I’ve been a member of this forum for over a year now, and I read hundreds of posts. I noticed that a common thread runs through most of them, which is: if only I could be sure my environment was safe, I wouldn’t harm my loved ones, I wasn’t homosexual (though I’ve nothing against homosexuality), my memories of certain events were false, I was in the right relationship, etc., my problem would be solved. There is a fixation on trying to fix a specific problem, which distracts from day-to-day activities.
However, what if this wasn’t the real problem? What if the problem was lying somewhere else? This question came to my mind when Natureloverpeace compared addressing a particular OCD fear to playing a game of Whac-A-Mole. I did a Google search, and here's what came up: “People often describe having OCD as similar to playing a game of Whac-A-Mole because it can feel like intrusive thoughts or obsessions constantly pop up in different forms, and even when you try to address one, another quickly appears in its place, creating a seemingly endless cycle of anxiety and the need to perform compulsive behaviors to alleviate it; much like trying to hit all the moles popping up in the game.”
This explanation resonated particularly well in me because I always felt, at some level, that the specific OCD problem that was occupying my mind at a certain point of time wasn’t the real problem. I had the vague feeling that if I were solving it, another one would appear in its place. I had to get at the root of the problem. I gradually came to the conclusion that the root of the problem was my difficulty to decide under uncertainty. I needed too much certainty to make up my mind in a lot of domains. Once I generally tried to require good reasons to make a decision and content myself with them in spite of the difficulties, individual problems that appear from time to time, like the fear of losing control or doubts about the viability of my romantic relationship, naturally stop taking an obsessional dimension. I wonder whether other people had a similar experience?
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A person’s specific superficial fear, such as a fear of touching a contaminated doorknob, needs to be addressed but if a person stops there, they’re missing the forest for the trees and will likely end up playing whack-a-mole with OCD. OCD may throw additional themes their way because their theme of OCD was treated, not the OCD itself. The person also needs a good understanding of OCD’s overall game plan or how OCD operates so they recognize its tricks. They also need to be able to take the skills learned in treating their particular theme of OCD and generalize those to OCD as a whole. OCD is OCD, the content or theme isn’t what matters, the process of OCD matters. Accepting uncertainty AND realizing that they are capable of managing unexpected, distressing things is also important. Also important is discovering what their core fear is and addressing that. If the core fear isn’t addressed then OCD will likely show up again , even adding on other themes. An example might be someone who is afraid to touch a contaminated doorknob might be afraid of getting sick>getting someone else sick> being responsible for getting someone else sick>being a bad person>being rejected>feeling shame>believing they’re no good. If the core fear isn’t addressed then it can be the driving force in another OCD theme.
OCD themes aren’t diagnostic categories and how they present can often overlap each other. They are just different ways that OCD can look on the surface.
This is why trying to treat an OCD theme instead of the person often fails. Two different people may seem to present with the same theme but have different obsessions and compulsions. Two different people may present with the same obsessions and compulsions but the themes could be different because what drives their OCD, their core fear, is different.
I think that although it does feel like whack-a-mole sometimes, and one obsession often recedes only to be replaced by a different one, defeating one particular OCD obsession does help to defeat OCD generally.
And the skills and tools needed to defeat one particular OCD obsession or compulsion are kept sharp by being in constant use. The more you fight OCD, the less OCD fights back.
Fight one obsession/compulsion and another is less likely to take its place. Tackle one obsession/compulsion, and you help to tackle them all.
You're raising an interesting question. Which strategy is right? Addressing the core fear at the root of OCD or fighting each obsession as it appears, one success making the next success more likely?
Let’s say my obsessional fear, after leaving my house, is to have left something turned on that could cause great damage. I could, after taking normal precautions, resist the temptation to return home to check and, with habituation, overcome that obsession. Then, if another obsession appears, I’d feel confident I could overcome it the same way. It’s simply a matter of tolerating a certain degree of uncertainty. I understand your point of view.
That works for a lot of people, but that wasn’t enough for my inquisitive mind. I knew that when I gave in to the temptation to overcheck for the first time, I felt some short-term relief that set me up for repeating the pattern. However, I wanted to understand the general principle that made me give in to the temptation of overchecking to begin with, so another obsession wouldn’t pop up like in a Whac-A-Mole game.
I came to the conclusion I have to be in the right frame of mind to form sensible opinions and make wise decisions, and when I’m reasonably sure of my judgment, it becomes easier not to let potential subjective or environmental triggers affect it too much. Natureloverpeace takes the example of an individual who is afraid of touching doorknobs. Digging deeper this individual realizes it’s her poor sense of worth that drives her fear of touching doorknobs (“someone who is afraid to touch a contaminated doorknob might be afraid of getting sick>getting someone else sick> being responsible for getting someone else sick>being a bad person>being rejected>feeling shame>believing they’re no good”). So, it would be more effective she learns to be reasonably sure of herself, not just to comfortably touch doorknobs.
