These are my personal answers to common questions about OCD. They’ve been reviewed by a psychiatrist and a therapist, but they are not intended as replacements for professional help.
How can I be sure I won’t act on my obsessions?
This is a hard question to deal with, isn’t it? If a professional has diagnosed you with OCD, you can be pretty darn sure you won’t act on your obsessions. This may seem oversimplified, but that’s kinda what OCD means. Lee Baer, who wrote The Imp of the Mind: Exploring the Silent Epidemic of Obsessive Bad Thoughts, says he has never met a person with OCD who has actually followed through on an obsession.
But consider this: Having OCD also means you want reassurance and a 100 percent guarantee that nothing bad will happen. And overcoming OCD means embracing doubt and learning to live with the uncomfortable idea that bad things do happen. However, you can’t prevent bad things from happening by performing a ritual.
The difference between you and a sex offender, for example, is that you don’t take pleasure in your obsessions. Think about it: Do you like those intrusive thoughts about [insert your worst fear here]? Of course not! Those thoughts are unpleasant, scary, and unwanted, and you may think of them as immoral, dirty, and wrong, too.
Is there a cure for OCD?
No, there is no cure for OCD. That might bum you out, but I hope it doesn’t. A cure isn’t the only way to make a sick person feel better, and in the case of OCD there is room for improvement of our symptoms. We can try different kinds of therapy, read books with tips and stories that help us realize we’re not alone, take medication, and use positive self-talk to get some control over our obsessions or compulsions. You might end up feeling so much better that it almost feels like you don’t have OCD anymore, or you might always know it’s there and have to deal with it more than you would like to, but once you have a toolbox of coping strategies you will get better and better at managing your symptoms.
My obsessions keep me from doing bad things. If I stop thinking of them as bad, won’t I lose the will to not do them?
Your obsessions do not keep you from doing bad things. They keep you from enjoying all of the good things in your life. If you’re obsessing about something that truly is “bad” (e.g., against your morals, harmful, or illegal), you already know that it’s wrong. That’s the reason you’re obsessing about it!
The goal is to stop obsessing and to accept that you are a good person, not that “bad things” aren’t bad.
Some people are gay. What’s the difference between being gay and having obsessions about homosexuality?
Another tough one, especially because kids who are questioning their sexuality have many of the same doubts and fears about what their thoughts mean. Not only that, but it could turn out that you really are gay (and that’s okay!) but you also have OCD and homosexuality is just one of the things you’ve obsessed about.
Ultimately, the biggest difference is that if you are having homosexual obsessions you feel distressed by them and they interfere with your day-to-day life. Again, someone who is gay may also feel distress, but it may be due more to external stressors, such as feeling accepted at school, by family members, or by a religious community.
One of my biggest fears was that I was gay. But looking back I realize that liking boys was effortless. I had my first crush on my neighbor before I even knew what a crush really was. Fearing that I liked girls instead was just that—a fear. And it came from the outside idea that homosexuality is wrong, so it has to be something I need to avoid, which means I have to think really hard about avoiding it, which means…oh, crap. I’m obsessing. Know what I mean?
On a similar note, what’s the difference between a sexual fantasy and a sexual obsession?
A sexual fantasy is pleasurable, whether the person is fantasizing about a socially acceptable act or not. A sexual obsession feels disturbing, is unwanted, and feels wrong and immoral (e.g., getting frisky with your cat, Frisky).
I go to church every Sunday and my faith is very important to me. Am I obsessive about religion?
Puh-lenty of people go to church every week. Some go a few times a week. Some pray many times a day. Some are pastors or missionaries or youth leaders. It is possible to have a healthy involvement in a religious organization or to have a strong faith without being obsessive.
Obsessing about religion means worrying excessively about offending God somehow. One might try so hard not to be blasphemous that one can scarcely think of anything else. Whereas prayer for a generally religious person is an important but pleasant activity, prayer for a person who obsesses about religion is a distressing activity, and may be done as a compulsion in an attempt to ward off bad thoughts or punishment, or to undo bad thoughts.
Crying about religious thoughts is a symptom of OCD. Not being able to think about anything but religion and God and the afterlife is a symptom, as well.
The difference between being a religious person and having religious obsessions is the feeling it brings you, and the effect it has on your everyday routine. As long as your faith is bringing you joy, meaning, and purpose you are doing just fine.
Isn’t it a good thing to stay clean and wash your hands?
Of course! But we’re not talking about washing your hands after using the bathroom or before handling food. We’re talking excessive, unnecessary hand-washing. A person’s hands won’t get any cleaner by washing and washing and washing. If you are washing your hands to the point that you are scrubbing them raw or you are washing your hands up to an hour per day, this is a problem.
Washing your hands to remove dirt or after you’ve sneezed accomplishes a task: your hands are now free of dirt or germs. But washing your hands because you have an overwhelming fear of germs and can’t come to terms with the fact that you have done enough is a sign that you need help from a professional.
Additionally, washing one’s hands to prevent “bad things” from happening is a compulsion, a symptom of OCD.
My grandma collects porcelain dolls. I swear she has a million! Does she have OCD?
Does she really have a million, or does it just seem like it because they’re so creepy looking? Can your grandma walk through her house, or is it so filled with dolls she doesn’t have room to sit down or have a place to sleep?
