may be linked to anxiety or obsessive thoughts.
“By choosing to confront these in a controlled, safe environment and not engaging in compulsions (physical behaviors, rumination, rituals, etc.), anxiety is reduced and the need to do a compulsion is lessened,” explains Hunter.
She adds that some situations may benefit from the use of medications in combination with psychotherapeutic methods. Antidepressants, for example, may help provide some relief.
Still, keep in mind that little is known about meta OCD, and no empirical data exists to indicate that ERP or medication treatment may help with the specific thoughts and behaviors associated with meta OCD.
Meta OCD isn’t a formally recognized diagnosis, but some people with OCD state that they experience it.
If you find OCD symptoms involve a fixation on OCD, living with OCD, or solving OCD, you may be experiencing meta OCD.
While this condition presents some unique challenges, you can learn ways to manage meta OCD without aiding your compulsions under the guidance of a mental health professional.