Often overlooked in treating OCD is the crucial importance of making assumptions. I have recently seen two OCDers who illustrate the point. One young man had the obsession “I don’t have sufficient faith.” It provoked hours and hours a day of various mental compulsions aimed at proving his worthiness in the eyes of his God. He talked about his having OCD, yet when it came down to trying to address the troublesome thoughts through therapeutic action, he would refuse. “It’s just too important that I have faith,” he would say. “I can’t experiment with faith, because my eternal life depends on it.”

Similarly, I counseled a middle aged Catholic woman with compulsive confessing who stubbornly insisted on the truth of her obsessional fear. She spent hours in the confessional whenever she could, and was driving her Priest crazy despite the fact that he attempted to restrict her sharing to only once every other week and to only present sins and not past ones. She told me “I have to confess all my sins, because my whole life depends on it. There is no way around it.”  This sort of inability to take action to oppose OCD occurs with all types of fears.  A person with germ phobias explained why she could not do assignments to combat her OCD, “Even if I feel that there is just one germ left on my hand, I must wash. “I have to because my life does depend on it.”

What we have to do is make the firm assumption that our obsessions are fears held irrationally. Remember that our lives are, in fact, completely based on assumptions. Who can ever be factually certain that he or she has enough faith to go to heaven, or has adequately confessed all sins, or washed away every harmful germ? Who can even be certain that his or her spouse is not having an affair?  We can have trust in our spouse or trust in God (this represents certainty in one sense), but we can’t have total factual certainty about anything! We must therefore make assumptions, and this is especially important for OCD sufferers, all of whom share a special problem with attaining factual certainty about their obsessions.

One cannot think clearly at the moment an obsession strikes. The fear is too overpowering.  It is in a moment of quiet reflection that we OCD sufferers must decide: Yes, this is OCD and that fear is irrationally held. Then when the obsession hits, we must remember our assumption and trust it best we can, and by will power act against OCD.

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