Living with Obsessive-Compulsive Disorder (OCD)

To understand your struggles with OCD you need to take into account both components.

by Michael R. Emlet

WHAT YOU NEED TO KNOW

Do you repeatedly check your door to make sure it’s really locked? Do you worry about germs and contamination even though you mop and wipe many times a day? Do you wash your hands excessively after touching doorknobs? Have you battled the repeated thought that you might physically harm your young child, even though the idea horrifies you?   Do you have a nagging fear that you have committed the unpardonable sin? Do you spend hours organizing your closet so that it will look “just right?”

If you do or think any of these things, please know you’re not the only one. About three percent of those living in the U.S. struggle with some kind of obsessive thinking and compulsive behavior, so that’s a lot of people. And what you are struggling with has a name: the American Psychiatric Association in its Diagnostic and Statistical Manual of Mental Disorders gives the name “Obsessive-Compulsive Disorder” (OCD) to people struggling with life-dominating obsessions and compulsions.

What exactly is an obsession?

An obsession is a persistent thought, impulse, or image that you find intrusive, inappropriate, and anxiety-inducing. There are some common obsessions that many people struggle with from time to time:

  • Fear of germs and contamination from germs
  • Repeated doubts (“Did I turn off the oven before I left the house?”)
  • A need to have things in a particular order or to do a task “just right”
  • Horrific impulses (that you might stand up in church and shout an obscenity)
  • Sexual imagery
  • Hoarding (an inability to discard things such as newspapers and magazines) 

Nearly everyone has had a thought like this at one time or another. The difference is that for some people such a fleeting, irrational thought turns into a recurrent pattern of thinking. Such obsessions result in a great deal of anxiety, and the harder you fight against having the thought, the stronger and more persistent it seems to become.

If you have an obsession, it is likely that you use compulsive, ritualistic behavior or mental processes to temporarily “neutralize” or reduce the anxiety associated with your obsession. If you struggle with a contamination obsession, you might wash your hands thirty times a day with a certain fixed routine. If you have a repeated doubt about the oven being turned off, you might check and recheck it to convince yourself that it’s really turned off. If you have intrusive and aggressive impulses to harm someone you might get rid of all the knives in your house, and in addition count to twenty forward and backward each time the thought occurs.

If you are dealing with an obsession you know very well how it feels, but what causes OCD? Some people see OCD only as a physical, brain-based disorder for which medication is necessary. They point to brain scans that show abnormal patterns in someone struggling with OCD and to the success of medications like Zoloft and Paxil (the selective serotonin reuptake inhibitors—SSRIs) in treating obsessions and compulsions. Others are convinced that obsessions and compulsions are simply sins for which repentance is necessary. Neither way of looking at OCD is completely helpful because both are too simplistic.

You are physical and spiritual

The Bible tells us that we are composed of both the physical and the spiritual. Our bodies, including our brains, are physical. But we are also spiritual beings. When God made us, He breathed His spirit into us, and we became like Him (Genesis 2:7). Because we are spiritual we can choose between right and wrong. Brain problems cannot make us do something wrong—our right and wrong choices come from our spirit, our soul, our heart. At our core (our heart) we choose to worship either the God who created us and thus organize our thoughts, emotions, and actions around Him or we choose to worship something or someone that He created and organize our lives around that (Romans 1:21-25).   

To understand your struggles with OCD you need to take into account both the body (brain) component and the spiritual (heart) component. If you focus exclusively on the possible physical components of OCD, you will miss the spiritual roots of OCD and not be able to live out the call to “take every thought captive” for the glory of Christ (2 Corinthians 10:5).  If you focus exclusively on the spiritual origins of OCD, you may underestimate the intensity of the struggle, experience unnecessary guilt, and unthinkingly condemn the use of medications to improve symptoms in yourself and others.

What common spiritual issues might lead to the experience of OCD?

