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The terrible 'what if': how OCD makes every day a matter of life or death (theguardian.com)
262 points by pmcpinto 7 months ago | hide | past | web | favorite | 134 comments

I'm appreciative of somebody who also has OCD writing an article like this detailing how the disorder isn't at all like the stereotype of a neat freak. What's funny is, I myself am actually a terribly messy person with books and papers always strewn about (among clothes not quite in the hamper, &c).

What's interesting to me from a personal history viewpoint is that one of my earliest compulsions also centered around door knobs. However, in my case I had to cover the whole surface area of the knob (hah!) with my hand and yank it shut multiple times (the exact number was arbitrary; merely whatever "felt" right) until I was sufficiently satisfied that the damn door was indeed closed. I still do this when leaving my apartment.

Hell, reading this article and writing this comment has "caused" (ie, compelled me to) do some of my own compulsions multiple times already because just thinking about doing them means I need to. Once I get into my head that I "have" to do X, Y, or Z then it's much harder to ignore than if the trigger (or what have you) came up in everyday life. I hope you HNers learned something so me sitting here in my underpants counting powers of 2 and repeatedly moving my head back and forth like a confused pigeon wasn't totally for naught! :)

EDIT: For those more curious about this topic (all dozen of you) I wrote a short piece on my blog attempting to better illustrate the painful bizarrity of OCD through the vehicle of a fictional dialectic: https://salt.mattwie.se/essays/all-mad.html

I have the exact same compulsion with locking my door. If I leave my apartment and I don't do my little ritual then I'll either be worried all day, or some times I'll drive back to my apartment and "properly" close the door.

Oh yeah I've had this one big time in the past. It sort of comes and goes, hasn't been bothering me much lately. But a few times at my old job I drove all the way back into work to verify I'd locked the door when leaving for the night even though I was _very_ conscious about locking it - I just wasn't was totally certain as I felt I needed to be.

If this starts bugging me again I'm going to start taking pictures of the locked doors for myself. :)

Have you tried balancing this urge to return, against self-anger and humiliation at all the time and gas you're wasting by driving back to check?

When I get irrational urges, I make the urges battle my insecurities and get out of the way. Insecurities usually win.

I used to do it too. I figured it was a short term memory flaw, then it became a habit, so it just feels "off" to not double check. I'm actually comforted seeing i wasn't the only one.

Thanks for sharing. The complexities of the human brain will never cease to amaze me. There should be a way, in all this neuronal maze, to escape those compulsions, but I bet it's really well hidden.

Well, one way out is behavioral therapy.

Obsessive compulsive disorder is a form of anxiety disorder. You are afraid of something (sickness, death, loosing control) - then you get obsessive about it and then you do some compulsive action to mentally ease that thought/anxiety.

But now you have "learned" to behave in a certain way to feel better. And you are weighting the triggering thought as more important by giving that much attention to it. This is resulting in a self-enforcing feedback loop in the end.

Behavioral therapy is a way to "unlearn" this behavior. Mostly by working against the initial anxiety. If you are unconcerned/neutral/bored of something, you cannot gain that much obsessive/compulsive momentum.

Unless you pull a logical trick to reduce every discomfort to fear, I don't agree that everyone that suffers from OCD is afraid of something and anxious about it.

I don't think that fear and anxiety are exactly the same thing. (fear being a very basic response to a very concrete (perceived) threat, while anxiety is more diffuse, constant, covering larger timeframes)

Assuming we are talking about the same thing (anxiety), why do you think that not everyone suffering from OCD has that as the cause? What other types do you know of? It is possible that I was focusing too much on intrusive thoughts and related issue, but my current understanding is that the OCD mechanism described above is the same for any type of OCD and that it is by definition an anxiety disorder.

The discomfort you are describing could be the same thing as the anxiety I was speaking of, although discomfort is maybe not intense enough to describe the internal experience of the disorder.

As always: these things are distributed on a spectrum with better/worse days and cases between people. It only becomes a disorder if you suffer from it on a regular basis in some phase of your life.

>I don't think that fear and anxiety are exactly the same thing. (fear being a very basic response to a very concrete (perceived) threat, while anxiety is more diffuse, constant, covering larger timeframes)

That could just be a historical product of the English language. Other languages don't necessarily discriminate this way between fear and anxiety.

E.g. we can equally talk about someone "fearing" they have forgot the stove open or "being anxious" about it in this here parts.

What 193 is describing isn't a conversion of discomfort to fear, it's an a-rational pattern of behaviour that's independent of discomfort or fear.

Orwell talked about reinforcing effects: "A man may drink because he is failing, then become all the more a failure because he drinks." OCD as a form of anxiety is about a sufferer having taught themselves to behaviourally self-medicate. And just like most forms of addictive self-medication, it becomes a reinforcing effect that's somewhat independent of any real objective cause.

CBT and other behavioural approaches to therapy try (with measurable success) to interrupt that self-reinforcing behavioural effect. Many here are talking about somewhat obsessively checking things, and they're describing it perfectly: "did I check? I'll check again just to make sure", which grants a moment of relief from the anxiety; give it a few minutes, and the anxiety returns, forcing another hit of reassurance to be sought. OCD is an extreme form of addiction to this cycle.

Traditionally the DSM categorized OCD as an anxiety disorder - apparently now it's categorized in the larger envelope "neurotic, stress-related, and somatoform disorders", which anxiety falls under as well. There's certainly an anxiety element, as it causes a great deal of distress to fail to follow the behavior.

>Unless you pull a logical trick to reduce every discomfort to fear

In OCD there's no external discomfort (like having your hand touch a stove or having a headache).

So it can very well be all about fear and anxiety in general without having to "reduce every discomfort to fear".

I would want to measure dietary Taurine levels in the body for a start. Experiments consuming 3g/day have shown no side effects, but your main source is limited to energy drinks so you have to contend with caffeine, and Taurine does not last long in the body (can start to be expelled in urine within 10mins), much like many of the water soluble chemicals classed as vitamins or minerals. Cooking actually destroys it from organ meats and some scientific studies have shown a link between vegetarianism and a variety of mental health issues including OCD. You wont find any substantial levels of Taurine in vegetables, but you will in raw liver, kidneys and brains. From my own experience, 3 or 4 Redbulls a day (1g of Taurine per can) can change many repetitive behaviours. Taurine also has many other positive effects on the body like including VO2 max, improving cholesterol profiles, improving bile acid patterns, reducing depression, improving sleep, improving memory, reducing atherosclerosis, reducing fatty liver disease, reversing some types of cataracts, reducing stones especially in women, to name some of the observed scientific improvements to human health. Its probably why its now added to formula milk for babies since the 80's (but at levels lower than breast milk) and has subsequently improved their cognitive abilities.

> From my own experience, 3 or 4 Redbulls a day

This seems like an incredibly bad idea. You would be far better off using taurine powder.

> some scientific studies have shown a link between vegetarianism and a variety of mental health issues including OCD

Could you provide links or keywords? My close family went full-vegan ~ 2y ago and I'm worried they may be doing themselves more harm than good.

If taurine is a start, then all other microelements are the continuation? Studies for taurine would also be helpful.

Is this a troll given the username?

If Taurine doesn't last long in the body yet has these wonderful effects, could you provide references?

I think you could lose hair faster that way, but it's just a hunch.

Ironic, in this case, as taurine was once extracted from bull semen.

so what if it is good for the health?

I do not ask how hot dogs are made, and I care even less for things I take for my health

It’s ironic when the author describes a fear of food contamination by semen, that possible relief might come in the form of bull semen, that’s all.

Would it help if you had a webcam pointed at the door so you could remotely verify it's closed and locked? Or do you need some the actual feeling of the door being closed to end the fixation?

