Doubting and Its Role in Obsessive-Compulsive Disorder (OCD)

By: Suzanne Feinstein, PhD

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Obsessive-Compulsive Disorder (OCD) is a mental health condition that is often misunderstood. While it is commonly associated with behaviors such as excessive hand-washing or checking, the underlying mechanisms are far more complex. One of the key elements that fuels OCD is doubt.

The Anatomy of Doubt

Doubt is a natural human response to uncertainty. It is a cognitive process that allows us to question, to weigh evidence, and to avoid jumping to conclusions. In moderation, doubt can be healthy, fostering critical thinking and helping us make informed decisions. However, when doubt becomes excessive or irrational, it can lead to distress and dysfunction, as seen in OCD.

Obsessive-compulsive disorder (OCD) is frequently labeled as the “doubting disorder” due to its primary feature of persistent doubt. This doubt can take many forms, such as questioning one’s memory or the sufficiency of tasks performed. 

Here are some elements that contribute to doubt in OCD:

  1. Obsessions and Compulsions: OCD is marked by persistent, often uncontrollable thoughts of anxiety, and regular compulsions in reaction to these thoughts. For instance, a person with OCD might begin to question their memory of checking the dishes or their certainty about having cleaned them properly, even after confirming that the dishes have been washed.
  2. Fear and Uncertainty: The essence of OCD is a doubt about one’s own memory. The act of trying to recall if something occurred or if something was done accurately can rapidly turn into an obsession. This degree of obsession can disrupt life and quickly monopolize attention.
  3. Rumination: OCD can lead individuals to fixate on certain thoughts, potentially resulting in indecisiveness. This indecisiveness can cause individuals to question whether they’re making the right decision or lead them to fret about all the potential outcomes that could be at risk.
  4. Neurological Factors: Studies suggest that doubt, uncertainty, and a lack of confidence may have neurological roots. This implies that the way individuals process information and make any decision may be inherently programmed into their brains.

It is crucial to remember that the causes of OCD are not entirely known, but common risk factors include genetics, brain structure, brain function, and the experience of childhood trauma. If you suspect you may be showing symptoms of OCD, it could be helpful to consult with a mental health professional who specializes in OCD and related disorders.

Doubt in OCD: A Double-Edged Sword

In the context of OCD, doubt often takes on a life of its own. It fuels the obsessions, making them seem more real, more urgent. Doubt tells the person with OCD that they can’t trust their own memory, their own senses, or their own judgment. This can lead to compulsive behaviors as the individual seeks reassurance or tries to mitigate the perceived risk.

For example, someone with doubting obsessions might doubt whether they turned off their faucet properly. This doubt triggers anxiety about a flood, leading to repeated checking behaviors. The relief is temporary, as doubt soon creeps back in, restarting the cycle.

Here are some examples:

  1. Checking the stove: Even after confirming the stove has been turned off, an individual might start to doubt their memory of having turned off the stove. Or despite not even using the stove, they worry they may have accidentally bumped into it and turned it on. They might go back and check the stove just to make sure.  
  2. Doubt about locking the front door: If an individual is trying to get a work task done but is obsessively thinking about their safety and doubting if they locked the front door, they might stop working while they think through all the possible negative consequences of leaving the door unlocked. They might even surrender to the compulsion by leaving work to check on the door.
  3. Doubt about performing an activity correctly: After completing an activity, an individual might doubt whether they performed it correctly or even did it at all. 
  4. Doubt about one’s senses: When carrying out routine activities, an individual might feel they don’t trust their senses – ie what they see, hear, or touch. 
  5. Doubt about one’s memory: At the core of OCD is doubt of one’s own memory. Trying to remember if something happened or if they did something correctly can quickly become an obsession.

These examples illustrate how pathological doubting in OCD can interfere with an individual’s daily life and functionality. If you or someone you know is experiencing symptoms of OCD, it may be beneficial to speak with a mental health professional who specializes in OCD and other related disorders.

The Paradox of Certainty

Ironically, the quest for certainty in OCD only breeds more doubt. Each reassurance is fleeting, each checked lock or cleaned surface a temporary salve. The individual becomes trapped in a loop, their actions feeding their obsessions rather than quelling them.

This is the paradox of certainty in OCD: the more one seeks it, the more elusive it becomes. It’s like trying to catch smoke with your hands; the tighter you grasp, the quicker it slips through your fingers.

Treatment Options

Treatment for OCD, such as Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP), often involves learning to tolerate uncertainty. Instead of seeking reassurance, individuals are encouraged to sit with their doubt, to let it be. Over time, they learn that they can cope with doubt, and that uncertainty, while uncomfortable, is not dangerous.

Conclusion

In OCD, doubt is a tormentor, a trickster that distorts reality and fuels distress. Recognizing and understanding the role of doubt in OCD is a crucial step towards recovery. It’s a journey of learning to live with uncertainty, of realizing that doubt, like fear, is often a liar. And in that realization, there is hope.

Advanced Behavioral Health, LLP helps people tackle their OCD using scientifically–proven CBT techniques. Call 646-345-3010 or email Dr. Suzanne Feinstein at drfeinstein@behaviortherapynyc.com for a free 15 minute consultation to see if you qualify for treatment.

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