In the end, there may be some truth in both strategies. Overcoming individual obsessions as they appear fosters a healthy self-confidence, and a healthy self-confidence makes obsessions less likely to appear.
I do appreciate that many of us with OCD have low self-esteem, and that this could be a driver for their OCD behaviour, but I don't think that it's an easy cause-and-effect scenario. The problem is that OCD defies logic and rationality, and it isn't necessarily low sense of self-worth that causes one to be so fearful of, say, touching a doorknob.
Often people with OCD have an over-inflated sense of responsibility, and this is a big driver of OCD behaviour.
Although improved self-confidence is likely to foster wellbeing generally, I don't think it tackles the loop in the brain that is OCD. That has to be tackled with CBT - teaching the brain to be content with just one check to make sure you've turned your appliances off, for example, or actually touching the doorknob without cleaning it or your hands.
Then the brain is less likely to go into an OCD loop and less likely to develop a new obsession/compulsion.
The more you give in, the more the obsessions/compulsions multiply, until you are immobilized by it. Tackling one makes it easier to tackle the others, as the brain is desensitized and more easily satisfied with more rational behaviour.
It's difficult to know, though, as we don't yet know enough about the brain, and how OCD develops and operates, to be more precise.
Sigmund Freud had only outward behaviour to go on when he was investigating how the mind works. Other scientists had to go by damaged brains in living people, or dissection. Now there is imaging and other ways - but brain science is still a puzzle!
By the way, as a student of English Literature, I observed in a seminar that some of William Wordsworth's poetry anticipated the work of Freud in its description of mental processes - the lecturer leading the seminar said that Freud had said that he got much of his understanding of the mind from the poets!
Poetry and literature give us indeed a lot of insights into the human mind. I believe that brain imaging can provide additional information in that regard, but cannot replace the knowledge gathered by writers for millenniums.
Most people agree that ruminations and compulsions seek to avoid some form of mental discomfort or emotional suffering, but you're right, the specifics vary from one individual to another.
You hit the nail on the head when you describe OCD as a loop. During an OCD spike, I always had the feeling to enter a loop from which it's so hard to get out.
CBT is an umbrella term that covers many types of techniques, including “talking” therapies and ERP. ERP is the gold standard treatment for OCD because it currently has the best quality and amount of evidence for it. It has for quite some time but things can change. Old school ERP was habituation only but it has evolved since then. OCD experts and researchers have discovered that treatments added onto ERP such as Mindfulness, ACT, Inhibitory Learning and identifying and addressing the Core Fear add to the efficacy of ERP. ERP is still the foundation of the treatment though. The core fear I used in the example is a person thinking they are a bad person or not good enough. That’s a common one but there are other common ones as well as not so common ones.
OCD is part biology and part learned. By learned, I mean classical and operant conditioning. There is much to be learned yet of course. Yes, there are structural and functional differences in the brain of someone with OCD but some of the differences are seen in other conditions too. It’s not known which came first, the OCD or the changes. fMRIs on a person who has overcome OCD show a return to “normal “ brain functioning and structure. So the question still remains which came first, the changes or the OCD? Researchers are looking at four different neural networks that appear to play a role in OCD. To further complicate things, genetics are involved but this is challenging too. Genes need to be expressed for them to have an effect and some conditions can have many genes as possible factors but not everyone with a particular condition will necessarily have the same genes involved. Telomeres, SNPs (single nucleotide polymorphisms) and polymorphisms may be involved. Epigenetics can be a factor as well as brain immunology. Brain immunology has been a factor in PANS and PANDAS.
You're right. It's difficult to know whether changes we see in brain images are the causes or consequences of a particular psychological disorder. Maybe science will be able to know the difference one day.
The human mind is indeed extremely complex. At the same time relatively easy tricks can help us control it. I read somewhere that individuals who were asked to set a time limit on their electronic gambling machine play could have a better control of their game. Or when people are asked to set a specific worry time during the day they can have a better control over their ruminations. It's amazing to see that simply slowing down or speeding up the pace of an activity can help us have a greater control over it.
I could see some people being able to do that while other people may really struggle with it or not be able to do it all. There are some interesting studies on impulse control. I like your attitude and mindset of hope.
It's because some people may really struggle with it that, as you know, therapists ask their clients to postpone their compulsions by small increments to make it more bearable.
One of the most profound realizations I had early on in my OCD journey was realizing that the fear was all the same thing. I have had OCD since I was a small child and have had themes ranging from harm to psychomotor OCD. It indeed does feel like wack-a-mole. I think these are the same thoughts and fears most people have in their life but I have an issue letting these thoughts "go". They stick with me for days at a time.
One of the best things I did once understanding I had OCD was to learn as much about it as possible. I remember reading somewhere that they have put people who have OCD into a CAT scan machine and found that there was an over reaction in a part of their brain they believe is responsible for allowing us to "shift" our thoughts. This part of the brain is also near the "fight-or-flight" part and it is activated by the overstimulation of the "shift" part near it. That is why OCD thoughts feel so overwhelming. Your brain is responding to a random concern the same way it would if you were being hunted by a tiger.
