At the beginning of 2017, I was diagnosed with OCD and left my psychiatrist’s office feeling I could truly see myself for the first time. My thoughts and behaviors went from being a disorganized and mysterious mess to falling neatly into place.
In general, my intrusive thoughts are these: that my surroundings are contaminated, that my body is somehow contaminated (either with germs or disease), that the food I’m eating is contaminated, that I may throw up, that I might choke on food, that if I eat something I’ve never had before I’ll have an allergic reaction, that my throat will close up, and needing to know everything I’ll do and eat in a certain day. I'm thinking some combination of these thoughts constantly, in great detail, and often with accompanying imagery, even when the context makes no sense.
I could be reading emails or out for a walk and suddenly my brain will decide that the yogurt sauce I made for dinner last night actually came from expired yogurt and any minute I will begin to feel sick as a contaminated food spreads throughout my body. It’s taken a lot of work, but now I can mostly shake this off and get on with what I’m doing. But it doesn’t ever truly fade away. It’s like a white noise machine on in the background and if I pay attention to it, it gets louder and louder.
Since these thoughts are always running on a kind of dysfunctional marquee in my brain, triggers in everyday life can also suddenly bring them to the forefront. I’ve had to find a delicate balance of how much I can handle, while also not demanding the people around me to change their behaviors. It can be helpful for me to take breaks from the office, or spend time alone—but not too much time. I’ve found that total solitude can lead to me getting lost in my fears and letting them overtake me. It can be beneficial to be confronted with what makes you uncomfortable, because you learn you can handle it and it becomes easier to deal with next time. (Like a real-life version of exposure therapy.)
I’ve always had specific phobias that took up more brain space than I liked to admit. But because I didn’t do the stereotypical OCD things—touching things multiple times, checking light switches and stoves—it didn’t occur to me that I had OCD. (I did spend years of my childhood as a compulsive hand-washer, but for some reason this never raised any red flags.)
My doctors told me that a big part of OCD isn’t just those compulsions that we hear about—it’s the “obsessive” piece too. That appears as upsetting thoughts that plague you for many hours each day, have no rational basis and yet you’re unsure if you can trust that they’re not true. “Unwanted, intrusive thoughts, images or urges that trigger intensely distressing feelings,” is how the International OCD Foundation puts it.
The accompanying physical compulsions are things “an individual engages in to attempt to get rid of the obsessions and/or decrease his or her distress,” which for me are slightly less present. My compulsions appear mostly as avoidance. That’s not as flashy as counting to seven all the time, but compulsive just the same.
Here's an average day's worth of obsessive thoughts or compulsions for me. I’m sharing this not to alarm the people around me or ask to be treated any differently, but just to show: People with mental illness have a lot going on in their heads. OCD can take many different forms; not everyone is obsessed with contamination. Some do have checking and repetitive compulsions. Others might have the obsessive thought that they've killed someone, or that they're a bad person. The one generality I'd like to offer is that it takes up a lot of our time and energy.
I read somewhere once that if it makes you happy, it's not OCD. OCD isn't a cute way to refer to how you like your desk to be organized. There's no contentment here. Just racing, repetitive thoughts and behaviors that you do to try and keep those thoughts from coming true.
1. Starting my day
When I first get up, I think about what my schedule will be, ten or 12 times. A lot of people think over what they’re doing in a day, but for me this is an obsessive repetition. It’s not enough to think of it once; I have to repeat it over and over or I feel like something bad will happen to me that day. The less mystery or change in my daily schedule, the less I have to dwell on this, so I like routine. This can make traveling and commuting tough, or any unexpected changes difficult for me to manage.
2. Working out
It’s important for me to exercise several times per week, and when I do so, I find my OCD symptoms dissipate. That said, I have a lot of obsessive thoughts while working out, especially if I’m feeling dizzy or not at my best. Obsessive thoughts will take over: Am I going to get sick? Then I’ll imagine, very visually, getting sick in whatever class I’m in. I have to be close to an exit door so I that I could hypothetically leave at any moment if I become sick. If I don’t get a spot near the door, I can’t stay.
3. Using the bathroom
Bathrooms in general are anxiety-inducing places for me, because everything feels extremely dirty. I don’t like touching anything, the doorknobs or towel racks, because I feel dirty afterwards, even after washing my hands. I sometimes hold my breath because I feel like I’m breathing contaminated air.
