Yesterday we looked at some common themes or subtypes of OCD, in hopes of getting to know our enemy a little better. What does it look like? Where is it influencing our lives?
We saw briefly that in the OCD cycle, obsessions, which are intrusive thoughts, images, or urges, trigger feelings of anxiety and distress; compulsions are actions designed to reduce or eliminate those feelings.
Looking at it on paper, one might think, “Well, the compulsions serve a function, then. Who cares if they’re a little irrational, as long as they help me feel better?”
If you think that, you are in good company. That is the tacit assumption of any OCD sufferer who routinely engages in compulsions. Most people with OCD know or suspect that their obsessive fears are irrational, and that their compulsive responses are irrational as well. They engage in compulsions anyway because the distress is so extreme that they feel, well…compelled to do something about it.
Unfortunately, there are a couple of problems with that strategy. The first is that, because human beings are rational creatures, made in the image and likeness of God, we were given the gift of reason to govern our actions. We only struggle with this because our passions are not subordinate to our reason. This is a result of Original Sin, not an inherent feature of the way we were created. Sadly, when we let our passions rule our decisions, we betray our rational nature, which can lead to catastrophic consequences.
This brings us to the second problem: one of those catastrophic consequences, in the case of a person with OCD, is that compulsions strengthen obsessions, further weakening our reason’s ability to guide our actions. That’s why I referred to the OCD “cycle” above. Obsessions and compulsions create a vicious cycle, which has no natural end.
This may sound odd. One would think that the obsessive compulsive “cycle” would be over as soon as the compulsion did what it was intended to do, eliminating the anxiety and distress arising from the obsession. Sure, it was an unnecessary action that didn’t correspond to the actual risk in real life, but who cares, if the obsession is gone?
The bad news is that, even if the compulsion relieves the obsession for now, it isn’t gone. Next time it will come back stronger. And for someone whose OCD is in full swing, “next time” could be…next minute.
This is because compulsions actually validate obsessions, teaching our brain that our worst fears are (or might be) true.
Take the example of contamination OCD. Suppose I develop an obsession that shaking someone’s hand in an upcoming job interview will give me leprosy. Everyone, including myself, knows that worrying about such a negligible risk is absurd. Most people wouldn’t even think about it; but I can’t stop obsessing about it.
I am barraged by thoughts like, “Sure, it’s unlikely, but it’s not impossible, is it? Leprosy is a very serious disease, so it warrants an abundance of caution. And suppose I did get leprosy? I might give it to my baby niece whom I’m going to meet for the first time tomorrow! I would never forgive myself.”
As you can imagine, these relentless, obsessive thoughts take a heavy emotional toll. They trigger feelings of anxiety and distress which escalate to an almost unbearable point. My mind seeks frantically for a means of escape from its discomfort. At this point, several deceptively simple options present themselves.
“Well, I could avoid the job interview. Sure, I wouldn’t get the job I’ve been working towards, and I’ll have a tough time paying my rent next month, but I would make that sacrifice to avoid the slightest possibility of giving my niece leprosy.”
Then again, I might think, “I can still go to the job interview. It will be uncomfortable sitting there and thinking about leprosy, but the moment I leave the meeting I will head straight to the bathroom and wash my hands as thoroughly as possible. It will only take a few minutes, no big deal.”
I might even attempt to tough it out, telling myself that my fears are irrational. After the interview, anxiously obsessing about the possibility that I was just exposed to leprosy, I will think of another means to reduce my distress. ”I’ll just call my mom on the way home and run this by her. If she reassures me that this fear is completely irrational, I’m sure I’ll feel better.”
Here’s the catch: All of these compulsions treat my irrational fear as if it were rational. Engaging in them teaches my brain that its deepest, darkest, most absurd fears are probably true or at least worth taking seriously.
Avoiding the job interview or compulsively washing my hands afterwards would be treating the infinitesimally negligible risk of contracting leprosy from a handshake as a legitimate danger. Even calling my mom for reassurance is treating my absurd fears as something worth considering.
All of these compulsions send my brain the message, “You were right! Shaking hands is dangerous, or at least there’s a good chance that it is. Thanks for the warning, anxiety! Please continue to send me warnings in similar situations. In fact, considering how serious this situation turned out to be, I’d like you to send me the warning a little sooner and stronger next time.”
This is what I mean about validating the obsessions. The effect is that, although my anxiety might be temporarily soothed, this particular obsession will take deeper root. Next time I am faced with the need to shake someone’s hand, I might feel even more anxious and distressed. I will probably resort to my old compulsions, but washing my hands one time won’t be enough to soothe my anxiety anymore. I might try washing my hands for longer, or washing again when I get home. I might add in a shower and a change of clothes whenever I return from an outing.
Calling my mom for reassurance probably won’t help anymore, either. My brain will come up with dozens of reasons she might be wrong or untrustworthy. I might try calling other people, googling my question, or researching it at the library. I might call my doctor, and then get a second and a third opinion when I stop trusting each expert.
Sensing that my efforts to soothe myself are chronically failing, I might start to avoid triggers altogether. At the beginning of this cycle, I was willing to risk the interview hand-shake as long as I took compulsive steps to allay my fears afterwards. Once I have been caught in the cycle for a while, I might feel the need to avoid shaking hands, avoid physical contact, and eventually to avoid leaving my home.
As you can see, indulging in compulsions perpetuates the endless OCD loop. There is no natural end to this merry-go-round of misery, unless we step out of the cycle.
So we should just stop acting on compulsions, right? Does that sound easy? It isn’t. There’s a reason we call them “compulsions.”
But there is hope! Breaking the OCD cycle is often where therapy becomes imperative. With the right support, the process becomes achievable and fruitful.
Catholic and OCD 