What do we mean by owning your OCD? Much of this book has focused on addressing the struggle to cope with symptoms over the long term, use CBT tools and mindfulness along the journey, and maintain self-compassion throughout. You put the effort into these practices because they work and because they chip away at the self-stigma that can make living with OCD so hard. Still, even after liberating yourself from the bulk of your symptoms, there remains an unavoidable truth. You have OCD. Owning that you have OCD means approaching the challenges of life with OCD from a knowledgeable and self-loving perspective. Having OCD is not your fault, but creating a life in which joy can be possible with OCD is your responsibility. In this chapter, we explore some of the long-term challenges of life with OCD and some of the ways that understanding and owning your OCD can keep you on the JOYful path.
At the start of this book, we discussed how the duration of obsessive-compulsive disorder in one’s life is chronic. We look at treatment of the disorder in terms not of a cure, but of minimizing impairment and maximizing fulfillment. Considering the absence of a cure, it can be tempting to view OCD as an impossible and hopeless burden. But this perspective, however easy it may be to empathize with, reflects an unfortunate misunderstanding about what OCD is. In some ways, the life of a person with OCD is richer because of the tools we must employ to manage the disorder.
Viewing life with OCD as a relationship, and not just a series of awkward dates, can be useful. Relationships have ups and downs, but a complete cutoff from your relationship with OCD is unlikely, due to its chronic nature. For instance, even when your OCD is not bothering you at all, it’s still with you. You can think about it like this: you may have a sibling you’re not all that fond of, because he annoys you. But even when you’re not around him, he’s still your brother. Knowing that you have a long-term relationship with OCD, you make decisions in the hard times, when it is bothering you, that focus on the Greater Good. Instead of relying on compulsions to provide immediate short-term relief, you rely on willingness, openness, self-compassion, and intentional contact with uncertainty to stay on top of things. Your attention to detail becomes a source of creativity instead of a source of self-hatred. Your sensitivity to anxiety becomes a source of inspiration instead of a source of depression.
There is no cure for OCD, but this does not make the disorder bigger than you or more powerful than you. A healthy way to think about this recognizes that obsessions and compulsions are natural phenomena. We can’t eliminate them, because unwanted thoughts and urges to respond to them belong there. It’s the disorder part, the part in which unwanted thoughts and rituals distract us from the things we truly value, where we seek to develop mastery. But if you’re one of those who have tasted this mastery and felt relatively free from disorder, you may have recognized that it doesn’t stay that way on its own. You have to do maintenance work to stay in command of your OCD; for instance, by playing some of the games we’ve suggested. Maintenance ERP helps you continue to maintain emotional distance from your obsessions, which helps you feel less compelled to do compulsions. It’s not the obsessions and compulsions themselves, but how we get carried away by them that becomes problematic.
Understanding your predisposition to being distracted in this way means understanding that to be mindful of OCD thoughts keeps your recovery strong, and to be mindless of these distractions increases your likelihood of returning to a disordered place. This is why it is so important when you are doing well to continue to incorporate mindfulness in your daily life and seek out exposure opportunities with some ongoing regularity. In other words, it’s not enough to push the OCD into its place with medication and therapy. You have to keep it in its place by continuing to strengthen and maintain your skills. But this work need not be deflating or disheartening. This work can be awe inspiring, full of humor and bravado, and extremely gratifying.
To help yourself frame this issue of OCD as a chronic disorder in terms that are mindful and self-compassionate, consider the following questions:
What aspects of my mind (my thoughts and feelings about death, sexuality, religion, and the meaning of life) will I be required to explore in depth, and in what ways could that be an asset?
It’s very easy to forget that OCD denies us the joy of exploring, without fear, major facets of human reality that are inherently interesting to explore. Cancer may be a terrifying illness to contemplate getting, but the science behind the behavior of cells in the body is fascinating. Living in fear of losing your sexual identity to an obsessive thought can be soul-crushing, but the subject of human sexuality itself is fundamentally alluring. If you struggle with religious or moral scrupulosity, you may be exhausted by your efforts to gain certainty about your role in this universe. But does this mean that philosophy as a whole becomes a pointless and frivolous mind game? No! The things we obsess about are often inherently interesting. Though people with OCD may not have a choice in how much, or when, any one of these things demands attention, they also have an opportunity to know the human mind and spirit in great depth. Could this conceptualization be the difference between thinking of your OCD as chronic instead of terminal?
How has the length of my journey of mastering OCD made me more aware of the suffering of others and helped me become a more compassionate person?