Because OCD is really an anxiety problem, it’s not surprising that the Bible has much to say about the spiritual roots of OCD. Remember, in the midst of your struggle with OCD,  your desires, thoughts, and actions are revealing what you are really worshipping—what is most important to you and what you treasure above all else. Jesus says, “For where your treasure is, there your heart will be also” (Matthew 6:21, ESV). So what are the things that OCD strugglers typically value or “treasure?”    

The need for certainty is perhaps most common. You might feel unable to live with any bit of uncertainty. You want total assurance and certain knowledge: “I must be sure that the back door is locked.” And “I must be certain that I’ve done everything possible to decontaminate my countertop.” Compulsive behaviors such as checking and washing are attempts to erase doubt and boost a sense of certainty. But what happens? Reducing or controlling anxiety becomes an end unto itself and so begins a vicious cycle. (“How do I know I’ve cleaned the floor enough? How can I be sure? Better to mop it one more time than to experience this gnawing anxiety…”)

Of course, not all doubt is sin. It’s not sinful merely to ask, “Have I locked the door?” and to check if you have. But this becomes a sinful struggle when the desire to be sure becomes a demanding tyrant that generates anxiety and leads to compulsive, controlling behaviors that make it impossible for you to focus on what God is calling you to do: love Him and love others (Luke 10:27).

How does the Bible speak to your quest for certainty and your futile attempts to control your world through compulsive behaviors?

  1. Remember: your reason for being certain about anything doesn’t come from within you; it comes from God as He reveals himself in Scripture (1 Corinthians 2:9-16).
  2. God tells you enough so that you can live responsibly, but He doesn’t give you complete knowledge. He is the only one who knows everything (Job 38-41).
  3. Truth, assurance, and certainty have their foundation in a promise-keeping God. And His promises come clothed in the form of a person, the Redeemer, Jesus Christ, in whom all of God’s promises are “yes!” (2 Corinthians 1:20).
  4. The antidote to enslaving doubt is to gaze long and hard at the person of Jesus, on whom your faith rests. It’s not the strength of your faith that counts, but the One in whom you place your faith. Reliance upon Jesus allows you to proceed in faith, even when some doubts remain (Mark 9:14-32, especially 9:24).
  5. God knows you completely and has detailed oversight of your lives (Psalm 139; Luke 12:22-34).

Another common spiritual theme in OCD is an overactive sense of responsibility. This heart dynamic is especially active if you struggle with aggressive or horrific impulses. When you have a thought that you might do something wrong, you feel the same weight of anxiety, responsibility, and guilt as if you actually did the deed. This often leads to compulsive behaviors that attempt to “pay for,” “neutralize,” or prevent the imagined sin. Not surprisingly, this theme is closely tied with perfectionism, the idea that your performance is critical for avoiding negative consequences, for yourself or others.

Again, the Bible has much to say about these concerns:

  1. These intrusive thoughts are not temptations to sin in the true sense of the word. While the horrific thought of picking up a knife and stabbing your husband could only occur in a fallen world, such a thought doesn’t fit the description offered in James 1:13-15 of being tempted by our desires. Why feel guilty for something you didn’t do and in fact, don’t even want to do?   
  2. As a sinner, you are capable of things far worse than you have imagined. And yet, where sin (even potential sin!) increases, grace increases all the more (Romans 5:20). God is not surprised by your bizarre thoughts!
  3. Jesus has kept the whole law and paid the penalty for your sins. There is nothing you can do to add to His work (Hebrews 10:11-18; Hebrews 7:26-27).

What about the brain-based aspect of OCD?

It shouldn’t surprise you that certain areas of your brain are more active when you’re struggling with obsessions and compulsions. The more you obsess and the more you practice your compulsions, the more entrenched those neural patterns can become. This is because your body and spirit are bound together. But this is also why tackling the spiritual roots of OCD can change those entrenched neural patterns and decrease the frequency of your intrusive, obsessive thoughts. Learning to trust in Christ for your certainty, your perfection, and your forgiveness can change the way your brain functions. 

