The Four Types of OCD - Part 3 - Just Right OCD
I hope everyone had a good week and if you’re working on your OCD I hope you made some good progress. I believe that with OCD it’s hard to just stand still - either you’re moving forward and limiting how much OCD is interfering with your life or OCD is taking over more and more territory… So here's to making progress!!
The Four Types of OCD - Part 3 - Just Right OCD
Coffee Cups and Parking Meters
Just Right OCD is probably the most difficult version of OCD to define because it presents itself in so many different ways. The basic theme, of course, is that something just doesn’t feel right, but that can be almost anything. A classic example of this type of OCD is having to arrange the items on your dresser a certain way to get the just right feeling. I’ve worked with clients who didn’t feel right when they picked up their cup of coffee in the morning and had to put the coffee cup down and pick it up repeatedly until it felt right. I had another client who parked her car and when she put her coins in the parking meter it didn’t feel right so she felt she had to go touch the next parking meter, and the next, and the next...after several hours of touching parking meters and feeling exhausted and terribly frustrated, she had to call her husband to come help her break out of the compulsive cycle she had become caught up in. Virtually anything can trigger the feeling of things not being “just right”. And, in contrast to other types of OCD, the uncomfortable feeling isn’t always anxiety. In the example above, the woman who got stuck touching parking meters didn’t feel anxious, it just somehow didn’t feel complete or finished. She described the feelings she had as discomfort or tension rather than anxiety. Of course both the fellow with his morning coffee and the parking meter lady both knew what they were doing made little sense, but nonetheless they still felt compelled to continue, which can make the problem that much worse.
OCD Threatens What is Most Precious to You
Some people with this type of OCD do experience anxiety if they do not or cannot engage in their compulsions. A client I worked with “had” to do a complicated jig with his feet in the morning as he got out of bed until it felt right or his parents lives were at risk that day. Another client had to put his shoes away at night following a complicated set of rules and if he didn’t follow the rules (if it didn’t feel right) then his children's lives were at risk the next day. Notice how devious OCD is because it threatens the people my clients love the most in the world if they don’t comply. Who wouldn’t do a jig or put their shoes away correctly if they thought their loved ones lives were at risk? The problem, of course, is that there is no additional risk to their loved ones if they don’t do as their OCD demands, but when in the grips of OCD it’s hard to believe that.
Checking, Contamination or Just Right?
Often times it is hard to tell what type of OCD the person is struggling with just by observing their behavior. If you see a person washing their hands excessively or repeatedly turning the light switch on and off you might guess at first that you are observing an OCD sufferer who has contamination fears or is checking to be sure the light was turned off properly, but you might be wrong. Sometimes people wash their hands until it “feels right” and the same for the light switch - they turn the switch off and on until they get the feeling that the task has been completed. And some people can have a combination of both types of OCD. An even more insidious aspect of OCD is that the person might keep repeating the task but not be able to ever get the sense that it is enough and that they can stop now. In the example above of the lady with the parking meter problem wasn’t ever able to break away and had to call for help, because it never felt complete/right.
How Do I Manage My Just Right OCD?
I will write future blog posts about some of the basic principles of how to treat OCD but I can mention a couple here. I like to use the term “framework” for some of the underlying principles of OCD treatment. One “framework” is the need to accept (even pursue) being uncomfortable. A client’s willingness to tolerate discomfort is essential if they are going to make progress in treatment. I’ve spoken before (and will cover more in future posts) about Exposure with Response Prevention (ERP) being the gold standard treatment for OCD and this basically means accepting the obsession but then not doing the compulsion. When I suggested to the father above that he not follow all the rules from the OCD for putting his shoes away at night, he was afraid that if he didn’t follow the rules he was putting his children’s lives at risk, and, of course, this made him very anxious. But for the ERP to succeed he has to “take the chance” and stop, or at first at least modify, the compulsions and accept the uncertainty regarding his children's safety. Another important “framework” here is that the goal of ERP is not to prove that his children will be safe even if he doesn’t do the compulsions, but to accept the uncertainty about what could happen. This is a crucial aspect of ERP.
As with all my blog posts I hope you find this helpful. Any questions or comments please let me know in the comments section below. Have a good week.
Dr Bob