I have found Obsessive Compulsive Disorder (OCD) to be very tricky and devious. Understanding and recognizing some of the tricks and distortions that OCD uses can be helpful when seeking to manage OCD. An OCD trick that one of my clients recently struggled with was wondering whether or not his current concern was OCD. This client was a phlebotomist at a local hospital and feared that he had inadvertently transferred blood to a roll of cotton which other phlebotomists would be using to dab future patients’ injection sites. He, of course, feared that the blood he had transferred might be infected and would cause the next patient to become ill and, in the worse case scenario, even die. He indicated that if he wassure that this concern was OCD he could use our previous work to stop doing his checking, stop seeking reassurance from his wife and family about what he had done and resist confessing his errors to his employer. He had become entangled in the web of seeking certainty around whether this was OCD. After much discussion we agreed that the best way out of his entanglement with this question was to accept the uncertainty and commit to stopping all of his compulsions. The minute he turns back to seeking certainty about whether or not this is OCD he has once again become entangled in the OCD web. Seeking to find “the answer” “to know for sure” or anything like that just further deepens the entanglement with the OCD web and will never result in any type of lasting solution. He must surrender the need for certainty if he wishes to free himself from the OCD.
A second OCD trick that had hooked this client was the idea that if I’m a little bit responsible then I am totally responsible. This has also been called black and white or all or nothing thinking. He could see that there were other people involved in the process, such as other phlebotomists, etc., but nonethelesssince he had some responsibility, he felt totally responsible for the potential (disastrous) outcome. Our way around this dilemma was to draw a “responsibility pie”, list all the people who could be potentially responsible for the outcome he feared and then beginning at the top of the list assign slices of the pie based upon how responsible each person was and ending the list with the client himself. What he discovered was that by the time he had divided the pie into sections based upon how responsible others were, hisslice that remained was very tiny indeed.
A third OCD trick that one of my current clients has fallen prey to is “if it doesn’t feel right then it must not be right.” This is usually referred to as emotional reasoning. Just because something doesn’t “feel” right doesn’t mean that there’s anything wrong. In fact, within the OCD world many things feel wrong and/or dangerous when they are not. In a very real sense when you have OCD you cannot trust your feelings in those portions of your life where the OCD has become active. Just because you “feel” that your hands are still dirty and does not mean that that is true. So in coming to manage OCD it is important to notice these feelings and then mindfully pause before responding to them. Rather than simply react and do what feels necessary, to pause, to reflect and then to choose the response that makes the most sense. For many clients it is rather disconcerting to consider the idea that they really cannot trust their feelings when it comes to the OCD. A particularly troublesome example of this is when the client suffers from Scrupulosity OCD. Many scrupulous clients make the assumption that these “feelings” are actually a message from God and/or the Holy Spirit and thus must be listened to and obeyed.
A fourth, and final trick for this blog post, is the idea that because a thought issomehow “louder” or “brighter” in one’s mind that therefore it must be more significant and worthy of attention that other thoughts. The idea here is that just because a thought is brighter and louder it means more, which of course isn’t true at all. It’s as if we are saying that when driving down the street the brightest neon sign is the most important neon sign or that the person who isspeaking the loudest must be saying the most important things. As with all forms of OCD, the way to not be taken in by this trick is to first and foremost be mindfully aware of what your mind is telling you. To look “at” these thoughts rather than “from” these thoughts. To notice that your mind is telling you the brightest and loudest thoughts are somehow different from the rest of your thoughts which of course they are not. To then mindfully resist the urge to treat these thoughts in some different way and put them into your usual thought stream and treat them like you would any other thoughts