4. Making breakfast
Another issue for me is the worry of food contamination. I think about food poisoning or if my food is contaminated several hours per day, and this starts with my first meal. I like to have smoothies for breakfast, and I keep my greens in the freezer. It’s very important that my fridge is at 37 degrees, and my freezer is at freezing or below, or I won’t be able to eat any of the food inside of it. Whenever I travel, I bring a tiny thermometer with me so that I can monitor the temperature of the hotel mini fridge. I can’t use communal refrigerators because I’ll spend the day worrying about if other people are holding the door open too long—changing the temperature—or if overcrowding will make the fridge too warm.
Unfortunately, my refrigerator in my apartment doesn’t always comply with my standards. If the temperature isn’t right, then I have to go to the store and buy new produce, which costs me time and money. Luckily, I live with a partner who doesn’t care about these things, who can eat the perfectly good food so it’s not wasted. When I lived alone while working in different cities, this was a big problem, and I felt massive guilt for throwing food away part of me “knew” was okay.
I can’t eat leftovers that have been in the fridge for longer than three days. When I’m stressed, this number drops to two days. For things like nut butters and condiments, I’m getting better at using them for several weeks. This can sometimes go awry if I feel like the safety seal came off a food product too easily, if there was too much condensation on a bottle when I take it out of the fridge (a “sign” to me that the fridge came above 37 degrees), or sometimes for no good reason, my brain will decide that something is unsafe and I just won’t be able to eat it.
5. Putting my dishes in the sink
The sink is another trigger area for me, because we put our dirty dishes in it and I feel like its surface is extremely contaminated. I don’t like to put silverware directly on the bottom of the sink, and if the sink looks dirty in the morning, I’ll spend hours of the day remembering and picturing how dirty it was and thinking about how it’s infecting all of my forks and spoons and other things I’ll eat off of later. If I had my way, I would bleach all the surfaces of the kitchen twice a day. I limit myself to once a week so as not to burden myself with chores, and because I’m trying to accept that’s a reasonable amount to clean your kitchen.
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6. Packing my lunch
Bringing perishable food anywhere makes me anxious, and I think the whole time I'm commuting about how it’s slowly going bad, growing food-borne bacteria, and will make me sick when I eat it. I circumvent this by power walking to work and having a lunchbox that’s literally an ice pack. Still, on really hot summer days it’s hard for me to go to the grocery store without insulated bags and tons of ice packs.
7. Walking to work
I can’t look at any splatters on the ground, like: spilled coffee, spilled water, spilled food, anything in a classic “splatter” shape. This is because it reminds me of vomit, and I think if I see something like this, it means I will be sick later. Obviously if I actually see vomit on the sidewalk (thanks NYC) and don't look away fast enough, it will take me several hours to calm down.
8. Orange juice
Sometime in the past year, orange juice has fallen into the category of things that makes me anxious. I know how strange this sounds. It reminds me of vomit, and I cannot look at it, smell it, or see people pour it into a glass. When I did exposure therapy, looking at spilled orange juice could make me cry. I’m not in that place any more, but it’d be hard for me to sustain a conversation with someone drinking or pouring OJ.
9. The "sick" emoji
Whenever Apple added that new throwing up emoji, they made it really hard for me to open the emoji keypad at all because I have to scroll by it to get to the other ones I want to use. I cannot look at this emoji, and if someone uses it in on Instagram or Slack or email, I can’t look at the screen until it’s out of view.
10. Any word that’s like "throw up"
After practicing looking at these words in exposure therapy, I’m a little better with them, but they can still be massively anxiety inducing: upchuck, chunk, puke, barf, vomit, throw up.
11. Using anything in the office kitchen
It's a real testament to my progress that I’m able to do this at all. If I’m not the one who washed a coffee cup, or water cup, or silverware, it can be challenging for me to use it because I can’t be sure it’s clean. I won’t use anything that still seems wet or smells weird. I pick things from the back of the shelf and inspect them for stains or any crusty leftover food or liquid stains. Despite the fact that I can use these things—and I force myself to—this thought will pop up many, many times in a day: asking myself if it’s really clean or not. The sponge in the kitchen is out of the question. I bring my own sponge.
13. Heating up my lunch
I’ve previously had to use specific numbers when microwaving my food, usually ending in odd numbers. My favorite was 4 minutes and 37 seconds. I heat my food up until it’s really hot because then I can kill any bacteria that have decided to live on my food that might make me sick. I have to stop the microwave on another odd number, usually 17 seconds. These days, I don’t have to do this most of the time, but I do still think the numbers while my food is being heated up.
