“I’m so OCD about my desk,” you might hear a coworker say as she neatens up her pens and papers. “I wash my hands so carefully, it’s kind of OCD-ish,” a friend might say as he scrubs between his fingers. But contrary to popular conception, Obsessive Compulsive Disorder (OCD) is more than just cleanliness and checking locks. And for those individuals who suffer from OCD, it can interfere with their thoughts and actions nearly constantly.
As the name implies, OCD is characterized by obsessions and compulsions that result in psychosocial impairment. An obsession is an intrusive thought, image, or impulse. A compulsion is a repetitive behavior performed in an attempt to neutralize the threat.
There are many ways that OCD can manifest, or many “themes.” Themes can include those related to contamination, harm to self, harm to others, somatosensory experiences, and plenty more, including perfectionism.
Here we're exploring intrusive thoughts related to perfectionism. We all know people who aim for perfection. For people with perfectionism-related OCD, their incredibly high expectation of performance often ends in excessive distress, to the level that it can paralyze them. The flawlessness that they are aiming for is usually impossible to reach, and certainly to maintain. So, many with these intrusive thoughts end up procrastinating or avoiding these activities altogether.
For those who do try to do engage in the activity, the demand for perfectionism can lead to compulsive thoughts and behaviors:
"Let me review my work or performance to ensure that it's 'just right.'"
"Can you please check this to make sure I'm on the right track?"
"I might lose this game, but I’ll remind myself over and over again that I won the other game."
"Can you tell me what to do?”
All these statements reflect compulsive behaviors including reviewing work for flaws, redoing, and reassurance seeking.
To those struggling with OCD, compulsions often feel like the only way to prevent the threat—in this case, not being perfect—from occurring. Unfortunately, despite a person's best efforts, it is impossible to consistently perform flawlessly. Perfectionism is an illusion.
So how can therapists who treat OCD help people overcome their obsessions and compulsions? In exposure with response prevention therapy (EX/RP), the goal is to do the opposite of what the OCD is telling you to do: Instead of avoiding the fear or activity—approach it! Do it! And do it without engaging in compulsions.
We can illustrate this treatment with the work that a very brave 9-year-old is doing in his EX/RP therapy. This boy loves playing sports and games, but his perfectionism OCD tries to convince him that it would be absolutely awful to lose—this is his obsession. To prevent that from happening, he would hesitate while playing so that he could make every decision very carefully; review each decision; and criticize his choices and performance—these are his compulsions. OCD was ruining his fun experiences. Our friend wanted to play games without panicking about possibly losing. And not only has he been working really hard on this, he wanted to share his artistic visual reminder with all of you!
Even the best athletes err and experience failure. Take a moment and think of your favorite athlete. What does their performance look like? How do they respond to failure? Are they perfect or excellent?
Just like Lebron James, our 9-year-old friend is working to play really well, forgive himself, and move on quickly after making mistakes. Aiming for excellence or greatness is much more achievable than aiming for flawlessness. And unlike perfectionism, freedom from OCD is certainly not an illusion.