It may help in the moment, but any action that reinforces the (faulty) belief that your obsessive thoughts are relevant and worth paying attention to will worsen OCD over time.

The right approach is to teach yourself to be OK with the uncertainty of the door being locked or not. This is what behavioral therapy for OCD, specifically ERP, aims to do.

You hit the hail on the head with your latter idea. At least in my case, it all comes down to the "feel" of the door being locked and shut; I yank the door around pretty violently some days if I'm especially stressed. At some point, the compulsion was about the door being closed for the security of the apartment, but now it's been bastardized over the years into just being a fixation on the door itself.

Also, as jcranendonk pointed out in a separate reply to your comment, reinforcing the behavior does more harm than good in the long run. In my case, I've been able to reduce some of the mental strain by following CBT principles in a therapy session and also on my own; I can't comment on ERP personally, but I do know it's shown widespread promise in the literature. My previous therapist incorporated some of its techniques into our sessions as well, but was principally following CBT practice.

Really want to see an answer on this

I expect it would just move the goal posts, and you would end up staring at the screen to confirm the door is closed or checking the camera to ensure it is pointed at the correct door or some similar way of getting the 'hit' that the door checking gives you.

I'm one of the "chronic checker" types. I used to be really bad about checking and rechecking door locks, particularly, but also the fridge and the garage. If I check absentmindedly and without intention, I'll have to do it all over again.

What really helped me get out the door in the morning, and still does, is actually to video myself doing it. When I got a Palm Zire 72, for the first time I could actually leave within a normal interval because I had a continuous, raw, time stamped record of everything I did from checking everything was off and secure to leaving the apartment and driving away. I refused to ditch the Zire until the iPhone 3GS because the 2G and 3G only did stills. To this day I still do it with my Pixel when I'm flying solo.

Which brings me to the other thing that helped: my very patient wife, who reminds me she saw me do it, you did it right, and get your butt in the car, darling.

The damnable thing about OCD is that a little is very valuable in my regular line of work (medicine). Without it I wouldn't be as careful, I don't think. It means it won't let me take shortcuts and it forces me to be thorough, and that's a very good thing in that business.

> The damnable thing about OCD is that a little is very valuable in my regular line of work (medicine). Without it I wouldn't be as careful, I don't think. It means it won't let me take shortcuts and it forces me to be thorough, and that's a very good thing in that business.

That's a really interesting take on the positive aspects of OCD and one that's not often discussed. Thanks for sharing. :)

There are a few famous athletes who've said similar things. Ray Allen was an NBA player known for having a beautiful, textbook-perfect jump shot and eventually setting the NBA record for three-pointers. He credits a good portion of this to his own OCD, which compelled him to repeatedly drill the motion beyond reason.

OMG I too am a "chronic checker". When my first son was born and my OCD was aggravated by exhaustion, and living in a relatively unsafe part of baltimore, I would have these 10 "check loops". I just couldn't be 100% certain the door was locked. Even at the time some part of me realized the absurdity of it.

> Even at the time some part of me realized the absurdity of it.

You've independently discovered a key diagnostic factor in OCD. :) What distinguishes OCD from, say, obsessive-compulsive personality disorder, is that the sufferer of plain ol' obsessive compulsive disorder knows full well the absurdity of their condition. She understands that doing 12 jumping jacks before leaving the house won't stop it from burning down, but the overwhelming "why not be safe?" urge compels her to do it just in case.

I'm a doctor of four years now and I completely empathise with you. The one thing I have learnt doing the job is not to fully trust anything but to check it yourself. That's how you get outstanding results.

It's unfortunate that it seems to take a toll on your private life. This past year I have developed a habit of double checking the front door even though I remember bolting it.

It's an interesting thing to ponder whether some mental disorders are extreme versions of adaptive behaviours that we all do from time to time.

Same here. I've always had some mild OCD but last year my car got stolen and that's when it really started. Before going to sleep I now have to know where exactly the car keys are, even though I'm both better insured and the lack of keys didn't really stop the thief last time.

What's worse is that while I've also always been a chronic key checker, last month I still managed to lose the keys. On top of that I didn't even lock myself out - either they're somewhere in the apartment(I'm at a loss here because I went as far as going through the trash - to no avail) or the single time my OCD didn't make me check if whether I left them in the lock I did just that and somebody took them.

Long time sufferer here.

There is still a _HUGE_ taboo around OCD and mental health in general. A lot of people still think it's all make believe.

In the last couple of months I've starting receiving professional help for a number of themes around OCD that have been traumatising me for most of my life. It's certainly helping, but also very comforting to hear from a professional the kind of issues his/her other clients might be facing.

Don't suffer in silence or try to fix it all by yourself. No matter how bizarre, how dark or how ashamed you are of your OCD you should know you're not alone. A professional therapist has probably heard it, or something very close to it, many many times before.

Good luck!

Mine is earthquakes and tsunamis. I live in Oregon, where we are due for a big one "some day", and I grew up on the Oregon coast, where there historically have been major inundations in some areas.

Every time I drive 101 on the coast, I'm constantly scanning and planning what driveway or what side road I'd go up to get away from a tsunami. "I could turn around and go back to that one road - oh wait here's a new one. OK that one."

If I'm driving across the Willamette Valley and I'm on the other side of the Willamette River from my home, I'm thinking, "OK if I make it across this bridge and then there's an earthquake, I can make it home. But if not then it might collapse and I'll have to figure out how to get across."

Ironically, I actually didn't develop this until I spent about 5 years working for seismologists, so I suppose it's kind of a rational, scientifically driven irrational behavior.

Do you commute a long way? Is it possible that it's just your mind keeping busy/creative while you commute? I find my mind playing out similar doomsday scenarios and solutions when I'm doing something repetitive for longer periods of time.

It's about a 10 minute drive to work, 15 on my bicycle :)

This is more when on the coast for vacation or when traveling between cities in the valley like on weekends.

That said I know what you mean - I do that when I'm biking with traffic, thinking about what people MIGHT do to cut me off, etc. as opposed to what's actually happening.

> thinking about what people MIGHT do to cut me off

That's probably very useful. Keeps you out of trouble.

I was like ten years old when I had to even out things if I stepped on a crack in the pavement. If I brushed by something on one side I had to even it out. If I bumped into something, I'd have to go back and bump the other side evenly.

One day I saw a TV show or a movie where someone was like that and people treated them like they were retarded. So I tried really hard to stop it. Over the next few years, I just got rid of the compulsion. I guess it was weak enough.

Just lucky, I suppose. I still have one terrible one but it doesn't let me talk about it or bad things will happen.

I used to have little compulsions like this as a kid, and I know some others who did. Perhaps it's not uncommon? Probably rather different to full-blown adult OCD though

> I still have one terrible one but it doesn't let me talk about it or bad things will happen.

Fuck; you're being held hostage by a compulsion? That's tragic.

I still totally have the 'evening out' thing, in my late 30s. But it comes and goes -- I could mostly rid myself of it, I'm sure, if I set my mind to it, like you did. I guess I'm very lucky in that way. I have had times where it was more prominent (perhaps in times of higher stress or anxiety) but for the past decade or two its' just been a minor background thing with no real consequence.

I can imagine how debilitating it must be for those who truly suffer.

I have had a close family member experience and recover from severe OCD. This was at UCLA's child and adolescent OCD program (which was amazing). Let me share what worked:

1) The program first prescribed SSRIs in order to reduce the child's anxiety enough to do the difficult work required.

2) Intense ERP (exposure response prevention) solo and in a group setting. The social aspect of being with fellow sufferers was critical.