14. Eating lunch
Two years ago, when my symptoms were at their worst, I developed the obsessive thought that I would choke while trying to swallow my food, unless I did the following: ate completely alone, touched my nose while I swallowed, and looked with my eyes up to the upper left hand corner of my vision. In therapy, I ate lunch every week with my therapist until this mostly went away, but I still have difficulty eating in crowded places where my thoughts tell me that everyone is watching me eat and waiting for me to mess up my swallowing. Swallowing is a highly complicated natural reflex. If you dwell too much on it, you can sometimes actually mess it up. I’m still working on this, and sometimes resort to the nose touching compulsion at times when I’m having a stressful day. I don’t need to it if I’m eating alone.
15. Other people coughing
If someone is coughing at the same time while I’m eating, I think that I’m going to choke or throw up my food. So I have to either stop eating, or ideally, move locations. I can't tolerate burping, hiccups, or spitting.
16. Anything in the news about food recalls
Recently there was a highly publicized and dramatic romaine lettuce recall, and whenever these happen they take up a lot of my mental space. It will be extremely difficult for me to eat romaine again—even when it's safe—which is a bummer because I really liked it. I haven’t been able to eat cantaloupe since its recall, and several other foods recently contaminated made it onto my "dirty" list. I’ll think about scenarios in which the groceries that I have at home were somehow contaminated by romaine, by being stored next to each other, or being in the same packing container. If those thoughts go on too long, it will lead to me needing to buy all new groceries.
17. Other people being sick
If someone around me is sick, my solution previously would have been to leave. No matter where I was, what I was doing, or how important it was. I’m better at this now, especially for illnesses like colds and flus. But if someone around me has the stomach flu, I'm a nervous wreck for weeks, and it’s hard for me to do anything except think—over, and over, and over—about how I’m going to get it. Two years ago, my boyfriend had a stomach bug and threw up twice. I moved out of our apartment and stayed in an Air BnB nearby, and couldn’t leave the Air BnB because I was convinced I would be sick. I made him—while he was still weak—deep clean our whole apartment with hospital-grade cleaner that could kill every virus out there. I still felt unsafe for the next month and was completely unproductive: unable to read, write, or do anything but worry. Because of this, people often don’t tell me when they’ve thrown up, which makes total sense. But the result is that I also spend lots of time obsessing about how everyone has recently thrown up and they’re hiding it from me.
Hearing about other people's more serious illnesses can also sometimes trigger an old obsession of mine: that I have MS. This was a very consuming obsession of mine for months on end, and I had countless painful medical tests trying to prove that I had MS. Thankfully, this obsession seems to be mostly retired, and has receded in my mind to wherever old obsessions go to.
18. Eating dinner
This is a new one: Lately, I have to eat dinner at 6 pm sharp. I wait for the clock to turn exactly to 6 pm, and then I am allowed to eat. I don’t know why, and I’ve been able to break this rule a few times, but it makes me uncomfortable. I also can’t eat two hours before bedtime, because I won’t be able to fall asleep: I think about regurgitating my food while sleeping.
19. Apartment cleanliness
In a famous book about OCD called The Boy Who Couldn't Stop Washing, the author tells a story about a young man who slept on park benches—not because he was homeless—but because after he cleaned his home, he so desperately didn't want to contaminate his apartment that he took to the streets rather than make it dirty. Boy, do I relate to this. I spend several hours thinking about all the surfaces and things that are dirty in my apartment. I think about the dirty dishes, and the inside of the fridge, and the dirty corners of the bathroom, how dirty the floors are, the kitchen table—basically everything. Sometimes these obsessions do come out and I need to bleach everything, throw a lot of my "dirty" belongings away, or hire extremely expensive cleaning services. Even after I do this, like the man in the book, my surroundings will never be clean enough, as long as I am living there.
This list is confined to a typical, boring day. Getting up, going to the gym, going to work, and coming home. When my schedule changes, and I'm placed in new environments and situations, the list can morph and grow, with new additions I've never experienced before.
If someone in your life has OCD, don't try to challenge their routines or thoughts in an attempt to make them better. It can be really upsetting, and you're not their therapist, who is trained to do so. Don't say things like, "Just think about something else." Believe me, we're trying.
And finally, remember that people with OCD are much more than their obsessions. I have days where I find it royally unfair that life can feel so hard, and it feels like anxiety is all that I am. But there are many other parts to my personality and life than my obsessions that I'd much rather talk about, like my favorite cartoonist or vegan restaurant, what stories I'm working on, and how I'm planning my first vacation in like six years. Obsession will always be a part of me. My goal is to make it the least interesting bit.
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