Barry EIchenbaum, Psy.D.
Why embracing uncertainty is the key to navigating OCD
OCD is commonly subdivided into different groups based on its particular manifestation. You might even be familiar with certain acronyms that highlight the differences, such as POCD (pedophilia OCD), ROCD (relationship OCD) and HOCD (homosexual OCD). Or, you may recognize other categories, such as contamination OCD, scrupulosity, and harm OCD. Dividing OCD into these various categories is helpful because it gives us a common language to describe varying experiences. This makes a lot of sense when we examine OCD from an external lens, from the external manifestations. For instance, the compulsive hand washer with contamination OCD can appear very different from the POCD sufferer who avoids being around young children. However, when you enter the internal world of the OCD experiencer, you’ll likely see that their core struggles are actually quite similar.
Life is full of uncertainties--WIll I lose my job? What if I suddenly contract a deadly disease? Will this relationship work out? These are just a small sampling of common uncertainties that people face all the time. The list of potential uncertainties is literally endless. While uncertainty can be a naturally uncomfortable experience for anyone, many people can accept the uncertainty and move on with their lives. But for someone with OCD, the reaction can be quite different. Thoughts about uncertainty constantly plague the mind and make engaging in other activities difficult. For example, many people experience thoughts about getting sick or having something dirty on their hands. When experiencing these thoughts, most people dismiss these thoughts as thoughts and have a sense of confidence that they won’t get sick, or that if they do, that they will be ok. But if you have contamination OCD, you may have difficulty tolerating even a small degree of doubt regarding the prospect of getting sick and feel a need to act on these thoughts. As a result, you will continue to obsess over these thoughts and engage in compulsive behaviors to alleviate this anxiety.
Once you recognize the common denominator of uncertainty in all forms of OCD, the particular content of the OCD, while relevant, is not the primary driver of the distress. The content is simply how the internal uncertainty manifests itself in the external world, but it’s not the root of the issue. Put differently, the content is the symptom, while “uncertainty” is the underlying disease. Once you appreciate how your OCD is rooted in uncertainty, two interesting phenomena begin to come to light. The first is that it’s common to experience several forms of OCD. The second is that it’s likely that the particular manifestation of your OCD may have morphed over the course of your life. Since your core struggle is the fear of uncertainty, it’s not surprising that there may be a variety of content that manifests in this uncertainty, and that the content may change relative to an individual’s stage in life.
This is also why attempting to use logic is often an ineffective approach to treating your OCD. If you have OCD, you or others around may try to convince you that the chance of your feared consequence coming true is extremely unlikely. But, as someone with OCD may note, this doesn’t necessarily translate to the symptom improvement that it’s intended for. This is because both the non-OCD and OCD experiencers may agree on the probability. However, the former focuses on the very high probability that the aversive event will not occur, while the latter focuses on the very low probability that it will occur. The OCD sufferer’s brain constantly sends them these alarm signals, often leading to significant distress. Even if a person with OCD understands that the event is unlikely to occur, he may still engage in compulsions in an attempt to make the thoughts and the accompanying distress go away.
We can take this a step further. The content of obsessive thoughts frequently changes even within the same general OCD theme. A common occurrence is for a person to have certain thoughts that they are able to label as obsessive. These thoughts aren’t that distressing because the person being able to label a thought as obsessive helps them feel that the thought is irrational and does not require a response. As a result, they no longer experience any meaningful uncertainty here. But when a thought with slightly new content arrives, the person may be uncertain whether to label it as obsessive, which they can ignore, or non-obsessive, which would mean they would have to take it seriously.
For instance, if you have harm OCD, you might experience intrusive thoughts of hurting your loved one. You might obsess over the uncertainty of whether you would ever act on these thoughts, doubts that could be very distressing. Let's say the intrusive thought that plagues you is an image of attacking a family member with a knife. While you may struggle with such thoughts for a while, you may reach a point where you are able to confidently label them as obsessive, which significantly reduces your uncertainty about whether or not you would act on this thought. But then you may begin having images of poisoning this family member. This is new content, and you may be thrown off guard. You might experience the following internal struggle: “This might also be an obsessive thought, but maybe this thought is different! Even though I don’t think I would stab someone, maybe I would poison them!” While the content may be different, this is really just another variation of the OCD sufferer’s core difficulty with tolerating uncertainty. Once again, you might be getting too caught up in the content and fail to consider the underlying basis for the thought. Regardless of the content, the important point is to identify whether the root of your concern is a fear of uncertainty.
Understanding OCD’s uncertainty roots can help when you experience obsessive thoughts. You can try the following:
If you detect an obsessive thought, try to unhook yourself from the content of the thought. Realize that the more you get hooked on the content, the more likely you will be to struggle against the thought.
Is the root of this thought a fear of uncertainty? If it is, then you have two choices. If you try to push away the uncertainty by engaging in a compulsive behavior that offers some reassurance (e.g. handwashing, checking, etc.), the benefit will likely be short-lived. But if you choose to live with the uncertainty, perhaps even embracing it, it may certainly feel uncomfortable in the moment, but it may afford you greater flexibility in responding to uncertainty in the long-term.
Repeat this even if a thought with new content emerges.
Living a life constantly dictated by avoiding uncertainty can be exhausting and can make it difficult to make decisions that best reflect your values. While accepting uncertainty can be scary at first, you’ll likely get used to it over time if you stick with it! Furthermore, the satisfaction of living a value-driven rather than fear-driven life can help motivate you to push through and embrace a life of uncertainty.