OCD and Instincts

questionAs we know, the front-line treatment for OCD is Exposure and Response Prevention Therapy, where sufferers are forced to face their fears, and accept the doubt and the uncertainty in their lives. An integral part of this therapy includes an initial rise in anxiety, but over time, this subsides. When someone is fully committed to ERP Therapy, it works.

But can it work too well? Can OCD sufferers, indeed can all of us, be so good at accepting the uncertainty of life that sometimes we don’t act appropriately? I’ve previously written about healthy doubt versus unhealthy doubt, where I discuss Jeff Bell’s suggestions for distinquishing between intellect-based and fear-based doubt. I think Jeff gives us invaluable tools to help us differentiate between OCD and actual situations that are cause for concern.

For OCD sufferers who have gone through intense ERP therapy, however, I’m wondering if accepting whatever comes along sometimes becomes the norm.  If an OCD sufferer experiences sharp pains in his abdomen, will he automatically assume it’s his OCD making a big deal out of nothing, and delay getting treatment? If another sufferer gets the feeling that her best friend is angry with her, will she just chalk it up to her OCD getting in the way, and not address the situation? Because treatment for OCD often involves doing the opposite of what our instincts are telling us, it’s no wonder that those with the disorder might have trouble trusting their intuition. Indeed, they might ignore it altogether.

To me, not being able to rely on your instincts, on your own inner compass, is a cruel byproduct of having OCD. Sure, we all questions ourselves sometimes. But try to imagine second-guessing everything you think or feel. Is this a valid fear or concern? Or is it OCD? Am I overreacting? Underreacting? How do I know? My friend Bobbi’s excellent post on this subject talks about OCD stripping away a sufferer’s ability to trust him or herself. In her case she was faced with decisions regarding her partner’s health.

So what’s the answer? I don’t know. But I believe those with OCD can figure it out for themselves. Jeff Bell has his way and Bobbi has her way. The bottom line is those with OCD typically do know what is a real cause for concern and what is OCD; they are rational people. They might have to dig a little deeper to figure it all out and to find the courage to trust those instincts they have repeatedly been taught to ignore. But it can be done and hopefully, in the process, they will regain some of the trust in themselves that OCD tried to steal away.

I’d love to hear how others deal with OCD and instincts.

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25 Responses to OCD and Instincts

  1. Hi Janet. Thank you for this really thought provoking post. I’m willing to bet a lot of people would wonder if ERP will take away that innate ability to trust one’s instincts. I look at it this way: people with OCD are just as good as anyone else at knowing what the “right” answer is about different issues that may come up. Dr. Jonathan Grayson, in “Freedom From Obsessive-Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty” describes how he uses something called “The Gun Test” to help OCD sufferers distinguish between what’s OCD and what’s not. Basically, he asks them if the situation is life or death (the trigger will be pulled if they guess wrong), what is their best guess about whether their concern is valid or not. He goes on to say that “To date, everyone makes the ‘right’ guess.” I do a similar thing with children and teens in my practice. I play “Game Show” with them. A million dollars is to be won if they guess right and can tell me if something is a valid concern or if it’s OCD. So far, they’ve all guessed right. Bobbi makes really great points in her post: “…OCD can not steal away knowledge.” “You know when something is really wrong.” So, I’m thinking that, in treatment, it becomes important for the therapist to remind the OCD sufferer of their good ability to distinguish between OCD and Not-OCD – really reinforce that. Thanks for spurring on my thinking this morning!

  2. You’re welcome, Angie, and thanks so much for your insight and concrete examples of how those with OCD are just as good as those without the disorder when it comes to the “right” answers. I’m not surprised!

  3. I had this fear myself. What is interesting is that sometimes, a friend might say “You are having an OCD moment; that is not a legit fear”, but I know somehow on some level what is OCD and what is real. I don’t know how to describe it, but the feeling between real fear and OCD is different. Feeling the subtle difference does not keep me from going though with compulsions or obsessing if it is my OCD; I check and obsess and redo anyway. But I guess my point is it never stops me from paying attention to concerns that deserve it. Hmmm…

  4. Although truth be told, I have not really implemented CBT, so perhaps I will experience it when I do start successfully ignoring my OCD…

  5. Thanks for sharing, Sally :)! What you describe seems similar to what I’ve heard from others who have OCD, even those who have been through CBT. It’s a subtle difference, as you say, but one that you are definitely aware of.