3) Coming up with rewards for successful ERP sessions (not food related due to potential overeating)

4) Starting treatment as soon as possible. OCD has a tendency to get worse and harder to treat over time. I clearly saw the difference in treatment efficacy based on how long it took for the child to start treatment.

The link to the program is https://iocdf.org/clinics/ucla-child-adolescent-ocd-intensiv...

I've been dealing with OCD for about 2 decades now (I was around the same age as the author when I got these compulsions).

A lot of it centers around health and death, it goes hand in hand with hypochondria and thanatophobia (fear of dying). It's related to my stress for sure, and I often get panic attacks because I can't let go of the thoughts of having become ill or dying.

It does affect my daily life, I have 'repetitive thoughts' almost the whole day. Not per se bad thoughts, sometimes just worrying about my eyes hurting from wearing lenses - I keep thinking that until it starts hurting.

I have some kind of 'pattern' when it comes to thinking and if I move outside of it, I start repeating myself. One of these is that, as a bilingual person, when I mix up languages in my thoughts that is 'wrong' somehow and I need to start the 'train of thought' again.

Sometimes - the moments I am most stressed - I end up in a cycle of causing more OCD moments by having stress, which causes OCD, ..

At times it just depresses me that my thoughts aren't "normal", I know it's not rational to keep repeating things to oneself, but if I don't do it I have a nagging feeling that just pushes me to do it.

I also think that OCD is not something only the person who has it suffers from, it surely does take a toll on the people around you at times - especially when it makes you seem stressed out all the time and like you're on "edge". At least from my experience.

I have OCD, although it's not crippling.

My triggers tend to flare up most at night before I go to bed, or in the morning when I leave for work. Did I checked the hob is off, is the fridge closed, did I lock the door? Did I close the windows? What if I left the iron on and it falls over and starts a fire the house burns down with me inside it?

It's amazing how the mind can "catastrophize" mundane situations.

I live alone which probably makes it worse, but it doesn't affect me too badly during the day.

>"Did I checked the hob is off, is the fridge closed, did I lock the door? Did I close the windows?"

This is exactly me. I have to be consciously paying full attention when I lock my door, otherwise I'll get uncertain about it once I'm a few seconds out the door, and I'll have to go back and check.

I have never managed to actually leave my door unlocked by accident, but I have locked myself out of my apartment on three separate occasions, so I'm actually 3:0 on that, but I still have that uncertainty.

Is that necessarily OCD? I do that sometimes, but I think it's just regular worries coupled with a poor memory (and inattentiveness), that leaves me often unsure if I really did something like lock the car door.

Wouldn't it make sense if all humans were along a continuum (possibly non-linear) with regards to OCD symptoms? Pick a point somewhere on that continuum; "normal" to the left, "OCD" to the right.

While this is somewhat true, it can easily lead to the idea that mental health problems aren't serious because they are just further along a scale than me.

We all have kidneys that don't work perfectly, so we are all on a continuum of kidney failure, however you'd describe some people as having kidney failure and others not, only a few people would be 'borderline'.

I appreciate that may not have been what you meant, just that your argument lies close to that kind of logic (though maybe by saying non-linear you mean to avoid this trap).

Mental health is totally a (multidimensional) spectrum, and in mental health it switches from normal to a "problem" if it's affecting your life. There are a ton of medical conditions where we've drawn lines in where we think it goes from normal to a problem (blood pressure, blood glucose) and I don't think anyone is saying "oh, your blood glucose is just different than mine, you don't have it that bad". We even have the term "prediabetic" to indicate that they are getting to the bad end of the spectrum.

I think it's incredibly useful to realize that all of us experience symptoms of anxiety and depression, intruding thoughts and compulsions, but those who with the problems are just those further along the line. It's not diminishing the issue, it's humanizing the sufferer. They aren't "crazy", they are suffering from something we all can relate to, but just in a manner that's unmanageable.

Too often the "spectrum" theory is used to humble-brag about one's own success in the face of self-diagnosed shortcomings. Vocal patients with mild cases of a disease can then receive more support and treatment than less-vocal patients with more severe cases.

That always happens. It's people clearing out "toxins" with "cleanses".

SketchySeaBeast responded eloquently, and I appreciate both of your posts. I'd also like to add that for me there's an aspect of scientific humility: mental health is complex enough that it's often unclear which conditions are more akin to kidney disease and which are more akin to high blood pressure. In that context, the labels "sick" and "normal" are too absolute.

How differently should we treat "sick" people? Do they milk their diagnoses extra sympathy as alluded to by stephengillie elsethread? Honestly I don't care too much about that. A much bigger concern is that labeling people "sick" justifies the creation of a self-sustaining industry dedicated to their "treatment". Even if nearly all of the researchers and physicians are well-meaning (which I believe), we need to be skeptical.

Most of all I resist the othering of the "mentally ill". What we regard as "normal" entails quite a range of irrational and strange behavior. I personally believe the best model is that nobody's "normal", yet medical intervention is rarely justified and ostracism is never justified.

When you combine it with having to count how many times I do it, e.g. I need to check the hob four times just to make sure.

I think it's a bit of both really, a bit of OCD, a bit of anxiety.

What is a "hob"?


Definition of hob

1 dialectal, England : hobgoblin, elf

2 : mischief, trouble —used with play and raise always raising hob

But your context describes some sort of appliance.

It's British English:

"Hob: the flat top part of a cooker, with hotplates or burners."

a stove

Couldn't get rid of all the compulsions for quite a long time (a few years really), but after starting meditating every day I was able to nearly totally get rid of them.

I'm basically finally able to just let go of the thoughts that once seemed overwhelming.

EDIT: To quote the article "because deep down, the sufferer knows the thoughts and compulsions are irrational. However, despite this knowledge, there always remains a terrible “what if”.".

That's basically it, I'm able to finally rationally decide that letting go won't have bad effects, so I'm able to let it go.

Trigger warning for health anxiety folks. Nothing to see here.

I will never forget one day I opened Hacker News, and the top story was about a 30-year-old programmer named Jonathan (also my name, and I'm 29) who found out about his terminal cancer spreading throughout his body. This was one of many trigger moments in my life.

I struggle against health anxiety. Specifically, I am obsessed with dying young from cancer.

I am not diagnosed with OCD, but health anxiety presents very similar behaviors.

When I feel particularly vulnerable to a specific kind of cancer, I tend to research and wrap my head around probabilities, prevention, and everything I can to hedge myself against that cancer. I'm constantly checking in with small pains in my body.

I have chronic back issues (partially because of my posture while working). Pain exacerbates the anxiety.

For the first two months of this year, I couldn't hold my infant son without ending up on the edge of tears, because I was emotionally convinced I would die before I ever had the chance to see him grow up.

One understated effect of OCD and anxiety is the feeling of guilt you can foster because of your own behavior.

My wife's father recently went through a battle with pancreatic cancer. It was a complete rollercoaster. He ended up having the unlikely type, in a good way - he is now cancer free. But one moment stands out to me: when she came to tell me about what they had found. She started out by telling me, "I don't want to trigger your anxiety..." This both broke my heart and made me feel understood.

This is something that really has more influence on life than you expect. I feel for those of you who struggle with OCD, anxiety, and any other mental health issues. I don't have an answer, other than you are not alone. You're not isolated. You aren't the first to experience this, and you can live your life WITH the struggle, even if it feels impossible.

Seek help. Surround yourself with people who love you and want to understand and help. Don't seek reassurance; seek acceptance.

