Over the years I have noticed an obscure form that OCD compulsions can take, that many clients and therapists may not recognize as ritualizing. The clients show up at my office highly educated about their disorder. They have read every OCD book on my book shelf and then some. They walk in with a bag of self-help books they are currently reading.
These clients may have visited multiple professionals from psychoanalysts, psychiatrists and cognitive-behavioral specialists, to healers, hypnotists and clergy, looking for answers. They have a large notebook full of writing they had scribbled down while reading or listening to the bevy of helpers, willing to provide the therapeutic information in hundreds of different ways. They are compulsively looking for a solution to their OCD.
The ritual continues when they sit down on my couch. They have razor sharp attention to the words that I say, that they skillfully balance with planning and asking a series of questions in rapid fire. They must be sure they cover everything before the session is over. Being in session is a major anxiety trigger because they feel that it their only chance this week to get the answers they need to reduce their suffering. I call it the “solving compulsion.”
Many of these clients have been through successful Cognitive-Behavioral Therapy (CBT) in the past and feel like they aren’t doing it right anymore. They may have been high achievers the first time they tried exposure therapy. They ask themselves, “Why isn’t it working now?” It is not working now because you’re targeting the wrong fear. Your OCD has pulled the rug out from under you and you don’t even realize it has shifted. The new fear is that you have doubt about your ability to keep your OCD under control. You used to have confidence that you had a handle on your treatment through all your CBT skills, but now your mind is flooded with doubts. Your OCD threatens you with the many consequences that could occur if the bad thing happens. This is your OCD now.
Intrusive Thoughts / Obsessions that proceed compulsive solving:
- Your OCD and panic symptoms will continue to increase until you spin out of control.
- Your life as you know it is taken away because you become more and more consumed by your OCD.
- You don’t understand treatment explanations perfectly enough.
- You don’t explain your experience perfectly enough to get the correct instructions back from your therapist.
- You’ll lose your job because you cannot function normally.
- You’ll lose your relationship because they don’t deserve such an impaired person.
- People feel sorry for and pity you because you have lost complete control of your mental health.
These intrusive thoughts are the new weapons that your OCD is using to encourage you to feed it with rituals. You become desperate to prevent all of these bad events from taking place. You ask yourself, “What is the way to prevent the destruction of my life by my OCD?” “Maybe if I become an expert on my OCD then I can gain control and prevent the feared outcome.” You begin reading and learning, talking to people, and checking in with yourself multiple times daily to see if you are any better. You’re not better, “Oh no!” This could only mean that you have not covered enough ground. Maybe your therapist is not skilled enough and you should see someone else. Maybe your medications could be altered. You search and read online about your medication for hours. You switch psychiatrists because clearly this medication is not working anymore.
You begin to imagine all the terrible things that may be happening to you. “Will I lose all control and my OCD completely take over?” “Will I have to check myself into a mental hospital?” “Will I ever feel normal again?” “Well, I certainly cannot stop my solution-seeking now.” You are in desperate need of more information. During your voracious reading you find a new idea about OCD that you haven’t seen before and a wave of relief rushes over you. “Now I must hold onto this information. I can use it to get better.” You write it in your notebook and a post-it on your mirror. “If I read it every day I won’t forget.” But the relief stops coming. “There must be more gems like that online.” “There is more I haven’t read or seen before.” “If I found that relief I can find more.” The search continues. During the investigation, you find other things that spike your OCD. You are compelled to pore over your notes from therapy. You may begin to compulsively do the assignments that were given by your behavioral therapist with the wrong motive, to feel less anxious. Exposures are meant to create anxiety intentionally until the exposure is unsuccessful at creating anxiety through the process of habituation.
What is the answer then? (I knew you would ask…)
People find it very illogical when I tell them to stop searching for the solution. They do not understand that the solution-seeking is the problem. I understand that it is completely counterintuitive. Stopping solution-seeking will feel like the wrong thing to do. The idea that you are suffering so badly and your therapist is asking you to do less reading, working and planning about how to fix it seems backwards. “How will I stop this from happening if I haven’t found the solution yet?” All of these reactions to your OCD fears make sense. Biologically we are programmed to find a way to avoid painful stimuli.
It is ironic that even coming to me for therapy or reading this article can be part of your compulsive process. Noticing the solving compulsion in a therapy session is critical. It is important for your therapist to understand that they may be participating in your rituals by answering questions repeatedly about how to do the therapy correctly. It is the proper response to allow you to feel anxious and uncertain about whether you explained or heard something well enough. Your exposure is to walk around with doubt about whether your perceived shoddy understanding of your therapy session is going to affect your progress negatively. This is the response that will weaken your OCD. If you do solving rituals in an attempt to be certain that your OCD will improve, you will feed your OCD and it will remain powerful and active.
