Since I’ve written about my experience with OCD in very broad terms before, I’ve received several emails from people asking for advice on how to think about or get help with OCD. I thought since I’m in the middle of some deep and unexpected book revisions and my creative brain is fairly fried right now, I’d take the time to write a post that I can refer back to that lays out my general advice and resources for treating OCD from a non-professional perspective. Here’s what I’m not going to do. I’m not going to share my personal journey with OCD treatment. That’s my story. I do believe there’s a danger in oversharing. But what I will do is share some of the wisdom I’ve learned for how to conceive of OCD as a believer. Whether you have OCD or know someone who does, you may find this helpful. OCD affects roughly 2% of the population, so it’s more common than you think. You almost certainly know someone who suffers from it. And unless you have it or have learned about it, you probably have a lot of misconceptions about what it is.
What is OCD?
OCD is the doubting disorder. Everyone doubts, but there are different kinds of doubts. You might doubt whether you remembered to pack your lunch. That could be a reasonable doubt. But if you distinctly remember putting your lunch in your bag, that would be what’s called a “obsessional doubt” or an irrational doubt. It’s not based in the here and now. It’s based entirely in your imagination. That doubt goes against the facts. But your imagination spins up possibilities: “What if I just think I put it in my bag? What if that was a different memory from a different day?” And so on. OCD makes you doubt your sense information and common sense and inner sense data. It makes you doubt everything. And that doubt comes with a wave of terrible anxiety.
OCD is not just about checking if the stove is turned off, although it can be that. And that can be tortuous in its own way. And it’s not just trying to be clean or washing your hands. It’s also things like questioning whether you are attracted to the same sex, wondering if God has damned you, wondering if you’re living in the Matrix, wondering whether you harmed someone twenty years ago, and so on and on and on and on. Its manifestations are as various as the imagination.
In response, your mind tries to resolve these doubts by some kind of compulsion: checking, researching, or figuring out. But the relief never lasts. Your mind always imagines new doubts. It doubts those senses too. If you check the stove top one more time, it will just make you wonder if you turned the knob all the way to the off position.
As a result, the OCD sufferer is stuck. They get into cycles where they go over and over trying to resolve these doubts which they believe to be serious and important to themselves and others. They fear that if they don’t act on their doubts, someone will be harmed. So they have to act, even though they (usually, but not always) know on some level it’s irrational. The ironic and painful part is that the more the OCD sufferer acts on their fears, the more they are taken away from reality and the more harm they actually do to themselves and others. For example, the person who washes their hands until they are raw to get rid of germs actually takes off the protective layer of skin that keeps germs away!
A key to understanding this stuckness is that the OCD sufferer does not want to be in it. They want to stop, but they feel compelled to act out of anxiety and morality.
As Christians, we may be tempted to say that such people need to just trust in God more and accept that he is sovereign. Their problem is that they want to control everything and they need to let God control things. I don’t discount that it is true that they need to trust in God more. In fact, I would go further. I would say that we all need to learn to stop trying to control our own little kingdoms. But people who suffer from OCD are not particularly more controlling or anxious about control than people without OCD. They aren’t afraid about letting God being God in general. In fact, they trust God in the vast majority of the areas of their lives: with their families, their careers, their health. But there are specific areas where they have fears. And those fears are tied with what I-CBT (one of the three main ways of treating OCD—more on that later) calls the “Vulnerable Self Theme.” The Vulnerable Self is the version of yourself that you are most deeply afraid of turning into. You might be afraid of becoming someone abusive, or someone negligent, or someone forgetful, or someone violent, or so on. And I-CBT argues that we get our particular OCD themes from our Vulnerable Self. If I’m afraid of being a negligent person, then I may develop doubts about leaving the door unlocked, and so on.
For me, as a Christian, I could see how the Accuser used accusations about my Vulnerable Self to fuel my doubts. By accusing me of being a certain kind of person, by digging up past examples of when I made mistakes, it made me vulnerable to doubts about my senses which I knew to be accurate. So part of recovery as a Christian looks like learning to turn to who God sees you as, not who you fear you might become.
Recovery looks like learning to trust your God-given senses again and learning to see yourself as God sees you. It involves not giving relevance to the doubts which are irrational and learning to trust in God’s love and providence. And it doesn’t happen overnight. OCD often goes undiagnosed for over a decade. That’s a long time for neural pathways to dig in. So it shouldn’t be surprising that it takes more than a little education for OCD sufferers to find relief. The mind must form new habits of dealing with thoughts and images and sensations, especially anxiety.
Resources
The description of OCD I’ve just given is roughly aligned with a treatment called I-CBT, or Inference-Based Cognitive Behavioral Therapy. It’s a newer treatment, but one that many have found to be very helpful. The older and “gold standard” treatment is ERP: Exposure Response Prevention, which is also extremely effective. It conceives of OCD differently, focusing on intrusive thoughts and the compulsions we do to relieve those thoughts. Where I-CBT focuses on teaching you to trust your senses, ERP teaches you to treat intrusive thoughts as irrelevant by exposing you to those thoughts and having you not do compulsions. I recommend both treatments, although I am biased toward I-CBT as you can tell from my use of its framework for my description of OCD. For a good understanding of ERP from a Christian perspective, I recommend following my friend
who will have a new book out soon. The third treatment for OCD is ACT: Acceptance Commitment Therapy, and it often goes along with ERP.Here are my top resources for dealing with OCD:
The International OCD Foundation Website. The best place to find an ERP therapist who is qualified to treat OCD.
I-CBT Online. The best place to find an I-CBT therapist. Also a good place to find more information about I-CBT.
Justin K. Hughes. An informative Christian site from an ERP perspective.
Five Ways to Beat Scrupulosity. A great talk on how to beat this subtype of OCD.
The OCD Stories Podcast. An inspiring and insightful podcast on OCD, which I’ve been on, but don’t let that stop you from listening.
As I’ve said repeatedly in my writings on mental health, the key is endurance, a commitment to your own recovery, and a hope in God. If something doesn’t work, try something else. Don’t give up, encourage loved ones not to give up. God is working all things together for our good, even when we can’t see that good in front of us, even when we doubt that good.
I wonder if a form of this is what leads some Christians to think they need absolute certainty about the status as "saved," rather than be willing to settle for mere "assurance."
Several key items you mentioned in this article are new to me (one diagnosed with OCD ~10ish years ago and who has benefited significantly from ERP).
But in my ongoing work to grow in emotional health, ERP helps to resist the obsessive thoughts and compulsions, but does little to replace them with a better/truer story. Because of this I do find OCD patterns (maybe sublimated?) expressing themselves elsewhere in my mind and heart.
So I-CBT, concept of the “Vulnerable Self,” and the emphasis on building trust internally with one’s perceptions and in one’s focus on God’s perspective—all this feels particularly relevant and helpful. I had considered these efforts separate from my OCD recovery work, and am very curious to learn more about I-CBT.