The Doubting Disease

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In this post I will discuss the Doubting Disease which is a label used to describe OCD. One common misconception about OCD is that people with OCD enjoy being neat, clean and orderly. It is understandable that an outside viewer might believe this because they might see someone with OCD repeatedly wash their hands or sort items based on color until they are in order. The disconnect can start to be resolved by gaining a better understanding of what is really driving the compulsive behaviors of someone with OCD.

Ultimately we must remember that a person with OCD is performing their compulsions not because they enjoy it but because there is an internal battle going on in their mind. The sometimes odd behaviors that someone is performing because of their OCD are done to get some sort of relief from the internal torment which is not usually observable from the outside.

The description of OCD as the Doubting Disease can serve as a useful tool to understand one important aspect of OCD. One of the main things that drives someone with OCD to perform their compulsions is uncertainty. The OCD sufferer is in constant doubt. Some of the common things they will doubt about are whether they are contaminated by something that will kill them, whether they have done something that will harm a loved one, or whether they are an immoral person. Thus the person is led to perform some action either physical or mental that will try and remove the doubt from their mind in hopes of proving to their OCD that it is wrong.

For a more concrete example of how this works let us consider the case of the classic checker. One type of this is the person who doubts whether they have locked their door when leaving the house. Most people will have some experience with thoughts such as forgetting to lock the door as they drive down the street toward work. The difference between someone with OCD and someone without OCD is the magnitude of the doubt and uncertainty. The none OCD person will just say something like "I probably locked it" and then continue driving to work and not continue to think about it. For the person with OCD the thought is much more intrusive and will not leave their mind. Thus they will eventually turn around and go back to check to make sure the door is locked. They need to be 100% certain.

Someone who is in the earlier grips of OCD might be able to go back to the house see that the door is indeed locked and then leave for work again. The only problem is that overtime this checking will not remove the doubt from the OCD sufferers mind but will begin to reinforce it. Perhaps, the next time the thought arises they will have to make two or three trips back to the house to check the lock. Eventually, the doubt will become so strong that a person could be standing right in front of the door, lock the door, be looking right at the locked door and still doubt whether the door is locked or not. It should be clear that someone with this severe of OCD is under extreme distress because they can see the locked door right in front of them but their mind is telling them it still might be unlocked. Furthermore, this person will not be functioning well and could lose their job from being late to work constantly.

It is also important to realize that as the OCD progresses it will require not just the repeated checking but will require other rituals to be performed. For example, the person who checks the lock might start taking photos of the lock so they can look at the photo while at work to reassure themselves that they locked the door. Another common compulsion would be for the person to try and mentally visualize themselves locking the door and replaying the event over and over in their mind to try and convince themselves that the door is locked.

This example of the checker illustrates the doubt and uncertainty that an OCD sufferer is plagued with. A person with OCD is constantly doubting things that someone without OCD wouldn't even think about or would think about for a split second and then move on with their day. For the OCD person the uncertainty becomes so crippling that they are eventually unable to do anything productive or leave their home because they are constantly performing rituals and do not have time to do anything else.

So, how can someone with OCD start to get better? One of the most important things for someone with OCD is to learn to live with uncertainty. The person with OCD is trying to remove the doubt from their mind but this is impossible. Instead they need to accept that the doubt is there and move on without doing their compulsions. When they get the thought that they forgot to lock the door they need to just carry on to work without going back to check. At first this will be extremely distressing for the person but overtime they will be able to eventually simplify or remove parts of their rituals and in the best cases they will get back to living a functional life. This does not mean that the thoughts or uncertainty will be gone. They will most likely deal with these thoughts for the remainder of their life but if they have learned proper coping strategies there is hope they will be productive members of society again.