Why OCD Can Be So Slippery
Updated: Apr 27, 2022
I see a lot of folks with obsessive-compulsive disorder (OCD). OCD can be distressing, exhausting, and debilitating for people. People find themselves spending hours engaging in obsessive thought patterns and related compulsions, sometimes without even realizing they are doing it. Even once they get to me and receive a proper assessment and diagnosis, as we begin our work together, people are often amazed – myself included – at how OCD can “jump” from one topic to another. What started as contamination OCD or “germ phobia” with compulsive washing or cleaning may shift to obsessing about having said something wrong publicly in the past and scouring the internet for proof of otherwise. We tackle that in session, and next thing you know, you are finding yourself worrying that you might be “going crazy” or could have a “mental breakdown.” Insert the subtle art of thinking yourself out of this fear and spending an inordinate amount of time being lost in your own thoughts trying to figure this thing out.
Oh, OCD, you are a tricky one. A slippery one. Once we start to get on to your ways, you put on your trench coat and try to slip out under the cover of darkness to another destination, hoping you will go unnoticed. I often say that OCD likes to “hijack” any topic it can. But we are on to you, oh slippery, sneaky one. You can’t fool us.
OCD shifts around like this because, at the core, it is not so much about the content of the thoughts or fears (though th
ose can be related to your learning history, core beliefs, and values.) What it is about, is that OCD hates uncertainty. Hates it. Wants to do whatever it can to get rid of that uncertainty and will attempt to control and think its way out of uncertainty until it is satisfied. Problem is…. It is almost never satisfied. Sometimes it is satisfied for a short period of time.
“Ah, okay, I have checked just enough times that I feel okay in this moment to move on from this uncertainty. I think
I have myself convinced that I am okay.” [[90 minutes later…]] “Wait, am I sure? I’m not sure. This could be a problem. Maybe let’s just check some more…” And so the cycle continues.
This is also because, at the heart of it, OCD is a pattern of brain function/dysfunction. Shall we call it over-function? I kind of like that. There is an over-functioning of certain “loops” in the brain – cortico-striatal-thalamic (CST) loops, to be exact – that drive the obsessing, overthinking, and compulsive behaviors seen in OCD. This same pattern of circuitry can latch on to whatever topic it wants to, really – which is why the nature and content of OCD symptoms can be so slippery. The basal ganglia loops involving the emotional areas of the prefrontal cortex continue to over-activate until we teach them not to and redirect them into a better state of balance. So, we need not alter brain content so much as function.
This is what we do through exposure and response prevention and acceptance and commitment-based therapy approaches, both of which Dr. Renfroe uses regularly within her practice. Sometimes, medication can also be of use. In therapy, we employ methods to reduce the association between intrusive thoughts and anxiety as well as the relationship between the anxiety and the urge to perform compulsions. We also employ methods to work on breaking those obsessive thought patterns by contacting the present moment, defusing from the thought patterns, allowing them to come and go without overly attaching to them, and committing to a different course of action and self-care. This almost always requires accepting a certain degree of uncertainty as inevitable and a part of the human experience in life.
If you or someone you know is struggling with OCD and you think these methods might be helpful, contact Dr. Renfroe with Tailored Brain Health at 336-542-1800. We are based out of NC and provide telehealth psychotherapy in 17 states.