Hi. I have suffered from thinking about the future as something dangerous (a question of life or death) that is determined from each decision I make. It has helped me a lot: 1) The faith: what is going to happen, what should happen. And that to receive it as learning. A spiritual conception has let me not be so attached to life. Knowing that if death comes it has a meaning. And that there is a transcendence. 2) Do not manipulate with the intention of achieving my benefit. Giving meaning to the life of the common good. 3) Communicate: Talk about what happens to my family and friends. Do not keep it for me, expose me. 4) Put myself in the role that I should occupy: At work, as an employee. In my family, as a brother, as a son. With the doctor, as a patient ... This order helped me to a better social development and a greater simplicity in my mind. At the beginning, it cost me a lot to respect the treatment. I thought that I would not be able to develop professionally (I'm a systems engineer), and that I would lose intelligence. But with family help, with patience and learning to be more flexible, medication has been reduced to a minimum. It's a process that has taken me years (and I'm still in process). I appreciate everything that happened to me, because it has brought me many learnings.

It's interesting how contamination OCD seems to be one of the most relatable forms of OCD to those who aren't sufferers. I'm glad articles like this are being written (there are a few other good ones out there), but it's unfortunate that this subset of the disorder is the only one that gets attention.

There are hundreds of variations of OCD -- basically, a variation for each thing you might have a fear over -- as fear and anxiety are at the root of the behavior associated with OCD. If you can fear it, you can probably create an obsession over it.

Much like the author, I also suffered a "nervous breakdown" in my 20s (and I'm still in my 20s, so this wasn't that long ago...) and tried to get myself hospitalized for the sake of my immediate family, as taking care of somebody in that state is emotionally exhausting. Fortunately, I had terrible insurance at the time that didn't allow for "non-critical" inpatient hospitalization, so I ended up going back home. This ended up being the right decision, because as mentioned in the article, exposure therapy is the best way to treat OCD. Avoidance behaviors actually _reinforce_ the damn thing, only making you worse.

I've thought about writing in more depth about my particular form of OCD, which is a difficult one to treat as my compulsions are entirely mental (compulsions are just reassurance seeking behavior, and you'd be surprised at the mental gymnastics one can try to jump through to reassure themselves about a situation). I consider myself very fortunate for having lived in a city with one of the best OCD clinics in the country, as I went through a few months of clinicians and psychiatrists not really understanding what was happening to me, before ending up at the right place.

Writing about OCD is incredibly exhausting, because as many other people have related in this thread, even reading about OCD tends to be triggering to sufferers. Writing about it is basically saying, "hey, I don't mind exposing myself to old and new anxieties over and over and over, with the potential to make my next few weeks miserable", so the people that do it are admirable. Probably healthier for it, too, given it's basically therapy.

I can't imagine what it's like to write a novel, like John Green did with Turtles All The Way Down, while also being a sufferer. I'm sure medication must help. ;)

I relate very keenly to this and found this resource really helpful: https://www.intrusivethoughts.org/ocd-symptoms/pure-ocd/

The main thing that has helped me has been meditation. I’ve also found labelling of thoughts to be very powerful. If you can realize what’s going on and label it as anxiety, it takes the sting out of it.

the fact that this article got upvoted so much probably also explains why there are always paper towels available and a waste basket near every restroom door in the bay area right?

I literally possess binary memory when it comes to "what is clean" and "what isn't clean (touched the floor, public restroom, etc)" for most of my things. Also used to have "San francisco shoes" and "South bay shoes"

>I literally possess binary memory when it comes to "what is clean" and "what isn't clean (touched the floor, public restroom, etc)" for most of my things.

after working in tissue culture where sterility matters (to put it lightly) i have developed a similar mentality. in the lab, it teaches you to be overly careful with things because a lot of the time you have to throw them out if they get dirty, and often the bar for "being dirty" can be as low as "was exposed to air while uncovered". it causes a lot of very wasteful carryovers into real life.

This scene played out almost every night, except I learned to be quiet so no one would know I couldn’t open the door because of a mysterious feeling that if I didn’t do it “right” something horrible would happen.

I didn't quite realize it, but how many people suffering from OCD are motivated by "something horrible" happening? Like I wonder how many people have compulsions that aren't motivated by something bad happen?

For most OCD sufferers, it's the "do this or you'll die" thing (at least, from what I've read).

> Like I wonder how many people have compulsions that aren't motivated by something bad happen?

I'm one. I have compulsions, and none of the obsessions involve me being certain of impending death if they aren't carried out just so.

For me, it's an extremely intense feeling of wrongness. Not like morality; just that there exists some "right" way to do certain things, and doing it any other way is somehow inherently wrong or incorrect. Why would I willingly do something the wrong way?

It makes my skin crawl if I do it wrong. Like there's a physical sensation of "You've screwed up; go back and do it again until you do it right." My stomach drops and I feel that one shiver you get when you're just a bit too cold.

Of course, I'm never compelled to do useful things the right way. My go-to example is from a few years ago. I eat cereal a lot, and historically have mostly always eaten Smart Start and Raisin Nut Bran. Maybe four years ago, I branched out and got some Cinnamon Life for the first time since I was a kid. I ate the bowl of cereal and all was well. Then I tried to put the box back on the shelf... and I couldn't. It was wrong. The box was printed wrong, and I didn't know what to do. You know how there's those interleaving flaps on the top? I like to put my boxes on the shelf such that the flap the goes on top is on the left and the nutrition information faces out (that way I can pick it up with my right hand and easily open the box and pour into the bowl — any other way of doing it would be wrong, somehow). But the Life box was printed such that the flaps and the nutrition information were at odds. I had to make a choice: either face out the nutrition information and have the flaps wrong, or put the flaps correctly and have the wrong side of the box face outwards.

I debated the best compromise for some thirty minutes, until my roommate came home and asked why I wasn't in class. I hastily shoved the box on the shelf (flaps correct, nutrition information be damned) and made some excuse about having missed my alarm. I was completely preoccupied with my decision for the rest of the day, and haven't bought Life since because I can't deal with the stomach-sinking feeling of having done something wrong.

An interesting podcast episode that talks a bit about OCD is https://www.npr.org/programs/invisibilia/375927143/the-secre...

One of my obsessions is that objects aren't the "right temperature", even if I intellectually know they should be.

This has led to many a burned hand throughout my youth as I would reach out and touch a hot stove or incandescent light bulb to make sure they were really hot like they should be.

I’m using a throwaway account and trying to keep personal details sparse to keep this as anonymous as possible. Also, despite my frustration with the situation, I’ll attempt to be as neutral as possible.

My significant other was always “germ conscious”; clean hands, no shoes in the house, etc. Nothing over the top or alarming. However, over the years, there have been huge shifts in behavior and routine in regards to keeping clean. This person has made the house the “clean zone”. All attempts are made to avoid contamination from the outside world.

The routines in the house start with the notion that you are dirty if you’ve been outside. “Outside” isn’t inherently dirty, so things like yard work and actual dirt are okay. Basically, if you’ve driven anywhere, you’re dirty. Anything that you or your clothing touches (while dirty) must be cleaned. If it’s the floor, it must be cleaned immediately to avoid tracking germs through the house.

The dirty rules apply to everything. Anything brought into the house from outside is dirty and must be cleaned before use.

Strictly speaking, the basement is dirty. Touching (nearly) anything means that your hands are now dirty. Shoes or slippers must be worn before going downstairs.

Shoes must be removed before coming in the house, but you can’t step where your shoes have been...otherwise your feet are dirty also. Sandal wearers must wear socks in the house.

We have guests over, but all walkways must be cleaned after they’ve left. Any surfaces they touched or sat on are cleaned as well.

Work days must end with a shower and change of clothing after coming home. It doesn’t have to happen immediately, but one can’t sit on furniture and should be careful not to contaminate anything.

The furniture, floors, cabinets, handles and counters see regular cleaning with either lysol wipes, alcohol wipes or lysol spray.

