Mental OCD

I’ve wanted to write something about mental OCD for a long time now, because it's really not talked about much in our society and it can be really torturous for the person experiencing the mental OCD. The treatment is also really different than regular therapeutic treatment, so it's vitally important someone goes to a specialist, or the problem can get worse. As therapists, we can easily fall into a trap of reinforcing the OCD, which I’ll go into later on. At the end of this post I’ll provide some helpful resources for mental OCD in particular.

Ok, so think of Obsessive Compulsive Disorder as a branch on the tree of Anxiety. There are two types of OCD, mental and physical. Most people are familiar with physical OCD - when a thought comes in (the "obsession") and the action ("compulsion") is physical. So a classic example is the obsession being, "germs are everywhere," and the compulsion is, "I have to wash my hands."

The obsession/thought is SUPER powerful with OCD. It's called an "intrusive thought". So take someone with a non-anxious brain. That person might come home from the park and think, "my hands are germy." It's a natural and healthy response to wash them as the solution. The OCD mind says, "my hands are germy," and washes them, but then the thought intrudes again. Maybe my hands are still germy. Am I sure I got all the germs off? Can I really be sure? So the compulsion to wash them over and over begins.

Mental OCD is much trickier, and the thoughts can be so difficult that very few people ever even tell their therapists about them. Mental OCD is nuanced; there are some thoughts that exist in distinct categories (health, sexual, religious) but some that are more random than that. The main root of mental OCD is that the person is terrified they are capable of something bad or harmful to others, or something that would make them repulsive to others. As with all anxiety, the fear is rooted in loss. What horrible thing about me would cause me to lose relationship/connection to others? The great OCD therapist Jill Garman shared this quote in a training: “Our fears are like dragons, guarding our most precious treasures," - Ranier Maria Rilke.

The OCD specialist Martin Sief would say, your mind has a ton of weird thoughts. Someone with OCD will have an odd thought, and then the mind wakes up and says - Wait a minute, what? You just thought about swearing in church? What is wrong with you? Oh my God, what if you did that? Wait, you had the thought, maybe that means you WILL do that. Maybe you're a bad person. Maybe you can't control yourself and how bad you are.

Or you’ll see a friend’s picture of their naked kid on instagram and you might feel a little uncomfortable. Your thought might just be – "huh, unusual". But then the OCD dragon wakes up and says, wait, why are you thinking of a kid being naked? Are you turned on? Are you attracted to that? What’s wrong with you for thinking that way? Are you messed up? 

Some common intrusive thoughts are:

Maybe I’m attracted to people of my own sex, and I’m gay

Maybe I’m attracted to children and a pedophile

Maybe I could give someone I care about herpes or another disease

Maybe I would hurt my partner, like stab or poison them

Maybe I would hurt my child

Maybe I would say a racial slur or something similarly awful to someone or in a house of worship

With mental OCD, the thought is usually so repellent to the person, they wouldn’t tell anyone about it. Can you imagine telling someone you’re scared you could be a pedophile? Or that you would hurt your child? And an untrained professional, who doesn’t know about this, could do some serious harm here.

The compulsion part of mental OCD is unique. Unlike washing hands, or checking to see if the door is locked multiple times, they “check” with their thoughts. So someone might “check” about the thought they are gay by thinking about people of their own sex, and thinking, wait, am I turned on by that? Am I having any physical change about that? Could I be gay? 

Or someone might check against past behaviors, “I’ve never hurt someone before, right? I’ve never stabbed anyone before, so why do I fear doing that right now?”

These reassurances provide only temporary relief, just like washing hands only provides temporary relief. This is where therapists can really go wrong.The therapist, coming from a good place, hears something they don’t think is true and reassures. “Suzy, I’ve known you for 3 years, you are not going to put your baby in the oven.” Suzy feels some temporary relief. “My therapist, an expert and someone who knows me, is reassuring me!” But that relief will only be temporary.

As you’re reading this, you might be thinking that someone fearing that they’re gay could mean they actually are gay. I have counseled both people who are trying to figure out their sexuality and fear family/societal rejection, and people who fear they are gay from their OCD. They are distinctly different. I can write more about this distinction later, or feel free to contact me if you want more information!

