OCD and Needing to Know for Certain

People often wonder how perfectionism and the need for certainty impact OCD symptoms. Perfectionism is at the heart of OCD. An individual suffering from contamination-related OCD doesn’t want to just be "pretty sure" they have washed a potentially dangerous substance from their hands—they "need to know for certain." Someone who thinks they might have hit a pedestrian on the way home late at night drives back and forth looking for a body not because they think it is likely, but because they "need to know for certain." A sufferer of pedophilia-related OCD yearns to "know for certain" that they didn’t accidentally view a minor five years ago. I could provide many more examples, but the important thing to remember is something no one wants to hear.

A large part of OCD treatment involves learning to lean into both uncertainty and the anxiety that inevitably arises from it. For example, an individual who worries that a substance will seep into their bloodstream and poison them if they don’t thoroughly wash their hands needs to work on two things. First, they need to practice resisting the compulsion to wash their hands (gradually if necessary). Second, they need to repeat a variation of the following thought: "I’m probably okay, but at the end of the day, I can never be completely certain that I won’t die from some kind of contamination." This is exposure and response prevention (ERP). Your therapist will play a significant role in helping you learn to lean into and handle the resultant anxiety. As we practice these skills, obsessions will begin to decrease, often dramatically.