Michael A. Tompkins
Co-director of the San Francisco Bay Area Center for Cognitive Therapy
What Does the D in OCD Mean?
Obsessions (the thoughts, images, and doubts that bother and scare you) and compulsions (the things you do and think to decrease your fear and discomfort) are upsetting enough but for some kids, the D in OCD can be pretty upsetting too. So what does the D in OCD mean anyway? The big D means there are four little d’s that are making your life hard. The first little d stands for disproportionate. This just means that what you think and what you do are a bit over the top. Washing your hands quickly after you use the toilet makes good sense. Washing your hands over and over after you use the toilet and then take a long shower because you still believe that you may have germs on your body doesn’t make good sense. In fact, it doesn’t make much sense at all but you still feel like you must do it, which makes the whole thing both scary and frustrating.
The second little d stands for distressing. This means that the obsessions and compulsions are really bothering you. Obsessions are not little worries. In fact, there not worries at all but they’re very upsetting thoughts that don’t make much sense when you step back and look at them. Many kids have obsessions that are not very distressing for them. They’re just a little uncomfortable and can easily shrug off the thoughts and move on to more fun and important things. They might not have this little d. However, if your obsessions are really scary, you may have a lot of trouble resisting the compulsions, and the frustration of having to do these senseless compulsions can be distressing for you too.
The third little d stands for disruptive. That means that the obsessions and compulsions are making it really hard for you to do the things you want to do in the way you want to do them. You may have trouble concentrating on your schoolwork because your mind is filled with all those scary obsessions. Even though you like school, you may hate going to school in the morning because of all the compulsions you have to do in order to start the day right. You may spend too much time washing, or checking, or counting, and this makes you late to the things you want to do and – it’s frustrating for you and for your parents and brothers and sisters. Although you don’t have to have obsessions that are both distressing and disruptive to have the big D – just one will do it — most kids who want help for their OCD have both.
The fourth little d stands for duration. This just means that the other little d’s (disproportionate, distressing, disruptive) have been pushing you around for longer than just a few days or weeks. Usually, if you’ve been suffering for more than six months, you may have this last little d.
So, that’s all the D means in OCD – something that you already know — the O and C are bigger than you can handle on your own. That’s where your family and the right therapist can help. Therapy helps get the D out of your life – even if a little O and C stick around — so that you can get back on track doing the things that are important to you. A little O and a little C never held back any kid. It’s the D that does that.
You’re Not Alone
No matter how scary the thought, how bad the thought, or how uncomfortable or guilty a thought makes you feel, other kids with OCD have had that thought too, in fact even kids without OCD have really strange and scary thoughts.
One of the hardest things about having OCD is that you may believe that you’re all alone. You may think that you’re the only kid who has scary thoughts or does things that don’t make sense. But you’re not. One percent of kids have OCD. One percent may sound like a small number but it’s not. How many kids in your school? If you’re in elementary school, there are about 300-400 kids. Most middle schools have about 600-700 kids. Most high schools have about 700-800 kids. This means that if you’re in elementary school, there are two or three other kids in your school with OCD. If you’re in middle school, there may be six or seven, and if you’re in high school, there may be seven or eight kids with OCD. Now think about all the schools in your city. Now think about all the schools in your state and then think about all the schools in the United States. That’s a lot of schools and that’s a lot of kids with OCD. So, you might ask, “If there are so many other kids with OCD in my school, why don’t I know them. Well, you may not know them because they’re too embarrassed or too scared to tell you that they have OCD too. But just because you don’t know who they are doesn’t mean that they’re not there.
Turn OCD on Its Head
OCD has made your life hard by fooling you into thinking and acting in certain ways. So long as you continue to think and act in these ways, OCD is in charge. However, you can start to turn OCD on its head by trying a few simple things. These things might not help you completely overcome your OCD, but they’re a good place to start.
Don’t try to Control Your Thoughts. Many kids (and adults too) believe that they can control their thoughts. They believe that they can think what they want to think and, more importantly, not think what they don’t want to think but this isn’t really true. Try this. Close your eyes and think about polka-dotted zebras. Let them swirl in your mind. Now, try to not think about polka-dotted zebras. Try to keep them out of your mind. Don’t try to think about something else to do this. That’s controlling your attention, not your thoughts. Just try not to think about polka-dotted zebras by keeping your mind blank. Try very hard. Really push hard to keep polka-dotted zebras out of your mind. What do you discover? Yep. There they are. This proves that we cannot control our thoughts, really, and if you were very frightened of polka-dotted zebras, keeping them out of your mind would be even harder. In fact, trying to not think about something only makes us think about it more because, in part, we’re checking to see if we’re thinking about it. And, guess what? Just as soon as we check whether we’re thinking something, sure enough, we start thinking about it.
