Answer to Reassurance Seeking/Self Reassurance/Uncertainty

Canadian with OCD tells us the s/he feels overwhelmed at times and seeks reassurance from others or attempts to reassure her/himself  about self harm.  S/he also notes that listening to the exposure script activates his/her fears.   I know it is really hard to do exposure, but remember, almost all OCD involves trying to attain 100 %certainty.   Most OCD sufferers are unable to do this, because there is no true certainty in the world.  As you know for every answer or reassurance there is a what if.  Thus every attempt at seeking reassurance from anyone is ultimately doomed.

I suspect that part of the problem with the script is that you don’t want to cope with the possibility that it could come true.  I would ask you to think of how you would best cope with it if it did (assuming you survived).  How can any of us know what we will do next.  I don’t expect to slice and dice my wife tonight, but I can’t know that I won’t go crazy and do it — after all, one doesn’t plan on going crazy.  I have to learn how to live in a world where that might happen and I can only hope it doesn’t.  What would I do if it really happened?  If this were my OCD problem, then my exposure would be to plan how to cope with the guilt afterward and to try to continue on.  Yes it would be horrible and I don’t want it, but what choice do I have?

Why would you want to cope with your worst possibility taking place?  Because trying to not have it happen is robbing you of life.  If it does happen, you will have lost the precious little time you have.  If it never happens, you will have lost all.  In life, the past is nothing but memory, the future nothing but hope and all we have is now.  The goal of acceptance is to learn to enjoy the only thing we can have, the moment.

23 Comments

  • I really just need some advice. I am 47 years old and I suffer from OCD as well as anxiety and PTSD. I was sexually abused for years while growing up plus other abuse. I have many fears and obsessions about sleep since most of my abuse took place while I was in bed. I am at my wits end at this point. I am in therapy and on meds but its not helping in the OCD area especially. I need help badly. I am so scared all the time, I am feeling hopeless at this point. Thanks. Joy

  • If “there is no true certainty in the world” you shouldn’t say “every attempt at seeking reassurance … is ultimately doomed.” We can’t be dogmatic if we want to live in the gray. You should say “Will probably not work,” “In my experience has never worked,” or instead of saying “every attempt” you could say “most attempts.”

    • Oscar, you are correct. I usually try to do what you suggested, but imperfection and mistakes seem to be high probability events compared to the possibility of perfection. Thank you for your thoughts.

  • To the individual saying that OCD can be managed with food supplements that increase brain serotonin level. There are 2 problems. First, OCD is a learned and a biological disorder, so any medication or biological approach may be useful, but it isn’t enough. Experts agree that exposure and response prevention, a cognitive behavioral technique is necessary. With regard to supplements, I’m afraid this post represents a common misunderstanding of the brain chemistry of OCD. To date, the medications that help OCD do not raise serotonin levels, but make the serotonin in the brain more availabe. Again, to date, there are no studies supporting the assertion of the writer. If someone wants a ‘natural’ medication, there is evidence that St John’s Wort can be helpful. In my clinical experience, I’ve seen some benefit, but not as much as the SSRIs. Also, whether ‘natural’ or not, it is a medication that can have side effects.

  • Hi Dr. Grayson,
    I am currently struggling with an obsession about my boyfriend. I constantly obsess that my boyfriend is going to somehow come in contact with his ex girlfriend and that he is going to want her back. Or, even if he doesn’t come in contact with her, I obsess that he secretly still has feelings for her. I question him often about what he thinks about her and if he would ever talk to her again. It is really hurting our relationship. I am seeing a therapist and he said I need to tell myself that what I am fearing is actually true – or COULD actually be true. This seems to be what you are saying as well.

    My question is: telling myself that my boyfriend still wants to be with his ex-girlfriend is what i’m already obsessing about. Why would i just keep telling myself that it is true – won’t that escalate the obsession? And if I do tell myself that what I am fearing is true or could be true… what if I really start believing it? I get depressed easily, and wouldn’t thinking these negative things(thinking my boyfriend is in love with someone else) end up making me depressed? I am afraid I might really truely start believing that he is infact not in love with me, and then I would end up breaking up with him…all over an obsessive thought that may not be true.

