Many people see OCD as a random and complicated disorder, but it’s actually neither of the above. The goal of this article is to provide a clear and simple framework for conceptualizing this disorder. And off we go…
Everyone has a worst fear.
While most people would describe their worst fear in terms of a concrete event (e.g., losing a loved one, going to jail, losing all their money, getting cancer, going to Hell, etc.), what they really fear the most is the emotional state they associate with that event; and their actual worst fear would be experiencing that emotional state forever.
So a person’s actual worst fear is experiencing their most feared emotional state, forever.
People with OCD are afraid of making a mistake that they can’t take back, that would lead them to experience their most feared emotional state, forever. This is their Core Fear.
The person with OCD avoids doing anything that could potentially lead to their Core Fear (Avoidance), and does extra things to protect themselves from their Core Fear (Compulsions). Avoidance and Compulsions are simply strategies that the person with OCD uses to protect themselves from their Core Fear, whatever that is. Unfortunately, these strategies cause problems in a few ways:
— First of all, avoidance and compulsion are limiting, distressing, and exhausting. These are the obvious problems, which typically prompt people to seek treatment.
— Avoidance and compulsion also backfire in that they lead the person to experience anxiety on an ongoing basis, because constantly protecting themselves from a threat entails constant mental engagement with that threat.
— Finally, avoidance and compulsion prevent the individual from learning that they are safe without these strategies.
To understand this last and most important consequence of avoidance and compulsion, consider the following metaphor:*
Imagine that for your entire life, you’ve been afraid that if you don’t hold up the wall of your home, the building will collapse; so you’ve never taken your hands off the wall.
There might be a part of you that wonders if this is really necessary, but you’re stuck, because if you remove your hands from the wall in order to find out if it’s necessary, it’s possible the building will collapse.
The only way out of this situation is to take a calculated risk and remove your hands from the wall, despite how scared you are that the building might collapse. It’s easy to understand why you’d keep holding up the wall forever, and why you might feel like you have no choice, even though you actually do.
The person with OCD is in a similar situation. They are afraid that letting go of the strategies they use to protect themselves could lead to irreversible consequences. But without letting go of the strategies, there’s no way to ever find out that they’re safe (and happier) without them. Furthermore, after so many years of feeling too scared to let go of these strategies, it’s easy to understand why so many people with OCD feel like they can’t control their avoidance and compulsions, even though they actually can.
That’s it. To understand any case of OCD, all you need to know is what the Core Fear is, and how each form of compulsion and avoidance is aimed at protecting against it.
To learn about Exposure with Response Prevention (ERP), the treatment for OCD, please see Exposure is About Learning, Not Habituation.
*Thank you to Dr. Elna Yadin for this excellent metaphor