You are right about the thought not being the real problem though. It is likely a combination of your thinking habits and your innate physiology. I think that's why the combination of medicine with therapy is so useful. A two pronged approach if you will. Address the physical issue while also the mental. However, the two are inexorably tied together and it probably comes down to the individual to figure out where to apply their efforts. I know for me, the realization that I had to devote myself whole heartedly to this problem was key in recovering. I think that is where some people struggle. They want the problem to "go-away" so that they never have to be concerned about it ever again. It's not as bad as they think though. When it's under control I'd liken it to living with diabetes or cholesterol.
Let me push your tiger analogy a little bit further if you don't mind. You said that, in OCD, the brain is responding to a random concern the same way it would if we were being hunted by a tiger because of the overstimulation of a neural function that manages our thoughts shifting from one subject to another.
Let's say you need to spend the night in the jungle and you're worried about the possibility of an attack by a tiger. No problem so far. An attack by a wild beast is possible nighttime in some areas of the world, but it isn't probable. You're now faced with a choice. You could let your thoughts race a hundred miles per hour, your imagination run wild, and examine in a chaotic manner all the possible ways a tiger could attack you and you could fend off such an attack. Because the stakes are high, it wouldn't be a surprise if those thoughts stick in your mind until the sun rises in the morning.
The second option is to slow down your mind so you don't lose your nerves, so to speak. As you slow down your mind, you let the prefrontal cortex play a bigger role in your deliberation and let your amygdala (part of the brain's automatic danger detection system) take a back seat. Yes, there is a risk, but once you choose an option (to stay put and awake, to stay put and go to sleep, to leave and try to find a safer place) your mind is even calmer, and intrusive thoughts aren't as disturbing.
PS: I went through that experience, with the difference that there were no tigers where I slept under the stars in the jungle, but a lot of snakes.
Hrm... I know for me the fear isn't logical; it's just there. I wholehearted wish I could overcome it with rational thinking. It was the fact that I couldn't that made me lose my self esteem. I thought I was weak for feeling the way I felt. I thought a strong person wouldn't feel this way. They would know that the thoughts were ridiculous. It made me think that I was worthless and that I would never be able to accomplish anything because of it. Growing up I think it really influenced by feeling that I was a loser. I know now that those thoughts aren't true, though I still struggle a bit with self esteem.
I've also had many sleepless nights where I would sit alone in the bathroom weeping and praying to have this taken from me. Those were bad times. I did learn to meditate though and I think that's helped tremendously as well. It does help to "slow your mind" as you put it and I've found it helpful to say something like, "Okay - I'm going to meditate right now. I'm giving myself permission to relax and do this. I can put the things I'm worried down for a bit and pick them up when I'm done if I want to.". Usually I feel so good after the fact I forget about what I was worried about to begin with. I guess that's a long winded way to say I agree with you.
Most people with OCD realize, and least to some extent, that their OCD fears are irrational. Sadly, some people totally believe that their OCD fears are real. Fear isn’t the only distressing feeling associated with OCD though and not everyone experiences fear or anxiety with it. Trying to use logic on OCD doesn’t work because there will always be another “what if”. OCD shines at being creative and coming up with more.
There are different neural circuits involved in OCD although many of the studies focus on just one of them. Yes, there are brain areas that are over-active in unmanaged OCD. Think of the brain as a house. If someone is spending a lot of time in one room of the house and wants to scrutinize something in that room, they will probably have bright lights on in that room so they can get a look at what they’re scrutinizing and engaging with. If someone drove by that house they would notice the bright lights on in that room. The bright lights in the one room is akin to someone engaging with their OCD and trying to satisfy its insatiable appetite for certainty. The bright lights on in that room compared to the other rooms in the house would be an analogy of an area of the brain being over-active like what happens in OCD and some other conditions.
The analogy of the restless mind turning on bright lights in a room to painstakingly scrutinize something as the rest of the world goes by is excellent.
You raised an interesting point. Does the fact that my judgment isn't master in its own house make me weak and not worthy of esteem? Like yourself, I thought that at one point. Then I realized it had nothing to do with my willpower. It had to do more with my mood. Depending on my mood, I can have a greater or lesser ability to control myself.
I remember an episode of my life when I fell in love to the point of taking leave of my senses. I was ready to do anything to be in her company, even if it didn't make sense in the eyes of an impartial observer. In other words, I had lost self-control. At one point we were supposed to meet after one month separation. For days I couln't think of anything else but that moment. However, she didn't show up and didn't let me know. I felt something breaking inside of me. That day my attitude towards her had changed. I had regained normal self-control.
Likewise with OCD. My ability to control the urge to clarify a point or solve a problem depends in part upon my mood. When morale is low, an urge that wouldn't be compelling otherwise becomes irresistible.
PS: I never got bitten by a snake, but when someone told me that black mambas sometimes climbed trees and fell on people, I caught myself more than once looking up.🙂
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