As discussed in A Simple Explanation of OCD, OCD is always about a fear of making a mistake you can’t take back that leads to experiencing a certain form of emotional distress forever (the Core Fear).
But sometimes a person with OCD will say that they aren’t afraid of anything bad happening if they don’t do their compulsions. They’re often at a complete loss to explain why they’re doing what they’re doing.
Such people often present with:
- A need to get something ‘just right’
- A need to do a nonsensical ritual (one that isn’t connected to preventing something bad from happening, even ‘magically’)
- A need to do a behavior that came to mind (e.g., watching pornography)
In these cases, a feeling of distress or discomfort typically accompanies the urge to do the compulsion, and the person is typically afraid that this feeling will persist permanently (or worsen) if they don’t do the compulsion, or if they don’t do the compulsion before it’s too late.
Here’s why these people are stuck:
- Because they are afraid of being permanently distressed or uncomfortable if they don’t do the compulsion, they always do the compulsion.
- And because they always do the compulsion, they never have an opportunity to find out what happens if they don’t do the compulsion.
- And what happens if they don’t do the compulsion? That feeling of discomfort or distress goes away. They don’t get stuck feeling that way permanently.
Thus, as is also always the case with OCD, the person is afraid that not doing the compulsion could be a mistake they can’t take back that leads to permanent emotional distress; and by doing the compulsion they prevent themselves from finding out that nothing bad happens if they don’t do it.
But rumination can complicate things:
Often a person with this presentation will object to the claim that the distress would go away if they didn’t do the compulsion. They will say that there have been times when they have put off doing the compulsion, and that they have felt bad until they finally gave in and did it. This convinces them that their fear is actually true: Their distress will continue indefinitely until they do the compulsion.
But in fact, the distress only continues because the person is ruminating about whether or not to do the compulsion, which perpetuates the feeling of distress. Rumination thus creates a self-fulfilling prophecy: By ruminating about whether the distress will continue until they do the compulsion, the person causes themselves to experience the distress until they do the compulsion.
People like this have only ever had two experiences:
- Giving in and doing the compulsion
- Putting off doing the compulsion, but ruminating about it until they do
As far as they know, there is no other way out. They can either give in, or suffer until they do. And why fight when you know you can’t win?
They have literally never had the experience of:
- Neither doing the compulsion
- Nor ruminating about it
Once they have this new experience, not only do they discover that there is another way out, they also discover that their distress actually goes away if they make a clear decision not to do the compulsion, and to stop ruminating about whether or not they are going to do it.
Contamination OCD often functions similarly to the above, but it’s a unique enough presentation that it deserves its own article.