One larger issue stems from the fact that my spouse is a medical professional and is fearful of transmission of things like MRSA. While there is a real concern there, I’m of the opinion that the cleanliness routine is too extreme. This person does not typically do not work in a hospital, but when they do, they have a routine that must be followed.

- The car must be sanitized

- Shoes are removed outside and sanitized

- Clothing is removed in the basement and put into the wash immediately

- Person showers, which unfortunately means a naked stroll across the house from the basement all the way to the bathroom.

- Clothing is washed again

- The washer is now washed

After drying on the line, the clothing is washed again and the line is sanitized

All items on the person (jewelry, purse, bags, phone, pens, etc…) must be sanitized

This behaviour has slowly gotten worse since we started living together. The logic is consistent, but new behaviours are constantly being added. Where I’m really beginning to become concerned is that we recently had a child. I’m hopeful that this will encourage positive change, as some behaviors aren’t sustainable with a antsy child. But, I’m concerned that they will get worse and that the child will pick up on these behaviours.

Early signs of concern with the child: The showering rule applies to everybody. So, somebody has to hold the baby while the other showers. You can’t put the baby anywhere, because that would be dirty now as well. This has already become problematic now that the baby is almost three. Basically, somebody is stuck with a squirmy kid that you can’t put down for upwards of 20 minutes.

ANY attempt at discussing this has been met with extreme hostility, to the point where I’m afraid to mention or question the germaphobia.

I try to be very patient, but I believe that I've enabled too much of this behavior for fear of sacrificing a happy household.

This sounds very much like OCD. One of the nastier traits of OCD that I experienced with a partner was the tendency for the OCD to hide itself, by convincing the sufferer that they were just a terrible person, or that what they were doing was normal. And this was post-diagnosis. My interpretation was that accepting you have OCD is the first step to acknowledging that the repetitive behavior isn't necessary, which of course the disease fights against.

It was very hard at times and there was often hostility but it was always recognizable to me as a symptom of the disease and not an intrinsic quality of the person.

I met another person with OCD who didn't know they had it - 5 hrs of cleaning each day and they didn't know, they just knew things needed to be clean.

I strongly encourage you to do what you can to get to a diagnosis. What helped the person I was close to in the end was cognitive behavioral therapy and a lot of hard work, to get to a point where things were manageable.

Finally - the biggest mistake I made as a carer was not talking to others about it or recognizing and acknowledging the effect on me. Get support for yourself if nothing else.

I'm not a doctor, but I'm almost certain your SO absolutely needs to discuss these things with someone to have any chance of relieving, or reversing the trend you mentioned.

From my past experiences, I must unfortunately say that you might be just about the last person they want to, or can discuss it with (as strange as that sounds), but without them confronting their habits, it is unlikely it is going to get easier. Even with crippling forms of OCD, it is easier to just "comply" than to challenge it, the latter being "guarded" by great anxiety that feels much more intimidating than even the most time-consuming and difficult routines, even if they fully realize some of the irrationality. (That, too, may be hard to understand from another person's view.)

They 100% don't want to discuss it with me.

I suffer from a terrible temper that goes from 0 to 10 before I know it. I've balanced it by taking constructive feedback and being mindful of my triggers. That was a hard road to travel and I still slip up. For the longest time, I thought I knew best and nobody understood. Least of all, my significant other.

So, I completely empathize with their difficulty discussing it with me. The problem is, they won't discuss it with anybody else either. I'm not sure if it was a slip-up, moment of clarity or a mistake. But, my spouse once said that "I don't want to live like this". Which was a window for an actually constructive conversation. I casually mentioned talking to a professional, which was met with stubbornness. But, there's be no progress since then.

We've been together for nearly 20 years, so I've seen this progress to where it is today. The next step is for this person to open up to somebody else. I just have to tip-toe on how I might suggest that notion. "In sickness and in health" right?

Ironically enough, when I was confronted with my anger issues, I was basically given an ultimatum that I needed to find help. To which I was very receptive.

This entire conversation is fraught with society's terrible attitude towards mental health, mental wellness and mindfulness.

You'll probably need to give them an ultimatum. My SO isn't as extreme, at least in the same ways, but I need to constantly police the boundaries of their obsessions and, gently, push back against them to the degree I think they can handle.

Late onset OCD is very much a thing, more prevalent with women, and pregnancy one of the most common triggers. Do not expect it to go away by itself.

I think you are going to need to find a professional to discuss how to handle the situation and how to get your partner to accept the help you all three need. It will likely take a few tries to meet someone interested in working the problem, rather than proscribing some pills. Getting to the point of your partner accepting the label and some techniques to help cope and reduce the anxiety OCD causes could be all it takes get things improving.

I think the stigma of pills is where the biggest problem lies in addressing mental health. The last thing I want is to put somebody on pills, unless it's 10000% the right way to go.

As I understand it, the "easiest" and safest method is exposure therapy.

Its pretty much the only thing recommended for OCD. Maybe meditation or mindfulness gets a look in. But you want to try to get less superficial diagnosis than some random person on the internet; the OCD behavior could be a side effect of something else, eg. comorbid GAD or many other things I'd only be guessing at.

I understand where this comes from, and your resistance to trying to override your spouse. My partner works in a hospital, too. She tries to keep her 'hospital clothes' separate from everything else, which is probably wise. In her old car, basically nothing else could go in the trunk. Groceries, day-to-day supplies, all went in the back seat, because the trunk was the dirty place. Who am I to argue? I don't see the horrible effects of infection day to day, and I don't go through the procedures they have drilled into them.

Thankfully, it's not like your partner's. We share a car now, and there's just one basket in the trunk for the 'dirty' hospital shoes. She tries to change out of work clothes as soon as getting home and throws them in the laundry. Reasonable precaution, that's fine. She's more squeamish than I am about touching raw meat. But those are all preferences, and it's well under control. I don't think it's OCD related at all, it's just precaution.

In your case, it sounds like your SO has crippling OCD that's being fed/reinforced by rationality. Can you have some kind of intervention where other people who are impacted by this behavior are the loudest voices in the room? It's not good for her, it's not good for you, it's not good for your relationship, and it's not good for your child.

I've read that some hospitals have standard procedure to change out of the work clothing before leaving the facility. Certainly a smart move for high risk situations and areas/patients with contact procedures in place.

I would be mindful of your partner's current state and do your best to nurture a healthy environment while not letting it spiral out of control. It's easy to find a logical path to sanitize everything if your root reasoning make sense.

I'm doing my best to get feedback on how to approach a plan that is suited for the individual. I think with mental health, that's the only way to approach it.

this might be medically unadvisable, but i have found that education goes a long way towards disarming the notion that anything can ever really be clean if it is in your house. i helped one of my friends be slightly less obsessed with cleanliness this way.

let's say you bleach down a perfectly smooth countertop in your kitchen. okay, it's clean, there's no bacteria there. for about two seconds. probably less, in reality. we can't see microorganisms with our naked eyes, but they are as much a part of our physical environment as the air.

put differently, you can't make them go away by cleaning compulsively. not even for a moment. not in your home, at least. sure, if you see mold growing on food, throw it out. but you aren't about to out-clean nature's ability to survive.

remember, nature has been playing the game of "gotta inhabit every potential niche, ESPECIALLY if nobody else is there, because then there will be more room for me!" for a few billion years. a lifetime spent applying cleaning products isn't about to make any headway, nor will it prevent disease beyond a certain minimal level.

The OCD notion of cleanliness doesn't always have really anything to do with any real germs or other pathogens. "Dirtiness" is more an abstract concept that varies and develops over time.

I think, in this case, it's the fear of the known that is the problem. "Dirty" is the concept used to describe all the reasons to clean stuff. But, real-world issues like MRSA are scary and the root of this slippery slope. Combined with the fact that my spouse works in a highly contagious environment doesn't help.