WHAT YOU NEED TO DO

There are a number of practical steps you can take to overcome obsessions and compulsions. Consider the following three pronged approach:

1. Build confidence and trust in God's care and provision in a daily, proactive way.

Think of this as training in “peace-time” that will give you a firm foundation for fighting your battle with obsessions and compulsions when they occur. How can you do this?

  • Recognize that OCD is a trust issue. Do you realize that your trust in the person, character, and work of God is what will break the obsessive-compulsive connection
  • Grow in that trust by meditating on Psalms that center on God’s care for you. Read through Psalms 23, 46, 62, 91, 104, 121, and 139. Meditate on at least one every day. But make sure that your use of these psalms doesn’t become another ritual! Remember, your goal is to deepen your relationship with God, not to create another rule.
  • Focus your thoughts on the finished, perfect work of Jesus Christ by reading through the book of Hebrews, particularly chapters 7-10.
  • Meditate on the love of God. Nothing (not even your worst case scenario) can separate you from God’s love (Romans 8:28-39).
  • Make a list of fifty things you are certain about. Then thank God for the many ways He is helping you to live without fear and doubt. Ask Him to extend the borders of your certainty and trust into your struggle with your obsessions and compulsions.
  • Recognize the ways in which your obsessions and compulsions keep you from loving those closest to you. Focus on these real sins, instead of the potential sins you have imagined in your mind. Then turn to Jesus Christ in repentance and faith (1 John 1:9).
  • Meditate on your status as a son or daughter of the living God, on whom His favor rests. (Galatians 4-4-7; 1 John 3:1) Remembering your identity as God’s favored child will bring freedom from the tyranny of over-responsibility and perfectionism. 

2. Address obsessive thoughts when they enter your mind.

  • Learn to "devalue" your obsessive thought.  Just because you have a repeated thought doesn't mean you have to take it seriously and counteract it.  The reality is that you take your thoughts too seriously (1 Corinthians 4:3-4).
  • Recognize you are overestimating the threat of danger. If your door really is unlocked, how likely is it that harm will occur? How likely is it, really, that you will stab your child with a knife? This is part of the irrational way you are responding to your thoughts.
  • Go to the Lord in prayer when a thought comes. Instead of trying to suppress the thought—which rarely works—ask your Father in heaven to pour out His grace and mercy in your time of need. Ask Him to fill you with trust and confidence regarding His love, His oversight of your life, His wise and good plan for your life (the very truths on which you have been meditating, as described above).
  • Recognize that it’s not only possible, but normal, to live with a mixture of faith and doubt. Let the prayer of Mark 9:24 be your prayer as well: “I believe; help my unbelief.”  

3. Take steps to weaken the temptation to engage in compulsive behavior.

  • In the midst of rising doubt and anxiety, let go of your quest for certainty and choose instead to trust God's oversight of your life. Freedom comes when you give up your right to control your world and rest in the One who holds all things--even you!--in His hands (Matthew 6:26-34).
  • Each time you refrain from acting out a compulsion when faced with an obsessive thought, you will weaken the obsession-compulsion cycle. Research shows that if, instead of immediately trying to quiet the anxiety induced by your obsessive thought, you hold off on doing your typical compulsive behavior for 20 minutes or more, you will weaken the frequency and insistency of your obsessive thoughts.
  • In addition to delaying your compulsive ritual, you can also shorten it (wash your hands for 20 seconds rather than 1 minute), or do it differently (to demonstrate that no harm comes from altering your typical compulsion).
  • Focus on the fact that God gives you good works to do each day, and seek them out (Ephesians 2:10). Then your life will have an outward focus on God and others, instead of an inward focus on your struggle with OCD. As you choose to act in love toward others rather than act out your compulsion, you will find the power of the obsessive-compulsive cycle loosened.
  • When you fail to refrain from your compulsive behavior, rather than hang out in a place of guilt, self-loathing, and condemnation, go to the One who understands the intensity of your struggle and who richly pours out grace, mercy, and forgiveness in your time of need (Hebrews 4:15-16).

