Overcome OCD:
What You Need to Know

by Dave Carbonell, PhD

Obsessive Compulsive Disorder can be a difficult, confusing experience. To overcome OCD, you need a clear understanding of how OCD works.

The Ultimate Doubting Disease

Obsessive Compulsive Disorder bedevils millions of people with repetitive thoughts and rituals. It's the ultimate doubter's disease. Overcoming OCD will require you to work differently with uncertainty and doubts.

Like all anxiety disorders, OCD works by tricking you. You need to understand how this trick works if you're going to overcome OCD.

The OCD Trick

The OCD Trick is this: you experience doubt, but respond as if it's danger.

You experience Doubt

Here's how it works. You experience an unwanted thought which suggests the possibility of a catastrophic problem. For instance:

What if I left the stove on, and the neighborhood burns?
What if I got insecticide on my hands, and my family gets poisoned?
What stops me from taking the carving knife and stabbing my spouse?
What if I got poked by a needle infected with HIV?
What if I ran over a pedestrian and didn't notice?

These are thoughts about catastrophes. Naturally, you want to set them aside, and assure yourself that all is well.

And you try. You try very hard, very repetitively, to persuade yourself that all is well. You probably recognize that the thoughts are pretty exaggerated, even silly. But you keep trying to get rid of them. You try to feel absolutely sure that they're false. Even though you've never experienced these problems in the past, you want somehow to be certain that they will never happen in the future.

You treat it like Danger

You end up treating the thought as if it were a mortal threat, a mad dog that has to be killed or captured. You fight the thoughts.

And you lose. Fighting thoughts is always a losing game. When you deliberately and forcefully try not to think of, say, Elvis Presley, your head will soon be filled with Elvis imitators.

This pattern has to change if you're going to overcome OCD.

Different Types of OCD

Some people struggle in their heads, without any change in their visible behavior. For instance, a person who is afflicted with thoughts of killing loved ones or accidentally burning down the neighborhood may continually think about it in an effort to reassure himself, or to somehow "undo" the thoughts, but otherwise doesn't do anything differently. This is what therapists usually refer to as an "obsessive only" type.

Others take specific actions they hope will get rid of the thoughts. A person who fears stabbing loved ones may put all the knives away, or avoid the kitchen, in an effort to get rid of the thoughts. A person who fears accidental fires will repeatedly check the stove to make sure it's off, even if he hasn't used it that day. These actions are what therapists refer to as "rituals".

In both cases, the person is desperately trying to stop thinking the unpleasant thought. The behavioral rituals, such as repeated checking of an appliance, are aimed at the same purpose as the invisible arguing with your thoughts. Either way, however, the thoughts typically become more persistent as a result. The efforts to get rid of the thoughts just make them more persistent. If you're going to overcome OCD, you need to change this pattern.

Why do I have these thoughts?

We still don't know very much for sure about why some people get OCD and others don't. However, it does seem clear that some form of biological or genetic predisposition is involved.

It's useful to know this, because people with OCD often feel guilty about it. You don't get OCD by doing something wrong. OCD is your problem, but don't get confused into thinking it's somehow your fault.

The presence of upsetting or abhorrent thoughts is not what distinguishes OCD sufferers from others. Studies indicate that the obsessive thoughts of OCD are actually common in the general population of people without OCD or any anxiety disorder. What sets people apart is not the presence or absence of these thoughts. The hallmark of OCD is getting into a struggle with the thoughts. The struggle is what makes them more persistent and chronic. To overcome OCD, you need to let go of this struggle.

How can I solve this?

OCD is an Anxiety Disorder, not a Catastrophe Disorder. To overcome OCD, you need to work with the anxiety of the thoughts, not the threats they make.

You're not up against the catastrophes depicted in your thoughts. You're up against the thoughts, and how it feels to experience the thoughts. Thoughts are a dime a dozen.

OCD is all about anxiety. The specific content of the thoughts - whether they're about an accidental fire, the murder of a loved one, a pregnancy or a venereal disease - doesn't matter. These thoughts are all symptoms of anxiety, the same way that the physical symptoms of a panic attack - heart racing, labored breathing, sweating, rubber legs - are all symptoms of anxiety as well.

Ritualizing (or thought stopping, or distraction) isn't the only way to reduce the anxiety. It might seem like the fastest, when you're terribly upset by some thought, but even this probably isn't true most of the time.

The path to recovery involves making changes in your daily behavior which enable you to accept, rather than resist, the obsessive thoughts. The more you can accept the thoughts, and the less you fight them, the better you will do. You don't have to accept the catastrophic predictions of the thoughts - just the fact that you have these thoughts.

This is easy to say, harder to do. OCD is a treatable problem, but it's usually hard work.

So I suggest you start with two steps, and you can do them in whichever order you prefer.

Consult a qualified therapist

Even if you have a mild case, and plan to overcome OCD on your own rather than with a professional therapist, I suggest you consult one before you start your recovery program. This should be helpful to confirm your diagnosis, to give you a chance to ask questions, and to identify a suitable professional should you want to work with one later.

What kind of professional should you see? It would be best to consult a psychologist or other professional therapist who is trained in the cognitive-behavioral methods of "exposure and response prevention". These methods help you to experience the anxious thoughts without resorting to rituals, and give them time to subside naturally.

There are medications which can be helpful in the recovery process. A decision to use medications depends largely on your personal preferences, the severity of your symptoms, and the availability of non-medication help in your area.

A psychiatrist will almost always offer you medication as the treatment method. If you know in advance that's what you want, then start with a psychiatrist. However, if you want to try non-medication methods first, start with the type of therapist described above.

Probably the best place to find a therapist who can help you overcome OCD is the International OCD Foundation.

You may also find it useful to search the "therapist finder" sections of the Anxiety and Depression Association of America and the Association for Behavioral and Cognitive Therapies.

Educate Yourself about OCD

There's no substitute for being an informed patient. Your understanding of OCD, and of the treatment method, will be a key to your progress. If you're going to overcome OCD, you need to become an informed consumer.

Be selective in your use of the Internet. There are many sites where people simply complain and post despairing messages about their symptoms. There are also many scams which sell false hope at high prices.

Here are three excellent web sites I recommend for further reading. All three sites have helpful material about OCD. They also offer recommendations of books and other resources.

The International OCD Foundation.

Dr. Reid Wilson's Self Help site.

Articles by Dr. Fred Penzel.

How to Overcome OCD:
The Keys to Recovery

Whatever you do, here are three key guidelines. Your efforts to overcome OCD should follow these guidelines.

Your recovery work should emphasize taking an accepting stance toward the thoughts. You don't have to accept the apparent meaning of the thoughts, just the fact that you have them. The only real meaning behind obsessive thoughts is that you're nervous, and you already knew that.

Your recovery work should emphasize postponing the rituals and resistance. The obsessive thoughts always include the idea that you had better do something about the thoughts, or they'll continue to bother you indefinitely. But this is probably not so. As you get involved in your ordinary activities without going out of your way to bring the thoughts to an end, they will bother you less and less.

Your recovery work should include the practice of regular, scheduled exposure to the obsessive thoughts. This can take the form of written scripts that you read, audio recordings that you listen to, and other forms of routinely working with material that can trigger your obsessive thoughts.

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