There are no OCD types or themes. Only OCD (and llamas).
It’s very popular in OCD patient communities, and in mental health communities in general, to get stuck on labeling superficial symptoms. But it becomes just another way to practice the judging and categorizing and discriminating that can fuel so many compulsions. A more effective approach to support recovery from OCD is to understand (and eliminate) the compulsive patterns of thinking and behaving beneath all compulsions, whether they bother you or not.
This might be easier to understand by looking at the sub type of OCD that is, without a doubt, the most horrific to deal with: LOCD. LOCD is the subtype of OCD that includes all of the compulsions related to the fear that you’re a llama. Common compulsions include:
- Looking at pictures of llamas to test whether you get aroused.
- Ruminating on “false” memories about experiences where you might have spent too much time near grass. You liked how it smelled. Maybe you wanted to eat it (because you’re actually a llama).
- Avoiding romantic relationships because if somebody actually knew you were a llama, they could never love you.
- Pulling out your photo ID to check if it’s a human or a llama in the picture.
- Telling people you have Pure O.
- Praying repeatedly to get those images of dromedary genitals out of your mind. Praying repeatedly is a compulsion but keep telling people you have Pure O. Confusion is human.
- Confessing to your partner that you’re actually a llama.
- Cooking meat until it’s like rubber because you’re afraid of getting listeriosis. It’s quite prevalent amongst llamas.
- Constantly checking that weird feeling in your stomach and Googling symptoms online because that feeling is probably listeriosis.
- Checking in mirrors repeatedly to confirm whether you’re a human or a llama.
- Only eating specific foods that llamas don’t eat (like baked Alaska) so you can consistently reassure yourself that you’re a human.
- Weighing yourself after every meal to make sure you’re not getting close to 375 lbs (the average weight of a llama).
- Avoiding social events because you’re afraid you might spit in somebody’s face or defecate in front of your friends.
- Tapping your fingers against each other and counting them. You have to start over if you get a thought about being a llama. You’re not sure why you began doing this but at least you don’t have hooves.
- Rereading work emails to check if you confessed to being a llama. You don’t want to get fired for being a llama.
- Ruminating about how you’re going to explain to your family and friends that you’re a llama. What if they never talk to you again?!
- Panicking when you hear a police siren go by because you’re sure they’re coming to take you away to a petting zoo and lock you up forever.
- Not getting into elevators with children because you’re a llama and you might bite them.
- Making sure you touch your right and left side evenly when you’re scratching yourself or bump against something. This actually makes you worried because it seems like something a llama might do.
- Checking whether you actually love your partner and feel “right” in your relationship. Maybe you’re not feeling what you should feel because you’re a llama. Llamas don’t feel love towards humans.
- Retracing your steps around your neighbourhood to check whether you kicked anybody with your back hooves. Search “llama attack” on YouTube. It’s no joke. You don’t want to do that to somebody.
- Wondering if that guy you’re messaging on an online dating site is taking a really long time to respond because he’s actually figured out you’re a llama and he doesn’t want to speak to you anymore.
- Questioning the meaning of existence. What does it all matter if we’re just llamas anyway?
I might have missed some. Please share your experiences with LOCD in the comments below.
Here’s the thing: You can just take out the word “llama” or any of the llama behaviors and swap in your particular fear or compulsion. That’s because OCD is about patterns. OCD is in the things a person does, inside or outside of their head, as a reaction to a fear or uncertainty or feeling they don’t like. It’s those patterns of reactions that need to change.
A big problem that people often run into is only wanting to make changes related to a particular topic that’s bothering them–their “type” of OCD. When somebody is talking about their type of OCD, it’s often just the symptoms that are bothering them the most. It’s a tiny part of OCD. If they only tackle that topic, but they keep engaging in the same compulsive patterns in other areas of their lives that don’t bother them, OCD continues.
OCD doesn’t have to be chronic, but if you only play whack-a-mole with the topics that bother you, then it’ll keep going for as long as you can think up things to worry about. The problem is the whack-a-mole machine, not the moles popping up.
And watch out for those llamas.
Wonderful article, Mark. Thank you for sharing this. 🙂
If my ocd is about my eyes blinking. Do i treat it the same as any other ocd? Even if the triggers are intrusive thoughts regarding blinking and the actual blinking itself?
