Obsessive Compulsive Disorder traits are not always obvious. They can linger under the surface, helping to form behaviours that are often given other diagnoses and only emerge as OCD when a person reaches emotional extremes, often around big life changes.
As a disorder, OCD is one that exists on a spectrum. It isn’t always present from childhood, and most people are only aware of its more extreme and most visual compulsions like repetitively turning on the lights, or washing your hands until they are raw. In reality however, sufferers are forced to deal with a constant internal wrestling over what they know to be real and true, and intrusive thoughts that they feel must be true, because they thought them and cannot make themselves stop thinking about them.
When I ended up in therapy last year after a series of unexplainable panic attacks and a seemingly unending period of terror, some form of OCD seemed to be the only explanation. I was having intrusive thoughts, obsessive guilt, constant rumination triggered by things that wouldn’t have bothered me a few months earlier. All of this was tied together with an overwhelming impulse to confess every bad thought to my loved ones.
Intrusive thoughts that I would have once dismissed became stuck in my head like a cartoon character in quicksand and the only way to rid myself of the conviction that this thought was positive proof that I was an inherently bad person, bad wife, bad friend, who lies and deceives and has something rotten at her core… was to confess. I could very literally feel the physical relief every time I did it, like I was dropping a weight off my back. The things I confessed were sometimes significant but the vast majority were trivial, meaningless thoughts or moments that in another frame of mind wouldn't raise a flicker of anxiety. It wouldn’t be long after one pointless thought was unburdened that a new one would unfurl, growing and stretching until it was an unavoidable obstacle to my attempts to work, socialise, or fall asleep.
It was only when my therapist asked if I had had a Catholic upbringing that something clicked in my head. The moral codes and understandings of right and wrong that I thought I had left behind when I lost my belief in God as a teenager, had come back to hold me in their grip.
Some of the earliest documentations of what we now understand to be Obsessive Compulsive Disorder are religious. According to charity OCD UK, obsessive behaviours and compulsions around religion and religious dogma were, back in the day, documented as ‘scrupulosity’. The diagnosis of ‘scrupulosity’ continues to modern day and, as they write, “echoes the traditional use of the term ‘scruples’ in a religious context, to mean obsessive concern with one’s own sins and compulsive performance of religious devotion." The term is actually derived from the Latin ‘scrupulum’, a sharp stone, implying a, "stabbing pain on the conscience".
When people have a pre-disposed propensity to think or behave obsessively, your religion can offer a framework of thinking that makes obsession seem not only logical, but essential.
According to Dr Sheri Jacobson, director of Harley Therapy, the connection between compulsions and religion is unsurprising — religion offers good material for OCD because of the hyper focus on intrusive thoughts. “We [all] have intrusive thoughts but we often can dismiss them as unimportant or irrelevant." In religion however, the intrusive thought is more focused on. An unwanted thought to a religious person is not innocent – it is as much a sin as an action. Jacobson goes on to point out that when you concentrate on morality, on 'good and bad' in terms of absolutes then, “it’s no surprise… that it can lead us into obsessive thinking... Religion can perhaps more easily set us up to have OCD than otherwise.”
This is, of course, not to say that a belief in a higher power is in any way responsible for people developing OCD, or that it is an inherently detrimental structure. However, when people have a pre-disposed propensity to think or behave obsessively, your religion can offer a framework of thinking that makes obsession seem not only logical, but essential.
Amrou Al-Kadhi wrote about this very topic in their book Life As A Unicorn: A Journey From Shame To Pride And Everything In Between. They told R29, “When I was taught Islam, I learnt to specifically focus on how much sin I was amassing. We were taught to count all sins on our left shoulder, and good deeds on our right, and the final tally on judgement day would decide whether we were destined for hell or heaven.” From age 7 Amrou was constantly searching for ways they had offended or made a mistake, and became an obsessive ‘counter’ of all their sins, which continues till this day. “I'm obsessively always searching for sin. It's exhausting, and not great for self-worth.”
One of the toughest things about managing OCD is that the compulsions that are used to soothe or alleviate the anxiety of the obsession are often things that are logical. Obsessive cleaning, for example, can be seen as an almost enviable trait if you hate cleaning, and an obvious response to a dirty environment.
