The Dark Side Of OCD

The Dark Side of OCD

Hello, people… hope everyone had an awesome weekend! Was it perfect? Because last week, we talked about POCD, perfectionism OCD. This subtype is pretty self explanatory; it’s the obsession with being perfect. Perfectionism is a little unusual, as it can exist outside of OCD, underlie many OCD subtypes, and be a subtype all on its own. In people with stereotypical OCD, perfectionism contributes to the need to do a ritual perfectly, or have things arranged just right. But when it’s extreme, when it’s rooted in obsession(s), followed by compulsion(s), and causes dysfunction in the person’s life, perfectionism can really be thought of as its own OCD subtype. Perfectionists rigidly adhere to the belief that things must be done in a certain way- perfectly- or not at all. It’s a tough way to live, and the pressure to constantly achieve this standard often becomes so great, at times it’s far easier for them to give up on doing something altogether. This week, we’ll be talking about Scrupulosity OCD, which involves obsessions with morality, being good or evil, or sinning; and Sexual Orientation OCD, obsessions involving one’s sexuality.

I love the word scruples… it’s fun to say. Scruupullzzz. Scruples are the moral principles or beliefs that make you unwilling to do something that seems wrong. Having scruples is kind of like having a conscience… when you’re considering doing something shady, that little knot in the pit of your stomach is brought to you courtesy of your scruples. Fun fact, a scruple is also a unit of weight in old school pharmacy- equal to 20 grains- so sometimes “a scruple” means a minute amount. I drink my tea with a scruple of honey. Okay, sometimes maybe a little more.

Scrupulosity OCD is usually thought of as an obsession with sinning or offending God- common concerns include devil worship, blasphemy, and hell- but it’s not always focused on religion. Secular or moral scrupulosity is more about right and wrong, and being a “good” or “bad” person. While research shows it’s common in orthodox Jews and Catholics, up to 25 percent of people with scrupulosity OCD say that they have no religious affiliation at all. It runs the gamut; I’ve seen very pious, religious people with scrupulosity OCD, as well as people who’ve never even gone to a church service. 

I recall a patient who was not raised in the church, who thought he was never going to find God. This internal doubt turned into obsession, requiring various rituals he had to complete. It started with conquering fears to prove that he was worthy; he had to challenge himself to conquer any fear that came up in his daily life. Then, he started to worry that he had already done something horribly wrong, something unforgivable, and as a result, God would never reveal Himself to him. To fix it, he had to do everything correctly, to be a good person, if he had any hope of finding Him. He was always scared that he was off “the path” and constantly tried to find ways to prove that he was on the path. He got totally obsessed with it, and every little decision that he made became monumentally important for how to do the right thing and be on the right path. He became so obsessed with getting on, staying on, and proving he was on the right path, his life deteriorated. He couldn’t get his homework done, couldn’t complete tasks or chores, or go out with friends. Eventually, his scrupulosity led to complete avoidance; he stayed away from people, avoided churches like the plague, and would even get scared whenever anyone would mention the devil or say the word ‘Satan.’ Until he started treatment, his thoughts only intensified, and he was sure that he was going to go to hell. 

Some other patients I recall include a woman obsessed about whether or not she felt enough empathy for people she saw suffering in fundraising specials on TV. She also obsessed about not recycling every single scrap of recyclable material, thinking it made her a bad world citizen, someone who didn’t care about the greater good. I remember another woman had to imagine the people she loved with a protective halo surrounding them at all times, to prevent them from being harmed. She was convinced that if she imagined them without it, a horrible fate would befall them.

OCD has a knack for latching onto whatever matters to the person, and that’s why scrupulosity can often strike people whose religion matters a great deal to them. And this can also make it hard to design exposures for therapy. The goal isn’t to make someone violate their true religious beliefs; you don’t want to force a kosher person to eat something unkosher. Instead, you challenge them with feelings of doubt; give them something kosher, but don’t allow them to triple check that it is. Or challenge a secular scrupulosity OCD patient from seeking reassurance that they’re not going to hell, or that they’re a good person. 

