Updated: Jan 17, 2021
A common suggestion to a sufferer caught in an obsessive-compulsive cycle is to "identify it as OCD and refocus your attention on something else." While this is a technique that can be helpful, it has its limits. At the core of most forms of OCD is an intolerance to uncertainty (more on uncertainty in a later blog post). The goal of treatment should be reaching a point of being willing to make the best of our lives despite the fact that extremely unfortunate events can occur. Simply labeling our concerns as "OCD" and moving forward can prevent us from truly embracing uncertainty and accepting reality. For a moment look at OCD (and just about any form of anxiety) on a spectrum; on one end is completely irrational and on the other is rational. Depending on who the observer is, the same concern may fall on various points along the irrational-rational spectrum. A good portion of those with OCD recognize their obsessions to be irrational, yet persist in chasing certainty. Let's use the example of contracting HIV from kissing someone. The person with OCD who kissed someone may fall deep into rumination after the act of kissing. Rumination may involve bringing up facts about how HIV is transmitted, or making statements such as "I don't have any cuts in my mouth." At some point, the sufferer may simply label this HIV-concern as "OCD" in an attempt to move past it. Sometimes this can be successful, other times not so much or else this technique would be the ultimate tool in treating OCD. Since uncertainty is at the core of most forms of OCD, almost every sufferer identifies with the fear of "What if it's not OCD [this time]?" So where do we go from here? We have a couple of options: 1) label it as OCD and accept the possibility that you might be wrong and continue to move forward anyway; 2) lean into the uncertainty of the content of the obsession. At times those suffering from OCD will be able to label a concern as "OCD" yet still believe the obsession/concern is valid, therefore being stuck with the obsession and finding little help in labeling it. For example, let us say I interview for a job and afterward can't stop thinking about whether or not I will get it. I begin to engage in mental compulsions of bringing up images of my interviewer's facial expressions, looking for signs of reassurance. I may reach out to friends at the company to see if they have heard anything about the hiring decision. I'm worried about not getting this job day in and day out. My behavior in response to the fear represents OCD (generalized-anxiety disorder would be more fitting but more on that in a later post). I can easily label this as OCD, yet my concern about not getting the job is still high, why? Because there is a possibility I may not get the job and that is terrifying. Option number two allows us to lean into this possibility and move toward acceptance. Option two would not consist of labeling our thoughts as "OCD" but rather asking ourselves "...and how will I cope with that if it occurs?" In other words, "If I don't get the job, how will my ideal and resilient self cope with it?" Will I apply for other jobs? Will I brush up on my interview skills? Will I feel like shit and meet with my therapist to talk about it? (Keep in mind, we don't want thinking of how we will cope to become compulsive either). Acknowledging the possibility that I may not get the job actually allows me to learn to embrace uncertainty and live in reality, which is really my only option because the truth is that I may not get the job, I may hit a pedestrian, or I may contract HIV via kissing. I am not completely against calling out OCD for what it is; it's when labeling it is not helping or we use it compulsively that I suggest the method(s) I described above. It's not always clear whether we are living in OCD-land or not, and at times trying to label OCD as OCD is akin to calling out the exact moment dough becomes bread. We may not feel certain, and it is in these times we need to lean into the uncertainty or create a new relationship with our thought life through mindfulness (more on mindfulness in a later blog post).