Few conditions cause people to feel more isolated, misunderstood, and debilitated than obsessive-compulsive disorder (OCD). That’s why OCD has been consistently ranked by the World Health Organization as a top 10 cause of disability, and why people with it often develop severe comorbidities like substance use disorders (SUDs) after going untreated for some time. In fact, a study found that between 25-40% of people with OCD suffer with substance use disorders, and 70% of people develop their substance use disorder after their OCD symptoms onset.
The condition’s chronic nature plays a big role in the turmoil it causes. Episodes strike unexpectedly, and when they occur, they hit like a ton of bricks. Over time, the frequency and severity of unexpected episodes cause people with OCD to do things such as self-medicate and avoid leaving their home – seemingly their only plausible solutions to end the pain. As a result, many people with OCD have a very difficult time holding down a job, attending school, or even engaging in common social activities.
But, when OCD is effectively managed, unexpected episodes become less problematic. It’s an incredibly liberating feeling to not have to walk on eggshells from morning to evening, just to avoid getting triggered and sent into a cycle of distress.
Experiencing this level of transformation starts with seeing a licensed therapist that is trained in Exposure and Response Prevention (ERP) – the evidence-based therapy for OCD that teaches people to extinguish compulsive behaviors – and it ends with learning how to effectively self-manage through OCD episodes when on one’s own.
Learning how to manage OCD while alone is probably the most important aspect of treatment. Given the chronic nature of OCD, even many people in treatment must be able to manage OCD alone, considering that most ERP therapists are typically only available for less than 1% of the week.
At NOCD, we know that when people with OCD are on their own, that’s when they need the most help. That’s why our therapists offer members self-help tools, support groups, and other services to manage unexpected episodes between sessions.
Therefore, my goal with this article is to provide another resource – a very specific explanation about how to manage when OCD episodes strike unexpectedly when you’re not in a session with your therapist, using real-world examples that our therapists have seen over the years.
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Scenario 1: Health Concern Fears
It’s 5pm on a Friday night and you are going out for happy-hour drinks with your coworkers. As you walk into the bar, you notice that it is jam-packed with others like you, who are enjoying time with their colleagues to celebrate the end of the week. You don’t think twice and push through the crowd in order to try and find a table for you and your team.
Suddenly, a man with a short-sleeve polo brushes up against your side, due to being in close quarters at the bar. You notice a small scab on his arm that is oozing blood slightly. Suddenly, you’re overwhelmed by a tidal wave of anxiety. Your mind starts racing with thoughts such as, “Did the blood touch me?” “What if he had HIV?” and “If I touch the blood, will I get HIV too?”
What Not to Do and Why
If you were to handle this situation ineffectively, you might immediately check your body to see if the blood spilled on you. Even if you see none, you might rush immediately to the bathroom and wash your entire arm for 5 minutes. Others in the bathroom may be looking at you as if there might be something wrong, but you’d ignore them, because you are dealing with a bigger concern at the moment. Once you get back to your table, you might even ask your colleagues to observe if any blood dripped on you as a double-checking mechanism. These are all compulsions – actions done to make the fear of contracting HIV dissipate.
You might also do more subtle safety-seeking behaviors to make the fear stop. For instance, you might mentally replay the scene of the man with the bloody scab bumping into you, just to ensure with complete confidence that none of his blood spilled on you. You also might deeply analyze the logic behind the thought, to understand why you are so afraid of the situation, and reassure yourself that it’s a low probability of contracting HIV.
Notice the commonality between all actions. They’re each done to eliminate a perceived threat or to make your fear go away. However, they’re bringing heightened attention to the fear and actually making it worse.
What to Do and Why
Now, if you were to handle this scenario effectively, you might respond to the fear by saying, “Yeah, that man might have had HIV, and I could have contracted it from him. Who knows – but I’ll accept the uncertainty and move on.” Or you might respond by saying, “So what? I’ll cross that bridge if it happens.”
These responses might feel idiosyncratic in nature, but they are perfect for replying to OCD. Why? Because you aren’t doing a specific action to try to push the thought out of your head. It might feel scary to confront your fear like this, but by doing so, you tell your brain that it is relatively insignificant. Regardless of the anxiety or distress from OCD, you can instead spend that moment celebrating the start of the weekend with your friends.
Scenario 2: Sexual Intrusive Thoughts
You and your family just walked into a grocery store on a Sunday morning to buy food for a brunch you’re preparing. As the automatic sliding doors open and you walk into the store, you immediately notice that it is bustling with people getting food in preparation for the upcoming week. Knowing crowds trigger your sexual intrusive thoughts, you begin to feel a subtle tightness in your chest, assuming that an OCD episode is on the horizon.
Sure enough, as you’re walking down the aisle to pick up some eggs, bacon, and a gallon of milk, you see a middle-aged woman walking right by you. Immediately, your thoughts start racing: “Am I attracted to her? When I look at her, do I have the same level of attraction that I’d expect? If so, why? If not, why not?”
Since you can’t answer your question one way or another with complete certainty, anxiety smacks you across the face, and you begin to panic.
