OCD is often described as “the doubting disease,” but what does doubt have to do with obsessions and compulsions?

In this OCD Chicago article by Dr. Fred Penzel, he explains:

If obsessions are intrusive, unpleasant thoughts, compulsions are the mental and physical activities that people with OCD come up with as a way of dealing with them. Since doubt is what drives most OCD, the answer, as OC sufferers see it, is to do, know, and control everything in a compulsively perfect way. When everything is perfect, there is no room for doubt. Compulsions start out as solutions, but inevitably become a large part of the problem themselves.

When Dan was dealing with his OCD, he was not able to drive. At this point I had little to no understanding of how he felt or what he was thinking and made the comment that his chances of getting hurt while driving around town were minute. Dan’s response was, “I’m not afraid of getting hurt; I’m worried about hurting someone else.”

The possiblity of their actions causing harm to others is not an uncommon obsession for those with OCD. So let’s say that an OCD sufferer returns home after driving and thinks,“Good, I didn’t hit anyone.” But then the doubt kicks in. “Well, I don’t think I hit anyone, but maybe I did. What if I hit someone? I probably should go back and check. What if I hit someone and they are lyng in the road right now? I need to go check.”

The goal of this checking compulsion is to make absolutely sure that everyone and everything is okay. Once this is confirmed there may be some relief for the OCD sufferer, but it is fleeting. The need for reassurance returns, and the vicious cycle begins again. In this first person blog on OCD, we are shown how doubt infiltrates its way into every aspect of an OCD sufferer’s life; in this case, the writer describes her thoughts as she tries to answer a question on a form.

So how can those with OCD be certain that their worst fears won’t come true? Indeed, how can all of us make sure nothing will go wrong? How can we control our lives, and the lives of those we love, so that nothing bad will ever happen?

The answer, of course, is we can’t. Because as much as we’d all like to believe otherwise, so much of what happens in our lives is beyond our control. And so the question OCD sufferers need to ask is not “How can I be certain?” but rather “How can I live with the uncertainty?” This is where the right therapist and therapy come in.

I have always liked this quote by the the French philosopher Michel de Montaigne: “My life has been full of terrible misfortunes – most of which never happened.” Replacing “what ifs” with “I’ll deal with whatever is,” is not an easy thing to do, but the payoff can be huge. Instead of concentrating on the uncertainties of the past and the future, OCD sufferers can begin to focus on what matters the most – the present.