  6. Excellent post that brings up important issues! I’ve worried about this. Sometimes I really can tell the difference between what we might call “valid” fear and OCD fear, but it’s difficult for me to put into words how I know the difference. I seem to recognize the OCD fear for what it is–not rational but troublesome nonetheless. It’s something I try to actively deal with to lessen. But there have been times in my life when I’ve felt real fear in the face of real danger. I didn’t doubt myself then, and my focus wasn’t on getting rid of the fear–it was getting myself out of danger.

    As far as trusting my instincts–I still have trouble with this. It mostly has to do with worrying about whether or not I’ve “read” the signals correctly, on whether the instinct is real or just another way OCD is rearing its ugly head. That’s when I have to do more self-analysis and figure out what is leading me to feel or believe a certain way.

    I’m sorry I sound so vague. Maybe some day I will have a better way of explaining all of this. 🙂

    • I think you explain yourself just fine, Tina, and you bring up such good points. As far as valid fear and OCD fear goes, I don’t think it matters if you can explain it at all, as long as YOU know the difference which it sounds as if you do. Reading your second paragraph about trusting your instincts I realize that so many of us (even without OCD) have trouble at times knowing whether to trust our instincts. Thanks, as always, for your great comment!

  7. Abigail says:

    ” Exposure and Response Prevention Therapy, where sufferers are forced to face their fears, and accept the doubt and the uncertainty in their lives” – I would like to suggest that if ERP is being done this way, it is not the healthiest way. I don’t like the “forced” part. I think “forcing” it can be hurtful. I’d say that ERP is “where sufferers [choose] to face their fears, and accept the doubt and the uncertainty in their lives.”

    As for instinct, I was thinking about that this morning. I have scrupulosity OCD issues. Sometimes I describe this OCD as my fake conscience. I know I have a fake conscience because it can make me feel guilty for things I haven’t even started and that I don’t plan on doing. Then there is my real conscience. I’m guessing I have one. But I’m not sure what it is. Really clear issues, like straight out steeling for example, don’t bring up a fake conscience war, but how I spend my money? OCD city. So I’ve probably spent money on things that I shouldn’t have.

    Life and death instincts, that gets harder. Actually, I think the hardest OCD exposures are those where I feel like I’m putting someone else at risk. I don’t mind putting myself at risk as much. I’ve probably put myself in semi-dangerous situations (being out in the dark at night) and decided to take as much care as I could to be aware but then went ahead and did whatever I planned to do.

    Well, that wasn’t really an answer. I guess I have to deal with things in a case-by-case scenario, including sometimes evaluating what I have to loose if I guess wrong.

    • Hi Abigail, Thanks for your comment. You are totally right that I should have used “choose” instead of “forced” in reference to ERP therapy. In my mind I was referring to the OCD sufferer forcing himself or herself (because really no one else can force you to do therapy if you’re not on board), but it didn’t come across right and “choose” is a must better choice. I should have chosen choose :)! Thank you for bringing that to my attention.
      Thanks also for sharing how tough it can be sometimes to sort out your instincts. I like your method of evaluating what you have to lose if you make a particular choice.

  8. It comes naturally for me to ignore my OCD fears and other OC’s fears … but then I doubt my decisions in relation to others. For example, my friend who has struggled with OCD was worried about a bump on her neck. She ALWAYS worries about stuff like this, and it’s always nothing, so my natural (post-ERP) inclination is to discount it. But then I started worrying … what if it IS something and I told her not to react to it and it killed her???

    • Thanks for commenting, Jackie. I think those health-related examples are tough. You don’t want to feed your friend’s OCD, but you don’t want to ignore a potential issue either. No simple answers!