So what to do instead? Next time you’re out with your family or a friend and an obsession enters your mind, trying singing the obsession to a silly tune. For example, if you are afraid that you will touch something and get sick, make up your own lyrics and sing it to yourself, perhaps to a favorite melody. For example, to the melody, Mary had a Little Lamb; sing something like, “Today, today, I might get sick. Might get sick. Might get sick. Today, today I might get sick and that is what I fear.” What do you notice? Yep, it’s tough not to giggle while singing a ridiculous song like that and that’s the point. It’s tough to be afraid of something that makes us laugh. You can try this in other ways too. You can speak the obsession in the voice of your favorite cartoon character. Bugs Bunny, Daffy Duck, and Elmer Fudd are funny characters but you likely have your own favorites. Say the obsession in a squeaky voice or a really low one, like Darth Vader. If you giggle, you win.
Negotiate with your compulsions not with your obsessions. Sometimes it’s not easy to tell the difference between an obsession, which is in your head, and a compulsion, which can be something you do but can be something you think too. For example, some kids reassure themselves. They think, “This is a silly thought or, there’s no way this would really happen.” You may feel a little better for a while, but this relief won’t last. Although it’s true that obsessions are silly and the scary predictions are very, very, very unlikely to come true, OCD will always say to you, “Yes, but are you 100% certain? Are you totally sure?” Then you’re anxious once again. You can never win an argument with OCD because you can never be certain. You can only be mostly and very nearly certain, but never certain, as in, no way this will ever happen certain. Some kids try to negotiate with their obsessions. They think, “Well, if I wash my hands six times, and make certain I washed thoroughly, then that should be enough. Right?” Then OCD says to you, “Yes, but are you certain – really and truly certain it’s enough?” You can’t reason or negotiate with uncertainty. The uncertainty always win and therefore the obsessions always win.
You can negotiate with your compulsions though. You can negotiate how much time you wash, how many times you check, how many times you do the same thing again and again. You can negotiate a delay doing the compulsion until the urge to do the compulsion fades and goes away. Then you win!
Try this. Next time OCD tells you to wash your hands or check the door, ask yourself how long you can delay doing the compulsion – five minutes, ten minutes, or 30 minutes. However, set a goal that you’re confident you can complete. Try to be at least 90% confident. For example, it may be really hard to delay washing your hands for the whole day but how about for 30 minutes? How about for 10 minutes? The longer the delay, the less confident you’ll feel that you can win against OCD. The shorter the delay, the more confident you’ll feel. So, if you’re 90% confident that you can delay washing for 10 minutes, then delay for 10 minutes. At the end of those 10 minutes, negotiate another delay with the compulsion. Perhaps you can delay another 10 minutes. Perhaps only 5 minutes this time. But 10 minutes and 5 minutes is a total delay of 15 minutes and that might be enough to win against OCD. Negotiating with your compulsions is okay. It will help. Negotiating with your obsessions, on the other hand, will only make your OCD worse.
Bend and break OCD rules. Rules, rules, rules. That’s OCD. Wash six times. Turn the faucet on and off twelve times. Walk a certain way. Think a certain way. You can free yourself from these OCD rules, however, a little at a time. Have you noticed what happens when you bend – back and forth – a paper clip? In a little while, it breaks. Bending an OCD rule is the first step toward breaking an OCD rule altogether.
When OCD tells you to wash in a particular way, such as making you wash each finger beginning with your little finger – bend the rule a little. Start with your thumb. Wash that first. This will make you a little uncomfortable but continue to bend the OCD rule this way until bending this rule gets easy and then bend the rule in a different way. Perhaps wash your thumb first and then go back to the little finger and then to the thumb again. It doesn’t matter how you bend the OCD rule. If it makes you a little uncomfortable, it’s working. Bend the OCD rule until you’re able to break it and stop doing it altogether. If the OCD tells you to always start to walk with your right foot, try starting with your left. If OCD tells you to read every single word on a page, try skipping one word per sentence or one word per paragraph. Remember, if it makes you a little uncomfortable, it’s working. You’re winning!
Step Toward Discomfort. Perhaps the most important step in turning OCD on its head is to practice stepping toward discomfort, rather than away from it every day. Stepping toward discomfort means that you no longer search for quick ways to escape your discomfort. Instead, you look for little ways to increase your discomfort, such as running your fingers along a dusty windowsill or scanning the newspaper for an article on a topic that, in the past, you would have avoided reading. Seeing discomfort as an opportunity rather than a burden will help you stay on top of your OCD each day and for the days to come.
Don’t be Afraid to Ask for Help. As you’ve learned, one of the ways OCD stays in charge is by convincing you that the obsessions and compulsions are a big secret that you cannot share with anyone. Reading this blog post is a great first step in turning OCD on its head and breaking free from the frustration and embarrassment that OCD has caused you. However, if after reading the book and trying a few things, you’re still having a hard time, talk to your parent or another trusted adult about getting more help. They can arrange for you to speak to a professional therapist who will know other ways to help you turn OCD on its head. Remember, you’re not alone. No matter what your thinking or doing, kids have thought those things and done those things before. Furthermore, with the right help, you can not only turn OCD on its head but also you can make it do back flips. Then you’re really in charge. Just like thousands of other kids with OCD have done before. Good luck!
Adapted with permission from Tompkins, M. A. (2014). Note to Readers, Ten Turtles on Tuesday: A Story for Children about Obsessive-Compulsive Disorder © 2014 Magination Press, American Psychological Association. No further reproduction or distribution is permitted without written permission. http://www.apa.org/pubs/magination.