When the obsessions of obsessive-compulsive disorder (OCD) strike, it can feel unbearable—time and again, you try to relieve your anxiety and discomfort by any means necessary. Even if you are very skilled with coping mechanisms, you can fall victim to the trap of resorting to compulsions. The intensity of your emotions can feel like it is simply too much.
Some compulsions, like washing your hands, are obvious, even to the people around you. Others, though, can be entirely invisible—and they can also be some of the most common. Let’s learn about research, rumination, and reassurance.
Research
Today, almost any information is available at the click of a button. Whether or not that information is accurate is hard to say—but it can be tempting to believe. Driven by a need to answer their doubts with 100% certainty, people with OCD often struggle with the compulsion of researching, often using Google to find answers they can feel sure about.
More often than not, though, those answers lead them down a “rabbit hole” of information—some of it factual, some of it misleading. One answer can lead to multiple more questions. Often, rather than being comforted, the sufferer is faced with even more doubt and anxiety surrounding their obsessions, and the cycle of OCD is repeated.
Example: Kyra
Kyra has always been concerned about her health. Generally speaking, she is in good physical shape. She eats well and exercises regularly. However, even the slightest change in how her body feels can become a major crisis for her. She estimates that she spends about two to three hours a day looking up health concerns online.
Last week, she had an earache. Logically, she knew that since she had been swimming, she had probably gotten water in her ear. Yet she still had these nagging “what if” feelings. Unfortunately, the more she Googled possibilities, the more she believed that something much more severe was going on. It wasn’t long before Kyra took a trip to her local emergency room, just to be sure.
Rumination
Sometimes, compulsions are even less noticeable then researching. Rumination, or simply thinking about a perceived problem or obsession over and over, is also a common compulsion, and it can be as damaging as any.
I always tell people who struggle with OCD that the difference between problem-solving and rumination is in the feelings that precede the action. When there is a real problem to be addressed, the answer is rarely needed immediately or with perfect certainty. There are usually shades of gray. In contrast, ruminating on an obsession feels horribly urgent, and the stakes of the problem can be blown way out of proportion. When rumination is compulsive, it can cause someone a great deal of difficulty moving about their day-to-day activities, feeling “stuck” until they have resolved their discomfort.
Example: Bradley
Bradley has recently been experiencing random, intrusive thoughts that he finds repulsive. He was recently at a party when he had what he says is his worst thought yet. He worries that he had an urge or a desire to rape another partygoer. The thought was fleeting, but just the idea that it was there in the first place really triggered his fears. He says that he cannot stop thinking about this. He wonders why the thought occurred, mentally replays what he was doing when it occurred, reflects on how he may have felt, and wonders endlessly if he has ever had any other thoughts that were similar.
He cannot seem to rest. He is wrapping up his finals in college and is finding it difficult to focus—all his mind does is wander to that night. He remembers a recent story in the news about a rapist who was caught. In that article, he remembers them talking about certain characteristics of the perpetrator. He tries to remember what these characteristics were, hoping to figure out with certainty whether he might be similar in any way.
Reassurance
Last, but certainly not least, is reassurance. Reassurance-seeking and OCD can go hand in hand. Again, reassurance-seeking comes with that same sense of urgency and danger. It is done in an effort to relieve feelings of distress. The problem, as it is with all compulsions, is that this only provides temporary relief before doubts and obsessions creep back in.
Sometimes people that I work with are confused, asking, “What is the difference between a reassurance-seeking question and an information-seeking question?” They may even wonder if they are really different at all. There are some distinct differences.
Information seekers look to people who they feel are well-equipped and knowledgeable to answer their concerns. They ask questions that can, in fact, be answered, and they accept the answer that they’re given. They want the person they ask to answer honestly. Information seekers can accept the truth, even if they don’t like how it makes them feel. They can also accept differing views or tolerate answers that are uncertain. Their goal is to make an informed decision or gain new knowledge.
Reassurance seekers, on the other hand, have a different agenda in mind, even if they don’t realize it. They want to feel better about a topic or a thought at the heart of their obsession. They usually want a certain answer—not necessarily the truth. Typically, they don’t ask just once, but several times. They can become very good at rephrasing questions in order to gain more reassurance. They may ask the person to repeat or rephrase their answer. They often will on knowing that the person providing the answer is sure, that there is no room for error, even when this is inappropriate or impossible. The primary objective is to feel less anxious and to neutralize their obsession.
Example: Deena
Deena works at a very successful corporation. She is very good at her job, often earning accolades and awards. She was recently given a promotion, and with it a new supervisor. She has been learning the new skills needed to perform her new position, but often feels inadequate.
Before she makes any decision, she feels the need to ensure that her boss agrees with this decision. This has become very time-consuming and cumbersome. She can tell that her boss is upset with her or at least annoyed, but she just can’t seem to stop herself. When her boss says things like “Looks good!” or “You’re doing great,” she feels better temporarily, but her doubts return every time.
ERP can treat all compulsions in OCD
If you are struggling with these “three R’s” when your obsessions arise, then exposure and response prevention (ERP) therapy can teach you how to stop performing these compulsions that perpetuate the cycle of OCD. In ERP, you will learn how to sit with uncomfortable feelings and resist the urge to do compulsions that only make your symptoms worse. This process can help you see that anxiety, like any other feeling, eventually passes, and you don’t have to do anything to make that happen.
The best way to practice ERP is to work with a therapist who is trained in ERP. At NOCD, all of our therapists specialize in OCD and receive ERP-specific training from some of the top OCD experts and researchers in the world. They’ll use their expertise to design a treatment plan for the OCD themes you’re experiencing and provide non-judgmental support every step of the way.
