Understanding your OCD

Many people with this type of intense anxiety face struggles that are not visible and are very distressing

By Armaan Amlani-Kurji, Registered Psychotherapist (Qualifying)

Picture yourself at a summer family barbecue with your partner. The sun is shining, there's delicious food and music in the air, and you're surrounded by loved ones. You spot your aunt and uncle who have travelled from Calgary just for this gathering, and you enjoy catching up with your close cousins about their year. Amidst this warmth and joy, you suddenly have the intrusive thought - “What if I don’t want to be with my partner anymore?”

In an instant, you’re overwhelmed by doubt and subsequent anxiety. Your mind floods with thoughts about how you have made a grave mistake by choosing them, which adds to your distress. You excuse yourself and go to the bathroom, desperately trying to maintain your composure. You think to yourself, “What if there is someone more attractive and compatible out there, and I have settled?” or “What if this whole time I ignored the red flags?” again, fuelling doubt and anxiety. You replay positive memories of you and your partner in an attempt to counteract the intrusive thoughts and distressing feelings about your relationship, and whisper a mantra to yourself “I love my partner” as you step back into the backyard.

But the anxiety doesn’t fade. You glance up at your partner upon returning - scanning internally to see what shows up when you look at them. You get another thought “our personalities are different, what if this means I shouldn’t be with them?” Again, your anxiety rises, but you also start to become filled with a sense of guilt and shame for experiencing these thoughts. You say to yourself, “What loving partner even has these thoughts?!” and you try hard to suppress your thoughts or avoid thinking about them, but that doesn’t seem to work either. To avoid the unbearable anxiety, you keep your distance from your partner for the rest of the event. When your partner notices your quiet demeanour and asks about it, you make an excuse about not feeling well. 

OCD symptoms can set in motion a cycle of unbearable anxiety. Finding ways to manage your symptoms can help make life better and more manageable.

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Your mind continues to give you intrusive thoughts and images about your relationship, and you try harder and harder to reassure yourself and chase the certainty that you are in this relationship for a valid reason and that you love your partner. You logically think to yourself, “We have been together for 8 years now, and we get along pretty well and still have so much fun with each other, there are no clear warning signs that would suggest anything bad in our relationship” only to be followed by “what if that was all just a facade, and now you are realizing it was all a mistake and that your relationship isn't all that?” Again, the mental debate continues as you try to chase certainty about your relationship. At this point, you are overwhelmed and filled with so much anxiety and shame, you abruptly excuse yourself from the barbecue and go for a walk around the block, convinced that there is something wrong with you.

This experience highlights what it’s like to live with OCD, particularly the subtype known as relationship OCD. While questioning and reflecting on aspects such as one’s relationship, sexuality, or character can be useful and healthy at times - OCD takes this to the extreme. As a result, logic simply does not work with OCD, so even rational counter arguments to fears lead to compulsive reassurance seeking to chase absolute certainty resulting in detrimental consequences to the individual’s life. While OCD is often associated with behaviours like needing a clean desk or arranging items symmetrically, many people with OCD face struggles that are less visible but equally distressing. Some other common OCD themes include:

• Sexual obsessions and intrusive sexual thoughts

• Moral scrupulosity and ethical obsessions

• Obsessions about sexual orientation

• Fears of harming others or oneself

• Contamination obsessions

• Obsessions around symmetry, order and perfection

While questioning and reflecting on aspects such as one’s relationship, sexuality, or character can be useful and healthy at times - OCD takes this to the extreme.

Despite the varied presentation of OCD, all themes follow a similar cycle: a trigger leads to an obsession, which causes doubt and anxiety, prompting compulsive behaviours that provide temporary relief but reinforce the cycle. The main driving force with all the themes remains the same - doubt and intolerance of uncertainty, which then causes anxiety, shame, guilt and other distressing emotions. OCD is often called the doubting disorder for a reason. The problem with the pursuit of seeking certainty via compulsions is that uncertainty is inherent to being human, and so this chase of certainty ends up becoming a moving goal post, and leads to more and more suffering for the individual with OCD. 

• Here are 5 common traps that perpetuate OCD:

  1. Overvaluing Thoughts: Individuals with OCD often feel compelled to examine every intrusive thought, believing each one carries significant meaning and that their character should be judged based on the involuntary thoughts that occur to them.

  2. Thought-Action Fusion: There is a tendency to believe that thinking something is equivalent to doing it, particularly with harm, sexual, and moral obsessions.

  3. Demand for Certainty: OCD sufferers may feel they need 100 percent certainty to feel safe or move on in their lives, leading them to engage in compulsive behaviours to seek reassurance.

  4. Belief in Thought Control: There’s often a belief that thoughts can and should be controlled, which is unrealistic and adds to the distress.

  5. Emotional Reasoning: OCD can cause individuals to use their anxiety and other challenging emotions as justification for compulsions, operating under the belief that if they feel anxious/ashamed/guilty, the threat must be real.

The reality is, people with OCD do not actually want to act on their obsessions. OCD is ego-dystonic, meaning it goes against the very nature of who the person is. This is why there is so much anxiety and distress in the first place - the individual cares and does not want these feared scenarios to occur, and so they do everything (no matter how futile) to prevent this from happening. OCD is amongst the top 10 debilitating illnesses in the world as per the World Health Organization, and it often takes an individual with the illness many years to find the right diagnosis and treatment. One study by Ziegler et al. (2021) found that it can take individuals with OCD up to 17 years to find the right therapy to address the OCD.

This prolonged suffering can impact relationships, work, daily functioning, and overall quality of life, increasing the risk of co-occurring mental health issues like depression and suicidal behaviour. Effective, evidence-based treatments are crucial. These include:

• Exposure and Response Prevention (ERP): ERP is considered the gold standard for OCD treatment. It involves gradually confronting feared thoughts and situations while resisting compulsions, allowing anxiety to diminish over time and the individual learning to become more comfortable with anxiety and doubt being present.

• Acceptance and Commitment Therapy (ACT): ACT helps individuals accept their obsessions as mental phenomena rather than engaging with them. It encourages acting in accordance with long-term values and goals, while bringing the distressing thoughts, feelings and urges associated with the OCD along for the ride.

• Medications: SSRIs can be beneficial in managing OCD symptoms by increasing serotonin levels in the brain, aiding the effectiveness of therapies like ERP and ACT. It is recommended that one first consults with a healthcare provider before starting or adjusting medication.

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Living with OCD can be incredibly challenging, often filled with feelings of isolation, shame, and guilt. However, it’s important to remember that you are not alone and that help is available, regardless of what your mind may tell you about never getting better. If you're struggling with OCD-like symptoms or grappling with intrusive and distressing thoughts and emotions, we encourage you to reach out for support. Facing OCD requires immense courage, but with the right help, healing is possible. We are here to support you on your journey toward recovery. Reach out and book a free 30-minute consultation and we can match you with a therapist who can support you.