A reasonable interest in collecting items is not an indication that a person has OCD. One symptom of OCD, however, is called hoarding. When a person can’t stop adding items to a collection (which may not have any rhyme or reason at all) and can’t let go of them, this may be a symptom of OCD.
Note: While the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) no longer categorizes hoarding under obsessive-compulsive disorder, it has long been considered a symptom and is still being addressed as one by the International OCD Foundation.
But what if I did leave the stove on?
Life is full of surprises, good and bad. It’s true—sometimes bad things do happen. But I can guarantee that obsessions and compulsions don’t prevent them or cause them. If a person you love dies, you get sick, or a fire breaks out, it has nothing to do with anything you’ve ever thought, any compulsions you’ve ever performed or not performed, or how much you have prayed or haven’t prayed. All we can do is try our best to remember to lock our doors, turn the stove off, blow out candles, and drive safely. It’s understandable that these worries can balloon out of control and turn into crippling obsessions and compulsions. But the knowledge that doing things like actually turning off the stove (rather than checking and checking and checking to make sure we did) is the only way to prevent accidents can go a long way toward moving past the obsessions and compulsions.
I’m not depressed; I just have trouble with obsessions. Why has my psychiatrist prescribed an antidepressant?
The term “antidepressant” may be too narrow in its description of what these drugs can do. Many medications treat more than one symptom or disorder, so don’t get bogged down by the label. Antidepressants can also reduce anxiety, and OCD falls under the umbrella of anxiety disorders. Most antidepressants work by targeting neurotransmitters, especially serotonin, norepinephrine, and dopamine, each in a different way. When these neurotransmitters are balanced, your brain cells are better able to send and receive the chemical messages that can boost your mood and prevent that broken record of thoughts OCD causes. There are currently seven antidepressants proven to treat OCD in teens.
Can I stop taking my medicine when I want to?
Don’t ever just stop taking your medication, ever. You might feel like you are on top of the world, on cloud nine, whatever. But part of the reason you are feeling a million times better is you are on medication. If you stop taking the medication, you might stop feeling great, too. And the way medications work, you might not notice for the first few days, or even weeks. Your symptoms may not come back until later, which makes it hard to connect it to stopping the medication. Another risk in trying to stop medicine on your own is that there is no guarantee it will work as well if you start and stop it.
Also, you aren’t addicted to smoking or drinking or something like that, so there’s absolutely no reason to go cold turkey and go through withdrawal to get off your medication. If you need to stop for some reason or you think the dose is too high, you must talk to your doctor. Am I being bossy right now? Good! Always, always talk to your doctor before making any changes to your medication. While this is your life and your body, you are not the person who should decide how to go about going off your medication—doctors go to school for a hundred years for a reason, so trust yours to help you.
Will I have to be on medication forever?
Not necessarily. But first I want to state this: Taking medication for OCD is nothing to be ashamed of, and taking it is no different than someone with diabetes taking insulin, a person with a risk of heart attack taking aspirin, or someone with an infection taking antibiotics. View your brain as any other part of your body, but even more important. Your mental health is so incredibly important and a vital part of your overall well-being. Never, ever feel ashamed of being on medication. It’s not too much of a burden, anyway—you’re just swallowing some pills, after all. That’s not so bad, is it?
But let’s address the question at hand. As you know (or should know), you are a unique individual, so there is no one right answer. Sometimes a person with OCD needs to take medication for a short time, say six or twelve months, and other times, a person will take medication for years and then taper off with the help of his/her doctor. And some people will stay on medication for life.
Will I have to go to therapy for the rest of my life?
It all depends on what kind of problems you have and how helpful you find therapy to be. This is a decision you and your therapist can make together. What is more likely is that you will go through some period of therapy, during which you will learn techniques for coping with your anxiety. If you undergo exposure response prevention therapy you will be exposed to your fears until they aren’t scary anymore, or at least to a point where you can take over on your own time.
Now, you may want to continue meeting with a therapist to talk through everyday issues as well as anything OCD-related you’re going through. Even after I felt tons better and was pretty darn capable of coping with my OCD symptoms when they happened to pop up now and then, I still liked seeing my psychiatrist once in a while, for a few reasons. (I recently found out he is moving to a different city, which bums me out but is good for him career-wise.) One is that I genuinely like him. He is very kind, to the point that I am sometimes brought to tears because I feel so lucky to have such a sweet, understanding person on my side. Another is that I realize how far I’ve come since I first met him eight years ago. Sitting in his office chatting about work or my marriage or whatever and not feeling depressed or anxious is a testament to how much I have improved with his guidance. He was the first person I really told about my OCD symptoms and he met the challenge I set forth with such compassion I will feel forever grateful.
Touching base with someone who grounds you can be beneficial, and there is certainly nothing wrong with continuing therapy. And, of course, if you have relapses over time you can get professional help again, this time knowing what to expect. As with medication, you should feel absolutely no shame in continuing with the regimen that works for you. The road to fewer symptoms and a life that is less weighed down by OCD might be long and slow, and that is okay! Really, truly. There are so many experiences and goals in life that take hard work to achieve, and the journey can be rocky and pleasant at different junctures. And there is nothing you have to do—this is your life, and you should do whatever works for you and makes you your personal best.