For example, you may fear that you did not understand the concept of mindfulness well enough after we discussed it in session. Eastern philosophy is often a key target for OCD solving rituals because it can be ambiguous and idiosyncratic in its application. You assume there is a correct way to apply the skills and feel you must find out how to use them properly. It feels too risky to take it for granted that a seed was planted and allow your acquired knowledge to unfold organically. You must know “for sure.”
Discontinuing solution-seeking will feel like flying into the dark with no safety net. That’s how it is supposed to feel when you are doing an exposure correctly. When a man with OCD touches a doorknob without washing his hands, he feels anxious and uncertain. Maybe he will touch HIV-infected blood or someone else’s urine. Feeling the pain of this doubt is how you will know you are on the right track. In your case, sitting with uncertainty and fear about how not perfectly understanding the therapy will lead you to a life of panic and incapacitation, (or whatever your feared consequence might be), without doing more solving is your Exposure and Response Prevention (ERP).
Exposure and Response Prevention
Exposure and Response Prevention is an evidence-based behavioral therapy that has been found to be the most effective treatment for OCD. By learning to face your fears directly (i.e. touching a door knob) and refraining from performing neutralizing rituals (i.e. washing your hands), you eventually habituate to your fears and weaken your OCD. Imaginal exposure is a method where you are asked to imagine or write scripts about your fears. Exposure scripting is a good method to use if you are afraid of losing and not being able to regain control from your OCD. You will attempt to spike your anxiety intentionally by writing about all the ways in which your fear will likely come to fruition, and when it does, all of the horrible consequences you will have to contend with. After you’ve spiked your anxiety, you must resist the compulsion to find the solution to your OCD.
Solving Rituals in OCD
In ERP, we will create a hierarchy of compulsions listing all of the compulsive solving that you are engaging in. This is done so that you can identify when you are slipping into compulsive solving. It might look something like this:
- Create list of questions to ask therapist when I get fear about my therapy
- Asking therapist to repeat instructions
- Online research about OCD treatment or medications
- Excessive note-taking in session
- Re-reading OCD articles or notes taken in therapy office
- Highlighting key concepts in OCD books / reviewing highlighted materials
- Visiting multiple types of professionals / types of therapy
- Researching medications
- Reassurance-seeking / Discussing OCD with loved ones
- Mentally reviewing any reassuring information gathered
- Overdoing homework assignments
- Resisting letting go of assignments after therapist has suggested they should stop
In therapy, your anxiety will spike when you doubt your understanding of the material, which should be viewed as another type of exposure. We will practice sitting with the discomfort and uncertainty of your OCD prognosis. My clients who engage in the solving compulsion often try to guide the session towards psychoeducation. I identify this behavior as a solving ritual, and encourage efforts to experience the desire for answers mindfully. They often leave the office feeling anxious and incomplete. Discomfort is what you should expect after an exposure. But when you begin to understand the solving ritual, you will know that walking away from session with uncertainty is because you had a good session of exposure work.
Mindfulness
Experiencing the thoughts and emotions caused by your OCD theme using mindfulness is a necessary step. Mindfulness is the non-judgmental awareness of the present moment and all that it offers. Allow the pain and uncertainty of your OCD to be present in this moment by noticing and inviting it in. You can make room for it if you are mindful. This will help you to resist engaging in the solving ritual. You might ask yourself, “Am I scrambling for a solution right now?” Cognitive-Behavioral Therapists often ask you to rate your anxiety on a Subjective Units of Distress Scale (SUDS). Instead, rate your level of resistance to the discomfort that is present in the moment from 1 – 10. If it is a high number, make a decision to lower your efforts to change the moment. If you don’t fight your OCD, it will eventually learn to stop trying to provoke you.
Having unwanted thoughts and feelings about losing control of your OCD is not the problem. Your effort to rid yourself of your thoughts and feelings is the problem. Realize that the structure of your OCD is now made up of both your overt and mental rituals. These rituals are used to “solve” the fear and uncertainty that you will not be able to gain control back from your OCD. It will feel like a risk to discontinue solution-seeking. I know it seems to be the only glue that is keeping your OCD at bay. In the beginning, learning about your OCD was helpful. It is important to recognize when to shift gears and acknowledge that the same behaviors are having a very different effect. Facing uncertainty and anxiety offensively is the method of treating all forms of OCD, and this is no different. Move forward bravely and take the chance that your OCD will spin out of control. You will deplete your OCD of the oxygen it needs to survive, your solving rituals.
