The Greediness of OCD

Obsessive-compulsive disorder (OCD) is, in part, characterized by greed.

The individual in its grasp often seeks out a high degree of certainty, almost superhuman. Because we aren't intuitively good statisticians, we tend to assign probabilities based on our options. When I, for example, get my yearly physical, naturally I think, I will either be diagnosed with cancer or I won't be—the odds of having cancer are 50-50. Yet, based on my medical history, latest health results, and family medical history, the true odds are much more favorable. However, when engaged in black-and-white thinking (which we do naturally), we tend to think that a result is either certain or uncertain and if uncertain, therefore likely, again based on the amount of options.

Thus, when those are our probabilities, OCD creates compulsions, sometimes mental and sometimes physical, to help foster certainty. Individuals with OCD often complain that they know something but don't feel it. This means they don't fully believe it. They often use therapy, and cognitive behavioral therapy in particular, as a means of reassurance, attempting to master their minds before they allow themselves to make meaningful choices.

Yet, when certainty is the goal, we can't help but lust for more and more information. The more we acquire, the closer we feel to paradise. If we just think about it a little more, ask a few more questions, and make a few more connections, then we'll finally feel as though we can take more risks, and be able to deal with their consequences.

Until then, many with this disorder attempt to offload responsibility onto others, terrified of making life-changing mistakes. Not only is OCD associated with black-and-white thinking, it's also related to catastrophic thinking, believing that terrible events will occur due to one's poor, or ill-considered, choices. In this respect, the only way to trust oneself is to trust someone else, someone smarter or more experienced. While others are making choices for us, we're gathering more information to eventually make those choices for ourselves.

The main problem with that strategy is that when the overarching goal is certainty and our time is consumed by acquisition, there's no necessary end. When we wish for feeling to match reason (which is a form of perfectionism), we give ourselves the perfect excuse to forego living. Yet, despite all of this, your feelings don't always matter, and that's a great thing! You can act in spite of your intuition, which we’ve already maintained could be wrong. Challenging your black-and-white thinking and catastrophic thinking, you may ask:

1. Are the odds that something terrible will occur really 50-50 (or something along those lines)?

2. Will I ever be able to acquire the optimal amount of information before making that choice?

3. Does more insight perpetuate my desire for more insights?

4. Is it possible to have too much information? (Some acquire so much information that they become stuck in "analysis paralysis".)

5. Will I be blamed for making a bad decision?

The final question seems to be the most significant one concerning OCD, as those individuals, finally, tend to personalize or take too much responsibility for their decisions. They expect others to hold them to the same internal standard. When every decision feels monumental, you may believe you'll be punished for each mistake. In treatment, we help our patients learn that:
A. Practically speaking, a mistake will likely not cause a catastrophic outcome.
B. People will afford you more empathy than you believe in the instance that you contribute to some negative event.

Because most people deeply feel decision fatigue throughout the day, they can easily grasp how difficult it must be for others. Unfortunately, because many with OCD grow up in highly punitive environments, much of the burden is placed on them and, thus, they seldom realize that their decisions hardly matter, especially when managing the emotions of a mentally ill caregiver. OCD is associated with a high degree of self-importance because it's associated with an inordinate sense of guilt.

Trusting that others will allow you to make mistakes is step one. (Remember that you already at least trust them to make sound choices.) Learning to live with them is step two. Terrified of living with regret, individuals with OCD fail to gain perspective, not realizing that regret is an existential fact of life. We're afforded the space to make mistakes because many expect the same treatment in turn. At bottom, we have to make decisions, learn from them, and trust others to be good to us. Seeking out certainty is antithetical to those goals because certainty doesn't exist. Asking yourself if you can act based on a 70 percent certainty that you're making a good decision may help (as would feeling grateful for your ability to make complex, sound choices). And asking for reassurance isn't itself bad, only when you're doing it so that you may, in the end, blame someone else for your mistake.

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OCD and the Paradox of Doubt

Our patients, after going through this process, find it helpful to remind themselves that something is an OCD thought, meaning not worthy of further consideration. They know that life can't spare us from our bad decisions.