 What breaks my heart about OCD is that it seems to manifest the most in such careful, conscientious people. Jill Garman described typical features of someone who suffers from OCD as:

Perfectionistic

People-pleasers

Self-critical

Agreeable and well-meaning

Struggles to tolerate uncertainty

I want to emphasize the “struggles to tolerate uncertainty” because I think it’s particularly important. My favorite analogy for OCD comes from the old Jim Carrey movie, Dumb and Dumber (see video). The idea that there’s a chance that someone could harm someone, give someone a disease, have a disease themselves, even if it’s 1 out of a million, will cause enormous distress. So a lot of the therapy is accepting uncertainty, as painful as that is.

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For people who want resources for OCD, and mental OCD in particular, these are the best resources I’ve found:

Overcoming Unwanted Intrusive Thoughts by Sally Winston and Martin Seif

S.T.O.P Obsessing, by Edna Foa and Reid Wilson

www.drmartinseif.com- he has a fantastic newsletter

Find a therapist who is specialized in OCD: https://iocdf.org

 

Is Your Partner Really A Priority To You?

Some couples I see are in a place of profound anger and despair. This post is not for you. If you are in that place, I wouldn't expect you to be making time together and enjoying date night. Likely, you can barely be in the room together, and are feeling incredibly hurt and wounded by each other. This post is more for couples who are neutral or feeling minor friction with each other. 

So, back to the point of this post  - is your partner really a priority to you? I hear clients all the time talk about the concern of if they are really a priority to their partner. And I think "priority" is a challenging word and idea, anyway. The reality is that your kids, partner, parents, work, personal health, friends all have to be priorities. And often times one of those things cycle into the spotlight for a while. A huge presentation at work, a parent going into the hospital, a kid that is struggling at school, all of those things will at time take more of your attention and energy. Sometimes, though, we forget to check back in and cycle the relationship into the spotlight again.

I think of the connection between partners like a rubber band. It needs to stretch and give bandwidth for each to, at times, not be as focused on the other. In a healthy relationship, it stretches out and then comes back in, where the couple restores and reconnects, strengthening their bond. Issues can come when the rubber band stays stretched too far out, and starts to strain and fray. 

Things can go off course subtly and quickly. As you start to feel depleted, and like you aren't getting the help you need, some resentment can start to build. Now, when your partner expresses what he/she needs, you start to feel like, "Hey, if you helped with the dishes, I would have more energy to want to go on a date night with you." Or, "If you had sex with me, I would feel loved and have more in the gas tank to go to your parents house for dinner again."

With a slightly distressed couple, I would try having a conversation about the way your partner feels the most prioritized. Be curious. What helps your partner feel the most loved? Why? What is it about that thing that makes them feel so good and so special? Try to be open to what's real for them. Instead of interpreting something like, "You like sex because you're a typical guy and you just want to get off," try to really understand what physical touch from you feels like and means to them. Or instead of hearing, "You want me to do the dishes because you're a nagging perfectionist with unrealistic cleanliness standards," understand what it means to them to feel like to have help from you, what it means that you care about what concerns them, that they don't have to do it all alone.

Pursuers and Withdrawers - Which One Are You?

The kind of couples therapy I do, Emotionally-Focused Couple Therapy (EFT), outlines the dance between Pursuers and Withdrawers so beautifully. When I first learned about this, it blew my mind. But before we get to the dance, how do you know what you are? Of course, no one is a cookie cutter, so this generally outlines what category you may fall into.

Pursuers:

Oh, Pursuers. You make the world go round. Verbal, motivated, organized. You are often the one on top of all the things in the household. You can fall into the role of manager, or even sometimes, blamer/demander. You pursue your partner for connection. You complain when something disrupts that connection. On the outside it might sound like, "Hey, you didn't do the dishes? What is wrong with you?" but on the inside it sounds like, "When you don't do the dishes, I feel like you don't care about me! Please know this and fix it, so I can feel close to you."

The Pursuer fears loss, and generally feel fairly anxious (female pursuers seem to be more connected to their anxiety, male pursuers seem to be more connected to a feeling of indignation). They fear they will lose their partner. They work really hard to explain themselves and try to resolve conflicts so this doesn't happen. They explain to their partner often what would help resolve the issue. The anthem of the Pursuer? "I've told him/her exactly what I need, why can't they do it?"

