Death is inevitable. We know it; it is an unequivocal certainty that is shrouded in layers of life’s seemingly incapability of predictability. Generally however, we do not spend every waking moment fixated on the possibility of an untimely death. We don’t wake up thinking, even believing that today could be our last. In every moment, every breath we take is filled with uncertainty. Yet how often does it dominate our minds?
It is estimated that 1 in 100 adults live with a disorder that does not allow them to function with uncertainty. That’s 2-3 million people in the US. The brain fixates and obsesses over uncertainty with whatever face it takes to that individual, which is an endless list of possibilities. It may look like anxiety. It may look like depression. It has many faces. But at the root is the chaotic and tragically misunderstood Obsessive-Compulsive Disorder (OCD).
OCD or just obsessive?
Everybody has obsessions and compulsions. A new song can play repeatedly in your head but you will still turn it off to go to work and have a productive day. Having the disorder is an entirely different entity. It comes in the form of intrusive and unwanted images, thoughts or impulses over and over and over again. They can be repulsive and deeply distressing until in some cases, it truly takes over the person’s life. Every moment contains an infinite potential of possibilities, which is why OCD has so many different subtypes and looks different for everybody. Enjoying a nice walk in nature? What if I slip and die. And a few minutes later it could be something equally as tragic. It is relentless. It is terrifying. And exhausting. Someone with OCD may struggle with free time, as this allows the brain to turn the volume up, so being busy is simply a necessary distraction.
What are compulsions?
Compulsions can and often take the form of (self) reassurance, avoidance, repeating and checking, people pleasing, perfectionism, and many more. Compulsions are a natural response as they temporarily alleviate the initial anxiety. For example, if one is excessively concerned with needing to know and remember everything, as a response their compulsion may be continually mentally repeating things in their head, or constantly writing everything down. Sometimes, compulsions can be extremely time consuming. They can also be invisible; Avoidance is a very common compulsion as one may avoid situations and triggers that would cause them anxiety. It also commonly comes in the form of reassurance seeking, to try and eliminate whatever uncertainty one may be obsessing over.
How much effect can it really have though? Naturally, we believe our own thoughts. If you’re falling asleep and your brain tells you that it heard the front door open, you’ll go check it. The terrifying truth for OCD sufferers is when your brain lies. Whether it fixates on relationships, religion, hygiene and contamination, existence and death, gender identity, or any aspect of your life. It isn’t just an occasional thought. It is a very real, formidable, and constant truth to that person. It becomes impossible to tell the difference between reality and the intrusive thoughts. For all intent and purposes, they become one. It is not enjoyable. Despite popular belief, there are no quirks involved. If one fixates on cleanliness, they are not simply enjoying being clean. The cleaning is a compulsion that temporarily softens often extreme anxiety. To live in this state can be debilitating. It makes the head a very noisy, unstable place to live in, terrified of any potential uncertainty and constantly, frantically chasing compulsions. This can have devastating effects on a person. It can be incredibly emotionally challenging to navigate, as it would when someone is constantly faced with their biggest fears. Generally, making a decision can be a near impossible feat, as to decide something means to face the risks and unpredictability within that decision, and this can feel insurmountable.
Isnt OCD just a term used for the super clean? Unfortunately, the misconceptions spread about the disorder seem to be just as unending, and incredibly damaging. It is imprudent and harmful to overuse and misuse the term “OCD.” This misrepresentation prevents people from getting diagnosis, treatment, and support. There is a whole world in between having obsessions and compulsions as everyone does, and having the disorder which takes up so much of people’s time and ability to mentally function. Therefore, it is not possible to be “a little OCD,” about something, it is not a personality trait and certainly isn’t obvious to the untrained eye. It isnt a reference to cleanliness, or a personality aspect contained within everybody. It is a hereditary disorder that for the sake of the unknowing and misdiagnosed, needs unmasking. From my own experience with OCD I can thankfully say it is also treatable. It is possible to not just overcome, but to live fearlessly, boldly. To turn around and look your biggest fears in the eye and smile. To live peacefully, with a quieter brain, and have the time and energy to live in the moment, and know that things might be okay.
Strangely, even though compulsions feel momentarily calming, they are actually feeding the obsessions. The more one is compulsive, even though they feel better in the moment, the more obsessive their brain becomes. The response becomes the fuel. The more reassurance you get, the more you’ll need. It will only escalate. This is the reason generic talk therapies, whilst great for other disorders, are not only not unhelpful, but can actually be damaging long term. Thankfully, extensive research shows through evidence that the most effective treatment for OCD is Exposure Response Prevention (ERP), alongside medication. If someone hears an alarm, they’d jump up and it could cause a spike in anxiety. If the same person hears an alarm every few minutes, by the time the evening comes even though the alarm sound holds the same level of significance, the person would barely register its noise, and certainly the same level anxiety wouldn’t be felt. This is the very general idea of ERP. It is by no means a quick fix. It is quite the opposite of avoidance; you don’t want to live in fear of a trigger, you want to know how to hear a trigger and be okay. How to feel okay with fear, doubt, and uncertainty. Ironically, after doing ERP correctly under the guidance of a qualified therapist, the anxiety dissipates. This is an essential part of the therapy; removal of the response until the anxiety dissipates. Eventually, what was once a loud, screaming voice becomes a very occasional whisper. At the beginning of treatment, ERP is an intensive, full time job, but it gets better each day as the thoughts get less and less frequent.
Death is inevitable. For a long enough time that truth consumed my entire being, and every moment would be a whirlwind of terror. With a recuperating brain, I can accept and even confidently embrace all the uncertainty the universe could possibly offer to me.
OCD is not a life sentence, it’s a life lesson. One that has an end, if you’re willing to face it.
Others may have very different experiences with OCD. I am in no way a professional and all information is based off my experience rather than specialised education. The purpose is to raise awareness and not as a source of medical information. For more information and resources: International OCD Foundation