You deserve to be able to trust yourself, but when you’re trying to evaluate your options or assess risk, obsessive-compulsive disorder (OCD) can make it hard. In some situations, the level of risk may feel clear. For example, It’s pretty easy to figure out that you shouldn’t take a dip in the ocean during a hurricane, or try to hand-feed a grizzly bear cub you come across while hiking. Most scenarios, however, have more nuance to them.
And if you have OCD, the desire to consider every possible level of nuance in your decision-making and risk-assessment is often part of pursuing an unattainable level of certainty. Depending on whether you’re just learning about OCD or already well-versed, you may already know this. But knowing doesn’t necessarily stop it from happening—or make navigating these decisions any less confusing. So how do you evaluate risk or decide what amount of consideration is “normal,” when you already know OCD might be affecting your perspective?
Why it’s hard to figure out what’s “normal” when you have OCD
Making choices and weighing risks can be difficult for anyone, with or without OCD. Society sends mixed messages about not only which risks we should take seriously, but also what it looks like to take them seriously. Watching the news or scrolling through social media can mean encountering dozens of different things to worry about, from food dyes, to climate disasters, to relationships, to the mental health effects of worrying about things—and hundreds of takes on what you should do.
Topics like these can easily become the focus of obsessive over-analyzing, leading to the dreaded “three R’s” of excessive and counterproductive research, rumination, and reassurance-seeking.
What can be especially tricky about some of the concerns OCD surfaces is that they can sometimes seem valid, to an extent. For example, if you have a subtype like contamination OCD (which creates intrusive fears of germs, dirt, or illness) or health concern OCD (which causes fear of becoming sick or hurt), flu season can be complex because there are steps you might take to reasonably protect and care for yourself that can also become compulsive, like cleaning and hand-washing.
You should take care of yourself, and part of taking care of yourself is doing things like asking a healthcare provider about symptoms that are impacting your quality of life.
But knowing that you have OCD can make it hard to understand what’s “okay” and “normal” to ask a doctor about. If you feel a twinge in your chest and know that you have health OCD, you might get caught between wanting to resist the compulsion to seek reassurance, and wanting to make sure you’re addressing a possible issue. You may even find yourself categorically trying to avoid asking anyone about it at all because you’re afraid of falling into a compulsive pattern—when in fact, this avoidance itself could become compulsive.
Asking for assurance vs. compulsive reassurance-seeking
Navigating a situation like chest pain when you have health OCD calls for an understanding of the difference between asking for assurance, and compulsive reassurance-seeking (a persistent, overwhelming, and compulsive desire to seek affirmation or guidance about one’s choices).
Not all reassurance-seeking is compulsive. Asking people we trust and respect for their thoughts is a regular part of existing alongside others, and it can help provide perspective that you might be lacking on your own. This is especially true during complex decision-making processes. If your chest hurts, asking one friend what they would do in a similar situation before reaching out to the doctor is part of being human, and can help you level-set if worries about exacerbating your OCD make you want to avoid help altogether.
However, if you’re asking five friends the same question in five different ways because the relief provided by each answer is fleeting, or you need the answer to feel just right before you can decide whether to contact the doctor, that’s a pattern of compulsion. Engaging in a behavior once doesn’t necessarily make it a compulsion. The function, frequency, and way you feel before, during, and after the behavior are more important than the behavior itself.
Relationships can bring out this question as well. Every relationship involves a certain amount of reassurance and checking in, as part of building trust and facilitating healthy communication. For example, you might ask your partner why they seem unusually subdued during dinner, or vent about a relationship conflict to a friend and appreciate their thoughtful response. But if you’re repeatedly inquiring about whether your partner is mad at you and running the granular details of your last fight by each of your group chats in turn, all the while feeling only temporary relief from your anxiety, your behaviors are likely compulsive. If this is the case, you may be dealing with relationship OCD, which creates intrusive thoughts and fears about your romantic, platonic, and familial relationships.
Non-compulsive ways to evaluate risk
Evaluating risk while in the grip of a compulsion can look like asking every person you know for their opinion without ever feeling like you have “enough” information to feel at peace or make a decision. Fortunately, there are ways to evaluate risk without falling into compulsions.
- Ask for someone’s opinion, but don’t let the need for feedback consume you. Identify someone whose values align with yours, who isn’t currently struggling with anxiety around this issue, and whom you have seen make grounded decisions that are in line with the level of risk you feel comfortable with. When you’re feeling uncertain, ask them once, or imagine what their perspective would likely be, and then trust the answer. The point isn’t to outsource the decision or assessment, but to step briefly outside the frame of OCD.
- Set guidelines before you need them. Once you understand the ways your mind begins to spiral when you’re confronted with a choice, you can try to get ahead of compulsions by pre-committing to a certain decision-making framework when you’re not actively struggling. Come up with logical questions to ask yourself, and parameters for decision-making, write them down, and use them later when OCD is loud and your judgment feels compromised.
For example, those with false memory OCD, which causes intrusive doubts about past events and memories, fear that they’ve hurt someone, acted immorally, or committed unforgivable mistakes, even when there’s little to no evidence that this has happened. If you have this subtype, and often find yourself so terrified that you may have hit someone with your car on the way home from work that you drive back through the route to check, creating guidelines while you’re not actively caught up in the OCD cycle can help you avoid retreading this ground. Maybe you can start with only checking your car, once, for evidence of the accident you’re imagining, rather than driving the entire route again.
- Ask the inverse question. OCD gets you stuck in evaluation mode by calculating the highest possible cost of doing something that scares you. But it hides the cost of avoidance or engaging in another compulsion. Ask yourself, “What’s the risk of me NOT doing this? What do I lose if I let OCD make this call?” Putting both sides of the equation on the table is itself a corrective.
- Align decisions with your values, not with OCD’s worst-case projections. Similarly, OCD is great at coming up with the worst thing that can happen. But you can’t live in crisis mode, constantly reacting to imagined disasters. Instead, work to identify how you do want to live, and make choices based on those goals.
How ERP can help
Finding your values is where ERP comes in. ERP, or exposure and response prevention (ERP) therapy, is the most evidence-based OCD treatment. It works by gradually exposing you to your fears while helping you learn to increase your tolerance for the discomfort and uncertainty they create. An ERP therapist will help you home in on your values, so that the discomfort of resisting compulsions is slowly countered by the satisfaction of knowing your choices are based in pursuing the kind of life you want to live. Knowing your values can help you recognize when OCD is driving your choices. Because OCD so often latches onto and distorts what you care about, having a clear sense of what matters to you makes it easier to see what an obsession is trying to target.
A good ERP therapist will also address your concerns within the context of reality—helping you identify what is and isn’t an OCD obsession. After all, when bad things are happening in the world—and there’s no shortage right now—it’s hard for anyone to know how to measure risk. Part of learning to tolerate discomfort is learning to tolerate gray areas. Having compassion for yourself in the midst of uncertainty can be key.
If you have relationship OCD, and every time you feel anxious around your partner you’re worried that you’re falling into reassurance-seeking and so you avoid telling them, an ERP therapist might encourage you to find ways of co-regulating that don’t feed the cycle. For example, coming up with a list of activities that help you refocus together, and talking to your partner about it when you’re not in the midst of a spiral, so you two can engage in quality time without engaging in reassurance.
ERP doesn’t insist that you dismiss your concerns, but it should help you change your relationship to uncertainty, so that you can make decisions based on what you want and care about, rather than what you’re afraid of.
