OCD, Obsessive-Compulsive Disorder. The mere mention of this disorder elicits images in our minds of excessive hand-washing, checking locks countless times, spending hours making sure that the books on the bookshelves are “just right,” and other compulsive actions. If someone is not engaging in such overt compulsive actions, you would think that he does not have OCD. The reality is quite different. It is actually quite common for a person with OCD to have covert mental compulsions.
Now, I know what you are thinking. How can a compulsive action be merely mental? If it is all in the head, what is the big deal? This is an excellent question.
The short answer is that mental compulsions are mental “actions” that one does in his head to alleviate the anxiety created by the disturbing thought. You are probably not any closer to understanding the nature of mental compulsions, so let us first review the fundamentals of OCD with obvious and overt compulsions, and then we can explore OCD with mental compulsions.
Obsessive-Compulsive Disorder is composed of two components: the obsessions (the “O”) and the compulsions (the “C”). Obsessions are unreasonable, intrusive, and unrelenting thoughts or fears, and compulsions are repetitive behaviors meant to prevent or reduce the anxiety that is related to the obsession. Compulsions tend to offer only extremely temporary relief. For example, if someone has an irrational fear of becoming sickened by germs on the kitchen counter, the constant fear of becoming infected is the obsession, and the repetitive cleaning is the compulsion. After an hour of cleaning, the counter might feel clean enough to offer brief relief from the obsessive fear. The respite is short-lived, however, and within a short time the obsession returns, and the OCD cycle starts all over again. This form of OCD is relatively well known. The compulsions are overt and in plain view for all to see.
However, in many cases of OCD, the compulsions are mental in nature. This form of OCD is also called Pure-O, since the compulsions (the “C”) are hidden from sight.
Here are some examples of covert compulsions that are typical of Pure-O OCD:
- mental attempts to drive the intrusive thought out of one’s head
- constant mental reviews of events to make sure that nothing bad happened
- thinking positive thoughts in an attempt to negate the negative thoughts
- avoiding situations that might trigger the unwanted thought
- constant mental prayers (if the unwanted thought is religiously disturbing)
- magical thinking (for example, that thinking about a certain number will offer protection)
I imagine that the reader still lacks clarity on what exactly is Pure-O OCD. Perhaps a few anecdotes (based on true stories) will clarify the nature of this agonizing disorder.
Reuven works in an accounting firm. Reuven’s boss is an easygoing fellow who treats his employees very well. Reuven is bright and hardworking, who by all measures is an excellent employee. Reuven is nevertheless obsessed with a fear that his boss might fire him. This all began when Reuven once made a mistake in his work that cost the firm $5,000. Reuven’s boss was understandably upset, but he told Reuven that he understood that it was an honest mistake that could have happened to anyone. Reuven was afraid that his boss’s soothing tone was disingenuous, and from that point on he feared that he might be fired. Whenever Reuven received an email from his boss, he would analyze it, sometimes for over an hour, to see if his boss liked him or not. Reuven constantly reviewed everything that happened that day at work in an attempt to figure out if his boss was planning to fire him. Each day at work was extremely exhausting, since Reuven’s brain was maintaining a constant vigil. It is as if Reuven held two full-time jobs. He was working as an accountant, and he was also performing full-time surveillance of his boss’s every move. Reuven seriously considered quitting his job, since he would then not have to fear getting fired.
Reuven suffers from OCD. His obsession is the intrusive thought that he might be fired. His compulsions are mental efforts to reduce the anxiety by reaching a certainty that he won’t be fired. Since absolute uncertainty is unattainable, his compulsions merely perpetuate the mental cycle of his OCD. To the rest of the world, Reuven does not appear to be engaging in any abnormal activities. But inside Reuven’s brain, there is a never-ending mental battle going on between his intrusive anxious thoughts and his mental efforts to neutralize them.
