Checking OCD: A Symptom and a Subtype
Checking and OCD go hand-in-hand, frenemies that partner up to wreak havoc on the lives of sufferers. In fact, checking is one of the major symptoms of OCD and it’s a subtype as well. But before we get into that, let’s explore the ins and out of OCD.
OCD, or Obsessive Compulsive Disorder, is often misunderstood by the average person. This is demonstrated by the innumerous people who claim to have OCD because of a personal preference for an organized office desk or a desire to keep their car free of food crumbs. Yet OCD is not a reflection of any sort of anal-retentiveness or desire; it’s based on anxiety and fear.
OCD is also not very common, with only about 2.3% of the US population diagnosed. It’s less frequent in children (with 1 in 100 diagnosed) but that may be a result of missed diagnoses rather than a reflection of lower incidence.
OCD doesn’t simply annoy the sufferer; it terrorizes them. This is one of the reasons awareness around OCD is so important. People who don’t understand it tend to minimize it. And that doesn’t do sufferers any favors.
The Ins and Outs of OCD
The most classic example of this is handwashing. The OCD sufferer fears that their hands are contaminated and so they wash them. This relieves their anxiety momentarily, but they eventually experience another intrusive thought, compelling them to wash their hands again…and then again….and then again. Because OCD is never satisfied, no amount of washing ever feels like enough. This leaves the sufferer in an endless loop of cycle after cycle.
OCD can be extremely disabling. According to the World Health Organization, it is in the top ten of disabling diseases worldwide and the 5th most disabling in certain demographics (such as women between the ages of 15-45). It is life-interfering and life-ruining and people who have it are ten times more likely to commit suicide than members of the general population. But it’s not all doom and gloom because there are plenty of effective treatments that allow sufferers to control their disorder. Though it can’t be cured, it can be managed (more on that later).
OCD sufferers often experience perfection, a sense of hyper-responsibility (which means they fear they’re responsible for things outside of their control), a propensity for guilt, and an extreme need for certainty.
What exactly are intrusive thoughts?
Intrusive thoughts are the main ingredient in the OCD recipe. These thoughts are egodystonic, which means they go against the sufferers true desires and morals. For example, someone whose intrusive thought tells them that they ran over a child while he was biking through a crosswalk wants, more than anything, not to hurt kids. This is why OCD latches onto this particular area; it attacks a sufferer’s values, giving it power and potency (and scarring the sufferer to no end).
While a prominent feature in OCD, intrusive thoughts are not exclusive to the disorder. These thoughts are also hallmarks in other mental illnesses, including anxiety disorders and schizophrenia. What’s more, they’re common in the general population as well.
But there is an important difference. The OCD brain takes these thoughts seriously; the normal brain ignores them as nonsense.
For example, if the OCD suffer experiences a headache, they may take it as proof that they have a brain tumor. They’ll jump on the internet, which only reinforces their fears (since the internet tells everyone bad news) until they grow convinced. Eventually, they may “check” to make sure they don’t have one by requesting an imaging scan at their doctor’s office. They’ll feel relief once this comes back clean, but only until their next headache. Then, OCD will tell them that the scan missed their tumor, that it just wasn’t visible yet, or that they suddenly developed one overnight.
Someone with a normal brain, on the other hand, experiences a headache, takes an aspirin, and moves along.
However, even with the above, the OCD sufferer does not buy into their thoughts 100%. In other words, they know – deep down – that their headache is just a headache. But because OCD demands complete certainly, the sufferer feels like they have to be sure. OCD pesters them with the question of “What if?” until the sufferer gives into the compulsion in an effort to be certain.
Unfortunately, certainty is elusive, which is why OCD is so powerful. It’s a disorder that causes its sufferers to chase something they’ll never catch.
The Specifics of Checking OCD
As mentioned above, Checking OCD is both its own subtype as well as symptom of various other subtypes. For example, if a sufferer suffers from Harm OCD (a type of OCD where they fear that their actions or inactions will harm others), they may spend a great deal of time checking to make sure they didn’t run anyone over while driving. They may turn around and check the roadway, they may check the news for reports of hit-and-runs, they may check their car for damage or signs of blood, or they may check the local police blotter.