  • Dear Dr. Grayson,
    I am writing for the second time. Finally I have purchased your book, Freedom From OCD, and have went over the first 90 or so pages. I truly admire your unique approach: Learning to accept uncertainty seems, quite possibly, the most powerful weapon against OCD when compared to other methods.

    Unfortunately, my obsessions and compulsions are what is usually known as ‘pure obsessional’ (pure-o) OCD and there appears to me no practical way to ‘expose’ myself to these tormenting thoughts and images. There are usually no triggers — it’s a 24/7 cycle. How do I learn to apply your Personalized Recovery Program technique to this? The checklists, logs and hierarchy are of no use, and I feel stuck … terrified in fact.

    My obsessions and (mental) rituals are based mostly on religion / blasphemy.

    Thank you,
    Armin

  • I obsess over a variety of things linked back to WHAT IFs about loosing control mostly of my mental health – when im feeling sad i WHAT IF about being clinically depressed.I fear certain bizarre thoughts I think and if I told people they could think i was crazy and Id be abandoned and humiliated.So i want to push them out of my head. Songs stuck in my head are another.

    Im obsessing over loosing control and by extension control of how people think of me. Im doing ERP, im scared to do ERP around the possibility of clinical depression for fear it will make me so. I guess i need to dive in. Opinion?

  • I am suffering from ocds and mental rituals that are driving me crazy. I think about ending my life all the time now. In fact the thought of suicide is comforting to me. I figure if it gets too bad I could release myself from it. The only reason I haven’t done it already is because of my kids and my patient loving girlfriend. I’m trying so hard now to get over this but I’m extremely depressed. If I’m not obsessing over something I might have done, I’m obsessing over my girlfriend. My brain is so screwed up that if I catch myself in a peaceful moment I stop and scan my fears to figure out what I need to be obsessing over. I had ocds as a child but the seemed to fade as I matured. Then I started having problems in my marriage and my ocds came back with a vengence. I don’t even remember the confident young man I use to be. I drove my wife crazy with obsessive reassurace seeking. Then she made my worst fears come true and she cheated on me and left me. I feel that I caused it. I hate myself for it. I just started therapy and i hope I will get this monster out of my brain.

  • Dr. Grayson,

    I am a clinician treating OCD, the basic idea of living comfortably with uncertainty has been very influencial and significant in my work. I often recommend that clients buy your book. I’m currently working with someone with whom that is not practical. Do you have any recordings of lectures available for purchase. I would like her to hear your ideas from another sourse (not me) and especially from YOU.

    Thank you.

    • Phyllis,
      Unfortunately, I don’t have any. There is a videotape of me discussing my approach to using ERP available at the online store of ABCT (www.abct.org). I hope this is helpful.
      — Jon Grayson

  • Dear Dr. Grayson,

    I rarely clean house, because I fear the germs from cleaning the house. When I start to think how disgusting my house is, I thenk try to clean but start having obsessions about being contaminated from the dirt. (example: what if the while scrubbing the toilet the toilet water gets on my clothes and then I take clothes out of the dryer and get those germs on the clean clothes) Its a vicious cycle… I dont clean because I fear the ocd coming on yet my house is dirty. I also worry about cleaning chemicals. I feel so guilty for not having a clean house. I feel trapped.

    thanks,
    amy

  • Dr. Grayson–

    I have been treating a client with a history of OCD, whose most recent obsession was that her boyfriend was cheating. She dove right into exposure therapy– wrote a script etc., and did really well. Here’s the kicker– she recently discovered he WAS cheating. Now, I have given her credit for being so brave in her self-treatment–and she met the clinical criteria when she first came to me– however– should I have been more suspicious of boyfriend’s behavior?– or, as I explained to her– some obsessions are scary because they ARE possible– and this time– it was! Any thoughts/advice?

