Just Right OCD: An off-kilter experience

By: Suzanne Feinstein, PhD

Just right ocd is a specific subtype of obsessive compulsive disorder in which a person experiences a physical tension that feels as if something is “off”, not quite right, not symmetrical, or not complete, and that it must be corrected. A desire to reduce discomfort generally accompanies the just right obsessions.

The mind promises to release the tension only after a comprehensive set of rituals is performed. Inversely, the mind threatens to hold onto the tension until a sense of completion or a just right feeling is achieved.

For example, people who struggle with just right contamination obsessions might feel that they need to perform cleaning rituals until they feel clean enough.

Unlike many other types of OCD, the just right obsessions are experienced as an internal feeling of discomfort rather than a particular fear. Refraining from performing a compulsion can be quite distressing, and even painful, for people.

People with just right ocd may perform simple motor rituals such as tapping, rubbing, blinking, rereading, rewriting, repeating, staring, checking, ordering, arranging, counting, repetitive prayer, or superstitious behaviors. They may also pick at their hair, skin or nails.

These compulsions alleviate the short-term discomforts of feeling out of alignment or not quite right. But it comes at the price of feeling mentally drained, physically exhausted, or aesthetically scarred.

Just right OCD lies along a continuum with transient tic disorders and Tourette’s Disorder. In both cases, there can be a considerable build up of tension if the compulsion is not performed. However, due to a heightened awareness, people who struggle with just right ocd seem to demonstrate more self-control than people with tic disorders.

Examples of just right OCD include:

  • Touching or tapping your fingers against an object until you feel you exerted the correct amount of pressure
  • Counting your steps in a numbered pattern until you feel just right
  • Staring at a light source until you feel balanced
  • Arranging items (colored pencils, clothes) until they are lined up in size order or according to their exact color hue from dark to light
  • Repeating or rewriting your words until you feel like you expressed yourself perfectly
  • Having to perform an action, like showering or putting on clothes, in a certain order
  • Repeating certain actions (ie walking through doorways, getting up or sitting down, picking up or placing down an object) until it feels just right
  • Seeking reassurance from others until you have certainty that you heard, saw or understood something exactly right
  • Having to finish all the food on your plate
  • Folding napkins or papers until the corners line up perfectly

Certain characteristics of this subtype of OCD include the following:

  • Pervasive slowness: Performing routine movements, tasks, or communications in an excessively slow and methodical way in order to achieve a just right feeling. The slow motor performance can be disabling, causing the sufferer to struggle academically, socially and professionally.
  • Perfectionism: The fear of making a mistake or not being perfect haunts someone with just right OCD. Just right OCD is also referred to as Perfectionistic OCD. The person experiences a deep sense of unease if something doesn’t look, feel, or sound perfect.
  • Distress Intolerance: People with just right OCD have a more difficult time tolerating distress. They do not trust their ability to withstand the discomfort and they fear that the distress will not pass until they perform a compulsion.
  • Pathological doubting: The mind does not trust the information that is relayed to it. The person seeks reassurance or compulsively checks until there is a feeling of certainty about what the eyes see, what the ears hear, what the body feels, or what the brain comprehends.

Treatment for just right ocd

A therapist who is skilled in CBT can teach you the proper techniques to overcome your just right ocd and ultimately help improve the quality of your life. CBT techniques for obsessive compulsive disorder require practice, dedication and repetition. Once mastered, you can break the vicious cycle of anxiety and physical tension. You can heal from pervasive slowness and perfectionism. You can become more tolerant of physical distress and uncertainty.

  • Exposure Therapy:

A skilled therapist in OCD will work with you to construct a hierarchy of both real life and imaginal exposures.  Through a multi-pronged CBT approach, you will learn a variety of coping mechanisms to help you face your fears and desensitize to the physical symptoms and emotional reactions that present themselves throughout each day.

  • Abdominal breathing:

Your body and mind will be taught to release tension as you slow down your breath, breathe deeply through your abdomen and exhale tension from your body.

  • Relaxation and Mindfulness:

Through progressive muscle relaxation, you will calm your nervous system and relax your body one isolated muscle at a time. You will train your mind to break away from the negative thought patterns and stay in the present moment.

  • Guided meditation:

Through guided imagery, a calm voice will guide you along a path toward relaxation. You will close your eyes and imagine yourself mastering the skills necessary to navigate through your daily challenges with a calm presence. You will see yourself no longer tensing up in the presence of your triggers. You will envision yourself handling each challenging situation in a relaxed way and feeling a sense of pride in your ability to do so.

Advanced Behavioral Health, LLP provides CBT for OCD using scientifically-proven 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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