  9. Briana says:

    Another piece that hits the nail on the head for me. Going through a rough patch now and self doubt in what I SEE is creating huge problems. Because of that, finally broke down and got an appointment with psychiatry. First thing I’ll ask is if he and the therapist now how to treat OCD/ GAD and treat using ERT / CBT. Otherwise, I’ll have to leave. Appt is Nov 25.

  10. Hi there, really interesting post. I’ve questioned myself numerous times over the years about whether some of my fears are actually natural instincts due to previous events, and which are more what many would call “irrational” I guess. Constantly second guessing, and analysing situations is very tiring.

    And I think this can be made more difficult with a diagnosis of PTSD as well (and no doubt several other diagnoses). When you’re trying to question whether something is valid you’re brain is also throwing back at you “yes, but, look what happened in [such a situation]”. Very difficult subject like you say. OCD is extremely challenging isn’t it!

  11. bemusedmuse says:

    This is really very interesting. It surely is a doubting disease and is very frustrating trying to distinguish between normal doubt and excessive doubt. People say that I don’t trust myself, but then I’m like… well which one is me?! I certainly have gotten into a habit of just letting everything go and I don’t feel anxious all the time but I literally have no idea what I’m doing from one moment to the next…

    • Thanks for sharing, and I think you give us a good idea of how confusing this issue can be. I would think a good therapist could give you some tools to help you sort things out. Good luck as you continue on.

  12. I read an article where you made reference to a “world renowned residential treatment program for OCD.” Can you tell me the name of this program, and other world renowned programs if there are any? I’m looking for a good place to get help for my 18-year-old daughter who has OCD (and ADHD).

  13. Jai says:

    I have recently started suffering from breathing obsession. I have consulted a psychiatrist who prescribed me fluoxetine and asked me to do pranayama. I am still 22 and don’t know what to do as I am spending whole day only thinking about this. Please help!

    • Thank you for sharing, Jai, and I am so sorry you are having such a difficult time. It sounds as if you have sensorimotor OCD (https://ocdtalk.wordpress.com/2013/10/27/sensorimotor-ocd/) and that is treatable with exposure and response prevention (ERP) therapy. If you don’t have qualified therapists where you live there are lots of resources listed on my sidebar and in my book. Even a self-help book can be helpful if you are willing to do the work. I’d take a look at the link I included in this comment. It should be helpful. I wish you all the best…..OCD is indeed treatable!

  14. Jake B says:

    I have chronic ocd and have had unsuccessful therapy and medication many times, and the reason I will never stop doing my impulses, is the fact it’s more instinctive in our body, I never had one voice or anything tell me to do something, it is always an instinct-like thought. Being intelligent has its downsides with OCD as I’ve even managed to talk myself into the belief that when I do my impulses and most of the time I have to do them numerous times due to having to have the correct thought along with the action I’m performing, who can tell me that times elapsed doesn’t find a gap in time that will get you past things you want to avoid, if anything ever happened if I stopped my impulses (they WILL NEVER) I’d feel responsible, I’m 24 and I’ve suffered since I can remember, about 5 years old, and it used to make me absolutely crack up until I found out later in life what it actually is, I used to have to blink 10 times at images I liked, on TV for example, but I couldn’t swallow or blink at all if a bad image was on.. my eyes actually adapted so I really had no irritation.. to force a blink. This later subsided and another impulse took over, not by choice, just lucky. I have impulses x100s in a day I couldn’t even imagine writing all of them
    I’d love to be able to think through the mind of someone ‘normal’ even just for a day…

    I hate how ocd is glamorised, for attention and for people to lie about having it just cos there clean or a tidy person, and feel they have to add things to their sad personality.

    My own quote to people who think they have ocd,
    Someone who is clean and scared of disease and washes their hands 10 times through the day hasn’t got ocd, their clean.
    Someone who washes their hands ten times in a row to avoid a car accident for example, has ocd.

    • Hi Jake, Thank you for sharing and I’m sorry to hear you’ve been suffering for so long. I am a huge advocate for ERP therapy but of course the choice to fully commit to it and break the cycle of OCD has to come from within.I wish you all the best as you move on with your life and make choices as to how to deal with your OCD.

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