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When people meet Obsessive Compulsive Disorder For the first time, either by experiencing it personally, or by interacting with a patient, their first reaction is often: “It doesn’t make any sense”. from outside, TOC Symptoms often appear strange and irrational, even humorous. But I assure you that the experience is just as disconcerting for OCD sufferers.
Once you identify them, the persistence of your OCD symptoms becomes frustrating, even frightening: “Why do I keep worrying? And why do I keep doing the same thing over and over again, even though it doesn’t help?
While OCD may seem irrational, the disorder actually follows a rigorous, almost algorithmic internal logic. Understanding the psychological machinery of OCD can help non-distressed people empathize with sufferers and even detect some of their own dysfunctional behaviors. And for sufferers, understanding OCD is the first step to overcoming it.
In my experience, the TOC cycle usually has four distinct stages:
1. Disruption
OCD symptoms are usually triggered by a negative experience. At first, it usually has an external element – meeting a person or situation you’d rather avoid, or discovering a problem you don’t know how to solve. But there is also an internal component, often instinctive or affective. OCD is usually associated with anxiety, but other affects, such as sadness or disgust, can also be taken into account. In the end, all that matters is that it’s something you don’t want to experience, and you immediately start wondering how to get rid of it, how to “fix the problem”.
2. Response
What most people don’t realize is that many symptoms of OCD begin with completely normal and rational problem-solving strategies. If you are shaking hands with a sick person, it is only reasonable to wash your hands. If a family member hasn’t been in touch, you can contact them and ask if everything is okay. If you’re driving to the store and realize you may have left the stove on, it makes sense to turn around and check. You recognize a potential problem and address it, putting your mind at ease.
Unfortunately, this is the stage in the OCD cycle where the disorder begins to exert its malignant influence.
3. Uncertainty
Most of the time, even for people with OCD, this simple problem solving answer is enough. You “fix” it, the distress goes away, you forget about the problem and go on with your day.
But at the same time – and this point is absolutely crucial to understanding OCD – you haven’t really solved this problem, at least not with complete 100% certainty. You could still get sick even if you’ve washed your hands, especially if you’ve forgotten the soap. Your loved one may have had a terrible accident when they hung up the phone. You checked the stove and you think it was off, but what if, while you were checking it, your hand accidentally touched another “on” button? Neither of these events is likely, but nor are they totally impossible.
And this is where TOC puts its finger on the scales. For those who are not in pain, the relief outweighs the lingering doubt. For OCD sufferers, the relief is fleeting, and the lingering doubt — and the danger it poses — is all that matters.
It is the short circuit that plunges the whole system into chaos.
4. Resurgence
At first, even for those with OCD, protective behavior offers some initial relief. This is why, as the fear and uncertainty return, you repeat the behavior. And repeat it again. Because it worked the first time, and it should always work, and if it doesn’t, just try again because you’re obviously not trying hard enough.
When you’re upset, it paradoxically becomes harder to think of new problem-solving strategies and easier to go back to the ones you’ve been practicing, even if they don’t work. It’s easier to stay trapped in familiar thought patterns instead of taking on the new perspective you need to escape. Pragmatic problem solving degenerates into a self-perpetuating cycle of obsessive thoughts and repetitive rituals.
What I hope I have conveyed is that, in the moment, each step in this cycle feels like a logical, rational, and obvious choice that leads naturally to the next one. OCD persists because it always makes sense – it takes an outside perspective to recognize that the costs massively outweigh the benefits, a perspective that the sufferer is unable to adopt when consumed by their symptoms.
If you are struggling with obsessive thoughts, I hope this column is a helpful roadmap to understanding the disorder and diagnosis, pursuit, and treatment. If someone close to you is struggling with OCD, hopefully this will make it a little easier for them to understand what they are going through and give them the support they deserve.
To find a therapist near you, visit Psychology Today Directory of Therapies.
Copyright Fletcher Wortmann, 2022. Please credit the original author, Fletcher Wortmann, and Psychology Today.
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