"Pure O", A.K.A. "But I don't have any compulsions..."

As a first step to the treatment process, I will always meet with someone to have a detailed discussion about their particular symptoms and the extent of the impact these symptoms have on their daily functioning. Often times when meeting someone with OCD, the individual will often feel like they must not have OCD, or that their OCD is somehow different than everyone else’s, because they claim they do not have any compulsions: “Yes I get worried thoughts (obsessions), but I don’t ‘do anything’”. When someone claims they don’t “do anything” they are referring to the fact that they don’t have any particular physical compulsions that are observable by others (washing hands, checking, etc.).

Upon further discussion, they come to realized that they do in fact engage in compulsive behavior - most often, these individuals are involved in mental compulsions. The reality is that any behavior, physical or mental, that is engaged in with the intent to decrease one’s anxiety and/or make an obsessive thought go away, is a compulsion. Mental compulsions cannot be seen by other people watching you but they are still compulsions nonetheless, and they still reinforce your fears and strengthen the OCD. One common example of such a mental compulsion, is logically arguing with the obsessive thought, using facts/data to try to reassure yourself that everything is ok and nothing bad has happened or will happen. Once you’ve reviewed such factual information in a debate-like style with your OCD, you may often feel a sense of relief - unfortunately, it is likely to only be short-lived. At that point, the whole process usually starts all over again.

So what have we learned? Not all people with OCD have visible compulsions, but I have yet to meet one person who did not actually engage in compulsive behaviors. If you think you have no compulsions, you probably do, they are just taking place inside your head where no one else can see you doing them.

The good news is, while this presentation of OCD might seem harder to treat, it is not. You simply need to be working with someone who is trained to guide you through the treatment process, as many professionals without significant experience will at best be uncomfortable treating certain presentations of OCD (ie, harm obsessions); at worst, they can unintentionally worsen your symptoms and possibly instill a belief in you that treatment doesn’t work.

Are You “Terminally Unique”?

I hope not.  

Let me explain.  

I believe we are all unique in our own way, whether it’s our interests and hobbies, the music we listen to, the way we dress and style our hair, etc., and I fully support individuality - it’s the spice to life that often keeps things interesting.  Often times, when someone is described as being unique it can be a compliment.  But being terminally unique is very different - it is not a compliment whatsoever.

Terminal uniqueness is a phrase that originates from the 12-Step arena (Alcoholics Anonymous, etc).  It is the belief that someone’s situation/illness is unlike anything faced by anyone else…ever - in this way, an individual believes that his/her situation is so unique to the point that he/she cannot be “lumped in” with everyone else with the same diagnosable condition.  Unfortunately, sometimes this includes believing that treatment won’t work for you.  The word “terminal” is used, because in the world of substance abuse/dependency/addictions, this type of thinking often gets people killed.  In the world of mental illness, this could be actual death (hopelessness and ultimately suicide), or at the very least, an existence with significantly more pain and suffering than is actually necessary.

I wish this was a rare phenomenon; however, over the years, I have met many people who felt that their OCD, depression, etc. was so different or so much more severe than anyone else, that they felt treatment was not going to work for them - spending time and energy trying to convince others around them (myself included) that their condition was unique beyond help…If they were to funnel that same time and energy into treatment itself, very often, success and progress can be the result.

Not only is someone who deems themselves terminally unique less likely to seek treatment or actively engage in it even if they are actually in treatment, but they are also less likely to seek the support of those around them (family, friends, etc.), including others with the same condition, because even people with the same diagnosis “are nothing like me”.  

If you think you might possibly be terminally unique, remember this:

1. You are NOT so different that no one could possibly understand the pain and difficulties that you live with; you might have a relatively unique set of life circumstances, but your issues are more common than you could imagine.

2. You are NOT beyond help.  However, if you isolate, you avoid help, and you don’t engage, then you will likely ensure a negative outcome.  That’s not proof that you were correct to begin with - that’s just the end result of you successfully orchestrating your own failure.

OCD...Everyone's A Critic!

Over the years, I have come across a lot of criticisms of people suffering from OCD - sometimes these critics are the patients themselves, but most often it is from friends and family, who just don’t seem to understand OCD; unfortunately, it is even sometimes therapists themselves who are critical due to their own lack of knowledge with regards to OCD.  Here I will review some of the more popular criticisms.  ***Keep in mind that any individual can be an exception to the rule, but for the vast majority of people I’ve ever worked with, the statements below hold true***

• You are not “crazy”.  You do not have schizophrenia.  You do not have a formal thought disorder.  Yes the obsessive thoughts you get can be a little (or a lot) “out there” and yes, many compulsions can make someone look very odd, but at the end of the day, you suffer from a condition which is biologically based and originates in the brain.  Just as someone else born with a different biological condition (i.e., Type 1 diabetes), you are afflicted much the same.  You are not “crazy”, or “insane”, or any other negative label you might have been given.  You have OCD, period.

• You are not stupid.  I hear this one a lot.  Just about everyone I’ve ever met with OCD has been a very logical-minded individual.  Patients tend to be very good problem-solvers in other areas of their lives, where logic is helpful, and they pride themselves on their logical mind and ability to fix things using this mindset - overall this provides a sense of self-efficacy and makes one feel capable and intelligent.   