In my research, I read about an exposure for one scrupulosity patient that was interesting to say the least… he had to go into a church, put up his middle finger and say “F@*k you, God.” Clearly, the idea was to do very blasphemous things, completely contrary to everything he was taught as a kid, in order to show him that God wasn’t going to smite him. In the interview, he said that it was extremely difficult for him to do at the time, but it made him realize that the less he let scrupulosity take over, the more faithful he felt. His therapist told him, “Every ritual resisted is an act of faith,” and those are the words he went by to help stop his compulsions. He decided that listening to the therapist, rather than listening to his OCD, was going to better demonstrate the faith that he was brought up with, as opposed to doing his various rituals. He was at a point where he was willing to do whatever it took, and he amazed himself when he lived through the anxiety. Thankfully, now he notices his thoughts, but doesn’t have to act on them. He can let them go, not dwell on the devil or hell, without reacting compulsively to fix the anxiety. Pretty powerful stuff. 

Sexual Orientation OCD

SO-OCD is characterized by obsessions and intrusive thoughts revolving around a person’s “true” sexual orientation. It has been referred to as homosexual OCD or H-OCD, but this term is somewhat misleading, and is increasingly discouraged due to its lack of sensitivity. In reality, SO-OCD can happen to people of any sexuality, about any other sexuality. It goes beyond just questioning your sexuality; because sexual desire is such a fundamental issue, and sexual orientation is such a big part of a person’s identity, SO-OCD often causes a great deal of internal distress, and sadly, shame. The truth is that though we’ve come leaps and bounds as far as acceptance goes, we’ve still got some ground to cover there. Constantly questioning, while simultaneously hiding the questioning, of something so fundamental causes a great deal of internal strife and anxiety. Keep in mind that OCD has that penchant for latching on to what a person values, so with SO-OCD, it can feel like there’s nearly endless fuel for these obsessive thoughts and anxieties. 

Someone with SO-OCD may experience fears about being perceived or labelled as having a certain sexual orientation, such as gay or straight. Or they might wonder if they’re actually of an orientation other than the one they thought; they may fear they’re in denial of their “true” sexual orientation. Or, they might fear that their sexual orientation could abruptly change, that they could “turn” gay or straight, and worry what this change will mean for their life. For example, will they have to leave their family? Will their relationship end when their partner discovers they’re not who they think they are?

They often constantly assess or question their behaviors and attraction levels to potentially nearly every person encountered, and can be excessively concerned with whether their behaviors align them with a particular sexual orientation. Asking things like: “I was attracted to that guy back there. This must mean I’m gay.” or “He’s attractive. Was I really into that last girl when we dated… or am I more into guys?” or “What if I’m actually straight and I’m not really in love with my partner?” These thoughts can really take hold of a person’s mind, and they won’t let go until they’ve found sufficient proof that their fears are unfounded. But as with all types of OCD, any relief they may find is only temporary, it’s only a matter of time before the cycle begins again. The most common compulsions to quell these anxieties often involve looking at pictures of women or men to see if you’re attracted to them, repeatedly asking people if you seem straight to them, and/ or avoiding people of the same sex altogether to avoid any confusion or complications. 

These intrusive thoughts and compulsions can be extremely distressing, and interfere with a person’s relationships bigtime. And we mentioned religion in our discussion of scrupulosity OCD, and it often plays a role in SO-OCD… it’s fairly common for people to fear going against a religion they were raised in or that their family believes in. Remember in the first blog of this series, I explained that OCD is a disorder of doubt? Well, SO-OCD isn’t so much about their actual sexual identity or orientation, it’s about the doubt that’s common among all subtypes of OCD. It’s really the same uncertainty that exists for everyone, that’s part of human nature… multiplied many fold by confusion and divided by doubt. It’s a tough equation. Nearly every SO-OCD patient I’ve treated has been unconcerned with which orientation fits them, they just want to know with 100% certainty what their sexual orientation is, just as everyone else does. This is how and why people of any orientation can have SO-OCD. Because sexual orientation plays such a big part of a person’s life and identity, and because OCD tends to latch on to what an individual values, it can feel like there is endless fuel for the intrusive thoughts and the anxiety that accompanies them. Altogether, it can make for a debilitating and life altering disorder.

I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon. 

Thank you and be well people!

MGA