What an awful situation for you both. Would a change of career be possible/practical/helpful?

Possibly, but my partner finds the work extremely enriching. I'd hate to upset that balance as well.

Previously on HN:

800 million viruses fall onto every square meter of Earth every day. They kill 20% of bacterial life every day. [0]

[0] https://news.ycombinator.com/item?id=16839636

really cool, never had a number for this. thanks for sharing!

OCD fears are often completely irrational, and sufferers often know it. That doesn't make the fears and anxiety less real. The common cleaning compulsion isn't so much to make things clean, but an attempt to cope with the fear and anxiety.

Still, education could point out that the behavior is not rational, and help acknowledge that there is a problem if the behavior is still necessary.

In some ways, the best compulsions are the ones that have a solution like washing your hands or checking the lock on the door four times. Unfortunately a lot of the 'what if' scenarios can't be so easily dispelled.

That's really hard to cope with and a big burden on you, particularly, especially since you see it leaking over to your child.

When you mention the hostility, what kind of things were said? How does your spouse justify their behaviour?

It sounds like there are attributes both of OCD and OCPD, and that makes for a very tough combination.

I defiantly learned over the years that my approach might have lead to more of these issues. Applying logic to each instance as resulted in the opposite effect and opened new doors in terms of what dirty versus clean is.

My spouse has a tendency to push back against things they might be told. For example, if somebody told them they were gaining weight, they would eat more.

Being somebody who struggles with a hot temper, I've learned that nobody really likes to be told that something is wrong with the way they are behaving. Especially if it's an issue that feels uncontrollable. The hostility purely manifests in pushback and stubbornness; which, of course, leads to heated arguments. I like to call it the "Because I said so" attitude.

In my opinion, the biggest justification is actually correct in it's baseline, which makes it so hard to break out of this cycle. Germs are everywhere and they can cause some real nasty issues. The disconnect comes in the thought pattern that they can eliminate the spread of germs. Of course you should clean things and be careful with raw chicken, diapers, feces, shoes in the house, etc.

> raw chicken, diapers, feces, shoes in the house

That last one isn't like the others! You could almost certainly safely lick the bottom of your shoes (assuming you hadn't just literally stepped in shit).

>Most people still think having OCD means you’re a neat freak or like your shoes precisely lined up in the closet. Come to my apartment; I’ll show you that’s not true. OCD is not a personality or preference. It’s a mental illness that can have devastating effects on how you live and interact with the world.

Well, yes, but it can also manifest in being a "neat freak" (and not just of the mild kind).

i used to be plagued by worries who some might relate to all kinds of stress disorders or obsessive / compulsive disorders. Recently in my life i found actually, that these things are stress, and that (i finally managed for a short while to..) if i resolve this stress in my life, this whole background noise of worries and negative thinking just goes away. like it's not even actually my own thoughts or something...

Not trying to tell how the mind or psychology works, but after a few diagnoses of incurable mental problems, i found that actually these were all wrong, and the problem was just plain stress. it;'s very hard and painful to accept and resolve these things, costs a lot of self-reflection and self-acceptance of the dark side to put it simply, but i'd want to encourage anyone who suffers from these things, to the point of being depressed for years and years on end, that there is hope to grow beyong yourself, to places more calm and beautiful than you can even imagine.

Keep up hope and positivity, and look into yourself for positivity and you will find it.


I am not gonna post this as anonymous, because I need to put this out of my chest: I am absolutely terrified of blood pressure being high/measuring it.

I was giggling (and almost crying) while reading the article, because putting it out into words makes it sounds really ridiculous, stupid, and obvious, but for us while we are following one of our 'mental stories', it feels very real.

I have the same stuff OP wrote about, but with blood pressure. I am absolutely terrified of 'having high blood pressure' because of traumas of the past, and stuff that was said to me that kinda stuck. I fear having my blood pressure measured and having that makes it go up as I try to measure it. It sucks and is really detrimental to my mental health.

I have anxiety and panic attacks. Whenever I feel uneasy or feel my heart beat faster and/or stronger in my chest, I think: "what if my blood pressure is severely high right now? that is why I am having these symptoms! what if... what if... what if..."

I have measured my blood pressure probably a million times and usually at the third reading it is fine (I need to measure 2-3 times because the first reading is always a little high, because I panic - heart rate goes up, my breathing gets strange). By the time I end my ritual, the blood pressure is always fine at 11-12/7 or 12-13/8, and I get relief for some days or weeks (the thought goes away).

I have also countless times doubted these good readings and thought 'what if by the time I just got this good reading it got back to being high? I don't know right now, it could be high right now?'. These doubts made me do insane things like measuring it all the time for some weeks (I'm past that phase, thank goodness).

I have also made my wife measure it while I sleep "just to make sure I really don't have high BP all the time" -- turns out, because I am sleeping and unaware I am about to be measured, my blood pressure readings (even the first one) are always good. I still can't let go of it...

Almost every time I go to cardiologist or anything related to heart/blood pressure, if the doctor approaches me to try to measure my BP, my anxiety goes off. And the reading is usually a little high. On rare occasions, if the doctor is understanding of my fear/condition and talks me out of it (and has patience), I get a good reading and that brightens my day up more than earning a million bucks.

Like I said, writing it out makes it sound so ridiculous to me, almost like a play. I just wish I wasn't cast to it...

'what if' is the true enemy.

PS: I jog 2km 5 times a week and swim 1.5km 3 times a week. I am still not convinced I am healthy and strong - if i get any palpitations from strenuous exercise "hey it could be my bp or my heart acting funny"

PS2: I have done multiple ekgs, dopplers, 24h ekgs, all fine. The only exam I haven't done yet is the '24h blood pressure readings' because guess what -- terrified of having that stuff stuck to my arm for a whole day.

Oh, this is so me. Except I'm constantly convinced I'm having a heart attack. For some reason I associate a fast pulse with imminent death. Then I start to panic and the adrenaline floods in and guess what? My pulse gets faster and the cycle continues.

It usually comes up out of nowhere when I'm alone, like I'm convinced I'm going to pass out and nobody is going to know and I'll die for lack of treatment. My doctor actually laughed at me when I described taking a shower, feeling my pulse go up, and imagining passing out, the hot water running out and me dying of a combined heart attack / hypothermia / drowning situation because it would be hours before anyone noticed I was missing. Don't get me started on what goes through my head while driving alone on a highway or, the horror, being out on a lake in a canoe.

I try to ride my bike at least 16km a day, and it does help condition me to experiencing a high pulse without sudden death. EKG, stress test, heart ultrasound all came back perfect save for the palpitations, which my doctor described as "extremely, extremely benign." I feel better for a little while after every test but it inevitably comes back, as if I constantly need a medical professional to explain to me that I'm not dying.

Are you considering treatment? I'm certainly thinking about it at this point.

PS: I am so obsessed with it that i measured it 4 or 5 more times.

Now it's at 65 bpm, and I am now satisfied.

this sucks

Reading your answer made me feel a little less crazy (thank you?). It is actually reassuring to know there are people experiencing the same stuff and doubts, and that i'm not alone.

We all should really talk about this with our friends, coworkers, etc. We should let the word out. I don't know about you but I feel embarrassed of this condition, like I'm a lesser person because of this. And not talking about it makes me even more anxious... I don't like admitting it. When I talk about it freely (like I am doing now, in a somewhat leap of confidence (hopelessness? haah)) I feel way more relaxed and the monster becomes a little smaller.

We are probably fine bro! You certainly wouldn't be able to bike 16km with a heart condition. It's all in our heads.

