Fear of losing control

What is the fear of losing control?

Fear of losing control involves fears that something a person does or fails to do will cause harm to oneself or others, will have a negative impact, or that one’s lack of diligence in maintaining control will somehow impact the world around them. The fear of losing control is one that underpins many subtypes of OCD.  People with these core fears are often hyperaware of their responsibility for the people and events around them, and may have an inflated sense of responsibility, believing that they can and must maintain perfect control of their actions in order to avoid negative consequences. As a result, they frequently agonize over worst-case scenarios in an attempt to control, anticipate, and avoid them. Case Example Lanie is a 24 year old newlywed who is currently unemployed due to her plan to start college in a month. She got married 3 months ago and is struggling to adjust to living together with her husband. Coming from a strict Catholic upbringing, Lanie did not live with her spouse prior to marriage, and spent 2 years before marriage living alone in an apartment. Since moving in with her new spouse, she has started to have intrusive thoughts and images about harming her husband. She fears that she will poison his coffee in the morning, even though she does not desire to hurt him. She also worries that she will hurt him when they are sleeping. Lanie was a sleepwalker as a child, and now worries this habit will come back and she will smother her husband with a pillow, or get a kitchen knife and stab him without even knowing it. Lanie worries that she will do these things without having any control over her actions. She has started waiting for her husband to fall asleep and then moves to the living room couch to sleep the rest of the night. The living room is downstairs. They have a gate on the stairs to keep their little dog from roaming the house at night, and Lanie feels if she sleepwalks from the couch, the gate will trip her and wake her up before she can hurt her husband. She also recently bought a single serve coffee maker, so she is unable to poison the coffee she makes for her husband. She spends several minutes each day inspecting the coffee pods to be sure that she has not broken the seal. If she makes the coffee, and hasn’t paid close enough attention, she will dump it out and start over. She also walks away from the coffee maker and does not return to the kitchen until her husband grabs the coffee for himself. Lanie’s checking and rechecking of other things in her house is now starting to become more frequent. She has stopped texting her husband throughout the day, because she fears she will type something absurd or confess to something that will make him leave her. Lanie keeps a time journal of thoughts/daily tasks throughout the day to be sure that she is aware of the things she is thinking. She writes in her journal each hour. It’s always something simple, but this makes Lanie feel like she can go back and review her day and know that she was not doing anything she shouldn’t and can hold herself accountable for the time. Her fear of losing control and doing something that will cause irreversible damage is ruining the beginning of a life she was so excited to start with her new husband.

Common obsessions experienced by people with a fear of losing control in OCD include:

• Thoughts that they may harm themself or someone else by losing control of their actions or surroundings
• Intrusive images that trigger fears
• Fears of saying, yelling, screaming obscenities in a public place
• Fears of embarrassing oneself 
• Not being able to remember something 
• Fear acting out against against one’s values or morality
• Fear of losing control while under the influence of substances
• Fear of losing control while asleep

**Please note that this is not an exhaustive list. As mentioned before, the fear of losing control can be a core fear in many OCD subtypes. 

Common triggers

People with a fear of losing control may be triggered by situations involving a perceived lack of control, other people being in control, situations where certain behavior is expected, or a situation pertaining to a specific fear, such as driving if a person fears losing control and veering off the road.

Common triggers for people with OCD with a focus on fear of losing control include:

• New living situations
• Being in a situation where certain social norms are implied or expected (funerals, weddings, work meetings, etc.)
• Driving
• Using dangerous implements, such as knives
• Periods of high stress
• Intrusive thoughts or images about harming a loved one
• Intrusive sexual thoughts 
• Intrusive thoughts about losing time, forgetting, or “going crazy”

How can I tell if it’s OCD, and not anxiety, cautiousness, or stress?

A person who has OCD with a fear of losing control will have certain symptoms and behaviors that distinguish their condition from others. One can ask themselves the following questions to get a better sense of whether they’re struggling with OCD:

• Are you experiencing intrusive, unwanted thoughts, urges or images related to the fear of losing control?
• Are you engaging in mental or physical acts in an attempt to escape, eliminate, avoid, or neutralize your fears or obsessions, or prevent a feared outcome?
• Do obsessions and compulsions cause a significant amount of anxiety or distress? 
• How much time do the obsessions and compulsions take? Do your obsessions and compulsions take more than one hour per day? 
• Do the obsessions and compulsions cause significant impairments in aspects of your functioning or daily life (i.e. work, school, relationships)? 

When people with a fear of losing control in OCD experience intrusive thoughts, images, feelings, or urges tIf the answer to one or more of these questions is yes, you may be struggling with OCD, and it’s important to speak with a qualified OCD therapist for proper diagnosis.

Common compulsions

When people with a fear of losing control in OCD experience intrusive thoughts, images, feelings, or urges that cause distress, they may engage in compulsions to try to neutralize, escape, or avoid these fears. These scary thoughts cause a great deal of fear, creating a strong urge to repeat rituals, seek reassurance, avoid certain situations, check, and research to make oneself feel better. However, engaging in compulsions will only make the OCD cycle stronger.

Compulsions performed mentally or physically by people with OCD focused on a fear of losing control include:

• Avoiding knives, guns, or similar objects 
• Avoiding topics of violence 
• Seeking reassurance from family or friends
• Researching the probability of losing control or psychotic episodes
• Counting, tapping, or other repetitive behaviors to ensure “bad” things don’t happen 
• Checking stove switches, plugs, appliances, locks, and other responsibilities
• Frequently checking in with family to make sure they are safe 
• Checking food, washing and rewashing to avoid contamination

How to overcome the fear of losing control

OCD focused on a fear of losing control can be debilitating, but it is highly treatable. By doing exposure and response prevention (ERP) therapy with trained ERP specialists, there is hope for a better future with significant symptom reduction. 

ERP is the gold standard treatment for all subtypes of OCD, and its effectiveness has been demonstrated by decades of clinical research. A trained ERP therapist will work with you to build a hierarchy of your fears, and from that hierarchy develop a treatment plan, beginning with exposing you to less intense fears, eventually building up to situations or thoughts that cause greater distress. In response to these exercises, called exposures, your therapist will guide you in resisting the urge to respond with compulsions. As a result, your obsessions will cause less distress over time, and you will develop a greater ability to tolerate uncertainty, distress, and fears about losing control.

Examples of possible exposures done to treat a fear of losing control in OCD include: 

• Directly facing feared stimuli: holding a knife, lighting a candle, walking in public, etc.
• Indirectly facing feared situations: writing and reading a script about the worst-case scenario of losing control while driving, reading stories about psychosis, viewing media about people doing harm, etc. 

Fear of losing control is a common theme in the OCD community. Regardless of what subtype presents itself, whether it be Harm OCD or Contamination OCD, “Just Right” (Perfectionism) OCD or sexual immorality themes, the underlying fear of losing control is often the driving force of OCD and many other anxiety disorders as well.

Perfect control is an illusion, but it is something that many people with OCD try with all their energy to maintain. It can’t be kept, and the OCD sufferer’s compulsive attempts at maintaining control only keeps them stuck in the OCD cycle. The acceptance of one’s lack of control, when paired with ERP therapy, can help them towards freedom from the debilitating and distressing symptoms of OCD. 

If you’re struggling with OCD and are interested in learning about ERP, As an OCD specialist, I’ve used ERP to help many people regain their lives from OCD. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment. All of our therapists specialize in OCD and receive ERP-specific training and ongoing guidance from our clinical leadership team. Many of them have dealt with OCD themselves and understand how crucial ERP therapy is.