As noted in the dedication of Understanding OCD: Skills to Control the Conscience and Outsmart Obsessive Compulsive Disorder this book consists of all the lessons patients that I have had the privilege of working with have taught me. I have learned that, for the most part, no matter what OCD symptom subtype people have, they experience a certain amount of conscience about not ritualizing. Even people who have already undergone successful ERPs, as measured by reduction in OCD symptoms and improvement in functioning, still continue to struggle and sometimes experience relapses.
As I began asking people about this, a clear pattern emerged. Unaddressed conscience-related factors in treatment seemed to leave many people vulnerable due to the nagging feeling that maybe not ritualizing is bad, wrong, immoral, or disrespectful of God. Maybe there would be retribution to pay. Most people feel compelled to ritualize in order to “protect” others and feel guilty about not ritualizing because that would mean they didn’t care about them anymore. But we all know that successful recovery requires elimination of all rituals.
Understanding OCD will help you see how your already good conscience falls prey to obsessive fear, even though your behavioral symptoms might be under reasonable control, and ways to cope. You will learn some of the science, developmental, cultural, and religious aspects that typify the exaggerated/distorted nature of OCD. You will meet some historical and religious figures who have struggled with this kind of OCD, as well as learn strategies to increase your resilience to negative emotions. Whatever your reasons are for picking up this book, Understanding OCD offers a new way to think about what OCD is and isn’t, and ways to tell the difference. Most importantly, Understanding OCD offers relief to your healthy, but battered, conscience that you are probably more resilient than you think against OCD fear and doubt. Understanding OCD may also be helpful to those who support you by helping them better understand that while the outward symptoms of OCD may be gone, you are likely to still be experiencing doubts of conscience.
After you work long and hard in putting faith into taking the perceived OCD risks, you want to feel free from false and empty obsessive threats and to really know that rituals actually never accomplish what you want them to. Instead of feeling guilty about not “protecting” loved ones from your obsessive fears by performing rituals, you can express and feel the real and actual love you have in your relationships with them.
Leslie J. Shapiro, LICSW, is a behavior therapist at McLean’s OCD Institute specializing in treatment resistant obsessive compulsive disorder (OCD).
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