A wolf in sheep’s clothing: how to address OCD concerns that look “normal”

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.

A wolf in sheep’s clothing

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.

Nuts!

Content note: if you have particular difficulties with contamination OCD or OCD focused on your perceived responsibility for other’s health, read on with caution.

When I was a young teenager a lot of my OCD thoughts were focused on preventing harm to other people. I had a period where I took care to make sure I didn’t cause a scuff on a carpet, in case someone tripped over, banged their head and died. I was very nervous around fire extinguishers in case I somehow damaged them in some way: if there was a fire and the extinguisher didn’t work because I had brushed past it, people might die. My OCD made me feel that these deaths would be my fault.

One way in which I worried about harming others was by eating or touching nuts. When I was a child/young teen I ate peanut butter sandwiches and Tracker bars with nuts in. However over time I couldn’t bring myself to eat them anymore, as I was so afraid of harming someone with a nut allergy. It became too much effort to try to make sure I avoided touching any nuts whilst eating those foods and/or make sure I could wash my hands immediately after without touching anything in the environment.

There was a girl in my class with a relatively severe nut allergy (she had to leave the room when we were burning peanuts in a science lesson – not sure why the teacher asked us to burn peanuts, something to do with energy). However I wasn’t only scared of harming her, I was scared of harming some unknown person who might have a nut allergy. For example, if I touched a nut and then opened a door I might transfer the essence of the nut onto the door handle. If the person who touched the handle after me had a nut allergy, they might die and it would be my fault.

I remember once being very distressed because we were playing a family game that involved passing a console around the group. My dad (and possibly others) were eating peanuts – I think it was a Christmas snack. I was really anxious about touching the console after someone who had handled nuts had touched it. It’s important to point out that I wasn’t going to be seeing any one with a nut allergy that day, or for many days after. It’s still making me feel tense to write about it though, about 16 years later.

I’m better than I used to be with nuts – I can eat peanut butter sandwiches and breakfast bars containing nuts. If offered a nut from a bowl I probably wouldn’t take one though, especially if I couldn’t wash my hands immediately after. Then again I’m not keen on eating food that other people might have touched anyway.

How to overcome this

I don’t remember treating this OCD fear in a direct way – it wasn’t really necessary as it wasn’t constantly interfering with my life like some of the other thoughts were. To some extent it faded naturally as my OCD morphed into other themes.

However, there are two cognitive factors that I’ve found helpful with this kind of compulsion. One is that it falls under the banner of “things that are biologically wrong”. The majority of people’s nut allergies are not so severe that they could be harmed by touching a door handle after someone who had just handled nuts. If they were that sensitive, they wouldn’t touch public door handles, which brings me onto the second factor…

You are not responsible for other people’s safety! Other people are responsible for their own health and safety. Repeatedly reminding myself of this fact has been helpful for me when I get these fears. I’ve built up my belief in this reality over many years, and now I’m towards the edge of the “normal” range of concern for other’s health – just a little more concerned than the average person. I’m happy with that.