Pursuers can be very gentle, making quiet, quiet bids for what they need. Or they can be strident, where there is no question that they are upset with you. But they tend to be the ones who bring the complaint first, and who can stay in the tough conversation a little longer.

Quiet Withdrawers:

I love Withdrawers. They are so not me. Thoughtful, observant, quiet. You take in the world, and pick up on much more than it seems. In conflict, though, you are a bit of a challenge. In conflict, Withdrawers typically shut down. They go stone cold silent or get defensive and then shut down. They may leave the room. They rarely come back the next day and say, "Hey, you know that fight we were having where you were telling me what a failure I am? Can we resume that?"

Withdrawers look stoic, but truly are far more sensitive than you realize. It cuts them deeply to hear, over and over again, that they are failing you or letting you down. Their brains go into a "freeze" mode in conflict, which makes it very difficult to stay engaged in even minor disagreements. Pursuers may not think they are telling the Withdrawer that they are failing, but trust me, that is what the Withdrawer is hearing deep down.

Whenever someone comes in and tells me, "My partner has no emotions, they are emotionally stunted." I think - oh, you're married to a Withdrawer. Quite the opposite, Withdrawers have as many emotions as anyone else (which are ALL EMOTIONS, for heaven's sakes, all people have all emotions!) they just don't look like it, because they have learned to suppress and deny their feelings. 

Reactive Withdrawers:

Reactive Withdrawers actually come with some gifts, even though you can look like firecrackers in the moment. Reactive Withdrawers have the same motivation of a Quiet Withdrawer, which is to end the conflict. Quiet Withdrawers end the conflict by literally not talking. Reactive Withdrawers end the conflict by turning on the firehouse and blowing everyone away. They look explosive, but they are not pursuing for connection. They are wanting the disagreement to end.

The bonus of the Reactive Withdrawer is that you stay somewhat verbal in conflict. Your brain is probably still getting flooded, which means you feel overwhelmed in an argument, but with some tweaking you can dial back that firehose and stay in the conversation with your partner.

Often, the dance we see with partners is Pursue - Withdraw. But sometimes you can have Withdraw - Withdraw, or Attack - Attack. Regardless, the questions underneath all these conflicts are the same. Do you love me? How important am I to you? Am I your hero or your disappointment? 

To learn more, read Dr. Sue Johnson's book "Hold Me Tight." She founded EFT and is a genius bringing healing to so many couples.

But I want to fix it ...

"Don't try to fix it. I just need you to listen." Every man has heard these words. And they are the law of the land. No matter what. A short film by Jason Headley at www.jasonheadley.com. Shared with permission.

It can be a hard concept to get your head around - you want to fix your partner's pain, but somehow it never seems to work. I hear clients say, "I just want to fix it," and of course that makes so much sense. Contrary to popular belief, it isn't just men who want to fix their partner's pain, we all want our partners to feel better. But think for a minute, do you actually want to soothe your partner's pain, or do you just want them stop feeling the pain? Because they are two totally different things.

Wanting our partner to stop feeling bad makes sense - it feels SO AWFUL when our partners are upset, especially at us. So we try to fix the source of their pain, or we minimize their pain with the hope they agree it's "not that bad".

Trying to fix the source

Partner 1: (after weeks of complaining about how awful his job is) I just can't do it another day, it's so stressful, it's killing me.

Partner 2: Just quit! We'll be fine for a while, just quit! Or go talk to your boss about it!

Minimizing their pain

Partner 1: (after weeks of complaining about how awful his job is) I just can't do it another day, it's so stressful, it's killing me.

Partner 2: It's not so bad, it'll be ok. Just hang in there.

Partner 2 is trying to fix their partner's pain by providing a solution or by trying to convince them it's not as painful as they think it is. While this is understandable, it's going to leave Partner 1 feeling kind of lost and alone.

Actually fixing it

Partner 1: (after weeks of complaining about how awful his job is) I just can't do it another day, it's so stressful, it's killing me.

Partner 2: I am so sorry, that sounds really tough. You have been working so hard, and it sucks that it's not getting better. What can I do to help?

 

When clients say to me, "I want to fix it," I say, "Great! You totally can. You just need to use a different tool than you have been." Now this gets much harder if the partner's pain is a result of us, if we did something that causes them distress or mistrust. But a good first way to try this is when it's something outside the relationship like with work, etc. Give it a try, see what happens.