Many people with Obsessive Compulsive Disorder (OCD) compulsively doubt their identity, their ability to keep themselves and others safe, their relationships, and their religion; doubt can be attached to anything and it is usually the most valued aspect of their life. This doubt can cause some people to spend endless hours ruminating, futilely trying to "figure out" answers to questions. This is because they are asking the wrong question, one built on sand instead of the solid ground of reality. This form of OCD is colloquially termed "Pure O" because it was once believed to be only obsessions. What we know now is that the compulsions are primarily mental. For more information on this OCD subtype, see this link: https://therapy-mn.com/blog/pu...

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Most people are familiar with the more physical form of OCD in which sufferers may wash their hands compulsively, or engage in visible checking behaviors such as checking to make sure the stove is off. Both forms of OCD can benefit greatly from Inference-based CBT which is an evidence-based treatment developed by Frederick Aardema, PhD, Clin. Psy. and Kieron O'Connor, PhD, Clin. Psy. In this treatment, the focus is on assisting sufferers with understanding their faulty reasoning and obsessional doubt that lead to compulsions. I use this form of treatment because I have seen the significant insights my clients have received from it and the freedom they then experience from OCD. For more information, please see this link: https://icbt.online/

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What is Rumination in OCD?

Rumination in OCD is a compulsion in the same way that checking the stove multiple times to ensure it is off, or washing hands multiple times unnecessarily are compulsions. We sometimes refer to rumination in the context of OCD as a "mental compulsion". It can look like revisiting a thought many times without being able to find an answer, or hyper-analysis of a feared thought. It can be seen in certain OCD subtypes, such as fear of committing harm (HOCD); relationship-focused OCD (ROCD); sexual orientation OCD (SO-OCD) and others. This is not en exhaustive list, and these subtypes  mainly represent ways in which OCD commonly presents. They are sometimes referred to as "Pure-O" because it was at one time thought to be only obsessions with no compulsions, but it was later discovered that the compulsions were mental.

 

Ultimately, the subtype does not matter and if your OCD doesn't fit into a common OCD subtype it doesn't mean it isn't OCD. What we are looking at mainly through the lens of Inference-based CBT is the tendency to "create where doubt is unnecessary", as Fred Aardema, one of the founders has said, and become absorbed in thoughts and actions trying to neutralize the distress the doubt causes. Many people engage in both observable and non-observable (mental) compulsions. Both are part of an intensely distressing, sometimes debilitating cycle that is painful and unnecessary. Thankfully we have approaches that help, such as I-CBT, ERP, ACT and mindfulness. I encourage you to find the fit that works for you so you can get back into your life.

 

Therapy is personalized, focusing on individual needs and goals. Collaboration between client and therapist is key for success.

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What is Anxiety Sensitivity?

Anxiety Sensitivity is not a diagnosis in itself, but it can contribute to concerns such as Panic Disorder, Agoraphobia and OCD, among other concerns. Through education and "Interoceptive Exposures", it is possible to learn that these sensations are not actually threatening, thereby reducing physical holding patterns that actually make anxiety worse.