    • To Michele whose client with obsessive jealousy went through treatment and then found her boyfriend was cheating. Michele, you probably were right not to be more suspicious, since most sufferers with obsessive jealousy can sound very convincing. In treatment, when we say that the goal of treatment is learning to live with uncertainty, we are not pretending. Everyone, with and without OCD, lives in an uncertain world in which the best we can do is to hope that when disaster strikes, that we will find a positive way to cope with it. It doesn’t matter if the fear is a higher or lower probability fear. As I have pointed out elsewhere in this blog, none of us want to maimed, disfigured and paralyzed in a car crash. What is our “brilliant” plan to deal with this possibility? It is not performing a check of the car’s safety system before every drive. It is not avoiding unnecessary driving, such as going to a movie theater. In fact, many increase the odds of injury by talking on their cell phone, eating/drinking while driving, talking to others and so on. So what is the “normal brilliant” plan? Hoping that their won’t be an accident and not dealing with it until it happens. Your patient was wonderfully brave and what she got from her treatment was some peace from the obsessions. Remember, her checking gave her no peace and no safety – for all of her agony, she didn’t get the prize. Ironically, she finds out after she gives up her OCD. Hopefully she included coping with the possibility of him cheating in her scripts, because this would help her to cope with the reality that occurred. If she finds herself slipping after this, work very hard on her OCD; after all, she has gone through a very difficult situation that she doesn’t want to make worse relapsing into her OCD.

  • I struggle with an obsession very similar to Melanie’s. Mine is about my wife being unfaithful. I also struggle with the idea, like Melanie, that I am supposed to, as part of exposure, to tell myself that what I am fearing is actually true – or COULD actually be true. By telling myself that my wife is being or has been unfaithful I fear that I will really believe that this is true. I also get depressed easily, and like Melanie, I fear that thinking these negative things about my wife will end up making me depressed and make me want to leave the relationship. I did not see a response to Melanie’s post here but would be interested in knowing Dr Grayson’s opinion on this. Thank you.

  • I love Dr. Grayson’s explanation from December 16th, which basically tells us that, with or without OCD, we all live in an uncertain world. So why not try and live without OCD, which always only makes matters worse…..

  • I have battled many obsessions successfully for 12 years. I have had one that I just cannot get a handle on for the past 2 years. I’m not really sure what the “root” obsession is: I obsess about being weak in my marriage, that my husband is too controlling, that I am in a bad marriage, that I don’t have a voice in my marriage, that my marriage is not as good as so and so’s or that my husband is not as good as so and so. I can think of thousands of examples to prove this is true and thousands to prove it’s not…I just ruminate on it all the time and constantly pick apart everything he says or does to see if there’s a threat there of “me being weak, or controlled or taken advantage of”. I have been married for 15 years. He is not abusive or controlling (I don’t think). He is very understanding about my OCD. He is very opinionated and can be short-tempered. Although we have disagreements like everyone else, we have developed good communication skills and have grown stronger, but I feel like I am always “on the look-out” for something to be wrong. Anyway, I don’t know if I need a marriage counselor or ERP. I feel like if I live with the uncertainty then I am in denial that I might not be in a good marriage. Ugh!!!IT’S EXHAUSTING My therapist says my husband loves and respects me, period. She says (and he does too) that we are in a top 10 marriage. Why am I sooooo obsessed, then?

  • Dr. Grayson– you are SO helpful– thank you– got a new one! Just got an 18 year old client who is obsessing that he is very mentally ill (schizophrenic or some other serious disorder)– I am 99.99% that he has OCD– he also dissociates when he has the attached anxiety… my question is– he was diagnosed a few years a go with “mild” ADD and was prescribed Concerta and then another drug. He says they help him concentrate–but he really doesn’t need them to concentrate– and they make he more anxious (he has some free-floating anxiety as well)– I feel he should just stop taking this med! I want to make a good case for this to the family doc who prescribed… (I’m not sure about the dissociation– I think it’s just a reaction to the anxiety)

