“If you step on a crack, then you’ll break your mother’s back”. How many of us twisted, teetered, and contorted as we hop-stepped along the sidewalk as kids; with that little saying running around in our head? Most of us have played some version of this silly little game. We drove our mothers crazy as we slowly made our way along the path/mall/grocery store when they were in a hurry. Now, imagine for a moment that you wake up one day and find that it really is true… If you (and only you) were to actually step on a crack, you would, without a doubt, cause some sort of cosmic rift in the universe and your mother would fall and break her back. Literally break her back. And it is preventable if you perfectly avoid every single crack. Forever.
What would life look like upon waking up that morning? How long would it take you to make your way across the tile in your bathroom? Kitchen? Down the bricked path leading from your front door to your drive way? How much longer would it take you to get through a normal day’s routine? Would you ever stop watching your feet? How exhausted would you be by the end of that first day? Would it even be worth leaving the house the next day?
This is what life is like for someone with OCD. They have come to believe that their rituals and routines are exactly that vital… that if they somehow fail/mess up performing the routine, something terrible and catastrophic could/would happen. It could mean something bad will happen to someone they love, they will lose someone or something important to them, they will even cause something as catastrophic as a deadly plane crash, tsunami, or earth quake. People with OCD do not always know what the “bad thing” will be exactly, but they have the haunting, ominous feeling that it will happen. And it will be All Their Fault.
Those who suffer from OCD often report a history of anxiety and feelings or fears of being out of control. Some have experienced traumatic events such as the death of a loved one, car accident, or sexual trauma which caused the feelings of uncertainty and lack of control. They attempt to reduce the anxiety by finding something they can control… such as rituals and routines. Logically, they know that they are not actually managing the world through hand washing and turning off lights. The feelings of control they have through performing their rituals provides a false sense of safety and security they are reluctant to give up.
When working with clients with OCD, simply focusing on extinguishing the rituals and routines will not be enough to bring long term relief. The source of the anxiety and fear of losing control must be explored. As the individual learns better ways to manage anxiety, and experiences an increase in emotional tolerance, the need to perform rituals will decrease. They will be able to challenge the obsessive thoughts and learn to replace them with rational thoughts.
Over the last few weeks I have watched the UK Wildcats make their way in the NCAA basketball tournament. I am a huge fan of UK basketball, stemming from my graduate school days. The final 4 game was quite a nail biter. There were 15 seconds left in the game, and UK was down by 2 points. The player raced down the court to take what was about to be the game winning 3-point shot. I was aware that I was crossing my fingers (on both hands) and muttering “c’mon, c’mon, c’mon” with increasing volume as the player charged down the court. Although I know this had no actual bearing on the outcome of the game, I couldn’t resist my superstitious little gesture. I’ve done it, you’ve done it. Who hasn’t, at some point in time, performed a similar little motion? For our friends with OCD, it is more than a superstitious gesture, or simple magical thinking. If we can think of the times when we have performed similar gestures (on a smaller scale) and then imagine what it would be like if I believed the action actually did matter; we will be able to have some empathy with what they are going through and show them the love and support they need to confront the deeper fears, anxiety or trauma that is the root of their OCD.