Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Do You Use Avoidance as a Compulsion? The Consequences Can Be More Extreme Than You Think.

By Stephen Smith

Sep 22, 20216 minute read

Reviewed byPatrick McGrath, PhD

People with OCD have intrusive thoughts, images, and urges called obsessions that cause severe distress. To make them go away, they perform safety-seeking actions called compulsions. Yet, despite sometimes alleviating anxiety in the short-term, compulsions cause OCD to worsen long-term, even though they may feel like the most logical response to one’s obsessions. 

Compulsions can be outward actions like washing, Google-searching, and asking someone for reassurance; or they can be mental actions such as reviewing past events, assessing or checking bodily sensations, and reassurance-based self-talk. 

Although all compulsions are counterproductive to treatment, since they cause OCD to become more severe, there is one type that can often be the most detrimental to recovery: avoidance. Here’s why.

OCD episodes often cause people to experience heightened anxiety. For instance, when out during a weekend night, someone with sexual orientation OCD (SO-OCD) might get unexpectedly triggered by being in a crowded room and feel a surge of anxiety that is so strong, it makes it difficult for them to breathe.  

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When they use avoidance as a compulsion, they might leave the room to get fresh air as opposed to sitting with their discomfort. They may also decide to stay home on future weekends, in order to prevent getting triggered and feeling crushing anxiety again. As a result, the avoidance not only makes the OCD fear grow stronger, since it’s a compulsion, but it can also cause the person with OCD to live in isolation. 

The ramifications of the isolation can be devastating and often falls into two categories: loss of family and friend connection, and loss of employment or educational degrees.

Loss of Friends and Family Relationships: 

Similar to the above example, instead of going to family gatherings, spending time with friends, or even holding their own children, people with untreated OCD might avoid these scenarios to prevent triggering intrusive thoughts, causing them to lose important relationships.

Here are four scenarios, based on real subtype examples that my team and I see regularly: 

Postpartum OCD:
A mother with postpartum OCD – a subtype of OCD that affects about 3-5% of all new mothers and some new fathers – might avoid holding her newborn to prevent having OCD fears that she might harm her. The avoidance both makes the mother’s fears worsen and could lead to the need for others to raise the child, preventing her child from forming healthy bonds with her mother. 

Incest OCD:
A person with Incest OCD might have recurring sexual intrusive thoughts about a close family member. As opposed to spending time with the family member, the person might avoid them completely for months or even years in some cases, which causes the relationship to dissipate. This might cause both the person with OCD and the family member to live alone in sadness, a driver of negative health consequences in addition to OCD. 

Health Concern OCD: 

Someone with Health Concern OCD may excessively check their body for new symptoms or symptom changes, for fear of getting a disease or developing a potentially life-threatening illness. A college student who has Health Concern OCD might avoid hanging out with her sorority in order to avoid becoming severely ill. As a result, she might spend the majority of her time in her dorm room in distress, completely missing out on forming long-lasting friendships with her peers.

Relationship OCD:
Whenever Relationship OCD strikes, it usually becomes extremely difficult to maintain a healthy relationship. People with Relationship OCD often avoid their significant other or they avoid situations that might trigger their intrusive thoughts. The consequences can be disastrous. Many will end incredibly happy relationships to make the pain and suffering of their intrusive thoughts go away. This usually doesn’t make the thoughts stop and instead fuels them, creating a scenario where the OCD becomes worse, and the person is left to battle the negative consequences of a traumatic breakup. 

Considering some of the happiest memories in life are shared with friends and family, it’s brutal to think of a life without them. Think of this point when you face uncertainty next and feel the urge to avoid your fears. 

Loss of Employment or an Educational Degree

When people with OCD avoid showing up to work or attending school because of their OCD’s severity, they sometimes lose their job or have to drop out of school. This in particular is a scenario that can be damaging, since it often creates an environment where OCD becomes very severe and treatment becomes completely unaffordable, which in turn can allow the condition to take over. 

Here are a few more examples that my team and I have seen: 

Pedophilia OCD:
Over the past decade, we’ve seen countless teachers, daycare personnel, and medical providers who avoid showing up to work because they fear that they’re secretly a pedophile. It’s important to understand that OCD attacks what people love most, so not only are these professionals with POCD typically the least likely to actually be pedophiles, but they’re often also great at their job. Since they’re so caring in nature, these folks would rather lose their job than put the children they serve in any potential harm’s way. 

The consequences are horrible for the people with OCD. They experience more severe symptoms over time, given they’re actively performing a compulsion, while also losing out on the income needed to access treatment and live healthy. 

Taboo Violent Intrusive Thoughts:
Given the frequency in which violence at schools is highlighted in the media, it isn’t uncommon to see high school and college students suffer from violent and unwanted intrusive thoughts. Like the professionals who suffer with Pedophilia OCD, students with OCD who struggle with taboo violent thoughts towards others are often the least likely people to ever be at-risk for commiting heinous crimes at school. They will, nonetheless, avoid school in a misleading attempt to make their thoughts stop and to keep others safe. 

There’s another cohort of students who suffer from these violent intrusive thoughts, but instead of fearing that they’ll hurt others, they fear others will hurt them. To ensure their safety with what they believe is 100% certainty, they will also avoid school. Like in the examples above, this scenario creates a dynamic where the people with OCD get worse and lose out on successfully completing their education. 

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How to address compulsive avoidance 

In some cases, the loss of family and friends can happen in conjunction with the loss of unemployment or degrees, which can even cause some people to encounter grave consequences, such as experiencing homelessness. This is one of the reasons why avoidance can be so difficult for people with OCD. 

If any of these examples have caused you to realize that you are suffering from OCD and are practicing avoidance compulsively, don’t feel dejected. There’s help available. The key to addressing avoidance and treating OCD effectively is by seeing a licensed therapist who specializes in OCD and is specialty-trained in Exposure and Response Prevention (ERP)

It’s important to see a specialist because they’ll specifically help you prevent avoidance and other compulsions. A specialist will teach you how to accept the uncertainty behind the OCD fears and will give you the tools and knowledge needed to learn how to implement acceptance into your daily life. 

At NOCD, we have licensed therapists that are specialty-trained in treating OCD with ERP, and I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment.

Even if a NOCD Therapist isn’t for you right now, there are other reputable avenues you can explore. The IOCDF has a directory, as does Psychology Today. (Note: Beware of licensed therapists who claim false expertise in OCD. We also recommend that you ask this list of five questions ahead of your first session with any therapist claiming to treat OCD – even those at NOCD. Working with a therapist who does not provide proper treatment for OCD is not only ineffective, it can be harmful and make OCD worse.)

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