  Understandably then, when faced with OCD, these same individuals assume OCD is just another problem they will solve logically…in short, this assumption is wrong.  At best, logic simply is ineffective against OCD; at worst, it “feeds” it, and symptoms intensify.  Using logic against OCD is a losing battle - but you would never know that - you are simply following human instinct.  That doesn’t make you stupid or dumb.  You just need to learn what you should do instead.  

• You are not self-centered.  You did not choose to have OCD.  You do not choose to have the obsessive thoughts you endure day in and day out.  And the compulsive behaviors you engage in - you often do not want to do, but more likely you feel you have to do, just in order to survive.  Someone on the outside who does not have OCD will likely see you as someone who is always in their head, selfishly worried about something about themselves.  They will erroneously think that you are willfully choosing to focus on these things, and that you could easily not do your compulsions if you cared to, or if you “just tried harder”.  Therefore you appear to be someone who only cares about themselves.  This couldn’t be further from the truth.  If your obsessions are focused on you, it’s not because you want them to be, or not because you enjoy focusing on yourself…and often, obsessions are focused on trying to help/save others you care about (worrying about the safety of loved ones is actually the opposite of being self-centered).  

• You are not lazy.  Often, people suffering with OCD are stuck between obsessions and engaging in compulsions.  This is a time-consuming loop and often disrupts normal daily functioning to the point that everyday productivity is impacted (ie, lack of homework completion, lower output at work, inability to attend school, unemployment, etc.).  The casual observer might notice this and assume you are lazy.  If they only knew how much hard work - blood, sweat, and tears (literally and figuratively) - you put into trying to manage your OCD, they wouldn’t call you lazy.  People with OCD are some of the hardest working people I know.  They are working so so hard! They just aren’t spending that time and energy doing what will actually help them get better.  Fortunately, we can redirect that energy towards therapeutic responding, which can be a total game changer.

• You MAY not have ADHD.  Very often, parents of children with OCD are contacted by a caring teacher, who notices that the child is unable to pay attention in class.  The child seems to be caught in a daydream much of the time while in class, thinking about other things, and ultimately unable to consistently focus.  As a result, they assume your child likely has ADHD.  While this might in fact be true, often times children with OCD look just like a child with ADHD.  This is because as a result of OCD, a child is getting unwanted thoughts throughout the day (even in school) - these thoughts are highly-anxiety provoking - the child might then be worried about the thought and trying to figure out a way to prevent a bad thing from happening.  If they are thinking about all of this while in the classroom, it would be very difficult if not impossible for them to effectively maintain their concentration.  So what looks like ADHD, may actually be a case of inattention due to anxiety created by the OCD.

What is Obsessive Compulsive Disorder (OCD)?

Obsessive Compulsive Disorder (OCD) is a common and chronic form of mental illness in which an individual suffers from obsessions, compulsions, or both.  It affects millions of adults and children throughout the United States (with prevalence rates shown to be similar internationally).  While symptoms can be mild, most often OCD can seem to take on a life of its own, and become very severe, negatively impacting all aspects of regular daily life — often preventing children from performing well in school or attending school at all, as well as causing adults dysfunction in the workplace and within social relationships.  

Obsessions are defined as recurrent and persistent thoughts, urges, or images.  They are unwanted and often intrusive.  When someone experiences an obsession, the likely outcome is significant anxiety and overall distress.  Often times these thoughts focus on something bad or harmful happening (to the individual themselves, family and friends, or even strangers), and often there is a deep sense of responsibility to prevent the harmful or bad thing from happening.

Although there may seem to be a limitless amount of specific obsessions, the content of these thoughts often falls in one or more categories, which include but are not limited to:

• Contamination Obsessions (dirt, germs, chemicals, etc.)
• Sexual Obsession (“inappropriate” sexual thoughts, or fear of being homosexual/heterosexual)
• Aggressive or Harm Obsessions (violent or horrific images, harm coming to one’s self or others)
• Religious Obsessions/Scrupulosity
• Need for Symmetry or Exactness

Compulsions are defined as repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession.  The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing something bad from happening.  

Compulsions usually fall into one or more categories, including:

• Cleaning/Washing (excessive or ritualized hand washing, showering, etc.)
• Checking (door locks, stove, etc.)
• Repeating Rituals (rereading, rewriting, etc)
• Counting
• Ordering/Arranging
• Miscellaneous (mental rituals, superstitious behaviors, etc.)

Most people with OCD suffer in silence.  There are many reasons for this, but one major reason is because the vast majority of people with OCD are intelligent and logical people, who understand that intellectually what they are doing compulsively and what they fear obsessively doesn’t make logical sense…yet they continue to do it.  OCD doesn’t respond to logic as does other problems and puzzles in life, so when someone tries what they think should logically work without success, they assume there is no hope.  

However, there is hope.  You simply need to learn what to do and how to do it with someone who is trained properly to help you.  Please don’t suffer in silence - it’s not necessary.