Yes. OCD isn’t in the topic of a thought or feeling, it’s in our reactions to experiences. It can help to approach physical experiences as the same as mental experiences. One challenge that often comes is that we tend to see mental or emotional experiences as not being “real”. But the discomfort we experience with something mental or emotional is just the same as something physical. And our reactions are the same. And when it comes to recovery, it’s the reactions we’re going after, not the experiences. So one thing you might find useful to look at is why you believe that blinking is different. You might find some beliefs that aren’t so helpful or useful when it comes to cutting out these compulsions. And then, like cutting out any compulsion, it’s going to take practice. And it’ll often be uncomfortable and your brain will think of all sorts of reasons why you need to react to these experiences.
I thought I’ll just reply on what I’ve learnt dusfar.
The absolute best strategy is to let go of the thought, not to grapple with it at all. The next best way is to accept it; you have to walk around with it. It won’t kill you, just resign yourself to having to do this, don’t fight it. This doesn’t remove it, of course, but what it does is take the edge off the fear, so while it’s there, it’s not as powerful and terrifying as it was.
There are probably things you have to deal with everyday that you don’t think about as even chores or bothers; they don’t have that status in your mind, they’re just things you do. Eating and sleeping are one example. I have to eat and sleep every day but I don’t think of them as chores, even though I’m obligated to do them. This extends to running, taking out the trash, brushing my teeth, and showering. It doesn’t even occur to me to give them the status of obligations. When your breathing hits this status, you know you’ll have taken the edge off. What you’re scared of is not breathing awareness, but you’re anxious about the anxiety of becoming aware of breathing.
You are not afraid of the thing itself — having your breathing set to voluntary control — you are anxious about what you think having voluntary breathing is.
In his Handbook, Epictetus writes: “What disturbs men’s minds is not events but their judgements on events: For instance, death is nothing dreadful, or else Socrates would have thought it so. No, the only dreadful thing about it is men’s judgement that it is dreadful.”
You have to live with this fear to see it won’t kill you. It won’t inconvenience you as much as you think, and, in fact, once you accept it, it’s pretty hard to keep your mind on it all of the time, even if you try. Once you’re aware that you’re aware of it, I want you to remember how you feel at that moment. Terrified? Or just kind of like, “Meh, this is a little inconvenient.” Write it down, if that helps. The next time you get afraid of becoming sensorimotor-aware, remember how you felt. It’s no big deal. OCD thinking isn’t real, rational thinking. It’s anxiety wheel-spinning thinking. “Let’s say the worst happened, and I had to literally spend the rest of my life consciously controlling my breathing and blinking. Anything is better than being anxious about it for some damn reason all the time. F*ck that noise.”
Imagine it a savings account at a bank. If the account runs low, the bank calls you. People with avoidant OCD tendencies wouldn’t want to glance at their account. Their fear isn’t running out of money; it’s fear of the feeling they’ll feel if they see their account is low. Fear not of not having money; fear of feeling anxious and guilty about not having money. How’s that for OCD?
Hi Mark,
I corresponded with you a few years ago and thank you for writing back at that time!
I have a quick question regarding your opinion on psychedelic medicines for the underlying fears that some OCD obsessions are drawn from.
There is exciting positive results coming out of MDMA therapy for those with PTSD. The FDA is expected to approve this treatment in 2021 with clinical trials being done by MAPS.
Given that obsessions can turn into “permanent” fear memories if we react to them fearfully with compulsions, they are essentially conditioned fear responses.
Well, MDMA (if you read about its effects on the brain lowering the amygdala response, etc.) has an uncanny ability to allow someone to form either extinction memories or even possibly update the fear memory through reconsolidation.
I am wondering once the drug is legalized for PTSD therapy, it might be possible to apply it to many other forms of anxiety disorders such as OCD or phobias, which have a large component of conditioned fear responses.
Could MDMA be used in CBT/ERP fashion to expedite the process of fear extinction in those with OCD?
It would not cure OCD, but it could wipe out fears and allow a person to maintain their progress through ACT and future ERP when any potential obsessions pop up.
This is just a thought, but it may be something that can be used to augment OCD treatment.