The Dark Side of OCD

The Dark Side of OCD

Hello, people… welcome back to the blog! We had some bigtime issues with our website, so we had to take a short blog break… but our IT guy got it sorted, so we’re finally back! Our last blog continued the discussion of OCD subtypes, and I went over Scrupulosity OCD, the obsession with morality and good versus evil, and Sexual Orientation OCD, the obsession with one’s “true” sexuality. This week, we’re wrapping up the OCD subtype series with a look at Relationship OCD, or ROCD, and an overview of Pure Obsessional OCD, aka Pure O.

In Relationship OCD, obsessions revolve around one’s feelings of attraction, attachment, and love for their partner. Recall again that OCD is a disorder of doubt, so ROCD presents as a preoccupation with doubting various aspects of the relationship. The person may wonder whether their person is really ‘the one,’ and about the level of sexual attraction or general compatibility; ‘Do they really love me?’ and ‘true love’ versus ‘just lust’ are other common themes. Whatever the doubts may be, they can become so pervasive and consuming that they can easily poison otherwise entirely healthy relationships… it can be exasperating to the person’s partner, and totally devastating to everyone involved. Imagine being married to someone for a number of years, maybe even having children with them, and then one day they tell you they’re not sure if you have sexual chemistry, or are compatible, and they don’t know if you belong together. Yikes! Scary stuff for everyone. It can even be a physical trait they’re unusually drawn to, and unsure if they can live with, or a common habit. Maybe you squeeze the toothpaste from the middle of the tube instead of rolling up the end. Jk on that last one people, though some folks, whether they have OCD or not, can be pretty particular about those kinds of things.

Sometimes people have a hard time understanding the difference between ROCD and more garden variety relationship doubts, and ROCD can even be misdiagnosed by mental health professionals if they misread the symptoms that way. Lots of people doubt their relationships from time to time, and there’s nothing wrong with taking a hard look at things and asking yourself some serious questions when choosing to settle down with a partner. We’re not talking about your usual commitment phobias here… make no mistake, people with ROCD are tortured continuously by their doubting thoughts. But the core issue with ROCD isn’t actually related to compatability or intimacy, once again, it’s about the doubt; specifically, the inability to tolerate that doubt. To draw the distinction, I’ll use a nerd word, people… ego-dystonic. For people with ROCD, the doubts they have are ego-dystonic, meaning that they are inconsistent with their actual feelings. They truly feel that they are attracted to, and compatible with, their partner, it’s just the ROCD causing them to constantly question it. Unfortunately, some clinicians and practitioners who aren’t familiar with ROCD may suggest to a person with it that “maybe you’re just not that into them” or that they “may not be right for you” or “not the one.” Worse yet, they might even tell them, “Well, maybe your gut is trying to tell you something… maybe those are your instincts, and perhaps you should pay attention to them” Alas, no. Telling someone with ROCD to listen to their doubts is the fastest way to send them into a tailspin of panic.  

Aas ROCD obsessions center on doubt, the associated compulsions center on being absolutely sure that the relationship in question is right, on ascertaining the justification for entering into or remaining in it. For the person with ROCD, attempting to arrive at this level of certainty is agonizing, and it leads to an intense and endless cycle of anxiety, because it’s impossible to arrive at a definitive answer for any length of time. The doubt can usually be assuaged for a short time by performing various mental compulsions, but it always returns with a vengeance. It’s no picnic for the partner, either. They’re forced to think about what their significant other might be willing to do to reach that goal to be sure, especially the possibility of cheating, which is the usual form it takes. For them, this often leads to constant uncontrollable guilt, fear, and distressing thoughts of what will happen.

As with all forms of OCD, compulsions must be performed in an effort to reduce the anxiety related to the unwanted obsessional thoughts. Some examples of what ROCD might look like may be a married woman who has the obsessional thought, “What if I don’t really love my partner?” so she looks at old pictures and mentally recites her wedding vows until she feels she does. Or a husband who imagines cheating on his wife, and then obsessively fears that because he imagined it, he must secretly want to be with another woman, sso he may test the theory so to speak. Maybe a guy is drawn to his girlfriend’s nose, and obsesses about whether or not he finds her attractive enough to be with her, or if he should break up with her. Whichever way he leans- stay or break up- it causes him huge anxiety, so he compares his girlfriend to other girls he sees on the street to find evidence of sufficient feelings for her. Perhaps a man is attracted to a girl he notices on the street, and he begins to obsess that this must mean that he doesn’t love his girlfriend, so he must be in the wrong relationship. This causes him a lot of distress, because he actually believes he does love her and doesn’t really want to break up with her… but the doubt persists. How about a girl who’s living with her boyfriend, and confesses that sometimes she feels turned off by the thought of having sex with him. She believes that since she’s not 100% attracted to him 100% of the time, this is proof that she’s in the wrong relationship. So she mentally lists all the things she does and does not find aattractive about him in an effort to figure it out.

Notice that these compulsions aren’t very obvious… things like mentally reciting wedding vows and making mental lists and comparisons of people can clearly go unnoticed by others, as opposed to someone washing their hands over and over or unlocking and re-locking a deadbolt 20 times to check it. These are more of a mental obsession game. In fact, all of the subtypes we’ve been discussing in this series are similar in this way- sexual orientation OCD, pedophilia OCD, scrupulosity OCD, emotional contamination OCD, and hyperawareness or sensorimotor OCD- all of these are primarily cognitive in nature. As such, they are loosely categorized under Pure Obsessional OCD, aka primarily cognitive obsessive compulsive disorder, aka Pure O. Though not a true diagnosis found in the DSM-5, Pure O is considered a lesser known manifestation of OCD, and is thought of as one of the most distressing and challenging forms of OCD, as people with it have terribly disturbing and unwanted thoughts pop into their heads very frequently, totally unbidden; and once there, they tend to stick around.