Stacey Kuhl Wochner, LCSW is a psychotherapist in private practice in Los Angeles, CA specializing in the treatment of OCD. Follow her on Facebook.
How curious no one posted a response here…
This article was great, thank you!
Thank you, Jason.
I’ve only just discovered this site (about 15 minutes ago). Amazing, fascinating, excellent article! So logical!
Now to read on!
Hi Linda, Thanks for your kind words. I’m glad you found the blog and you’re finding this article helpful.
Thanks alot for writing this article, its shocking how accurate it is. I get anxious seemingly out of nowhere and I frantically try to think of a phrase or something to make it go away. Sometimes its “What’s causng this?”, or “Why am I feeling this way?” and “I need to figure this out so that it will never return.” Afterwards, I continually check to see if its still there. Is this the solving type of ocd or is it just a negative reaction to anxiety? Its like I fear something, I guess its anxiety that I fear im not really sure. Or maybe its fear of losing control.
Thanks again for the article.
Hi Chris, I’m glad the article resonated with you. It is very common for all of us to want to avoid uncomfortable emotions. It can rise to the level of OCD if a person begins performing rituals for more than an hour a day to try to neutralize unwanted thoughts / feelings. The example you described, “…frantically try(ing) to think of a phrase or something to make it go away” certainly fits the description of a compulsion. While I can’t diagnose you since we haven’t done an assessment, I have certainly had clients whose primary fear is losing control over their mental state / being overwhelmed by their OCD / anxiety. Exposure and response prevention therapy can help with exposure to fear / uncertainty and reduction of solving and other rituals, coupled with mindfulness skills training to help with acceptance of unwanted feelings.
In my last session with my CBT therapist she told me that I am over thinking everything about my OCD. When I read your article, in which you mentioned the “solving compulsion”, I immediately recognized myself. My fear of losing control of my OCD has dominated my thoughts the last few weeks. The immediate insight that I felt that I have gained from reading your article has given me encouragement and renewed hope in living with my OCD.
Hi Charlie, I was hoping my article would reach some of the solvers out there! I’m glad to hear it gave you some insight about your OCD as of late. Keep recognizing and labeling solving when it shows up. It will feel very uncomfortable and that’s how it supposed to feel when you are doing it correctly.
Ma’am, aren’t these symptoms of OCPD?
The obsession of losing control of OCD treatment success that leads to solving rituals described in my article is OCD. It is often proceeded by or accompanied by other OCD themes as well. These clients wish they did not have to engage in solving rituals but they feel forced into ritualizing out of fear of spinning out of control. The presence of true obsessions and fear-induced compulsions makes this OCD. While individuals with OCPD have developed a personality style and life philosophy of perfectionism, rigid rules, organization and schedules, those with OCD have a distinct obsession and compulsion cycle that improves once the person faces fears and stops doing solving rituals and other types of compulsions.
How is this different from OCD-based perfectionism? Some would argue that they’re not the same; others, that OCPD “represents a marker of severity” in OCD (Lochner et al., 2011) — i.e., that OCPD is a type of ego-synton/insight-lacking OCD.
To be honest, we’re not really interested in making or understanding this distinction. This article has only drawn our attention because we’ve done something similar to the “solving ritual”, and what we would really like to know is whether any of these patients does or did suffer from scrupulosity and/or perfectionism OC(P)D.
Thanks for the thoughtful discussion. I just got the Melvin Udall reference 🙂 This is not about a diagnostic category, but rather a ritualistic pattern of responding to fear. In other words, those with OCD and co-morbid OCPD may also engage in this ritual but not exclusively. I have almost exclusively seen clients who engage in ‘compulsive solving’ to be the mental ritualizers, the expert analyzers – HOCD, POCD, Harm OCD and the like. After a course of ERP, the OCD is not too keen that the client isn’t as willing to do compulsions. The OCD will then take this unconventional approach and the client falls for the new fear as real danger. In the publication you cited above and in my experience, those with the OCD + OCPD combination often fall under symmetry, ordering, organizing and hoarding themes. While they may have strong and perfectionistic beliefs in the way they organize their environment, the efforts to ‘fix’ the problem as in ‘the solving ritual’ is often not present. In fact, they often argue in therapy that the way they do things is the right way and frequently defend compulsions. Due to their lack of insight they want to stay the same when the ‘solvers’ want to change…yesterday. In regards to perfectionism, my ‘solving’ clients have a tendency to want to do things expertly and think of things in an ‘all or nothing’ way.