Also, there is a lot of it to being a perfectionist. I somewhere read that having a low pulse is a good sign. When I'm really relaxed my pulse is like, 60-58bpm.... now picture this:

I am at work right now, sitting in my chair, typing this and juggling 10 other tasks, I am definitely not relaxed. Just measured my pulse using a cellphone app, I'm at 70bpm, which is quite good (since the normal range is 60-100). BUT:

- Why did I measure my HR in the first place just because I read about yours, even tho I am not experiencing any kind of symptoms right now?

- Having measured it, and seeing a pretty normal number, why am I not satisfied? why am I apprehensive that it's not the 'best' number that could come out, it's only a 'good' number? I would have had some reason to be worried if i was sitting here feeling absolutely nothing and then I got a reading of idk, 105bpm. So why everything has to be always perfect in my head?

We create these fantasies that things are/should be clear cut in real life, but we know everything is chaotic and imperfect. As we cling more and more into our 'perfect mental models' we suffer because it will always mismatch with reality.

We should take a moment to stop and be grateful for what we have, instead of suffering for not attaining the perfect unattainable pattern we strive for.

Answering your question: I have taken meds before (Xanax), and all symptoms went away, and then my ocd kinda receded too, I had a phase I simply forgot about all this and just lived.

I am off it now because my doctor said I am already experienced enough to power through the panic attacks, and she knew I have a preference for not being on meds if I can (which is where I am now - trying to be sane and exercise and eat well and just power through).

My BP phobia is really hard on me but if I don't relapse to the 'measuring everyday all day long' stage I am not going back to meds, nope. I want the real thing.

Right now I am managing it quite okay, following the shrink's recommendation to just NOT MEASURE IT. not even if i have symptoms, not even if i have palpitations. The thought occurs to me and I try to acknowledge it and talk myself out of it, much like starting to meditate.

Sorry for the huge answer but I felt 'at home' sharing this with you since it looks like we are very similar in this regard. Hope this helps you and everyone that reads this.

If you wanna reach out, I am here.


Well, reading yours made me feel less crazy. I feel like you don't hear about this aspect of mental illness that often. It's like a weird cross-section between anxiety, hypochondria, and OCD (which I hadn't considered before). My doctor referred to it as "hypervigilance" and it seems like there is plenty of literature out there concerning it.

This study actually looks pretty interesting: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862826/

I stopped actually counting my pulse a while back. It wasn't exactly willful... more like I just don't want to know because it's probably artificially high and it's not like I've ever felt better after checking it anyway.

I know I'm in good health, which is where the "I'm not dying, just a little crazy" thoughts come in. When it gets really bad most of my energy is spent remembering that I can do things like ride 16km and feel just fine, despite feeling like I can't breathe and my heart is going to jump out of my chest and my nerve endings feel like they're on fire. Xanax has been recommended to me but I'm very reluctant to start down that road. I can't really justify why, it just seems slightly scary or somehow unpleasant.

Also, you're right. I should communicate with those around me a little better. It gets very awkward trying to explain an attack away.

Thanks for talking!

> Well, reading yours made me feel less crazy.

Btw, I believe my wording made you think that somehow I said that you're crazier than me ahhaah and I feel better because I know there are 'crazier people than me'. English is not my first language, so sorry :-) What i really meant is that it feels good to know there are people going through the same stuff, because usually when we are having these symptoms, we tend to feel really alone ("why does this only occur to me?"), which is wrong -- there are lots of people going through this.

Don't be scared of Xanax, I took it for two years and it really helped. It won't cure you, but it will do better: if you're struggling too much (daily) it will give you some time off to reorganize your thoughts and understand the whole situation (when you're in panic you're not able to have a logical train of thought, right?). And with better understanding comes better mental tools to deal with it (reassurance, previous experience, etc).

Have a good one!

I understand why you have these feelings. I ended up in a similar place for awhile after a traumatic event. The desire to be sure it’s not going to happen again is incredibly strong.

The thing is, there is no way to know for sure that you are healthy. Any of us could keel over and die from some previously unknown or suddenly occurring problem at any moment.

You’ve already done your due diligence by checking to be reasonably sure you do not have high blood pressure. Now, you just have to let it go. When it comes to stuff like this, 99.9% sure is the best you’re ever going to do. Accept the uncertainty. It would be a real shame to waste part of the life you do have by constantly checking for something that doesn’t exist.

The best thing for your mental and physical health is to accept you are probably, albeit not certainly, just fine. If you cannot get over this yourself, I highly recommend cognitive behavioral therapy and medication as appropriate. Good luck!

There's a large group of people who are similarly obsessed with low blood sugar when their blood sugar is in fact just fine. There is even a term for this: "functional hypoglycemia", as opposed to actual hypoglycemia. Exact same story.

It's basically anxiety, and it can be treated by a psychiatrist. A combination of drugs to calm you down and psychotherapy (cbt or emdr) to address any underlying "stuck" reactions or other causes. And when I'm saying "drugs" I don't mean something heave that turns you into a vegetable, for milder cases like yours there are fairly mild drugs.

Go to a specialist, you don't have to keep playing this role. Many people end up much better in 8 weeks of treatment.

I have been reading more and more about CBT. I will research about it and if things swing the right direction I'm going to try it.

Thanks, man!

Hallmark of anxiety is warped perception of own health. Don't fall into the trap of incessant research. Instead schedule an appointment with a psychiatrist as soon as you can get enough focus to make the phone call. Or ask a friend to do that for you.

Can you feel your heart beating within your chest, and blood pulsing through your body? Why do you trust external metrics more than internal metrics?

Doors are always unlocked for me, I have to go back and try it a few times. Or the dog will 100% somehow get through the other doors in the way, pull the handle, then run into the road. Also if I sleep with the bedroom window open he'll 100% definitely jump out of the window when I'm asleep. Fun times.

To add to the comments here, it's also important to stay very humble about those compulsions, knowing that they can appear anytime in life, when you have kids, when they to go college, when you lose a parent etc, even sickness can bring it.

I don't known if I have OCD or I'm just a over thinker. Most of the time I must process the words I'm about to say to another person. I have a hard time making spontaneous conversations.

Not a sufferer of OCD, but anxiety and depression (and associated neuroticism). One of the scary things to accept is that you have no control over what you think, free will is a (darn good) illusion.

Since we have no idea why these obsessive and dark thoughts are occuring in psychiatric patients, the best thing you can do, as a patient, is to get good at identifying all the bullshit that's going through your head: "No, that random crowd of people doesn't deeply despise you", "No, you don't have to kill yourself because you can't finish your studies in regular time", "No, you won't be laughed at because you're looking for an SO"

Precisely none of the fears I had have ever come to pass. I am, relative to people I interact with, (by a huge margin) my largest critic, which can be disabling, when every time you make some small trivial mistake you think "Oh god, nobody will ever forgive me for this, what a stupid PoS you are". It's all a fiction told by a disordered part of the mind.

On the bright side, things have been improving a ton for me since when it was really bad a year ago, but it takes medication (not an option for everyone), time and lots of patience.

One of the best things I came across on the web are the works of Robert Sapolsky, biology and neurology professor at Stanford. Specifically his 25 part lecture series: https://www.youtube.com/playlist?list=PL150326949691B199, his talk on depression: https://www.youtube.com/watch?v=NOAgplgTxfc and his book "Behave" (there's more from him, just look around).

It's not that I learned some "magic fact" that suddenly frees me from all nonsensical thoughts, but it has opened up the complex, nuanced world of human biology and behavior and numerous interactions between genes and environment, between mind and body or between different functional parts of the brain (obviously a course like this can only give a broad overview).

