This post is intended to help both people with OCD and those who support them.
Sometimes OCD sounds absurd (e.g. “my mum will die if I touch the sofa”). However, sometimes OCD looks like an extreme version of an everyday concern. For example, someone may be worried about getting germs from a door handle. It’s perfectly possible for this to be either a) a symptom of OCD or b) a concern held by a neurotypical person who is conscious of hygiene. (As an aside, if you want an excellent example of how it feels to be “stuck” in a bathroom because you can’t touch the door handle, watch The Aviator, a film about Howard Hughes who had OCD).
These thoughts look the same on the surface, but they behave in very different ways. I’ve written elsewhere about how to tell if the thought is OCD or not. Here I want to look at how the best response to an OCD thought can be very different to the best response to a non-OCD concern.
Example: Contamination fears
The other day a friend of mine was concerned about contaminating her bed sheets. She was having OCD-driven thoughts that her body would get germs on the sheets. A mutual friend responded to my friend’s concern by suggesting that she could wipe the sheets with a wet wipe or similar. This is a logical solution to the apparent problem, but when the problem comes from OCD, this solution is unlikely to help.
I want to reiterate that I am not diminishing our mutual friend’s attempt to help. Rather, I want to show how the nature of OCD means that advice which would work for a neurotypical person with exactly the same problem wouldn’t work for a person with OCD.
One of the many ironies of OCD is that whilst we can spend hours seeking reassurance that something is safe, ok, or clean, we rarely succeed in accepting that reassurance. No matter how many rituals you do or how many times you repeat an activity, it won’t feel ok (although that doesn’t stop OCD lying that if you just do it one more time you might be able to make it “safe”). I read an interesting paper suggesting that this might be because a specific part of the brain has difficulty sending “safety signals” which tell the rest of the brain that the situation has been resolved. After reading that paper I found it helpful to think to myself “my brain can’t make me feel like it’s ok, so I have to choose to believe that it’s ok”. (Cognitive reappraisal helps me with this – more about this at the end of the post).
So to return to the example, if my friend had wiped her bedsheets, she may have momentarily felt ok, but soon enough the OCD would return and she would worry that she hadn’t wiped them thoroughly enough, or that the cloth she used to wipe it had germs on, and so on.
This ties in with another aspect of OCD that has come out in research – we often over-estimate the extent to which germs can contaminate objects. For example, say I were to touch a toilet seat, and then touch my phone. I then wash my hands and get on with the day. I later make a call on the phone, and later lie down to go to bed. My perception might be that the germs from the toilet seat had transferred from my hands, to the phone, to the side of my head, and on to the pillow. Most neurotypical people don’t think in this way – I sometimes see other women doing their hair in the bathroom mirror before they wash their hands from going to the toilet. I only have mild contamination symptoms these days, but this is an example of something that bothers me that most neurotypical people wouldn’t even notice.
Thinking back to my friend’s situation – my advice would be to think about the fact that people are responsible for their own health. If anyone else sleeps on the sheets, that is their choice. Think about what a neurotypical person would do, and copy that. If a neurotypical person accidentally wets the bed, they may think about germs, and they will change the sheets. Otherwise, they won’t think about germs. Society survives with, and even needs, a certain level of germs. If you are within the boundaries of what a neurotypical person would do, you have done enough. Protecting other people from germs is not your responsibility.
So, in summary, don’t be dismayed if your OCD or your loved one’s OCD persists in the face of advice that would calm a neurotypical person. Sometimes you have to take a different path to the one that seems intuitive to neurotypical people. The more you read about OCD, the more you will learn about what is likely to help you or your loved one. Cognitive reappraisal is a technique which I have found very helpful. This often involves writing down arguments for and against your OCD thought (usually there will be very few arguments on the OCD side!), and reassessing how you think about a situation. The paragraph above, which describes other ways of thinking about a contamination fear, is an example of cognitive reappraisal.