The terrible 'what if': how OCD makes every day a matter of life or death

The terrible 'what if': how OCD makes every day a matter of life or death

The first time I thought someone contaminated my food was at the Paramus Park mall food court when I was 12. As the employee handed me an extra gooey Cinnabon nestled in crinkly tissue, I noticed he had a scab and a Band-Aid crossing his knuckles.

“Thanks,” I said, suddenly feeling like the floor had dropped out from under me.

I walked over to the small table where my friend was waiting. I stared at the Cinnabon. Suddenly, it seemed as though the sweet treat was crawling with disease. I could almost see blood and scabs in the cinnamon, pus in the sugary glaze.

I got up and threw the Cinnabon in the garbage.

“Why’d you do that?” my friend asked.

“I don’t feel so great.”

“I would have eaten it!”

For the rest of the day, I thought about the Cinnabon. Even though I hadn’t eaten it, I had been in close proximity to what I deemed infected food. As my friend purchased Proactiv at the kiosk near the escalator, I thought of flesh-eating bacteria. My heart scrambled in my chest while we sat on the floor of the bookstore flipping through Hit Parader. By the time her mother picked us up, I knew for sure I was dying.

I hadn’t considered tainted food before that day. But afterward, the specter consumed my thoughts at nearly every meal prepared outside of my home. I saw scabs, imagined meat was replaced with human flesh, and assumed someone had pissed, ejaculated, spit, or defecated in my food. I’d take my fork and slowly pick and move food around my plate with a miserable, paranoid meticulousness. I’d stare the food down, dissect it.

“That could be semen,” I would think for no good reason, or “that might have been someone’s fingertip”.

OCD is often called the 'doubting disease' because deep down, the sufferer knows the thoughts are irrational.

Because I was consuming all of this human waste, I pictured my body as host to myriad viruses and bacteria: HIV, hepatitis, listeria, salmonella, botulism, mad cow, and so forth. I imagined my brain riddled with holes, like the cross-section of a lotus root. I considered my body toxic. I thought of myself as a walking disease.

There have always been cultural myths about contaminated or poisoned food. Growing up, we traded gossip about razor blades in Halloween candy or condoms in fast food hamburgers. But even those urban legends have a slant of truth to them. The razor blade story can be traced back to the 1974 murder of eight-year-old Timothy O’Bryan, who was poisoned by his father on Halloween night via cyanide in a Pixy Stix. In 2007, Van Miguel Hartless bit into a hamburger from a Rutland, Vermont, Burger King and allegedly found an unwrapped condom. He sued and settled out of court. “I know it sounds kind of funny now,” Hartless said, “but I had dreams where I would be doing random things and whatever I was holding would turn into the hamburger or the condom.” In February of this year, a family from Redlands, California, sued Starbucks, claiming they had found a barista’s blood in their Frappucinos.

But food contamination panic or trauma was not the reason behind this overwhelming fear that I was consuming tainted food. I didn’t know it yet, but this fear was the latest manifestation of my obsessive-compulsive disorder.

My OCD first manifested when I was eight. I was standing in front of my bedroom door, trying to open it – but for some reason, I couldn’t. I twisted the doorknob to the left and the right, but my brain wasn’t letting me open the door. It was a simple as that; no tangible cause, no connection I could make.

Most people still think having OCD means you’re a neat freak or like your shoes precisely lined up in the closet. Photograph: Illustration by Jared Freschman

“Count to eight,” my brain said. “If the doorknob twists to the right on eight, and you feel good about it, you can go in.”

My mom found me in the hallway.

“What’s the matter, sweetie?”

“I can’t open the door,” I said, which was only half true.

“Is it stuck? Let me help.”

This scene played out almost every night, except I learned to be quiet so no one would know I couldn’t open the door because of a mysterious feeling that if I didn’t do it “right” something horrible would happen.

Most people still think having OCD means you’re a neat freak or like your shoes precisely lined up in the closet. Come to my apartment; I’ll show you that’s not true. OCD is not a personality or preference. It’s a mental illness that can have devastating effects on how you live and interact with the world. You might spend weeks of panic wondering if you’re dying of a rare disease and go to at least seven different doctors, never satisfied with an answer. You might refuse to drive a car because you think you will steer it over a bridge. You might miss work because you can’t stop checking if the stove is off. OCD is often called the “doubting disease” because deep down, the sufferer knows the thoughts and compulsions are irrational. However, despite this knowledge, there always remains a terrible “what if”.

Before I started talking openly about OCD, my friends and family had no idea I was suffering because most of the drama was taking place offstage in my head. I was very good at hiding my mental illness. I even took perverse pride in the fact that I moved through the world looking like someone who didn’t think they were being poisoned or fed body parts.