Beautiful post. Funny thing I already knew it yet I’m here. I hope this positive feeling doesn’t turn into a ritual and make me come back to this site haha.
Hi Brandi, Thanks for your comments. It is a slippery slope, right? It is good to read up on OCD but also good to be mindful of your current intentions. A good rule of thumb is to read when you don’t feel desperate to “fix” your OCD.
Your article lets one infer that this type of patient has masterfully conquered all of his other obsessions/compulsions. If that is true, then this really must be some kind of “solving ritual”. But if not, I doubt it is anything more than “information hoarding” with a specific, limited focus on OCD.
I think of information hoarding similar to the hoarding of physical items, gathering all kinds of useless information in the event it may be important or one might need it in the future. Those performing the solving ritual are responding to a very specific fear of losing control of their CBT skills and feel vulnerable to relapse on their previous theme. They don’t realize there is a new theme in town. But we use these terms to help understand OCD, so whatever works to help a person gain insight on obsessions and compulsions can be equally as effective depending on the individual.
There was an interesting article in the OCD Newsletter of Late Fall 2006, “Information Hoarding: The Need to Know and Remember,” written by Renae Reinardy, PsyD, where she classified this compulsion in three different categories, based on “the types of information that people feel compelled to acquire and save”: a) (personal) memory items, b) research items, and c) general knowledge items.
“Research items include information that is sought out for a specific purpose. Common sources for this information include researching on the Internet, books, magazines, newspapers, ‘Consumer Reports,’ and asking questions of friends and family. Research items are often acquired either with the intention to help the individual make some type of decision or for general interest. People with this type of hoarding will often research items for days or weeks with the intention of assisting them in making the ‘right decision,’ regarding home appliances, doctors, home repairs, where to travel, employment opportunities, and volunteer positions. They are often trying to reach the experience of ‘fully knowing.’ Many people will do research when making an important decision, but with hoarding this process is much more laborious than is often necessary. Information hoarders may enjoy this process or feel tortured by their feeling of ‘needing to know.’ This process can lead to hyperfocus – that’s when individuals will research for continuous hours without realizing the time or taking care of basic needs (e.g. sleep, eating, family time).”
(The entire article can be found at the St. Louis OCD Support Group webpage.)
Yes I would say the difference here is the “needing to know” vs. the desperate need to fix / solve to prevent relapse as in my article.
How can I receive the right medication for my neurosis without telling a psychiatrist about my symptoms? I really don’t want to talk about “obsessive-compulsive disorder” anymore.
I believe the obsessions and compulsions are okay to have, as much as I’d rather not have them, because I believe OCD is the natural, organic of humanness (under certain circumstances) to develop. I also believe that, like a wound to the flesh, the less I pick at the OCD, the better and quicker it’ll heal (and with less chance of scarring).
Hi Ishmael, I recommend talking about OCD with your psychiatrist to make sure you get the proper medication at the correct dose. You may want to vet the person over the phone about how many OCD clients they have treated so the process can be as painless as possible.
Hi Lisa, It is true that OCD will get worse with more picking…like a mosquito bite. Good analysis.
Hi Stacey and other friends visiting this site,
Please help me. I incured this problem of incursive thought on 22 July 2014. I was holding my son, 19 month old, ground floor of my partment in the morning. Playing fleetingly, he kicked on my genitals. This had happened many times in the past also. But, that day I remember – reason unknown to me – an idea fleeted in mind (all in million of second) that Am i thinking sexually abuding my darling son. I can tell you with promise of my life that this was definitely not my thought but obviously my mind threw this thought at that moment. I become so anxious, depressed, sad and reclusive. I started forgetting this thought. I started analysing this thought that ” Am I a pedophile?”.
The reality is I love my son more than my life. I can,t even think I will be able to describe – in writing – how much I love him. I can even tell sometime to myself how much i love him. He is my life. The problem is, from that day onwards I have never forget that thought. Whenever I see my son I start analysing that thought again and again. Its snatching my life.I feel utterly depressed. Sometime I think that I am happy and try to think if I have forget that thought and by doing this I simply remember the thought again. Its so disturbing and I think someone from you help me in fighting this out and cope with the situation. In the end, I must say again and loud, I love my son so much I can’t even imagine plucking one of his hair. All help, even in small word is welcome and appreciated.
I do not intend to self-medicate, don’t worry. I was just wondering whether a psychiatrist would be willing to give me prescription drugs without having to talk about my symptoms too much — just by telling him/her, “I have OCD, trust me.” I doubt it, though…
Wow! This is me to a tee! Thanks for the article.
