Did you know that could be OCD?!
Obsessive Compulsive Disorder is like a spectrum; there are many different ways that it can show up for someone. There are of course commonalities and similarities between symptoms of OCD, however, it can be very personalized and can often go after what people value and love the most. Because of how personalized it can be, OCD can become very intense and scary to people which is why they ultimately become stuck in a cycle of OCD. To learn more about the OCD cycle, click here to read our other article.
These different ways that OCD can show up are known as subtypes. These subtypes, though all different, are all a result of the same thing, OCD. Because of the variety of ways that OCD can show up for someone, it often can be tricky to properly identify as it can present on such a large spectrum. It can even be tricky for clinicians to identify if they don’t have a trained eye. In this article, we’re going to go over and talk about some of those uncommon subtypes that may get overlooked or misunderstood.
False memory OCD is when someone is experiencing extreme doubt around something that happened in their past. It is continual, recurrent intrusive thoughts that are focused on if someone did or did not do or say something, or if something really happened or not. It’s important to note that this isn’t an exhaustive definition as to how it can show up for someone. People who experience false memory OCD can often engage in mental compulsions, essentially making their OCD invisible. This is called mental ritualizing without overt compulsions which is mental obsessions and mental compulsion – overt means obvious, not hidden, done openly. So without overt compulsions, this means someone is not acting out compulsions physically. Everything is done in their head.
Let’s look at an example on how this can show up for someone.
Last night she and her husband went to a family dinner at her dad’s house and had a really fun time. Family is important to Abigale, and the time they spend together is impactful and meaningful to her. Once she got home, showered and settled into bed for the night with her husband, she had the thought, “Did I use an offensive word during our dinner conversation?” Abigale got very worried for a moment. “No I didn’t, we had an amazing time. I would know if I did that.” She tried to reassure herself or neutralize the thought, because the potential of offending the people she loved brought her a really strong feeling of guilt and worry. The mental reassurance wasn’t enough and the thought persisted. “Mmm, I’m pretty sure you definitely said something offensive.” Abigale was now in bed, stuck on this worry and guilt that she may have said something offensive. It was getting harder and harder to tell what was just a thought and what was a real memory.
While her husband slept soundly, her mind kept scanning to figure out how to solve this very real problem of her possibly offending someone since the initial reassurance wasn’t enough. After being stuck in this loop for 45 minutes, she began reviewing and replaying the whole evening in her head. In her mind, she reviewed everyone’s facial expressions, body language, reviewed all of the conversations she had with everyone and reviewed every joke she said. This took about 2 hours, scanning over the evening until she proved to herself that everyone was happy the whole night and she didn’t actually say anything to offend anyone. Once this was identified and the guilt and worry went away, she was able to finally go to sleep, almost three hours later from when the thought originally appeared.
- Abigale had an intrusive thought, “Did I use an offensive word during our dinner conversation?”
- Because this felt like a real and possible situation, Abigale’s brain attached meaning to the thought (“this might have really happened and I need to figure it out”). This created the obsessive thought “Did I say something offensive?”
- This began causing her distress, such as feelings of guilt and worry and she got stuck in an obsessive loop.
- The compulsion was to thoroughly review and scan over the entirety of the evening.
- Once her brain finished scanning the evening and validated she did not say anything offensive (which took almost three hours), she was able to go to sleep bringing her temporary relief until the next thought came and she repeated this process, illustrating the OCD cycle.
- This goes on unknowingly to the people around her as this is all done in her head and can often get pegged as ‘over-thinking’ but it is actually rumination.
Moral Scrupulosity OCD is where we see the desire to be a good person taken up several notches. Most people want to be a good person and do good in the world, but people that experience Morality OCD may feel that they have to be 100% honest all of the time, may often find themselves confessing ‘bad’ thoughts to make sure they’re still a good person and may constantly questioning their actions and behaviors to see if it aligns with being a good person. This is not exhaustive, but just some ways in which Morality OCD can show up in someone.
Let’s look at another example.
- Craig got the intrusive thought, “If I don’t tell my girlfriend dinner is overcooked, then I’m lying to her and I’m a bad person.” This is meaningful to Craig, so he became stuck on it.
- The guilt and shame of being a bad person was so overwhelming to him, that he felt he needed to do something about it;
- Craig began confessing (the compulsion), stating how she overcooked dinner to rid his shame of being a bad person by not being truthful.
- Confessing this only provides temporary relief however, reinforcing the OCD in the long run.
- Gabby gets intrusive thoughts all day about the meaning of life and death. (“What is the point of anything?” “It doesn’t even matter anyway.” “We’re all going to die one day.”)
- These intrusive thoughts cause Gabby such distress that during the day, she avoids them and distracts herself which is the compulsion. Remember invisible OCD? This is it too!
- Once Gabby is alone and no longer busy, the intrusive thoughts persist and again cause her distress
- To remedy this, she turns on music, the TV, and Facetimes friends to avoid and distract herself from the intrusive thoughts and associated feelings. Avoidance and distraction are also considered compulsions.
- Because avoidance and distraction only provide temporary relief, the thoughts return the next day.
This subtype of OCD is where we see people relationships questioning and having constant doubts about their relationship that they are otherwise satisfied in. This, like all of the other subtypes, can show up in different ways and what is discussed here is not exhaustive. People who experience relationship OCD may question their behaviors or actions to ensure they do not align with being unfaithful or untruthful to their partner. People who experience relationship OCD may often question or experience doubt around if they’ve ‘found the one’, or feel they are in a constant pursuit of finding ‘the one’. They may feel like they could have ‘done better’ than their current partner, despite the fact that they are happy with that partner. They may find themselves preoccupied with their partner’s past relationships or worried that they don’t love them enough.
Let’s look at one of the ways on how this can show up.
- Craig experienced a thought regarding finding the actress attractive which triggered the intrusive thoughts around his decision and feelings to marry Kallie.
- Because he loves and values Kallie and their relationship, this becomes distressing to him and he experiences feelings of anxiety, guilt and shame.
- To try to solve this and feel 100% certainty about his decision to marry Kallie, Craig engaged in mental reviewing, reviewing all aspects of their relationship to ensure he was or was not making the right decision in marrying her. Later, after the movie, he also texted a few friends to ask what they think about his relationship for reassurance, which can be another type of compulsion.
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