I was glad to see a chapter on this form of obsession of doing things "just right, " also known as symmetry OCD, organizational OCD, and perfectionism OCD. The authors get the fact that the opposite of "just right" feeling is "feeling dead wrong," which has emotional intensity.
The one compulsion that resonated the most with me was:
- Checking to see see if things appear as you feel they should(for example, reviewing the placement of two pillows on a bed to make sure they are in the perfect position.)
When my health anxiety would be active, I would check whatever symptom I had against the opposite side of the body. This summer I had a feeling of a something stuck in my throat, and my urge was to keep checking to see if my tonsils were parallel, and then feeling ashamed that I looked in the mirror, and berating myself for my vigilance.
An Acceptance tool for Just Right OCD is allowing the "off" feeling to be there, noticing the body sensations, and carrying it with you "on your way to doing something greater than your compulsive fixing."
An Assessment tool for Just Right OCD is dealing with all or nothing thinking. When I used to sew for Home Ec class, I would become so fixated on any small asymmetry of top stitching, and therefore the whole garment was "ruined," even though other people would have a different frame of reference, and not even notice the stitches, but rather overall shape of the garment. Ironically, I won an award for excellence in Home Economics in 9th grade, even as I was convinced any flaw meant I was incompetent.
Taking Action for Just Right OCD includes recognizing that focusing on perfection can mean a tiny trigger can feel as disturbing as something more obviously huge, so setting up a hierarchy of exposures can seem impossible.
It's important to get in there and take any opportunity to let things feel "off" rather than trying to fix it. Trying to decide if I had a hierarchy of exposures "just right" could take up all my time and it helped that my ERP therapist understood this and encouraged me to practice tolerating the thought that I might do my exposures wrong.
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Great post, and I like how you point out that perfectionism can get in the way of doing ERP. That's something therapists, as well as OCD sufferers, need to be aware of.
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