Some therapists believe there is a core fear underlying OCD symptoms, and any effective treatment should break down that fear, not just treat the symptoms. A good example would be Lady Macbeth rubbing her hands in an attempt to wash imaginary blood away. She feels that the distressing recurring thoughts about the King’s murder will never leave her alone, and her hand washing is a desperate attempt to drive them away. In that case, ERP will not be just a matter of abstaining from excessive hand-washing and getting used to it, but to address her core fear of being doomed and show her a more adapted way to redeem herself and regain hope.
Those therapists see the determination of our core fears as an essential first step in treating OCD. For instance, for Michael Greenberg the basic core fear is the fear of emotional suffering. OCD sufferers are ready to go to great lengths to avoid that unpleasant feeling. Alex Pollard divides our core fears into three categories: fear of the “not just right” feeling, of a catastrophic event, and of making a potentially devastating mistake. Elna Yadin sees our fear of causing irreversible damage, of being ‘bad’ in some way, or of death at the root of OCD. The idea is that identifying our core fears will allow us to tailor ERP exercises to our specific needs and so make them more effective. It’s not just a matter of restraining from checking or washing excessively. It’s learning to break down one’s core fear so OCD wouldn’t reappear in another form.
The problem with that approach is that it assumes there is, at the beginning, an underlying core fear feeding OCD. But, what about if there is none, and OCD is mainly a self-fueling disorder, that is, once you start on that path it’s extremely difficult to stop, but if, from the start or after treatment, you use appropriate ways to deal with life difficulties, you’re okay.
It’s like the question of what comes first. The chicken or the egg? Let’s take a personal example. In the past I’ve done some volunteer accounting work. Logically, I knew that below a certain sum, it’s not worth looking for mistakes, but I couldn’t help doing it. So, the question is, was I greatly disturbed by a discrepancy not worth to worry about and compelled to find its source at any costs because there was an underlying fear of the “not just right” feeling or of causing some kind of irreversible damage? Or was it because, from a young age, I became used to rely on the elimination of all imperfections and uncertainties in certain domains as a source of peace of mind?
You see, if, for instance, the possibility of losing a loved one or having caused irreparable harm generates some anxiety in me, I may use the performing of a ritual or an excessive search in my memory to lower my anxiety. The anxiety is normal. What’s not normal is the way I choose to extinguish it. If I use maladaptive ways to reduce my discomfort instead of accepting that I can’t control everything in life and making the best possible choices given the circumstances then I lose my freedom of choice because I do it at the expense of more sustainable/healthy sources of comfort. Performing rituals, excessive checking or cleaning, ruminating, etc. becomes a compulsive need because I emotionally depend too much on it and not enough on more sensible behaviors. It’s kind of a vicious cycle from which it’s not always easy to escape.
In a nutshell, I agree with Michael Greenberg that at the root of OCD there is a core fear like the fear of emotional suffering. However, from my own experience, I tend to think that starting to use dysfunctional ways to suffer less and appease our mind amplifies a fear that’s initially normal and set in motion the OCD spiral, instead of assuming there is a starting buried fear (inherited from unresolved childhood issues if one believes in psychoanalytic ideas) fueling OCD.
Rumination-focused ERP?
what should I do?
OCD is a monster that I can't defeat alone.
Mom of OCD son - at a loss
