I'm a few weeks into my exposure and response prevention treatment, and we're still working on things like writing scripts, nailing down my obsessions and figuring out what exactly my compulsions are. During this process, I've realized something–figuring out what is OCD and what is a valid concern is sometimes difficult. I've also realized, in terms of my anxiety and behavior, it may not matter.
Warning: Too much information ahead.
I'm going to use the example of a health problem I have been having to elucidate my point here. I have a chronic urinary problem that we haven't quite figured out yet. I get frequent infections and symptoms of infection even when one isn't present. I also get blood in my urine, so my doctors run regular tests to make sure something scary isn't cropping up. The chronic pain, which waxes and wanes, and the real concern that something is the matter are problems that are not just "in my head." My OCD hasn't made up a scenario for me to fret about. It's real, but what is really interesting is that the distinction doesn't matter. My mind behaves the same way for real threats as it does for obsessive and intrusive thoughts. So, what does this mean?
When I get sick or am in pain, I obsess. I worry I will have the problem forever, my doctors aren't treating it correctly, they'll never figure out what it is, the medical bills will crush me, or that I'll need some medical attention that my anxiety will stop me from getting. In short, whether my OCD started it or not, it's there, wreaking havoc on my thinking process. I think the healthy thing to do would be to treat the thoughts, rumination and fear that comes from these "exterior" (real life) scenarios in the same way that I treat those that come from purely "internal" scenarios (sh*t OCD makes up in my head). They both provoke anxiety. They both get treated with rumination, reassurance seeking and the like from me, so why treat them differently? Sure, I'm in physical pain, but the mental anguish can be dealt with.
I think the moral of the story for me is that when I am faced with real life problems, taking care of OCD's reaction to those problems will let me handle them in more realistic and productive ways. I don't have to think "well, this is actually happening, so of course I'm going to panic." OCD treatment is not just about conquering irrational fears and worries. It is about taking better control of the ones that are rational and recognizing the irrational thoughts that tend to sneak in the back door when we are in pain, sick or in danger.
If you have any thoughts on this topic, please share. I would love to hear how people manage their OCD symptoms when they are faced with challenges.