In addition to the types we’ve discussed, some other common themes of Pure O thoughts and obsessions include:

-Responsibility type, which is marked by an excessive concern over someone else’s well-being, and hallmarked by guilt over believing they have harmed them, or might, either inadvertently or intentionally.

-Health type, which is essentially a contamination type, where they have constant fear of having or contracting a disease, generally through seemingly impossible means; for example, by touching an object that has just been touched by someone with a disease. This type can also include obsessive mistrust of the medical establishment and/ or diagnostic testing. It’s important to note that this is not the same as hypochondriasis, which is an illness whereby affected individuals falsely convince themselves they are physically ill, potentially to the point that they may even manifest physical symptoms. Maybe that’s a good topic for another blog.

-Existential type, which involves the persistent and obsessive questioning of the nature and meaning of self, life, reality, the universe, and other philosophical topics… all the deep stuff.

It’s important to distinguish Pure O from a singular fleeting thought. All humans experience unwanted thoughts. However, non-clinical people, or those who don’t have OCD, are able to easily dismiss the thoughts as uncomfortable, weird, or just something their brain does. What distinguishes Pure O from a fleeting unwanted thought is the anxiety that becomes affixed to the thought, which then creates a significant amount of distress to the sufferer. As you’ve probably noticed throughout this series, the nature and type of Pure O obsessions vary greatly, but the central theme is the emergence of a disturbing, intrusive thought or question, an unwanted or inappropriate mental image, or a frightening impulse that causes the person extreme anxiety, because it’s typically oppositional to their religious beliefs, morals, or societal norms. The fears associated with Pure O tend to be far more personal and terrifying for the sufferer than those of someone with traditional OCD… scenarios that they feel would ruin their life or the lives of those around them, the stuff of nightmares. Not to minimize the fears associated with stereotypical OCD, but to illustrate the difference, think about being overly concerned about security or cleanliness, and then imagine being terrified that you’ve undergone a radical change in your sexuality, or that you want to molest your baby nephew, or stab your father. You might be a murderer, you might cause some harm to a loved one, or an innocent person, or to yourself… or maybe you are, or will go, insane. You don’t actually want to do these things, but your brain makes you doubt that, makes you think you might want to. You have to think about it all the time, just to be absolutely sure that you won’t. That’s the pure hell of Pure O.

People with Pure O understand that these fears are probably unfounded, that it’s highly improbable, or even impossible, that they would ever hurt anyone or themselves, but the anxiety they feel will make the obsession seem very meaningful and real. While people wwithout Pure O will usually instinctively dismiss any bizarre, intrusive thoughts as insignificant impulses that are part of the normal variance of the human mind, just doing its thing, someone with Pure O will respond with alarm, followed by a desperate attempt to neutralize the thought and banish it… anything to try to avoid ever having it again. Even though they usually realize that their fear is irrational, a fact which just causes even more distress btw, they’ll constantly ask themselves, “Am I really capable of something like that?” or “Could that really happen?” and they’ll continuously put tremendous effort into resolving or somehow escaping the unwanted thought. It ends up in a vicious cycle, as they mentally search for reassurance, while trying to get a definitive answer to the question(s). This is generally through creating specific mental rituals they must accomplish in order to reassure themselves their intrusive thoughts are untrue, or that they aren’t a bad person. They may repeat specific words, recite special prayers or mantras in their head, or mentally review certain images each time there’s a negative thought, in an effort to neutralize it.

People with Pure O often report that it’s these thoughts that make them incredibly anxious, that they can’t get out of their head. This is an important point: what ignites the symptoms of Pure O isn’t having the experience of intrusive thoughts, but actually the reaction to them. The more they hate the experience of the intrusive thoughts and try to repress, control, or fight them, the greater the frequency of intrusive thoughts they’ll experience. It’s the very act of trying to not have the thought(s) that guarantees they’ll resurface agaain and again. This is because Pure O is rooted in the faulty assumption that as humans, we have control over our thoughts, when in fact, not so much. The human brain has evolved to be constantly searching and seeking, aware and alert, to find interesting problems to solve, and to search for threats to safety and existence. In addition, the brain is hardwired to be particularly interested in thoughts that contain uncertainty, and OCD thoughts are the epitome of uncertainty. When the brain of someone with Pure O lands on a thought or question that’s unacceptable or fearful to the person having the thought, the fear network of the brain is alerted that something is wrong, and that something must be done about it IMMEDIATELY. It comes down to the fight or flight response, and it’s this fight or flight experience that causes the sufferer a great deal of distress.

Remember when I talked about perfectionism being a little unusual because it’s really a subtype of its own, but also a common feature of stereotypical OCD as well as the other OCD subtypes? Many people with Pure O also experience comorbid features of perfectionism. They tend to maintain a high overall standard for what their brain “should” be thinking, and the level of control they “should” have over their thoughts. Individuals living with Pure O will commonly berate themselves, saying things like “I shouldn’t be thinking this,” “These thoughts are wrong or bad,” and “I should be able to control these thoughts.” They spend a great deal of time analyzing why they’re having them, with negative self talk about what the thoughts say about them as a person. Sadly, for many sufferers of Pure O, failing to meet this self-imposed standard of control over their own brain will lead them to conclude that they are a bad person, when the truth is that they are not… their brain may be “disordered,” but this is not, and should not be, a reflection on them as a person. They’re typically their own worst enemy, and they need and deserve our empathy and understanding. 

Now you know more about the dark side of OCD- that it’s not all cleaning, straightening, and arranging- and that brings us to the end of this series. Next week, new topic… I’ll surprise you… as soon as I figure out what I’m writing about.

I hope you enjoyed this week’s blog, and found it to be interesting and of course, 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