Written by IOCDF Advocate Andrew GottWorth. Learn more about our advocate program.
If you’re like me, when you first learned about OCD, you thought it was about hand washing and alphabetizing DVD collections.
Later I learned about intrusive thoughts and other types of compulsions. Even though I was in therapy for anxiety and depression for 10 years already - I finally got an OCD diagnosis. I think part of the delay in diagnosis is that I did not see myself doing any compulsions. I wasn’t big into washing my hands or rigorously cleaning my house. I wasn’t organized and didn’t spend time sorting, arranging, or putting things in their proper place.
These can be real OCD compulsions that are quite debilitating, yet I didn’t see myself reflected in it. I didn’t think I actively did anything. I was able to structure my life so that I could either do my compulsions, or avoid my stressors. It wasn’t until much later that I realized that avoidance was a compulsion. And oh boy was it a big one for me.
Social Situations
Along the way I probably had awkward social situations like we all do, but then I started to dread them. I set up my life in a way that felt fine, but I was gradually reinforcing the idea that social situations can and will go bad, so I should limit or avoid them. I wanted to ensure that things did “not get worse” (a giant worry). This is how it showed up in my life:
- Leaving parties / friend gatherings early
- Skipping parties
- Constantly having an “out”
- Flitting from conversation to conversation so I didn’t stay long enough for it to “turn bad”
- Turning towards hosting so I had more control and could always leave a situation to help out or check in with a guest
- Staying in a group so as to not have a one on one
- Avoiding eye contact
- Ignoring or procrastinating on returning texts/emails/phone calls
I once was “talking to” a girl, but our communication was an issue. She said “Andrew, you text me in a way like it’s ending the conversation. You leave me with nothing to reply.” And she was right! I was afraid of long conversations because I might mess something up, so I was trying to end them, even though I really wanted her to talk to me! I also always had an “out” on phone calls, even with family members, best friends, or crushes. So when I first went into therapy and they said “Do you have any compulsions?” I said “No I don’t think so.” It’s only now that I realize that in every moment of my social life, I was trying to avoid the feeling of it “going bad”, “getting worse”, “being awkward” etc. I couldn’t articulate that to myself, much less anyone else.
The Five Senses
We can all also develop avoidance to sensations, some for good reason! Don’t touch the stove because it will burn your hand. Don’t be right next to a blaring speaker, because you might damage your ear drums. The taste of some things are awful, because they might be harmful to you. Etc.
But a brain can also run away with these and try to over protect us. My experiences:
And those are pretty easy right? I was lucky enough to have a life where I could always have light, music, a shower, and could choose my own clothing. I didn’t notice the lack of it. I also didn’t notice for how many year of my life I successfully avoided all these.
Off Limits Topics
If I don’t like something, why would I want to watch something about it, or hear about it? I don’t want to think about it! Or at least - that’s how I used to think. But I didn’t realize how much that built on itself. So I started to avoid any movie, show, lecture, class, discussion, etc that involved: Death, Eternity, Sex, Blood/Veins, Spiders, Snakes, Infinite space.
It’s generally easy not to do things. It doesn’t feel like an action. But it is a deliberate choice. I chose not to take an anatomy class. I chose to not to read that book with sex scenes. I chose to not watch that movie about death, the afterlife, etc.
What's the Big Deal?
So - looking back over all the things I’ve mentioned (and there are plenty of other avoidances that didn’t make the list), I managed to go 25ish years without it seeming like a “problem”. My constant stress and anxiety seemed unrelated. What about you dear reader? Any of those topics resonate with you or make you think of other things you try to maneuver around? We’ve made it this far, so what’s the big deal about not doing certain activities, or doing other activities that we do like?
Well, after 3+ years of treatment (and we’ll get to what that is), I’ve noticed what a toll it was taking on me. On one hand - I was missing so much! Now I stay in social gatherings, parties, and conversations longer, and get to have deeper, more enjoyable experiences. I’ve tried new foods, worn new clothes, got a Fitbit. I’ve watched important movies, read excellent books, gone to fascinating classes. I have more things in my life that I would have otherwise missed.
The other key piece is that I didn’t realize how much it was contributing to my anxiety and distress. To successfully avoid things, you must constantly be on edge / on guard to see them coming. You must constantly be planning for an alternate activity, meal, experience, etc.
And when the distressful thing actually came - being in an awkward conversation, being too warm, being in a lecture talking about a blood draw - I went into full alert to try to problem-solve it / get out of it. Shooo… I can feel the Fight/Flight/Freeze rising just thinking about it!
What to Do?
So what’s the cure? There’s no magic potion or “do these 3 simple tricks”. What worked for me, and what’s considered the “gold standard” is Exposure and Response Prevention therapy. I’m not a therapist, just a first hand experiencer - so go find a therapist and work through this together!
What it looked like for me, was (over time) being exposed to things I wanted to avoid - like staying longer at a friend get-together than I wanted to. Then preventing my response of leaving early. So then I was just there. At the thing I wanted to avoid. And sometimes I was right - there was an awkward moment, or uncomfortable silence, or a misunderstanding. And sometimes it was fine. Either way, eventually I could stay longer and longer without that dread and panic.
What didn’t work for me was what I tried in the beginning. I would try to do an exposure, but the whole time say in my head “I hate this. I hate this. Oh no oh no oh no. Just get through this and you’ll be ok. Come on. Just make it through”. For me - that just reinforced my brain’s belief that it was awful and I should continue avoiding it. Instead, I learned some techniques from my therapist that overlap a bit with mindfulness:
Now - you’re rightly thinking - there’s a balance between being a little too warm, and getting burned. A difference between avoiding topics about death and just having a preference for comedy. A difference between sitting with the distress of darkness and not actually having enough light to see. That’s best left for you and an ERP therapist to decide.
Am I perfectly capable to do anything distressing and be at peace? NO. But I think that’s ok. It’s a journey. It’s trying, failing, and trying again. Still though, after trying to prevent my avoidant response, I have gained so much more in my life. So if all of this sounds familiar to you, but you’ve not tried ERP yet, check it out! And if you’ve been through therapy and you needed a reminder, this is it! Go do the thing!
I work as a counselor for a hockey academy for high school students. I have a student who avoids class, which causes him to get behind, which gets him more stressed, which makes him want to avoid class again. Yet at the same time, he is always ready to play hockey, but always wants to avoid class. Can any OCD therapist treat his avoidance by using ERP?