Nobody expects you to celebrate your own suffering. But if you live long enough with any challenge and work hard enough on developing mastery over it, you can’t avoid an increased awareness of our common humanity. To understand one’s own struggle is to be able to connect with another’s. Consider that your long-term journey with OCD is about more than just obsessions and compulsions; it is also about empathy and kindness for anyone who faces a challenge in life. For instance, you might know someone who suffers from bipolar disorder. While you may not understand the ins and outs of that mental illness, you can empathize with and compassionately understand how those with bipolar disorder, for example, may be feeling out of control of their emotions, distanced from society, or just plain scared of how their minds can betray them. Your own experience can make you more attuned to the experience of others and impel you to help alleviate their suffering, if only with a kind word.
How has the ongoing course of OCD in my life led to greater mindful awareness and allowed me to explore multiple perspectives or points of view?
People with OCD must go against the instinct of rejecting their mind, with all its imperfections, and instead learn to embrace and open up to their mind with all it has to offer. Though no one would blame you for preferring an easy path, the hard path of developing mindfulness skills to reduce the impact of your OCD also leads to greater knowledge of the self, the mind, and the relationship between the two. A sunset when you’re obsessing may just be a reminder that you didn’t get enough done today, but the same sunset when you’re being mindful becomes color, warmth, movement, and beauty in one present moment. People with OCD have to get to know their minds at a depth most people take for granted. Is it a curse or an opportunity for you? Can it be both?
Here we explored the issue of OCD as a chronic condition. Though we cannot discuss the disorder in terms of a cure, we can look at the role of OCD across the lifespan as more than a destructive force. There are silver linings to having this chronic condition. For instance, as OCD therapist and author Dr. Jonathan Grayson explains, when people learn ways to master OCD, they become “better than normal,” because they become exceptionally good at coping with uncertainty—not just OCD uncertainty, but overall uncertainty in everyday life (Ralph and Grayson, 2016). Your bravery in learning to master OCD can do more than simply reduce symptoms; it can reveal assets and rewards as well.
You have probably heard at some point during treatment that developing good support is helpful to maintaining a strong recovery from OCD. But exactly what does “good support” mean? We define it as empathetic encouragement that you can stay on top of your OCD. Let’s look at each of these in more detail: what empathetic encouragement means, what support looks like, and how to avoid potential support pitfalls.
Empathy has four components: (1) perspective taking, or being able to put yourself in the other person’s shoes; (2) suspension of judgment, or not judging what the other person is doing, thinking, or feeling as “good” or “bad”; (3) recognizing emotion in others, or being able to identify what emotion someone else is feeling; and (4) communicating emotion back to someone, or being able to express to him that you understand how he is feeling (Wiseman 1996). Encouragement basically means sharing with someone that you believe in her, that you believe that she can do the potentially challenging task in front of her, and that she has what it takes to succeed. Combining empathy and encouragement can look like this:
Or, it can be as short and simple as, “Ugh, I know this is painful. I’m right here with you, and you can do this.”
Notice that in these examples we are recognizing the feelings the person is probably experiencing and then we are communicating this recognition to her without judgment, while also sharing that we believe in her ability to do what’s necessary to help herself to feel better.
It’s great if you can coach one or two close friends or family members in how they can support you in your OCD recovery. However, it’s really important to keep in mind that you can’t control other people. Some people are, unfortunately, just not good at giving support, and that’s OK. But if you have one or more loved ones who are willing to try, here’s how you can coach them to most effectively support you.
Share what empathetic encouragement means and how to most effectively communicate this to you. Let them know that there are some support rules to live by that will make life better for both of you. For example, they need to avoid hostility. It has been shown that loved ones being critical and hostile makes it challenging for people with OCD to continue with treatment and even see benefits from it (Steketee and Van Noppen 2003). Others need to avoid being overly emotionally involved in your OCD recovery. If they are too emotional (such as angry, scared, frustrated, and so on), they are going to add to your distress and make it harder for you to resist doing compulsions. Further, if they become emotional around you when you are struggling with OCD, you are going to start to avoid them because they become associated with unpleasant, negative emotions (Steketee 1993). You also need to recognize that watching you suffer is emotionally painful for your loved ones, so be compassionate for how difficult this request is.
Your supporters need to ask whether you want their feedback on your OCD. Sometimes family members can provide what seem to them to be “helpful” comments about how OCD is doing this or that. In fact, criticism from family members, as long as it’s not hostile, can be a motivator for therapy (Steketee and Van Noppen 2003). However, unwanted feedback from loved ones, even if well-intentioned, can lead to resentment, so it should be given only if you have asked for it.
It may take a while for your supporter to learn how to appropriately provide empathetic encouragement, as many people have never received training in practicing empathy. Internalizing the support rules can also take time, especially if your supporter has been interacting with you differently up until now. Remember that support is not a black-and-white concept, and learning to live with gray areas is an important part of the art of a strong recovery.
