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by Jedidiah Siev

Candace has repeated, intrusive thoughts about losing control and stabbing her children with a sharp knife. She becomes intensely anxious and is concerned that these unwanted thoughts signal her impending loss of control, or at the very least indicate that she is fundamentally a bad person. In an effort to be certain that she will not act on these horrific impulses, Candace insisted that her partner remove all sharp knives from their house.

This week is International OCD Awareness Week, and Candace is likely among the roughly three million people in the United States who have obsessive-compulsive disorder (OCD). OCD is not a disorder of quirkiness or being finicky. People with OCD experience recurrent, unwanted thoughts, images, or urges that cause distress, usually anxiety. These are called obsessions. They also engage in behaviors or thoughts that function to reduce distress, often by preventing feared outcomes or neutralizing obsessive thoughts. These are called compulsions.

When you think of OCD, perhaps you picture someone with contamination fears and excessive washing. You might be right. Perhaps you picture someone with the need to order and arrange everything symmetrically. You might be right. Perhaps you picture someone checking and rechecking the door lock, stove knob, or iron plug so as not to be responsible for a burglary, gas poisoning, or fire. You might be right.

But there is nothing special about contamination, order, or accidental harm, when it comes to OCD. OCD fears can focus on anything including violent harm, religion, taboo sexual fears, or one’s sexual orientation. Some individuals obsess about even less concrete things, such as acquiring unwanted characteristics of a bully by using a pencil he touched or losing part of one’s essence when discarding personal items. OCD is opportunistic, latching on to what matters to an individual. OCD has been called the “Imp of the Mind” because it tries to make you think most about the very things you find most unacceptable or matter most deeply to you. New parents with OCD often obsess about harming or neglecting their children, for instance.

Most people with OCD have insight about their fears (e.g., “I know you can’t get HIV from a door handle, but…”), and that is because symptoms are typically fueled by “what if” fears about what is possible, not necessarily beliefs about what is probable. Put differently, people with OCD struggle with tolerating uncertainty in the domains of their obsessions; however, efforts to achieve absolute certainty are doomed from the outset. How can one be literally certain that they are not a pedophile or that they truly did lock the door this morning, and are not conflating memories?

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