There's so much hidden stuff happening that, without us being conscious of it, influences who we are, and yet one doesn't have to be a plaything of one's environment, because several of these factors can be influenced like which experiences you seek and which you avoid, once you are aware that these things can shape you. That said, a lot of stuff like your genetic predisposition, prenatal environment, childhood, external stressors (e.g. death of close relatives and friends) can not be changed, but it also matters _how_ you think about them.

One will not become resistant to psychiatric illness no matter how fancy and elaborate you think about it or yourself, but it takes off the edge of thinking of oneself as this especially hopeless case. And equally importantly Sapolsky's course/book shaped my thinking of others, made me much less prejudicial (I sometimes catch myself with prejudice, but normally I notice), much more aware that everyone else is also subject to the same rules and phenomena that govern human thought and behavior and there's nothing "wrong" with them (in the sense that they're just "an evil person" or somesuch thing).

I never knew ocd had anxious thoughts to them. I thought they were thoughtless compulsions.

It doesn't primarily manifest as anxiety, more of an intrusive thought (obsession). E.g. until you have washed your hands, you are actively aware of a feeling they are unclean and need to be washed. This can amount to distractability and irritability, which is remedied by the compulsive act (washing hands). Combined with the highly co-morbid condition of ADHD, the intrusive thoughts can impair ability to manage attention.

Ugh. What a terrible affliction to have.

I thought this was referring to XKCD's "What if".

I've OCD and i was on a verge of complete failure.

Untill a friend recommended me to try Ashwgandha (Withania somnifera)

After that my life completely changed positively.

I've lost my anxiety since then. I usually take it with a glass of milk.

Now, I've very less stress.

Were you under any sort of medication before?

My preliminary research shows it's in the realm of homeopathy and folk medicine. But still might be worth a shot if it can reduce anxiety.

Can you elaborate a bit on how to find it and how it changed you?


If you haven't encountered it, examine.com is a good resource; they curate research on supplements.

In the Human Effect Matrix, in the Anxiety entry, you can see a link to 3 double-blind, placebo controlled studies examining the effects of ashwagandha on anxiety: https://examine.com/rubric/effects/view/a42299063269c89b14ce...

As far as sourcing, you could look at consumerlab (paid subscription; they do independent testing of supplements).

Memantine (5-10 mg) + selank.

Add a multivitamin, D + K, and chelated/TRAACS magnesium supplement. Like AOR Ortho-Core (or Life Extension Two-per-day if too expensive), Life Extension D + K, and Doctor's Best High Absorption Magnesium.

Can also add Doctor's Best DHA 500 and Doctor's Best Real Krill.

Nutrient tests like NutrEval catch many deficiencies. And a comprehensive hormone panel (include thyroid panel). And genetic testing.

I first tried this kind of thing over 10 years ago. In my experience, it gives initial benefits, followed by a relapse to an even worse state of ill health.

Mental illnesses are not just physiological in origin and cannot be treated as such.

They are a complex combination of physiological and emotional issues, and both must be addressed in step with one another for complete healing to occur.

Did you try what I mentioned or something else? The first stack, for example, took effect quickly and continued to work.

Upvoted not because I like the idea of giving (unsolicited and shotgun) medical advice on HN, but because it might be interesting hearing from other commenters about what has worked for them and what hasn't.

I had OCD (compulsive hand washing, obsessive food hygiene beyond normal, obsessive about which things touched my lips or hands)

It was tiring. Frustrating. Depressing. It felt like a disease that ruled my life.

A change in circumstances distanced me from unrelated stresses in my life and the OCD disappeared. It seemed that it was a manifestation of unrelated stresses.

I seriously wonder if OCD could be is created because of our lifestyle in society. Yesterday I went to a coffeeshop (creamery in SF) and there was this crazy bathroom where I had to scan a QR code to get in. The door automatically opened, I walked in, and it automatically closed behind me. When I washed my hands, the water faucet detects motion and it has a built in air dryer as well. When I'm done, I pushed a button and the door automatically opened.

Afterwards, I thought about why such a crazy bathroom was built and I realized that my entire bathroom could be done without me touching anything so I could keep myself clean. It made me think about all the germs in every bathroom door handle and all the hands touching it. If I didn't consciously stop myself, I could see myself becoming slight OCD.

At the same time, I wonder if someone who practiced true altruism would ever develop OCD. If I'm only focused on helping others without thinking about myself, would it be easier to let things go?

I might offer some insight here. I’m slightly obsessive about not inconveniencing other people. I try hard to put things in their proper places, not to eat the last bite of anything without asking or being offered, not making noise, not leaving electronics in misconfigured states, not leaving my own stuff lying around, I could go on.

It’s worse than the few obsession I’ve had around my own preferences, because I lack the introspection when it comes to people other than myself. I don’t know if they are sensitive to this or that particular nuisance and my priors seem to be dialed up to eleven.

I end up trying not to be around other people do that I won’t fall into these obsessive patterns as often.

Right, but how do you do this at home?

Extreme hygiene isn't good for your immune system. With exposure, you build up a higher tolerance. If I use too much soap, I get acne. Hygiene is ultimately a balance. There's no such thing as clean or dirty. Those are made up extreme definitions in our head to act upon. However it is a spectrum, an equilibrium. And if you kill all your good bacteria and remove all your sebum you damage that ecosystem.

To tackle OCD, you need to get to the root of the problem first. Understand why it is happening (stress/anxiety related but how exactly?). As with any personality disorder this is best done under the guidance of a professional.

Example though: if I sit in public transport, I frequently check if I got my wallet, phone, keys, etc. but there's a very good reason for that. Mugging is high in Amsterdam, and I tend to lose things. But sometimes I check too often, and then I tell myself I'm overreacting. I can also very much recommend mindfulness. I do guided sessions in public transport and it makes me calm when I arrive at my destination. To be fair, I don't have OCD; I have autism. My partner as well, and she's way more anal about hygiene, sometimes getting close to OCD-esque symptoms. I got something similar with using keys to close doors but again there's a very good reason for that. I've had my key in my door (external) for a night, I've left my door open for a night, I left my bicycle with key on street, I lost my keys multiple times, and I've forgot to lock my doors countless of times.

BTW, those build-in airdryers? They blow bacteria through the air, on your clean hands. More dirty than a paper towel you throw away afterwards (and either isn't dangerous).

Yeah, I think it's important to consider very hard whether the carefulness is adaptive and maladaptive. This is not an easy problem. I have done my fair share of both underchecking and overchecking.

> I wonder if someone who practiced true altruism would ever develop OCD. If I'm only focused on helping others without thinking about myself, would it be easier to let things go?

Sounds like a recipe for developing scrupulosity, not having/communicating personal boundaries, or both.

I'm one of those people who uses a paper towel to open public bathroom doors. I get upset when:

1. There's no trash can by the door for my auxiliary paper towel

2. The door isn't push on the inside (can't kick with my foot).

For the reason you mention. I'm sure it's mostly just conditioning. It's a harmless preference and it probably saved me a few colds (although, perhaps getting a virus would have helped me in the long term...).

> It's a harmless preference and it probably saved me a few colds

Or not, you know?

Sometimes there is a trash can by the door but it has a lid (with a handle). Even if the door needs to be pulled from the inside you simply grab the door handle with a piece of paper and open the door, and then throw the paper in the trash can.

Which is why I'm upset when I don't find one by the door. Wouldn't the lid make it even more of a pain? I guess I didn't understand what you said.

Hygeine OCD is only one small subset of OCD.

If you pressed a button then it wasn't automatic.

That's a moot point given that:

> I realized that my entire bathroom could be done without me touching anything so I could keep myself clean.

So would you be fine with staying in the bathroom forever?

IIRC many stores have automatic doors that actually open when you walk in front of them. I don't see why the same technology couldn't be used for OP's hypothetical bathroom.

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