Two final but very important thoughts: First, tell others about your struggle so that they may join you in prayer. Many people struggle with OCD in silence and shame. If you’re one of those people, share your burden with several mature believers. Second, if the obsessions and compulsions are severe enough to interfere with daily life and relationships, seek out a seasoned counselor with experience in ministry to those with OCD who will walk this difficult road of change with you. 

Although overcoming obsessions and compulsions is not an easy task, God promises that the gospel-centered truths of the Bible (the Word) along with His presence (the Spirit) are the resources that will allow you to face your doubts, fears, and anxious thoughts head on.

FREQUENTLY-ASKED QUESTIONS

What about the use of medication?

Research shows that the brain of someone actively struggling with OCD is functioning differently than the brain of a normal person. And yet, the treatment that has the longest and best track record of success in the secular world is not medication, but counseling that specifically targets the obsessive thinking and compulsive behavior (commonly called “cognitive-behavior therapy” or “exposure and response prevention therapy”). Over time, as someone responds differently to his obsession (takes the thought less seriously, gives up the quest to control anxiety, and refrains from carrying out a compulsive behavior), his brain activity patterns may well change back toward normal. 

However, if the struggle with OCD is so severe that it significantly disrupts daily life and relationships, then medication may be a helpful treatment, along with counseling. The use of these medications may enable you to more thoughtfully and prayerfully engage in the hard work of counseling. The class of medications most commonly used for OCD is the selective-serotonin reuptake inhibitors (SSRIs) such as Prozac, Paxil, Luvox, and Zoloft. They have a good track record of safety, but they are not without side effects, so be sure to discuss the pros and cons with your prescribing physician. 

Can you walk me through what I should do when I have my typical obsessive thought of "Did I lock the front door before I came upstairs to bed?"  Although I checked it once already, I'm tempted to check again and again because I doubt what I see with my eyes.

First, you need to be meditating frequently (not just when you have an obsessive thought or compulsion) on God’s providential care of your life, His faithfulness to you because of Jesus, and the security that comes from living as a son of the living God and not an isolated, fearful, orphan. Saturating your mind with these truths will help you address the insistent doubt when it occurs.

When the thought comes, try saying something like this to yourself:

“Just because I’m having this thought doesn’t mean that it’s a reliable indicator of true danger. While it feels like I must check the door to decrease my anxiety and persistent doubt, I will choose instead to rest in the care of my loving heavenly Father, who has pledged Himself to me for eternity through my trust in the life, sacrificial death, and resurrection of Jesus Christ. Even if my worst case scenario would happen—a thief entering my home and killing me or my loved ones—there is nothing that can separate me or them from the love of God that is in Christ Jesus. Only in Him can I find true security. Lord, I trust you to do what is best; into your hands I commit my spirit…”

Couple this exercise of faith in the character and redemptive work of God with a refusal to give into the temptation to check the lock. If you wait long enough, the anxiety you feel should diminish. By waiting, you are weakening the link between the obsession and the compulsion.

© Copyright 2009 by the Christian Counseling and Educational Foundation.  All rights reserved.  Used by permission.

For more information on caregiving, read Michael R. Emlet's minibook, Counseling Obsessive OCD, from New Growth Press.

More information about the Christian Counseling and Educational Foundation is available at its website. To look at all available CCEF resources, visit New Growth Press.

Michael R. Emlet, M.Div., M.D., practiced as a family physician for twelve years before becoming a counselor and faculty member at the Christian Counseling & Educational Foundation (CCEF). He is the author of the book CrossTalk: Where Life & Scripture Meet, and the minibooks Asperger Syndrome; Angry Children: Understanding and Helping Your Child Regain Control; Chronic Pain: Living by Faith When Your Body Hurts; Help for the Caregiver: Facing the Challenges with Understanding and Strength; and OCD: Freedom for the Obsessive Compulsive.

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