Finding the Compulsions in Pure-OCD

Worried woman
Photo by kennedy

One of the first challenges on my path through exposure and response prevention therapy is identifying what triggers my anxiety, what I fear about those triggers and what compulsions I use to neutralize the anxiety. Because I have what is misnamed as purely obsessional OCD, it is exceedingly difficult to identify my compulsions. I don't wash my hands, count things, check locks or circle back in my car to make sure I didn't run someone over. My compulsions are subtle, even to me, which made this task interesting.

It turns out, there are a lot of compulsions that people with Pure-O engage in. They include, but are not limited to:

• Mental checking
• Seeking reassurance
• Ruminating 
• Trying to cancel out bad thoughts with good thoughts
• Avoidance
• Escaping
• Confessing
• Prayer
• Repeating a comforting phrase, number, song, etc. 

I realized this morning, as I sat through my morning panic attack and did my therapy homework, that I engage in most of these, and probably more.

When I get a song stuck in my head that evokes an emotion that triggers my anxiety, I try to cancel it out with a song that is happy and upbeat. This makes it worse, causing sh*tty, sad songs I heard at the grocery store to get stuck in my head for days or even weeks.

I constantly gauge people's reactions when I tell them about my intrusive thoughts to see if they think I'm crazy. I am reassured briefly when people tell me I'm not crazy and that I will be fine. I seek reassurance on the Internet about a wealth of obsessions. If I have a self-harm thought, I use my Google-fu to find stats that will tell me the likelihood that a Caucasian woman in her 30s with OCD will kill herself. This behavior ALWAYS backfires because there is always that one page with some alarming statistic that cancels out all of the comforting information I found. I also sneakily seek reassurance from my mental health care providers.

I ruminate for hours everyday. This involves spikes or intrusive thoughts and then engaging with them. I will examine the thought excessively, trying to find definitive proof that my fear will or will not come true. I feel like knowing will make my panic, which is very uncomfortable, go away, so I keep doing it, knowing it is a compulsion that is feeding my disorder.

I escape in so many ways I cannot even list them. Like people who suffer from PTSD (a diagnosis on top of OCD that two professionals have floated my way so far, based on my abuse history–I'm skeptical.), I try to find exits from places, situations and even feelings. I analyze situations before I'm in them to determine if there is a way to escape them. If there isn't, there is a strong possibility I will then avoid the situation, which is another compulsion. Unlike people with PTSD, it's often not a safety concern that drives me to search for an exit strategy. It is the intensity of my anxiety symptoms. I can't stand to feel trapped. My fight or flight urges me to DO SOMETHING, so I can't be in situation where I can't, such as being in a car on the highway. I'm not afraid of crashing. I'm afraid of having a panic attack and being stuck in the car.

I sing the ABCs in my head, with decreasing success. I confess my intrusive thoughts to other people in the hope they will reassure me. I avoid books, movies and people who make me sad or anxious. I stay away from weapons and poisonous household products. In short, I guess I do have compulsions. The question is whether it is possible to prevent them when I do my exposures. We'll see.

If you know of any other compulsions that Pure-O sufferers have, please fill me in in the comments section.