In high school, I spent a lot of time in Barnes & Noble. While devouring the psychology section for books on depression and anxiety, I found one on obsessive-compulsive disorder.

“Oh,” I thought. “This makes so much sense.”

My parents meant well when they said “everyone has quirks” and “this will pass”. But they were not equipped to deal with a mentally ill daughter and were afraid it would reflect poorly on their parenting. So I struggled, and then I was hospitalized in my 20s for a nervous breakdown triggered by anxiety, depression, and insomnia. I’ve been in therapy and on medication for 10 years, and I still struggle, although these treatments help buffer the panic so I can approach situations more rationally. OCD is chronic. Symptoms wax and wane over the years. They mutate. I add new obsessions to the collection. I get rid of old ones. I adapt. I maladapt. I castigate myself. I try to be more compassionate. It becomes a part of life to vaguely wonder if someone spit in the soup, eat the soup anyway, and then try not to think about the soup later.

Perhaps more than anything, OCD has forced me to confront how I interact with both friends and strangers alike – especially when it comes to asserting my needs and establishing boundaries. I have to navigate how to approach each particular situation with a number of factors in mind: is this a high-risk situation? Will I be sick about this incident for weeks as opposed to days? What can I tolerate? Will this person be offended?

Imagine having to repeatedly tell friends and family you do not, under any circumstances, share food or beverages. No, you cannot eat from my plate. No, I do not want a bite of your bagel. No, I do not want a sip from your cocktail. This gets old fast, especially if you are a people pleaser like me. OCD is probably one of the most frustrating illnesses to have when you don’t like offending people. And with food-related contamination fears, it’s very easy to offend. I’m constantly navigating how to engage with people in contamination situations.

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Recently, my husband and I were walking our dogs when an elderly man stopped us on the street.

“Hi, can I pet your dogs?” he asked.

“Sure!” I said.

“They don’t allow dogs in my building,” the old man said. “I like making friends with them outside.”

Then, looking at my dog, he said: “Do they like lamb lung? I have some.”

Before I could throw out my tried-and-true lie – “No, thank you, they have food allergies” – my husband chirped up.

“They love lamb lung!”

The man pulled out a plastic baggie, and I, once again, felt like I was going to die. I stared at my husband with wide eyes, and he realized his mistake. Too late. The dogs were munching away at the delicious treat.

As we walked home, I started sobbing.

“They’re going to die! That was probably poisoned!”

My husband tried to calm me down. He profusely apologized for forgetting my OCD and tried to reassure me that the old man was probably just lonely and loved dogs and that we most likely cheered up his day.

All very reasonable.

I cried all night. I made myself sick. I imagined my dogs foaming at the mouth and convulsing. I monitored them closely.

“Do you think you’re also upset because you weren’t able to tell the old man ‘no’?” my husband asked as we got ready for bed.

I cried even harder because he was right. When faced with what I perceived as a life and death situation, I couldn’t risk offending a stranger.

So, how can I navigate a world in which I’m constantly negotiating and managing so-called life and death situations?

One of the main strategies in OCD therapy is called “exposure and response prevention”, which is a type of cognitive behavioral therapy. ERP “encourages patients to gradually encounter increasing doses of that which is contaminated, while resisting washing, checking, avoiding, or conducting magical rituals”. The goal of ERP is to force sufferers to “stay with the anxiety” and eventually realize they are going to be fine. This is more difficult than it sounds, especially when “staying with the anxiety” means staying with thoughts of illness, death, and your own culpability. And that’s really what’s at the dark heart of OCD – the sense that your choices have catastrophic consequences, that you have more control over your existence than actuality dictates.

Confronting what I think will actually harm or kill me or my loved ones is not a picnic. And contamination fears actually can make sense at times. If you share food with someone who has bronchitis, you’re likely to get bronchitis. No one tells you to go around eating used tissues or licking mystery substances on the sidewalk. It can be hard to draw the line between commonsense hygiene practices and fantastical hypotheses about the mysterious waste lurking in my food.

I live in New York City. I am surrounded by some of the best restaurants in the world. I enjoy spending time eating a big, lazy meal with friends. I like people-watching at fancy venues and quietly tucking in at cozy cafes while I work. For a while, I didn’t think it was possible to do these things without feeling deep anxiety. Now, with medication and therapy, I anticipate what I’m going to order for dinner or what the new menu at my favorite restaurant holds. If I start to pick through my spaghetti Bolognese or arugula salad looking for evidence of contamination, I take a deep breath and force myself to think about how unlikely that is.

“Hey,” my OCD says. “Don’t you think that looks like a blood clot?”

I cringe. Is it?

“No. It’s sauce. Shut up.”

Then, I eat. Does this always work? No. But I refuse to give up on such an enjoyable part of life because OCD tells me I’m eating literal shit.

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