The general public is aware of some of the manifestations of OCD from the television, such as compulsive fear of germs in the show ”Monk”, but this disorder has many faces and can shift its target issue even in the same person. Some of the ways do not even have external behaviors others can observe. Unlike playful television portrayals, this condition can be tortuous to a person and impair their functioning in relationships, work, and spiritual life.
OCD is a disorder that frequently goes undiagnosed. Research reveals that people can be in treatment for years before this becomes a focus of therapy. This can be due to embarrassment, or fear of having to risk not doing the compulsion (which seems impossible), or by the counselor just not looking for it due to other issues being the focus, or it being masked by other serious symptoms.
There are subtle ways OCD symptoms can be present. Some people have a compulsion to move their bodies in a certain way in response to certain internal or external environmental stimuli, e.g., having to shake when leaving or entering a room. Purely mental compulsions include having the compulsion to count syllables or words when reading, writing, or speaking, so they end on an even or odd number, or a certain multiple of numbers. Some people have the compulsion to pray in just the “right” way and repeat the prayer over and over until it feels “just right.” Often this is linked to an illogically related disastrous event that may happen if not done correctly. Wow, that’s a lot of added daily stress to keep the world safe.
Scrupulosity is a form of OCD that causes a person to constantly doubt the rightness of one’s performance. Scrupulosity can show up by doubting job performance to the point that one will be fired, jailed, or drive the company to ruin. Ironically this seriously affects performance and satisfaction. A terrible form of scrupulosity is a complete doubt of one’s salvation usually related to the scripture in Mark 3:29, “But whoever says evil things against the Holy Spirit will never be forgiven, because he has committed an eternal sin.” UGH! I wish Jesus said this differently. Yet, even if he did, the scrupulous person can pull on other scriptures to “prove” he is not saved. Doubting salvation removes much of the comfort and joy we have as believers in this difficult life. There is no mere arguing out of this because it is a brain hic-up, and not due to ignorance.
Religious compulsions have the added dilemma in that a resource for strength in doing the difficult work of recovery is corrupted by the disorder. OCD has a close relationship in the brain to Tourette’s syndrome. There are people with Tourette’s whose tic is to cuss. A person who does this during prayer or devotions can assume he is being oppressed by a demon and sadly tries running to people to pray this away. The anxiety over this can be devastating to one’s physical and mental health. There is great relief in naming it and ceasing the anxiety around it, and having faith in God’s love and power restored.
When going to counseling, a person has an opportunity to reveal all that is affecting his sense of well-being. This may be at the beginning of counseling, or later on when the client feels more comfortable, and trusts the counselor with sensitive and confusing parts of himself. On intake, I like to ask directly about OCD and give examples of the purely mental ones. I do not make a clinical issue out of small things that cause no distress or impairment. We all have quirky things we do. It’s speaking about these difficult things that is a critical step for healing for someone suffering in silence.