OCD (obsessive-compulsive disorder) is a mental health condition comprised of obsessions and compulsions. The first comes from internal or external triggers, such as dirt and subsequent contamination fears. The second is feeling compelled to perform repetitive behaviour, such as washing. For example, a person will repeatedly wash to alleviate anxiety or prevent harm.
When a person develops the onset of OCD, an earlier interpretation of facts and reality becomes lost to obsessional doubt. So, tolerating uncertainty is tricky because the person is no longer in accord with the realities. For example, suppose the facts are that they turned off the stove. They see it with their senses and common sense that it’s off, but they doubt it simultaneously. But before the obsession, they had no doubt. In short, compulsions to check the oven now replace facts and logic to get the certainty they once had. But of course, it does not lead them to certainty but increases doubt.
Doubt is a core problem associated with OCD and differs from everyday doubts. For example, an ordinary doubt might be what to eat or wear. A person will make up their mind pretty quickly and feel okay with it, even if they are a little uncertain about whether they’ve made the right choice. But they don’t generally feel anxious about it.
However, OCD doubt is pervasive, persistent, and often irrational. It can affect all aspects of a person’s life, from the most mundane to the most critical decisions they must make. People with OCD constantly question their thoughts, feelings, beliefs, and actions. They will examine the validity of their perceptions, despite having no objective evidence or logical reason to do so. As a result, they may find themselves doubting their ability to remember things accurately, make the right choices, or judge situations correctly.
Uncertainty Becomes Unsettling
Moreover, uncertainty is an element that feeds into OCD doubt. For example, as we’ve seen, a person with OCD may have been able to live with some level of uncertainty without it causing distress in the past, like the person choosing what to eat or wear. However, once OCD takes hold, uncertainty becomes unsettling, and a need for surety arises. In this case, again, it leads to compulsive behaviours.
For instance, suppose the person choosing what to wear or eat experiences an intrusive thought. For example, something terrible will happen if they choose one food and not the other or one item of clothing and not the other. Suddenly, they are fearful of this awful consequence. As a result, they do not trust their senses and common sense in the here and now. In other words, they are fearful of trusting that nothing terrible will occur. So, instead, they question the doubt.
The doubt in OCD insinuates itself into rational thinking, making it difficult for the person to trust the facts. They struggle with inferential confusion. In other words, they misconstrue reality and consider an obsessional belief an actual probability. For example, an intrusive thought about a terrible thing happening is not likely to convert to action, whatever the choice about what to wear or eat. However, a person with OCD relies on doubt and resolving it. They count on inferences, gut feelings, or hunches to make decisions “just in case” a bad thing could happen, further increasing mistrust in the realities and authentic self. They tend to analyse their intentions, every situation, every possible outcome, and every worst-case scenario, leaving them mentally and emotionally exhausted.
Since OCD doubt and subsequent feared consequences lead to anxiety, people believe they can find certainty and eliminate doubt by doing more rituals. For example, their fear of making a wrong decision about what to eat or wear (or something else) leads to a lack of confidence and self-doubt. Therefore, it can impact their ability to function in their everyday lives.
Still, inference-based therapy can help break the cycle of inferential confusion associated with OCD. It is an evidence-based treatment, allowing people to reorient from the obsessional way of living to their authentic selves. Subsequently, they reconnect with their senses and common sense in the present moment and ultimately overcome OCD. Inference-based therapy is an effective stand-alone treatment but can be combined with other therapies for OCD.
Read more about inference-based therapy in the following books:
Clinician’s Handbook for Obsessive-Compulsive Disorder by Kieron O’Connor and Frederick Aardema
3 Effective Ways to Treat OCD and Reclaim Your Life: Evidence-Based Treatments for Obsessive-Compulsive Disorder by Carol Edwards Frederick Aardema approved the chapters of this book on the inference-based therapy approach, according to his model with the late Kieron O’Connor.