Amrou says that they think their OCD is why they are so ambitious, “I'm forever trying to counteract the feeling of myself as 'bad' by achieving external markers of success. People saw I'm alarmingly hard-working.” Likewise, obsessively praying or attending confession is just evidence you are particularly devout in a sinful world. And if you have an irreligious form of scrupulosity, otherwise known as ‘moral scrupulosity’, attempting to constantly do better and not harm those around you is commendable. This can all make untangling the mental distress these compulsions are meant to alleviate that much harder: if your religion says that telling the truth, or being clean, or being devout is the way to be, then how do you know when it’s harming you? And what happens when those actions no longer keep the demons at bay?
'Confessing' (either in a religious or interpersonal sense) is particularly interesting in this instance. As Sheri outlines, confessing does have positive qualities, especially in the way it emulates talking therapies. “Having someone witness and hear [your thoughts and anxieties] can be great relief in its own right. It also helps clear your thoughts, maybe help you to work through, start to untangle emotional difficulties and real life problems or issues.” In that sense, if you are having intrusive thoughts, confession can act as a great way to assuage the distress and be comforted by an offering of forgiveness.
When you are told in no uncertain terms that even thinking something is wrong, it makes it hard to talk about outside given frameworks.
However, what it comes back to, as it does with all compulsions, is whether confessing actually relieves the distress or just perpetuates it. The usual benchmark for OCD, according to Sheri, is asking if the compulsion has negative impacts. ”Does it affect you or someone else negatively? Does it take so much time that other aspects of your life suffer as a result? Does it just outright to make your mood feel worse?”
Sharing your darkest thoughts and unburdening yourself is a publicly accepted form of relief: the dynamic set up in the world is that the truth will set you free. But this is far trickier with certain iterations of mental ill health. When you are told in no uncertain terms that even thinking something is wrong, it makes it hard to talk about outside given frameworks (confession booth, prayer, or therapy, in trusting relationships).
All this can lead people to suffer in silence as their thoughts and their fears are either too embarrassing or too ingrained to be voiced. And their roots can run deep. Decades after first developing OCD Amrou still wrestles with it daily. “OCD is like an abusive partner who I can't get rid of [but] I'm proud of how I've turned its taunting energy into productivity and trying to make a positive difference in the word. I think the main thing it has interrupted is my being in a relationship — it's so hard to commit to another partner, because I have this OCD in my brain constantly convincing me of things that aren't there, and telling me I'm not worthy of being in a relationship. I need to figure out a way to break up with him safely.”
Breaking up with OCD is about learning to accept however you can that there is no absolutes, something that's hard in a world that thrives on binary thinking.
There are ways that you can loosen your grip. Many therapies, including Cognitive Behavioural Therapy (CBT), Exposure Response Prevention therapy (ERP) and more recently Acceptance and Commitment Therapy have all been shown to help those suffering manage their OCD. Outside of therapy, re-evaluating our relationships with our systems of belief, and even binaries in themselves, can ease the struggle. Amrou, who is non-binary, says they feel they are actively transgressing what they learnt as a child. "I work really hard to free myself from all learned binaries as much as I can, as these do provide me with ephemeral moments of liberation. When I am in drag, say, or visibly expressing my gender nonconformism in public, it does feel like a fuck you to the demon in my head searching for sin."
They've also been working on reconceptualising the role Allah plays in their life: "by re-reading the Quran and finding passages that show Allah to be benevolent (and which seem to resonate with queerness), it's helped to turn Allah into a force who wants me to be good. It's why I give Allah a non-binary pronoun!"
Finding ways to see and understand that there is space between good and bad, right and wrong, is not only essential for those suffering with OCD, but can even, without being too cheesy, help all of us better connect and support one another. It forces us to be compassionate not only to ourselves but to those around us. The more we exercise the forgiveness, the more likely it is that people will forgive themselves their failings, their intrusive thoughts, and strive to be better people without any self-flagellation. This is true irrespective of if you believe in a higher power but ironically, I've come to realise that this was the message at the core of the religious teachings of my youth.
Over a year on from when I first started therapy and went back on medication, I am definitely in a better place. In fact, maybe ironically, it’s made me a better person. It’s forced me to consider how I interact with the world and other people, how I make sure I try and act in a way that won’t send me into a guilt-induced panic attack. I’m not holding myself to a rigorous code of absolutes, but trying to accept my failings as they come. I manage the OCD by managing myself more carefully than ever, but with that caution has come an understanding that I never was an inherently bad person, just someone who tried and sometimes failed to do good. As are the vast majority of people, if we give them the space and understanding to be.