Most people turn to the Internet for information when a physical or psychological problem worries them, but people with OCD find its allures particularly irresistible. Seeking reassurance by doing research and comparing their symptoms to others’ is one of the most common compulsions.
The need to find comfort in numbers has led to a proliferation of on-line communities for “subtypes” of OCD, such as harm OCD, relationship OCD, “pure O,” and now, one I’ve only recently discovered, “real-life” OCD. In a previous post, I discussed why breaking OCD into categories based on content is misleading and possibly even counter-therapeutic. When treating OCD, I stress the irrelevance of content. OCD often changes its focus from one theme to another but all its many manifestations share a common underlying cognitive feature: intolerance of uncertainty.
Discussions about so-called “real-life” OCD imply that obsessions about events that actually happened, rather than about future-oriented, hypothetical possibilities, are somehow more valid. Such logic has all the earmarks of an OCD trap!
Is “real-life” OCD real? Is it different from other forms of OCD? Does it require another treatment approach?
The answers are here in my blog post for the Anxiety and Depression Disorders Association.
The idea of making a decision based on a “gut instinct,” or intuition, may have some theoretical merit but for someone with OCD, it’s like kryptonite.
Neuroscientists have constructed complex processing theories to explain the concept of “just knowing,” or intuition. Our brains are like computers, constantly comparing new sensory information and events with memories of past experiences and stored knowledge to come up with predictions of what will happen next. This process occurs so quickly and subconsciously that we’re not aware it’s happening—hence, the idea of a gut feeling. The opposite of intuition is methodical analytical thinking. Both can be helpful, depending on the situation. But people with OCD tend to overanalyze decisions, while also falling prey to emotional—typically, anxious—reasoning. The result? Uncertainty and decision-making paralysis.
One common OCD worry is whether a relationship is “right.” Typical obsessive questions include: “Do I feel love for my partner?” “Do we share enough in common?” “ What if my feelings change?” “How can I be sure I want to be in this relationship?” Constant analysis—compulsive checking for the elusive, correct emotional reaction, seeking reassurance from relationship websites and forums, asking friends and family for advice—doesn’t resolve the doubt and causes more anxiety, making it impossible to experience a rewarding emotional connection.
A site dedicated to forming healthy relationships describes a gut instinct as “your immediate understanding of something,” requiring “no need to think it over or get another opinion—you just know” [italics mine].
This type of popular wisdom—the idea that you can “just know”–adds to the distress many people with OCD experience in the face of major life decisions—not only about whether to get married or divorced, but also about whether to have children, go to graduate school, change jobs, or buy a house. OCD makes it virtually impossible to trust your gut because one of its major cognitive manifestations is doubt. It’s more likely to kick you in the gut and overwhelm you with incessant questions about your choices than to allow for intuition to help you.
So if you have OCD, don’t expect a feeling to inform your decisions. Rely, instead, on analysis (but not too much), experience, values, and common sense to guide you. And make room for a healthy measure of uncertaintly about the choices you ultimately make.
In the wake of the #MeToo movement, I wrote a post last year about the spate of men I was seeing in my practice who worried about being perpetrators of sexual assault. It struck a chord and prompted many emails to me from men across Europe, where treatment for OCD is limited, saying they’ve been tormented by similar thoughts.
As the piece resonated with so many people, I decided to revise the original for the Anxiety and Depression Association of America website.
You can read it here.
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