Rachel and Yosef have been married for under a year. When Rachel met her husband, she was instantly impressed by Yosef’s kind nature and sterling middos. Shortly after their wedding they had their first fight. It was a very minor disagreement that should have rapidly dissipated on its own. However, Rachel became nervous that maybe Yosef was not the kind man she thought she married. The rational part of her brain told her that a minor disagreement is not a cause for alarm, but part of her needed absolute certainty that her husband would not be abusive to her. She was possessed with the terrifying thought that perhaps her marriage was not “meant to be” and that, if she stayed in the marriage, there would be a horrible outcome. Rachel spent hours per day making mental lists of Yosef’s qualities, trying to reach the unattainable certainty that she was desperately seeking. She consulted her Rav, who reassured her that her husband was a wonderful fellow and she had nothing to worry about. But Rachel knew that already! Her problem was that her obsessively anxious brain needed absolute certainty, which is impossible. The more Rachel sought reassurance, the more she needed it. Rachel’s life had become a living hell (not to speak of her husband’s suffering). She became extremely depressed and lay in bed most of the day crying. She secretly wished that Yosef would divorce her so that she wouldn’t have to worry about this anymore.
Like Reuven, Rachel suffers from OCD with mental compulsions. Her obsession is the irrational fear that her seemingly wonderful husband might be a monster. (You never know…) Her compulsions are the constant mental efforts to convince herself with absolute certainty that her husband is as wonderful as he seems.
This final anecdote sounds so bizarre that many readers will doubt that this could ever happen. But therapists who deal with OCD on a daily basis know that this is actually a fairly typical case of Pure-O OCD.
Devorah was in her kitchen slicing her roast beef with a rather large knife. Her three-year-old son was seated in a high chair at the kitchen table. He was whining at the top of his lungs. Devorah was very tired and not in the mood of dealing with her son’s tantrum. At that moment a thought popped into her head. “Wouldn’t I be better off if I just killed him with this knife?” It is actually quite common for our brains to generate extremely bizarre thoughts. Just as we have nightmares when we sleep, we will sometimes have a grotesque or bizarre thought pop into our head unexpectedly when we are awake. People who are not predisposed to OCD will just find the thought funny and intuitively understand that random bizarre thoughts have no basis in reality. However, Devorah was predisposed to OCD. The fact that she had such a thought shocked her to the core. “How can I have such a thought? Is it possible that I am a psychopath and would gruesomely kill my own child in cold blood?!” She started having grisly thoughts of her killing her son regularly. The more she tried to avoid having these horrific thoughts, the more they kept haunting her. Whenever she was at home with her son, she was frightened that she might actually kill him. This caused her to be in a terribly anxious state whenever he was around. In order to neutralize these thoughts, she kept herself extremely busy with distracting activities. Her son could not understand why his Mommy wasn’t giving him any attention. She also stopped using knives in the kitchen, out of fear that she might kill him with the knife. (Ever tried cutting a piece of chicken with the side of a spoon?) Additionally, she constantly repeated in her head the thought, “I love my child,” in order to negate the thought of killing her child. She even contemplated suicide, since she would not have to be concerned about killing her child if she were dead. In reality, Devorah does not want to kill her child. Psychopaths don’t have anxiety from the thought of murder! (That is why they are psychopaths; they lack empathy.)
As you have probably figured out, Devorah also suffers from OCD. Her obsession is the thought that she might kill her child. Her compulsions are distracting activities, avoidance of knives, and neutralizing thoughts.
By now, you probably have a pretty good understanding of the nature of Pure-O OCD and how debilitating it can be. Unfortunately, people with Pure-O OCD often suffer for years, because they often do not realize that they have OCD. Rather, they believe that they are evil or insane.
Fortunately, once they are properly diagnosed, there are very successful treatments. OCD treatment is a specialty, and a psychotherapist with specialization in the treatment of OCD is required. Additionally, medication might be needed to assist in the reduction of the anxiety.
The Talmud (Kiddushin 39b) tells us that Hashem does not equate thoughts and actions. The Talmud is acknowledging that our random thoughts are often not reflective of our true selves. We should all merit to be in touch with our true selves and in this way be able to properly serve Hashem.
Rabbi Hauptman is Director of Relief of Baltimore, a mental health referral service. Contact him at firstname.lastname@example.org or at 410-448-8356. This article was reviewed by Dr. Mordechai Zeiger, Psy.D., who has a subspecialty in anxiety disorders and OCD. Contact him at 443-220-8142.