  • Dr. Grayson- I believe i am suffering with “Pure-O” and Scrupulosity OCD. Ive had ODC for awhile when it comes to doing certain rituals. I do these rituals so the bad thought in my head wont happen. Now i feel like my OCD has escalated.I question my memory and wonder “did this happen?” or “what if i did this.” For example, I went out with a friend the other day to a guys house just to hangout with him and his friends. I hardly know his friends and as i can remember i hardly talked to them, im pretty sure i just followed my friend around that i was there with. But somewhere during the night a thought came in my head asking myself if i cheated on my boyfriend. (which i would never do.) But my minds telling me that i could have done it out of anger, when i dont think i was angry. (My mind is questioning everything) And these past couple of days i have been trying to relive the night and remember everything that happened to reassure my self it didnt. But my mind says things like what if you cant remember or plays out scenarios of it happening. Ive obsessed about this thought so much that i feel it is reality, and i feel guilty for something i know i didnt do (but my mind tries to tell me otherwise) which makes me uncertain. Both my friends that were there have reassured me that it didnt happen.But my mind still wonders “what if”. I’ve thought about it so much that i feel like it has happened, and that everything is different, and ive imagined myself already living the consequences. I try to tell myself its not true, but my mind will make me think otherwise. Is there any way to cope with this and to stop questioning myself.

  • Dr. Grayson,
    Hi, I’m pretty sure I have OCD mixed with BDD, but having you clarifying this will help me quit. I have done research and what I have is a little different. It can probably be compared to being addicted to a drug. The two main triggers are when I shave and when I shower. There are others that are not as bad, but I pretend to prove myself wrong and the anxiety goes away. So, when I shave or take a shower, I feel different, like it changed me. I don’t know when or how I started doing this, but I think it has to do with me having mood swings. So, right before I shave the last stub on my face, I say and repeat these positive words to myself, like things that have to do with the way I look, to how smart I am. And if I mistakenly think or say the opposite, I have to start over. Same with showering, but just right before I shut the water off. If I decide to grow a beard, then I feel totally fine. Because then I don’t have to worry about shaving. And doing all of this right is like a big rush and I feel confident, but at the same time it feels like I’m living a void life. If I do it wrong, then I may feel like I could have, for example, done this or that better if I did my rituals right. Thank you for your time and I hope to hear back from you. -Neal

    • Neal, I’m sure you are a unique person, but not in your OCD. As you have found, the ritual can feel great when it works, but then you start to doubt that it is working and slowly there are more and more repetitions over time, more agony than the ‘relief’ the rituals promise. OCD is like the devil, promising something great, but there is a catch, it always wants a little more. The rituals become a drug that you no longer get a high from, but you keep trying. Changing is scary and fighting OCD is both scary and difficult, but not as scary and difficult as watching it take over your life. I would urge you to learn more about exposure and response prevention and if possible find a therapist who uses these techniques to fight OCD.

    • Neal, I’m sure you are a unique person, but not in your OCD. As you have found, the ritual can feel great when it works, but then you start to doubt that it is working and slowly there are more and more repetitions over time, more agony than the “relief” the rituals promise. OCD is like the devil, promising something great, but there is a catch, it always wants a little more. The rituals become a drug that you no longer get a high from, but you keep trying. Changing is scary and fighting OCD is both scary and difficult, but not as scary and difficult as watching it take over your life. I would urge you to learn more about exposure and response prevention and if possible find a therapist who uses these techniques to fight OCD.

    • Neal, I’m sure you are a unique person, but not in your OCD. As you have found, the relief from your rituals is complicated by uncertainty they were done right leading to repetition. OCD is like a devil, promising you relief, when, in fact, it keep demanding more. It is the devil to whom you give an inch, but it takes a mile. Rituals become the drug you are addicted too, always wanting more and it is never enough. Fighting OCD is both scary and hard, but not as scary and hard as having OCD take over your life. I urge you to read more about exposure and response prevention and, if possible, find a therapist who uses these techniques.

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