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Mark Goulston M.D., F.A.P.A.


Obsessive Compulsive Disorder

Don't confuse being "not in control" with being "out of control."

According to Wikipedia:

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry, by repetitive behaviors aimed at reducing the associated anxiety, or by a combination of such obsessions and compulsions.

Symptoms of the disorder include excessive washing or cleaning; repeated checking; extreme hoarding; preoccupation with sexual, violent or religious thoughts; relationship-related obsessions; aversion to particular numbers; and nervous rituals, such as opening and closing a door a certain number of times before entering or leaving a room. These symptoms can be alienating and time-consuming, and often cause severe emotional and financial distress. The acts of those who have OCD may appear paranoid and potentially psychotic. However, OCD sufferers generally recognize their obsessions and compulsions as irrational, and may become further distressed by this realization.

Knowing a wide number of people with OCD, or at least strong features of it — as well as working with some of them — I have observed a number of things that I hope you will find as helpful as some of them have.

The more people living with OCD feel “not in control” in major areas of their life, including their job, school, love, friend and family relationships, and their future, the more intense their OCD symptoms. It’s as if they feel that focusing on something finite and small will magically translate into feeling in control everywhere.

Unfortunately, the opposite happens. The more they focus on their OCD to the exclusion of the other areas of their life, the more they go from not in control in those areas to being even less in control. And then the more that happens, the more their OCD intensifies.

For instance, a number of people I have seen over the years with anorexia have focused so much of their attention on eating and exercise that they have literally lost more and more control in their relationships, school, or job. What appears to be going on is that they feel that if they are “not in control” then they are out of control. And if they are out of control, then at any given moment they feel they are at risk of exploding, imploding, shattering, fragmenting, or disintegrating.

Perhaps the last word, “disintegrating,” is most apropos. By that, I mean that the integration of their self and being feels at risk of coming apart. That becomes so terrorizing that they connect being integrated to being perfect regarding food and exercise or some other OCD symptom.

The reason “not in control” feels like being out of control is because they have a conditional relationship with how they relate to life. If a, b, and c (their OCD symptoms) are perfect, they are in control; however, if that symptom is anything less than perfect — and I mean one iota less than perfect — then they are not just less than perfect, they are nothing. They are not just "not in control"; they are out of control. And that feels as if they are on the brink of internal annihilation.

This conditional, gotta-be-perfect approach to life may be contributed to (I am not saying caused by) genetics, being raised by OCD or OCP (which will be discussed in Part 2 of this blog post series) parents, or a social environment where it seems that most of their peers are under the sway of the same obsessive thinking (i.e. you can’t be thin enough) and compulsive behavior (i.e. not eating anything and looking at the calories of everything).

What to do?

One important step is realizing, accepting, and then vigilantly training oneself to believe that being “not in control” is not the same as being “out of control.” As such, when you are next experiencing obsessive thoughts and before they overflow into compulsive actions (usually as a way to get rid of the thoughts) stop and say to yourself, “What am I feeling out of control about right now? And am I actually out of control or merely not in control? And is my need to be totally perfect and totally in control something that others can do that I can’t and is it good for me or bad for me in terms of how it is taking control of my life? So stop right now, pause, take a deep breath, and let go of having to think this and do this.

In addition something I learned from John Seeley, author of Get Unstuck! The Simple Guide to Restart Your Life, that is helpful. When you feel you can’t overcome an obsession or compulsion and are saying, “I can’t stop thinking about a or doing b,” imagine putting a psychological wedge into your head and saying to yourself, “Up until now I have not been able to stop thinking about a or doing b, but from now on I am going to do both.”

I am fortunate that I don’t have many obsessive-compulsive thoughts or behaviors (other than blogorrhea). That said, I do have a tendency to berate myself after talks I have given where I think I could have done better (or blog posts/articles I have published that have spelling and/or grammatical errors — as I’m sure this one has). That thankfully has lessened as I have grown older.

However, when it does happen, I imagine my beloved and deeply missed deceased mentors and few living ones asking me the above questions. When I do that, I feel less alone in my struggle to overcome my negative overpowering thoughts and my gratitude towards these wonderful people for having been in my life and caring about me. That also makes me want to honor them by taking better care of myself and not beating myself up so much.

Stay Tuned for Part 2 on obsessive-compulsive personality: Just because you feel other people are trying to control you, doesn’t mean they are.


About the Author

Mark Goulston, M.D., the author of the book Just Listen, is a Clinical Assistant Professor of Medicine at UCLA's Neuropsychiatric Institute.