When OCD's 'cure' is worse then the problem

As therapists with OCD we really do understand why our clients believe that their OCD fear is the most terrible thing that can happen. We believed it too – once. But the truth is, by the time many clients present for therapy, their lives are often worse than their OCD fear.

By ‘worse’ I mean, they are often more distressed and disabled by OCD then they would be if their OCD fear actually happened. The 'cure' that OCD is offering them is the problem.

An example would be relationship OCD (ROCD) where the worst fear might be, not being in love with their current partner, or their partner not being ‘the one’. Should either of these concerns materialise, it would be upsetting for sure, but relationship issues and break-ups are an unfortunate part of the process of life. In contrast, obsessing for 99% of waking hours, suffering acute anxiety (often panic), coupled with life disabling mental or physical checking, comparing, seeking reassurance and problem solving aren’t a necessary part of the process of life.

I’ve worked with clients where the majority of their waking hours are spent ruminating about their relationship to the point where their relationship is strained and their social life, family and work are suffering. Relationship break-ups are hopefully finite and there is a natural recovery and healing process, however, there is no end or limit to the distress of untreated relationship OCD. Moreover, if the person with OCD takes the ill-advised step of ending their relationship due to the OCD, they may well face the same traumatic experience in their next meaningful intimate relationship.

When it comes to responsibility OCD, where a person’s greatest fear is harming their family, their symptoms are usually sufficiently severe that their family is very concerned, worried and confused. In essence they are already suffering as they watch their family member with OCD deteriorate inexplicably before their eyes, regardless of the harm detailed in the OCD thought. Whether the OCD fear is contaminating their family or harming them in some other way, the negative impact of the OCD upon the family is often worse than the original fear. A family member is likely to handle accidental harm more easily than coping with the long term impact of constant reassurance, involvement in rituals, helpless concern and overwhelming confusion. Ironically, the OCD fear of harming their family can result in the family members suffering mental health issues, leading to medication or therapeutic support of their own.

We care for our clients so we’d like to offer them a ‘VIP: it will never happen’ gold card but we know the relief won’t last. What we can do, as part of a larger programme, is help them see that OCD is making their current life worse than the thoughts they are being threatened with. To help them see that the 'cure' offered by OCD is the problem. We can never guarantee that their worst fear won’t happen (as is true for everyone) but we can 100% guarantee that, without managing OCD, their life will be worse.