What Not to Do and Why
The more taboo you believe the thought is, the more likely it is that you’ll do mental compulsions, because you don’t think it’s socially acceptable to ask for reassurance for taboo fears. In this situation, the worst thing that you can do is to mentally reassure yourself that there isn’t anything wrong with your levels of attraction for the woman.
In addition, you might analyze your sexual intrusive thoughts to try and find the answers that will ultimately make the doubt stop. When analyzing the thoughts, you might compare your current situation to past situations and feelings, so that you can confirm that you are completely fine and nothing is wrong. You might even check your body for specific feelings. When these actions don’t lead to immediate improvement, you might begin Googling the meaning behind your thoughts to confirm their invalidity.
None of these actions will lead to progress, since they are all compulsions. That means they’ll make your fear and anxiety worse long-term. The hardest part is that sometimes these actions feel automatic because they’re mental, so you can’t control the safety seeking behavior. When this happens, it’s key to resolve the situation by immediately applying your “Response Prevention tools.”
What to Do and Why
The best way to manage this situation is to accept that you might have felt an attraction to the woman in the store. Since it is impossible to know if that means anything other than only experiencing attraction, the best action you can take is to carry on with your day by living your values.
This may be easier said than done, as it’s difficult to face your fear knowing that you risk finding out that your fear could have merit. But, how could you ever find that out with complete certainty?
There is no answer that will satisfy OCD, since neither humans nor OCD can predict the future. You don’t want to spend your life in a consistent cycle of questioning, so consider saying to yourself, “I’ll accept the uncertainty. I could be attracted to her; but either way I’ll move on and live a happy life, even if there is doubt about any part of this.”
Scenario 3: Violent Fears
You’re watching The Texas Chainsaw Massacre with your friends on Halloween night. It’s a brisk fall evening, making the atmosphere feel eerie and perfect for a scary movie. As the film progresses, its gore becomes apparent: not only are people losing their lives, but their murderers are cannibals who enjoy eating the remains of their victims.
It’s atrocious to say the least, but the chaos makes you have a thought, “What if I would like to eat a human?” You’re immediately disgusted, to the point where you wonder if your body is feeling a level of repulsion that is adequate for a scene so horrific. Anxiety pours into your head, and you’re deep into an OCD episode.
What Not to Do and Why
Believing that this thought is “unacceptable,” you might immediately check your body for signs of enjoyment or disgust. You may start assessing your feelings so you can confirm with confidence that you are in fact not desiring to kill and eat people. In addition, you might replay the scene over and over again in your head to measure your reaction to each moment.
While you are doing these actions, you are burning inside with anxiety, pretending as if everything’s “normal,” while your friends are enjoying the movie. The distress causes additional doubt and you begin reassuring yourself mentally. At this point, you’ll do anything to make the fear stop, so you reach for safety-seeking behavior after safety-seeking behavior to end the drowning. Eventually, the reassurance works and the anxiety ends rapidly.
In reality, you are in the eye of the storm, and the relief lasts for only about 10 minutes. Suddenly, the intrusive thought returns with vengeance, causing you to run out of the room to the bathroom. You begin searching Google nonstop to find an article to see if this could be a form of OCD, since if it’s just OCD, you’ll know that you actually aren’t a want-to-be cannibal murderer.
The more safety-seeking actions we do, the more OCD will return. It’s scientifically proven to be the cause of OCD. If that’s the case, what should you do?
What to Do and Why
What to do in this scenario is to resist pushing the thoughts out of your head, and instead embrace their presence. Don’t avoid the situation, and lean out. Lean in. In the moment, realize that you could find out one day that you are a cannibal murder, as technically it’s a possibility, but then again, its also technically possible to walk through a brick wall.
Therefore, your best bet is to face your fears without trying to push them out of your head, and live your life based on your values. When you have a fear, consider saying to yourself, “Maybe I’m secretly a want-to-be cannibal murder and just didn’t know it, but I’ll accept the uncertainty and carry on with my life.”
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How You Can Manage Unexpected Episodes
The truth is since OCD doesn’t go away, OCD episodes will happen – but the good news is you can successfully manage them. By building a toolbox of strategies that will help you to deal with your obsessions and not give into your compulsions, you’ll be able to handle unexpected episodes whenever they arise, even when you’re on your own.
I hope you can apply the recommendations in this article to help you as a start. But, proper treatment is the best way to both minimize the frequency of OCD episodes, and to help you long-term to manage them when they do occur.
The first step to receiving this proper treatment is to work with an ERP-trained therapist who will teach you how to manage your OCD on your own so you don’t feel stuck on disturbing thoughts. They will help you become equipped to respond in effective ways no matter when OCD strikes.
Even as you’re receiving treatment, having support when you’re not meeting with your therapist is critical, because you’ll spend the majority of your time on your own. The most challenging part of any treatment journey is trying to self-manage, especially when OCD pops up seemingly out of nowhere.
That’s why NOCD makes sure that you’re never alone on your treatment journey. You can work with a licensed therapist who is specialty-trained to treat OCD using ERP therapy, and who will begin to teach you to manage OCD on your own. You will also receive always-on support between sessions through the NOCD platform by messaging with your therapist, accessing self-help tools, connecting with peer communities, and more. This is especially useful to have when you’re on your own and have unexpected episodes.
If you’ve been struggling with repeated OCD episodes, I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment.