The Danger of Doubt: The Ruthless and Frequently Misunderstood Logic of OCD

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Guest blog post by Fletcher Wortmann –
OCD is called the “doubting disorder,” at least among people inclined to give cutesy alliterative nicknames to mental illness.  OCD is the pathological intolerance of risk, however minute, and the surrender to protective ritual, however unbearable.  I know this because I suffered from severe OCD symptoms for twenty years without my family, or teachers, or even therapists correctly identifying my symptoms.  Despite frequent portrayals of OCD in books, television and film, I’ve found many people’s understanding of the disorder is tragically limited.

Now, “intolerance of risk” may not sound atypical or extreme.  After all, each of us has moments when, against probability and common sense, we attempt to eradicate ordinary uncertainty using our minds.

Think about it: You get halfway around the block and realize that you might have forgotten to lock the front door, so you drive back around to check it.  It’s near the end of the seventh inning and things aren’t looking good, so you pull out your favorite baseball cap because sometimes it seems to help.  You call your child’s phone twice to make sure that she got to the party okay.  You cross your fingers, you knock on wood, you wish on a coin or a star or a stray eyelash.

Everyone does this.  It’s not a problem for most people.

But it’s a big problem for people with OCD.

Obsession comes from a simple glitch in cognition. Ordinarily, you have a built-in time clock in your mind. After turning over a certain problem for a while, a committee of highly efficient business-people in your brain decides, “okay, that’s probably the best solution we can come up with for now – enough,” and they table the issue and move on. That’s healthy and normal.

When you obsess, however, your mind refuses to admit defeat, to accept that you just can’t come up with a better answer. After all, what’s the harm in thinking about it just a little more? And more again? When you suffer from OCD, a sliver of doubt always persists that you haven’t examined the issue from every angle; and so you wrestle with your problem a little longer, trying to find a new solution that reduces your uncertainty and leaves you satisfied.

Obsessive-compulsives are taken in, every time, by the promise of one more look at the problem, even if we’ve already worked on it for hours, for days, for months.  OCD demands safety and certainty, and the fact that nothing can ever be totally certain is regrettable but irrelevant to its purposes.

Sometimes this leads to the physical compulsions so many identify with the disorder.  If we have scrupulosity and we’re afraid of God, we may run a rosary until the chain snaps. If we’re obsessed with catching a disease, we may wash our hands over and over again.  Eventually the behavior of the sufferer is entirely divorced from reality.  Hand-washing is no longer a basic hygienic practice but a magic charm, a banishment cast against the ambiguous, malevolent threat of all “germs.”

But these physical compulsions, which so many assume are the greatest burden of OCD, may be only modest indicators of a terrible internal struggle.

And, some of the most distressing forms of OCD have no visible signs, no tangible compulsions. I have a variant of the disorder referred to as “Pure O,” or purely obsessional OCD, characterized by runaway intrusive thoughts. With Pure O, the mind is held captive by its worst nightmares:  fears that the world is about to end, for instance, or that the sufferer is a murderer or a sexual deviant who could succumb to uncontrollable violent urges at any moment.  Whatever the single most inappropriate or offensive thing you can imagine, at any particular moment - Pure O knows what it is, and it exploits it.

With Pure O, these problems can not be put to rest through physical rituals like hand-washing or counting. Instead, the sufferer is left obsessing, silently and almost continuously, incapable of finding conclusive proof that these hideous scenarios will not occur. We can not tell anyone, for fear of being labeled paranoid or psychotic, and because our symptoms are internal, people don’t notice, and we’re rarely offered help.  As an OCD sufferer, I did any number of asinine, irrational things not because they would protect me, but because I thought they might, and I’d be darned if the one night I failed to properly pray the lord my soul to keep was the night I died before I woke.

If a sadistic billionaire decided to gather every Pure O sufferer into an Arkham City of twitching misery, then (according to Lee Baer’s The Imp of the Mind) it would be the fourth-largest metropolis in the United States. Yet the disorder continues to be under-diagnosed. It is the invisibility of the disease that gives it power: because so few can recognize our symptoms and because so many do not understand them, many of us struggle for decades before successful diagnosis.

OCD sufferers aren’t straight-jacketed neurotics or treacherous psychopaths or lovable buffoon detectives. We are people who suffer, in a way that is familiar to almost everyone, but to a degree that no one should have to endure. I lost the first twenty years of my life to OCD but I hope that, by continuing to spread awareness of the nature of the disorder, we can bring it out of the shadows and work to alleviate the suffering of so many.

fletcherCopyright, Fletcher Wortmann, 2013. Author of Triggered:  A Memoir of Obsessive-Compulsive Disorder (St. Martin’s Press), named one of Booklist’s “Top 10 Science & Health Books of 2012”.


  1. E.W.'s avatar
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    Good article.

    OCD is a horrible disorder to live with and has been by far the biggest obstacle in my life. Otherwise, I consider myself so lucky and I try to see the good side of things...OCD however is a cockroach that won't go away.

    Exercise, therapy, and medication help, but can only do so much. Psychiatrists can make you feel like a guinea pig, while your whole livelihood is at stake, waiting to see if the medicine works.

    It's interesting to me when people ask "normal" questions like "do you think about quitting your job?", "do you think about cheating on your girlfriend?", "do you think about this, etc???"

    When you have Pure O, you can think of almost anything and everything that is disturbing, demented, self-destructive, dangerous, etc...On an everyday basis, you can't help but envision horrendous things happening, especially to those you care about.

    Pure-O is misunderstood, and also harder to portray in the media. I like watching movies about people with OCD and other mental illnesses, and some of them do a pretty good job of it. But it's usually for checking, cleaning, or magical thinking. Kind of hard to really portray a character who has to rewind the image in his mind of a family member dying, and "erasing" that thought, to something less bothersome.

    When people say "I'm so OCD about this" or "everyone is a little OCD", I'd just like them to spend a couple of days in my shoes, and then say that bullshit. Sometimes when people ask "am I being OCD about this?", I like to reply with "do you think someone you love is gonna die because you don't do it right?". If the answer is no, then I tell them they aren't lol

    For many years I just thought I was crazy and really sick/twisted in the head. It makes you feel better knowing it's a disorder you can't help, but it's still an everyday struggle.

    Perhaps the worst thing is that OCD can shift and move. Pure-O? You learn to deal with it and ignore it for the most part....then you enter a serious relationship. Now it's relationship OCD.
  2. Janet Singer (ocdtalk)'s avatar
    Janet Singer (ocdtalk)
    | Permalink
    Fletcher, This is a great article, and I especially like your reference to "highly efficient business-people in your brain." Also, it still amazes me how misunderstood and mis(or un)diagnosed OCD is. Your writing will help to change that. I was hoping to connect with you at the IOCDF conference this year, but will not be able to attend for a variety of reason. Take Care!
  3. Jackie Lea Sommers's avatar
    Jackie Lea Sommers
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    Fletcher, this is an EXCELLENT and well-written article about OCD. I think I'm going to feature it on my blog. If you'd ever be interested in writing a guest post for my blog, I'd love that. I have about 2100 followers and blog about OCD several times a week. Let me know.

    P.S. My story is very similar to yours-- 20 years of Pure O torture followed by 12 weeks of ERP, and now I have experienced freedom for the last four years!
  4. Lisa Lambert's avatar
    Lisa Lambert
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    Fletcher, you explain this so well and so vividly. From the outside looking in -- and even from the perspective of many mental health professionals -- OCD doesn't look dangerous or erratic. So, it's given less worry and doesn't make the headlines much. But in my years of talking to families and youth, it can really slow down or derail people. Thanks for speaking out so eloquently.
  5. Fletcher Wortmann's avatar
    Fletcher Wortmann
    | Permalink

    The most important and effective treatment for OCD is Exposure-Response Prevention, or ERP therapy. It involves the sufferer confronting the source of his anxiety instead of using compulsive behaviors to avoid it. It's difficult, but in my experience it's the only kind of therapy that really helps with the disorder.

    I've written a bit more about my experiences with ERP therapy in a column for Psychology Today:

    And if you're interested in finding a therapist trained in ERP for your grandson, the International OCD Foundation has a number of resources available:

    Best of luck to your family and particularly your grandson. But please know that, as challenging as OCD can be, effective treatment is available!
  6. Carol Evans's avatar
    Carol Evans
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    You said you lost 20 years of your life...what happened to change that. My grandson has been diagnosed with OCD since age 6, he is now 14 and has gone through many rituals, he is an excellent student, athelete, takes Prozac, but stills has some symptoms.
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