I have OCD

What OCD is

OCD is two parts working together: an intrusive thought you can’t stop, and a behavior you do to neutralize it. The behavior gives you brief relief. The relief trains the next thought to be more urgent. The urgency demands more behavior. The cycle gets tighter over time. The behavior might be a hand wash, a checking, a counting, a repetition, a mental rehearsal, an avoidance. The thought might be about contamination, about harm coming to someone, about being a bad person, about something terrible happening if you don’t perform the action exactly right.

You know the rituals don’t really prevent anything. You also can’t stop doing them.

How OCD takes over your day

The first time the thought arrived, you did the action and felt better. The relief told your system that the action worked. The next thought arrived a little easier. You did the action again. You felt better again. The action got faster, more automatic, harder to skip.

Now the thought-and-action cycle takes hours of your day. You’ve started arranging your life around it. You’re late to things. You hide it from people. You’ve tried to stop and lasted a few hours before the thought broke through and you did it again.

Which version of OCD do you have?

• I can’t stop checking things. Did I lock the door? Did I turn off the stove? Is the email I sent okay? → I can’t stop checking things

• I wash my hands compulsively. Or shower for hours. Or use sanitizer constantly. → I wash my hands compulsively

• I’m afraid I’m contaminated. I’m avoiding surfaces, public places, doorknobs, anything that could be unclean. → I’m afraid I’m contaminated

• I have intrusive thoughts that I’m a bad person. Thoughts that don’t match who I am, and the having of the thought feels like proof. → I have intrusive thoughts I’m a bad person

• I have intrusive sexual thoughts. Unwanted thoughts about people I shouldn’t have them about. → I have intrusive sexual thoughts

• I have intrusive violent thoughts. Thoughts about hurting someone I love. → I have intrusive violent thoughts

• I count things obsessively. Steps, ceiling tiles, the times I do an action. → I count things obsessively

• I have to do things in a specific order. If the order breaks, I have to start over. → I have to do things in a specific order

• I can’t throw anything away. Hoarding, with the conviction that I’ll need it or that throwing it out is wrong. → I can’t throw anything away

• I pull my hair. Trichotillomania. Sometimes I notice, sometimes I don’t. → I pull my hair

• I pick my skin. Excoriation. Faces, scalps, hands, anywhere there’s something to pick. → I pick my skin

What kind of OCD do you have?

Why telling yourself to stop doesn’t work

You were probably told to ignore the thoughts or stop doing the rituals. Ignoring an intrusive thought produces more of the thought. Stopping the rituals cold turkey leaves you with the original thought and no neutralizer.

The standard CBT approach for OCD, called exposure and response prevention or ERP, works for some people. For many it relapses because the underlying mechanism stays intact: as long as the thought feels intolerable, performing the ritual stays the obvious solution.

The thoughts aren’t your enemy. The ritual is what’s been training the thoughts to keep coming.

How we work with it

Strategic therapy treats the thought and the ritual as one mechanism, because they are. We don’t ask you to ignore the thought and we don’t ask you to white-knuckle the ritual. We work the relief that lands when the ritual completes, since that’s the precise piece training the next thought, and we do this with assignments calibrated so you can actually carry them between sessions.

Your rituals stop being the thing your day is built around. The thoughts get quieter because nothing is answering them.