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OCD and Uncertainty


Overcoming OCD involves giving up the need to know for sure.

These are difficult times.

Lately, it seems, each week brings with it something truly horrifying. A shooting or an act of terrorism, a hate crime committed against an individual, a disease that affects the unborn. You can hardly turn on the news without hearing about something that incites fear.

Yet… We get up every day and go about our normal lives. We get in the car, we drive to work, we come home to our families. We live as if we are untouchable. Technically, we’re not, but we’re often happiest when we live as if we are.

Some of us do this easily. The awareness of our own fragility doesn’t linger. Others of us are tortured by possibilities.

What if this happens to me? What if this happens to someone I love?

OCD brings with it superhuman attention to possibilities.

OCD wants us to think that the only acceptable world is a perfectly safe world. Unfortunately, the world we live in can sometimes be dangerous.

Although we may not often think about it, the possibility of danger is omnipresent; it’s all around us in nearly every moment of every day.

  • What if I get in a car wreck on my way to work…?
  • What if I fall down the stairs and break my neck…?
  • What if my child’s school is attacked by a terrorist…?
  • What if my food contains trace amounts of poison that could kill me…?
  • What if my pharmacist gave me the wrong medication and I have an allergic reaction to it…?
  • What if a plane crashes into my house…?
  • What if I forget to lock my front door and somebody breaks in…?
  • What if I “snap” and kill my family…?
  • What if I’m going to hell…?
  • What if I get hit by a meteor…?

Hopefully, some of these dangers seem a bit far-fetched to you; whereas, others may seem more plausible. In reality, they’re all possible. In fact, every one of them could come true today.

Although these thoughts can be scary when we actively think them, most of us are fortunate in that these possibilities generally live outside our conscious awareness. Ignorance can be bliss. Our brains often filter out these possibilities, or we attribute so little significance to them that they quickly get swept away in the stream of our thoughts. This process is generally automated and may occur so quickly that we may not even perceive that this is happening. Our minds can be incredibly adept at filtering out unimportant and irrelevant information.

However, even when we’re operating in that blissful state of ignorance, there’s always the possibility of danger. We just don’t think about it or feel it.

In some situations, we can become acutely aware of these possibilities.

For example, if you have recently been in a car accident, you might find yourself constantly scanning the traffic around you for signs of danger. The recent memory of the car accident is fresh, and it’s closely associated with driving-related cues. Previously neutral stimuli or activities (e.g., stop signs, merging traffic, changing lanes) can become linked to anxiety and panic.

Additionally, many individuals with anxiety disorders like OCD also experience changes or distortions in their perceptions of danger. They start to perceive excessive danger in situations that used to feel neutral or “safe.” This newfound fear can result in unhelpful avoidance behaviors or rituals that are designed to neutralize potential threats. In the end, avoidance and rituals keep fear from extinguishing and actually perpetuate greater fear.

Even if you have OCD, chances are that you don’t actively fear each what-if above. Your mind will notice some of the thoughts and then just move on — even though the thoughts are technically possible.

This is profoundly powerful. Why?

Because it shows you that you can tolerate uncertainty.

Yes, it might not be the specific type of uncertainty that you’re typically tormented by — but it shows that you can accept possibilities without needing to know for sure.

This is the goal of OCD treatment — to be able to extend an ability you have in most areas of your life into the domain that OCD has colonized.

In this way, you’re not really learning a new skill; you’re simply learning to generalize a pre-existing skill to a different situation.

“If I can do this in some areas of my life, I can learn to do it in other areas of my life.”

Should you take preventative action whenever you perceive the possibility of a threat?

Absolutely not.

This can have the unintended consequence of making your threat detection system even more sensitive.

The problem with having an overly sensitive threat detection system is that it makes you more likely to respond to false threats as if they were true threats

This can be stressful and exhausting.

The other downside is that every time you misclassify a threat and neutralize or avoid a “safe” situation, you reinforce fear learning in your brain. In other words, by playing it safe and dodging today’s “bullet,” you make it more likely that you will be assaulted by a barrage of “bullets” tomorrow.

Every ritual–no matter how innocent–makes your OCD stronger.

This brings up another important point. How can we know what danger is real, and what danger is fake?

Unfortunately, we can’t. At least not perfectly.

We can never be absolutely certain.

However, there is some comfort in the knowledge that our perception of danger can be completely unrelated to the actual danger of any given situation. This principle motivates exposure therapies like exposure and response prevention (ERP). ERP involves choosing to defy your perception of danger and take the risk anyway. It’s like a leap of faith that can sometimes feel like jumping into darkness.

However, with each successful jump, you gain confidence in your ability to move through these experiences.

“To learn which questions are unanswerable, and not to answer them: this skill is most needful in times of stress and darkness.”
― Ursula K. Le Guin, The Left Hand of Darkness

Just because you’re not thinking of a potential danger doesn’t mean it won’t happen. Similarly, just because you are thinking of a potential danger doesn’t mean it will happen.

The situations and environments that OCD chooses are not arbitrary, in that they are most often meaningful to us. They often concern the safety of ourselves or the safety of people we love, important moral issues that may involve things like sexuality or religion, or other types of situations where we have responsibility. OCD wants us to be overly conservative when it comes to our ability to tolerate risks in these areas.

OCD can make us so risk-averse that we end up giving up the very things that we love and that make us who we are. How many parents with “bad thought OCD” willingly sacrifice time with their children, because their OCD says that it’s the only way to keep them safe? How many students with “bad thoughts” isolate themselves in their college dorm rooms and give up on their college careers because of the terrible thoughts in their heads?

Avoidance is not the answer — at least not in the long-term. In the long-term, it only hurts us.

Remember: We can tolerate risk. We can tolerate doubt. We can tolerate uncertainty. We demonstrate this countless times each day…even when we’re not paying attention.

This is true.

This is our source of strength.

We don’t need perfect proof to be okay.

Interested in OCD treatment in South Florida? Look no further than my South Florida OCD treatment center or call the phone number at the top of this page.

Questions?  Comments? What uncertainties do you tolerate with ease? Where do you need to expand your ability to tolerate doubt and uncertainty? Sound off below…

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  1. Excellent post Dr. Seay. Never, ever thought of ERP as just a way of learning to spread already mastered skills into other areas of our life. That is seriously brilliant, and something that I just know that I will be sharing with other sufferers from now on. As usual, right on point. Thank you! Monique

  2. thank you for sharing ☺

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