OCD is an excellent observer, unfortunately, and it focuses on the words or actions of others that reinforce its point of view. So you need to be aware of some subtleties in how you ask for and receive support that can make a difference in how effective that support is. Not taking those subtleties into account can lead to some common pitfalls that you’ll want to avoid.
First and foremost, reassurance is not support. Having someone tell you, “Oh, you’re fine. Don’t worry, that won’t happen” is exactly the kind of statement your OCD lives for. Also, take care not to confess your obsession to your supporter, thereby allowing your OCD to use his reaction as implicit reassurance. For instance, saying, “Oh, I’m obsessing that I just ran over someone” to the passenger in your car is a sneaky form of confessing and reassurance seeking—if your passenger doesn’t act like you just ran over someone, your OCD is reassured that you probably didn’t.
Be cautious not to become overly dependent on support. Sometimes people with OCD can start to think they can handle the present episode only if they have a supporter with them, and the support person becomes a crutch, and going to her becomes a compulsion. Make sure that you use your self-compassion tools first and then reach out to others when you still need help.
Giving and receiving support is a process that you will refine by trial and error, just like two people learning to waltz. You will learn through practice how and when to ask for support, and your supporter(s) will come to understand how and when to give it. Recognize that you will both make mistakes, but if you are both open and compassionately honest with each other, you will eventually be able to dance beautifully together.
If you had diabetes or a heart condition, your physician would probably recommend that you make some lifestyle modifications, such as in your diet or exercise routine. OCD is like these other chronic conditions in that if you choose to make some lifestyle adjustments, you’ll have an easier time managing the disorder. Mindfulness and self-compassion are two lifestyle choices that will make a huge difference in your well-being. How can you make them a part of your daily life?
One of the easiest ways to start developing a lifestyle of mindfulness is to find a cue in daily life to remind you to come back to the present. Coming back to the present is exceptionally important, because OCD content lives in the past or the future. If you can stay in the present, mindfully aware of your thoughts and feelings, it is harder for OCD to make you time travel forward or backward. One aid to staying present is to set a mindfulness timer on your phone or to use one of the “mindfulness bell” apps built for this purpose. When the bells chime, it’s a signal for you to stop and notice what’s happening in the present moment. Some people like more everyday cues, such as getting up and down from your chair or getting in or out of your car. It’s so easy to get caught up in the rat race of daily life and to miss what’s happening right in front of you, and mindfulness cues are a great way of training your brain to come back to the present, over and over again.
There are also additional ways that you can continue to build a mindful lifestyle. Drive to work without listening to anything except the sound of the car and traffic. Run a quick errand without taking your phone along. Eat a meal without also reading. We encourage you to be creative and come up with your own mindfulness experiments to bring the present moment to life.
Don’t worry if, as you get started, you’re able to really be present only once a day or a few times a day. Every moment is a new opportunity to begin again. Of course, a daily meditation practice makes being mindful moment-by-moment easier, and even a few minutes a day of meditation as described in chapter 1 can strengthen your mindfulness muscle.
Developing a self-compassionate lifestyle also takes work, but it is immensely worthwhile. The more self-compassionate you are, the less you sound like your OCD, making it easier to recognize and deal with it through mindful exposure. As you become more self-compassionate, you’ll also find you’re more motivated, as you aren’t constantly berating yourself. Further, becoming more self-compassionate is built on a foundation of mindfulness, as you need awareness of how you are treating yourself in the present moment in order to practice self-compassion.
To begin, work on becoming mindful of how you talk to yourself. For many people, especially those who have OCD, a negative stream of self-criticism runs subconsciously, in the background, all throughout the day. To counter this tendency, you can use your mindfulness cues for a dual purpose: to bring you into the present moment and to remind yourself to pull any self-critical thoughts into conscious awareness. For instance, “I was just berating myself for not having started cleaning the house earlier.” Then, give yourself a self-compassion break using one of the self-compassion exercises from part 2.
As you make self-compassion more and more a part of your daily routine, treating yourself kindly can become second nature. Further, as your tendency to be self-critical diminishes, it will become even easier to be mindful of intrusive thoughts, as they will sound so different from your new way of addressing yourself.
In this chapter we’ve discussed the difference between owning your OCD and being owned by it. You are not your OCD, but it is a part of you over which you can take command. OCD is a lifelong condition but absolutely not a lifelong sentence to simply suffer through. Support is a crucial part of recovery—you are not alone, so choose not be alone by reaching out for support in healthy ways when you need it. Make mindfulness and self-compassion lifelong companions as well. Finally, managing OCD for the long term means changing your perspective of the disorder: it is not the enemy, but a worthy adversary who makes you stronger with every challenge it presents. As you become stronger, you will feel more confident that you can do this. After all, owning your OCD means that you, not the disorder, are the one with the power.