Worry, Doubt, and Checking in OCD

Feelings of uncertainty and being compelled to check are hallmark symptoms of obsessive-compulsive disorder.

Stuck in the OCD Cycle

Chronically experiencing stubborn worry that won’t seem to go away, feelings of doubt, and feeling compelled to check and re-check are hallmark symptoms of OCD. While they certainly aren’t the only symptoms, these ones in particular play a big role in feeding the OCD cycle. That cycle is where people with OCD tend to get stuck and feel as if they are losing control over their own thoughts and actions. The good news is that understanding the symptoms of worry, doubt, and checking and how they proliferate the OCD cycle brings you one step closer to understanding how to get OCD under control and take back your life.

Obsessions and Worry in OCD

Worry isn’t unique to OCD — it is a symptom shared among most anxiety disorders. People with Generalized Anxiety Disorder (GAD), in particular, also feel a strong sense of near uncontrollable worry that is debilitating to living a comfortable day-to-day life. Worry in GAD can also take up a lot of time, just as in OCD. So how do mental health professionals differentiate between them? By determining what clients worry about. Whereas individuals with GAD tend to consistently worry about a broad range of everyday issues that change frequently, the worries of people with OCD tend to be much more specific, and typically unrealistic. These worries are called obsessions. And while obsessions can change topics (for example, from contamination to spirituality), someone with OCD will tend to worry about the same topic more consistently and specifically. This is how an obsession is differentiated from general worry.

People with OCD Engage in Compulsions

Something that people who have OCD also experience that people with GAD do not, are compulsions. The symptoms of doubt and checking play heavily into this aspect of OCD. Research has shown that individuals with OCD are more strongly affected by “possibility-based information” (Aardema, O’Connor, Pelissier and Lavoie, 2009). In other words, a great deal of the discomfort that comes with obsessions is the possibility that they may or may not come true. Although there is no way to confirm it, there is always a tiny possibility that we or our loved ones will experience awful consequences such as disease or injury. People with OCD not only have obsessions around such fears, but typically feel they must do something to relieve it.

Checking is a Compulsion

These actions are compulsions, and checking is a compulsion which seeks to relieve anxiety by confirming reality and squashing out the worrisome possibilities. Unfortunately, the relief from checking is always temporary because of the symptom of doubt. After doing a compulsion, feelings of doubt creep in, causing the person to worry that they may not have checked or performed other compulsions well enough. Doubt can lead people with OCD to construct compulsions that are more and more complicated — called rituals — in an attempt to stop anxiety from obsessions.

Compulsions Provide Only Temporary Relief

Worry, doubt, and checking are ingrained into the OCD cycle of obsessing, engaging in compulsions, temporary relief, and then increased obsessions and anxiety. People experience these symptoms to varying degrees, so being aware of them in yourself and what they feel like for you can help greatly in the process of beginning to tackle your OCD. Exposure and Ritual Prevention (Ex/RP) therapy can help you further by teaching you how to break the mental associations between obsessions and feeling compelled, and compulsions and feeling unhelpful, short-lived relief. By doing so, ERP helps to ease the intensity and frequency all three symptoms.

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Sources:

Aardema, F., O'Connor, K. P., Pélissier, M. C., & Lavoie, M. E. (2009). The quantification of doubt in obsessive-compulsive disorder. International Journal of Cognitive Therapy, 2(2), 188-205.

Brown, T. A., Moras, K., Zinbarg, R. E., & Barlow, D. H. (1993). Diagnostic and symptom distinguishability of generalized anxiety disorder and obsessive-compulsive disorder. Behavior Therapy, 24(2), 227-240.