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When Does Dough Become Bread? Understanding GAD vs. OCD

This article is not meant to be an all-encompassing explanation of generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and their diagnostic differences; rather it is an attempt at providing a new perspective on how we see, relate, and approach treatment for both "disorders." In a nutshell, OCD consists of obsessions (troublesome and repetitive thoughts, urges, sensations, memories, ideas, mental images, etc.) and compulsions (physical or mental behaviors, including avoidance, that attempt to relieve discomfort brought about by the obsession). Quite often, obsessions fall into particular categories, such as: sexual orientation OCD, POCD, contamination OCD, "just right" OCD, essence OCD, religious/morality OCD, hit-and-run OCD, real-event OCD, relationship OCD, et cetera. To many people, including those with OCD, the concerns present in OCD may seem irrational. To others, the concerns may be considered rational or somewhere in between rational and irrational. The ability to see where a concern lies on a rational-irrational spectrum can be referred to as insight. Sufferers have good, fair, or poor insight. Most people I have seen tend to have good or fair insight. Poor insight is essentially when someone believes, with a high degree of conviction, that their obsessions and compulsions are warranted and have high probability. For someone with poor insight there is initially more focus on cognitive therapy and restructuring. Good or fair insight is part of what leads to a slightly different type of suffering versus someone with poor insight. Someone with good/fair insight has a feeling that something is excessive or irrational, yet feels compelled to obey OCD's demands. This results in a kind of internal tug-o-war. For example, "I know I don't want to hurt my children but I feel like I could snap and end up doing it so I better avoid them.") It's when our thoughts and feelings don't align in a coherent way; we think one thing but feel another. In other words, logic and rational thought have failed to help us think our way out of discomfort.


Side note: Logic and reason doesn't always influence how we feel as much as we think it should. If it did, the next time we are in a bad mood we could simply think ourselves into a good mood. An example of this is with gratitude. There has probably been a time in your life where you felt bad but knew you had a ton of things to be grateful for. Knowing the things you have to be grateful for doesn't necessarily translate into feeling grateful. I don't know if I've ever thought myself into a good mood, but I have acted (behaved) my way into a better mood! This is a similar principle seen in ERP; we lead with action rather than thought or feeling. One of my favorite quotes is by Bill Wilson, the cofounder of Alcoholics Anonymous. Bill said

"You can't think your way into right acting, but you can act your way into right thinking."

Generalized anxiety disorder is different, generally, only in the perceived normalcy or rationality of the given concern(s). If someone is constantly terrified they hit someone while driving their car and constantly turn around to check to see if someone was in fact hit yet fails to find a person laying in the street, we would probably consider this person to have OCD. Why? Because 1) The experience fits into a common OCD category (harm/morality/hit-and-run), 2) Is likely perceived as irrational, and 3) Involves obsessions and compulsions. To the naked and untrained eye this concern would seem "irrational." The untrained person may say, "How could you NOT KNOW if you hit someone with your car?! That's impossible! You would know!" We could argue endlessly about how rational or irrational this fear is. For the OCD sufferer, this may not get him very far.


With generalized anxiety, someone may have a worry that isn't typically considered to be highly irrational, and if it is, it tends to fall within a common or "normal" life -category, such as fears about: losing a job, a marriage ending, children getting sick, failing a test, being late, saying something embarrassing, et cetera. How rational or irrational a concern is should not carry an extremely high degree of importance in treatment because regardless of rationality, we are left with possibility, and possibility can be scary. To many sufferers, there is little difference in how risk is experienced emotionally regardless if there is a 1% or 25% risk. What are the chances of hitting a pedestrian with your car and not knowing it? What are the chances of developing lung cancer due to living near an airport? What are the chances of snapping and murdering someone in a fit of rage? What are the chances of not getting the job you just interviewed for? What are the chances you'll get in a non-fatal car accident in the next two years? I'm not really sure, and frankly we can't ever be sure. Even if we were sure of the odds it wouldn't mean the feared outcome is impossible, and that can sound scary. It's important to keep in mind that we tend to only allow this type of reasoning to function in the negative. Accepting and being open to possibility is what's important. Difficulty accepting uncertainty is at the root of BOTH OCD and GAD, therefore treatment for both can share a common approach, which is learning to live with uncertainty.


So when does dough actually become bread? If you could watch bread bake the way you could watch paint dry, is there a specific single moment in time when the dough clearly stops being dough and becomes bread? Or is there a huge gray area where it's hard to tell? Maybe the outside resembles bread but the inside resembles dough. Even then, there would be a section of the dough/bread that is somewhere in between. I find a lot of us sufferers want to be able to clearly define bread as bread and dough as dough. In other words, we want to be able to clearly identify when something IS OCD and when IT'S NOT OCD. Many times this can be done, but where does it leave us when we can't tell? Usually searching for an answer (compulsions) or embracing uncertainty (recovery). The choice is ours.



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