Monday, August 23, 2010

How do I know when I'm done? OCD and the Desire for Complete Assurance

Light switch noir

OCD affects aspects of human experience that most people don't think about, or only fleetingly. It's not that OCD is totally alien, but it is more severe than what people without OCD experience. I have OCD but don't usually check switches and such. But when leaving on vacation, a few years ago, I was halfway out of town and couldn't remember if I locked the door, and went back to check. Everyone has had a day where they aren't sure, and go back to check. Sometimes special circumstances like vacation will make you more aware of the consequences of an unlocked door.

Usually someone without the compulsion to check doesn't need to remember if they locked something or turned off a switch or a knob, because they do it, and move on without even thinking about it. It feels "done" but it's barely conscious, and they flow into the next actions of their day. OCD can disrupt every aspect of the flow of life. Someone with OCD can turn off the light switch, and stand there in the dark and still not be absolutely certain they turned it off, because they get a surge of anxiety that is gut wrenching, and a host of possible feared consequences, ie. "If I don't turn this off, a circuit could short and burn the house down. So I'd better keep checking."

The other day I watched my husband search for a muffin recipe online. He looked at a couple, one fit his ingredient list, and he hit print. He knew he was done. I could even say he "felt" done, but it's so a part of him that he doesn't really feel it as much as keep moving in the momentum of what he wants to get done. Part of my OCD is not feeling finished, not feeling I've fulfilled my goal, and I'm well into page 10 or more on Google when looking for a recipe. It's like I don't have an "off switch," and I am very likely to feel anxious if I don't feel "just right" or "done" and ironically, my OCD pretty much guarantees I won't get that feeling, no matter how much compulsive searching for the perfect thing.

Even when I find something that fits my criteria, I don't believe it, because I want to be certain that it's the right thing, and I'll feel anxious if I take the chance of printing something from page one. OCD isn't about logic. This can frustrate both the person with OCD and their friends and family. There is a tendency to assume if you explain the illogic, that this will solve the problem. "You are standing in the dark. Of course the light switch is off." "You've checked 5 review sites, and they all recommend the same product--why do you have to keep looking?"

I've always been fascinated by phenomenology--the attempt to understand what someone's experience is from the inside, the lived sensations of consciousness. OCD is that moment of wondering if you locked the door, and thinking you probably did, but having dire visions of thieves in your house while on vacation. You feel anxious. You don't want to ruin your vacation worrying about this. You drive back to check the door. But OCD will keep generating those moments of stabbing fear, even after you've checked. Did I really check? How can I be sure? There's no stopping point.

Cognitive Behavioral Therapy can get hung up at this point if the instruction is to guess the probability of something bad happening, and how much of it would be your responsibility--it could be .00001% and the OCD is still going to be clamoring about no risk being acceptable. For me Exposure Therapy has involved choosing something off the first page of Google, even if I break into a cold sweat, to help retrain my brain recognize that I'm done and can move on. I spent years waiting for fanfare and illuminated signs that a decision was right so I wouldn't have to feel anxious, but I am learning that most decisions don't get that kind of certainty, and that I can actually live well in spite of this.

8 comments:

  1. Great post. I am always baffled by how other people feel that assurance of being "done." I struggle with it. I have turned around to check to make sure a burner was off after being more than an hour away from home. I'm constantly checking that the fridge is closed (I have this fear of food going bad), and I can check and re-check my alarm clock over a dozen times before bed. I don't know what I'm looking for -- some magical OK from the universe? It can be very disruptive. Some days are worse than others for me. I think it is rooted in discomfort with uncertainty. I like things very orderly and secure. I think this is the basis of my anorexia too.

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  2. Good post. I had thought about titling my blog "It's Not Done Until It's Done," but since I have more intrusive thoughts than checking, I didn't. When I check or compulse, I don't count. I just do it until it feels right or "done." LOL

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  3. I agree about the limitations of CBT here. I am currently in week two of exposure therapy for OCD for relationship and sexual obsessions. I've realized that trying to logically estimate the probability that I am gay doesn't help at all. There is always that nagging "but you don't know for sure do you?" question ready to pop up. Right now I am struggling immensely with the increase of intrusive/nasty thoughts and trying soooo hard to just let them be there. But your point in this post that you have waited and hoped for years that somehow you'll get that magical indication that you can be SURE about some things just won't happen. I appreciate the fact that you have decided to go ahead and endure the anxiety anyway. That inspired me because right now I'm sure feeling a lot of anxiety!!!!

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  4. Awesome blog! I really can relate to what you are saying. OCD loves uncertainty!

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  5. As usual, I love what you have to say. Your fascination with attempting "to understand what someone's experience is from the inside" seems so fitting since you do just that so well in writing!

    The example of someone standing in the dark wondering if they turned off the light reminds me of the times when I have stood in front of a sink filled with soap suds, hands and arms dripping with water, wondering if I really washed. The way OCD works is unfortunate but at the same time fascinating. It is amazing how doubt can persist no matter what evidence there is.

    I know I take my ability to move on from a lot of things for granted; however, I also don't always realize that certain things tend to consistently take me longer than the average person until I am doing them with someone else. I am notorious with one friend for always managing to extend our shopping trips to closing time. I tend to get set on finding particular things in particular stores and will continue the hunt with determination where others might recognize that second best is probably worth the saved time and energy. I don't mean to blame this on OCD necessarily, but I feel like it goes with the tendency to want things to feel "right."

    It's so true that logic doesn't really help. I have friends who will say things like "urine is sterile" or "I don't think you will die from that." But I know these things already, and recognizing that urine is sterile or that the risk of dying from not washing my hands is probably infinitesimal doesn't help me overcome my fear of feeling dirty. It doesn't make coming into contact with urine or not washing seem any less "wrong." Logic doesn't have stable footing within the slippery world of OCD.

    This is something I still struggle with though. My therapist is always saying something along the lines of "If you change your behavior, your thoughts and feelings will follow." It is often hard for me to forgo washing when I feel I should, though, because it just seems plainly and irrefutably "wrong." It is difficult for me to do what my therapist asks sometimes when it does seem so wrong, especially when it also seems like an impossibility that my position on what is "wrong" could change or that I could be okay with myself if I altered my definition of what is "wrong." But perhaps this is exactly what my therapist means, I just have to change my behavior first, even if it seems wrong, and even if it seems wrong to let my definition of what is "wrong" shift, and my thoughts and feelings will most likely change, as well. Then again, the idea, I suppose, is not to convince myself of this, but rather to accept the possibility that it won't be "alright" and to live with that uncertainty.

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  6. Like Kim and Anonymous both said, I've waited for the "magical sign or indication from the universe" and it doesn't happen--and I suspect even if it did, I would recognize it! It truly sucks that one of the symptoms of OCD is doubting you have OCD, because it makes it much harder to move ahead, when I get stuck on step one and questions like "Is this really OCD?" That's why I value the community of readers here--more ways to chip away at the credibility of the OCD argument that we can have certainty.

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  7. Most of the time I have the urge to go back and check if I turned the alarm on when I walked away from the car, but I'm lucky that my wife knows how to deal with my OCD. I still walk away with the feeling that she might be wrong, but I know that once I get home and get my mind preoccupied with something else, the anxiety and the thought will be gone. But it does take a while to get use to it.

    Sometimes I do get stuck with something like checking the stove one, two and even three times before going to work. It's just hard to brake the cycle sometimes.

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  8. Tony--sometimes I think habit has worn grooves in my brain! That even if I have succeeded in stopping a compulsion in the past, my default setting is to keep doing it--I am glad I am getting better at interrupting the cycle, but it's definitely a challenge.

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