Hello. Thanks for sharing your experience about your unwanted thoughts about harming your son. We are not our thoughts, we are the beings that witness our thoughts. Because your son accidentally kicked your genitals, your mind generated a thought that is fairly normal. The part that is OCD for perhaps you and many of my clients, is that the thought is repetitive, causes anxiety and appears meaningful in some way when it’s not. Instead of trying to eliminate the thought or checking if it’s gone, instead try to bring in the thought purposely multiple times every day. Making contact with the thought will change your philosophy on experiencing it and help you to cope with the symptom rather than fight against it. Exposure and Response Prevention with a trained OCD specialist is recommended.
It wouldn’t be a good idea to withhold information from someone prescribing medication to you, but I can understand your concern. Many people have had bad experiences with going to psychiatrists who misunderstand their OCD symptoms. You may want to vet the person over the phone to be sure they have seen clients with similar obsessions and that they understand and believe in CBT / ERP for OCD.
Thanks, Eric.
Wow, i can’t believe you nailed that down like that. That’s amazing i needed to read that. Someone in an online support group posted it. I know i’m doing it, i can feel it. It’s amazing that we do whatever it takes to avoid that raw fear. Maybe the compulsion of reading this to reduce my anxiety about my ocd will actually lead to a reduction in compulsions, that’s a first. It was very helpful. Thanks matt
Hi Matt, Thanks for your comment. I’m glad the article was helpful. As you say, facing the ‘raw fear’ is the only way. At least this time your compulsion led you to something that will help defeat it!
Great article.Thanks Again. Fantastic.
Stacey, this is pure gold. I have searched in vain for years for an article dealing with obsession about obsession (and subsequent solving rituals), there is very little out there. I wish I would have found this sooner.
I have played “whack a mole” with pure-o my entire 51 year life. A lot of standard stuff; inappropriate thoughts/words/images, fear of diseases, anxiety about anxiety. I have successfully banished and rebanished such over the years, but obsession about obsession (or obsession about getting into the ocd depression “bubble”) has been the most brutal, frustrating one of all (or so it seems). I managed to slip into it over two years ago.
I will often try and tell myself that in having a “doubt disorder”, that the subject of my obsession doesn’t matter, and that I have to mentally get above the doubt and forget about the topic…but I fear that has become a ritual as well. Trying to work the 4 steps in the book Brain Lock also seems like it becomes a ritual. Trying to mindfully examine your thoughts apart from seeming to have no control seems like a ritual.
So if I’m understanding you correctly, the ERP in this instance is to allow yourself to be overwhelmed by the fear/thoughts/panic of not being able to forget about your ocd (or the ensuing sense that you are spiraling into a mental abyss), and don’t do anything to try and stop it? That has happened to me on a fair amount of occasions anyway because I didn’t feel I had a way to stop it, and yet the pattern continues. Maybe I ritualized on my way “out” and so did not get the benefit of the plunge.
Thanks for sharing your insight on this frustrating ocd rabbit hole.
Mike
Hi Mike, Thanks for reading my blog. You are correct. Think of the moment when you feel overwhelmed, confused, and doubtful about what therapeutic technique to use next and if you are using it correctly as the obsession. Think of your mental examination of the perfect actions you should take as the compulsion. If you practice mindfulness and allow yourself to sit in the doubt and confusion, while it is present, than you are doing your ERP.
Thank you for this detailed post explaining exactly my frustration of not feeling adequate in finding a solution to resolving my OCD – I thought it was just me that acted the way you describe and have not read anything previously that reassures me I am not alone in performing this solving ritual.
I was an analyst for many years and therefore thought that I was just not reading the right articles or books to find the correct solution or magical statement to help me.
My OCD thoughts of being inadequate in ‘solving’ this condition actually increases my anxiety. I take from this article that I must learn to ignore my concerns to put more effort into finding answers or solutions.
Hi Lily. I’m glad you related to this article. It is so counterintuitive to allow the OCD questions to go unsolved, but finding this balance is what will set you free.
Great article. Prior to seeking your office for treatment, this is exactly what I was doing. In fact, i was trying to find a way to quantify who would be BEST qualified to help me, and then after making a decision, fearing that if I can’t be helped… i’m screwed! The first suggestion I got after my first visit was to stop researching. Talk about hard! I felt like that was the only thing keeping OCD at bay enough for me to function.
It’s surprising how tricky OCD can be.
The fact that I read this article could be me compulsing… I think i’ll just go on with my day 🙂
Thanks for your comment. It is very tricky. OCD is a con artist and it need to con you to survive. But you are ahead of the game if you are noticing this and labeling it! Be kind to yourself with mistakes as nobody can be perfect with it.