Checking OCD, like all types, looks different for everyone. It may also evolve and change, ebb and flow. OCD tends to be very creative and often feels like a game of Whack-a-mole. As soon as a sufferer figures out how to best one obsession, another pops up.
For instance, someone with Checking OCD may fear that leaving their coffee pot on will cause their home to burn down. As a result, they’ll check and re-check that the coffee pot is off until they’re satisfied. Eventually, they may address this obsession by investing in a coffee pot that turns itself off automatically or has a built-in safety feature that prevents fire. But this doesn’t cure their OCD. It only cues OCD to latch on somewhere else.
Common Checking Obsessions
In theory, Checking OCD can involve obsessions about anything. Some people fear that their car tires aren’t inflated properly and at risk of exploding in the middle of the highway. Other sufferers may fear that their newborn baby will stop breathing in the middle of the night. Another may fear that they’ll send an email to their boss filled with curse words.
Overall, some of the most common checking obsessions include:
- Fear of causing a fire by leaving the stove, oven, or coffee pot on
- Fear of causing a fire by failing to recognize a fire hazard (such as loose wires in the clothes dryer)
- Fear of running people over while driving
- Fear of children being harmed because of a lack of vigilance (such as not childproofing the outlets properly)
- Fear of sending emails or letters filled with inappropriate language or incorrect grammar
- Fear of losing important things, such as a checkbook or a driver’s license
- Fear of leaving the door unlocked or the garage open
Often, the fears are much more than meets the eye. For example, someone who fears leaving their front door unlocked isn’t really concerned with the lock but rather the consequences of an unsecure entry. They fear an unlocked door will allow a robber or murderer to enter as they sleep, harming and/or killing their family.
Like other types of OCD, Checking OCD is not rooted in logic. While it is theoretically possible that leaving a door unlocked could allow a serial killer to enter the premises, it’s still unlikely based on the fact that people are at low risk of becoming murder victims. In the US, the risk of being murdered is around 1 in 20,000. And, even then, a significant portion of the risk involves being murdered by someone they know (such as a spouse or significant other) rather than a total stranger.
But none of this matters to OCD. It demands 100% certainty and the only way to appease it is to check the doors dozens of time to make sure that they are as impenetrable as possible.
Common Checking Compulsions
To manage the obsessions, the OCD sufferers perform compulsions, which are rituals that relieve anxiety. These tend to be repetitive and time-consuming and only temporarily affective.
Overall, some of the most common checking compulsions include:
- Checking for signs of a hit-and-run (checking for persons lying in the road, damage to the car, blood on the street, etc.)
- Checking that stoves and ovens are off
- Checking that coffee pots are off
- Checking that candles are blown out
- Checking that holiday lights are off or not leaning against anything flammable
- Checking that doors and windows are locked
- Checking that the garage is shut
- Checking that water faucets are turned off
- Checking one’s memory to assure things they fear from the past are just figments of their imagination and not actual recall
- Checking the news reports for bad things happening
- Checking that cars are locked
- Checking to make sure personal items are in the proper place (such as jewelry or credit cards)
- Checking emails or written communications for errors or inappropriate language
- Checking on children to assure their safety
- Checking on sleeping newborns to assure they’re breathing (sufferers may check on children and/or people of any age but newborns often elicit the most anxiety because of Sudden Infant Death Syndrome)
As mentioned above, OCD is never satisfied, which means people don’t simply doublecheck that their front door is locked and call it a day. Rather, they check it multiple times a night, never finding that they’re truly convinced that it’s fine.
What Causes Checking OCD?
What science has uncovered so far is that people with OCD have abnormal brains, both in structure and in function. Communication appears compromised in certain areas of the brain, especially the orbitofrontal cortex, the anterior cingulate cortex, the striatum, and the thalamus. Neurotransmitters, specifically serotonin and dopamine, are crucial to OCD too and sufferers may have lower levels than what is normal.
But even with the above, there is no “smoking gun” that we can blame for OCD’s existence. The best guess is that it’s a disorder that occurs because of a complex relationship between genetics, cognition, neurobiology, and environment.
On the genetic front, it has long been believed that OCD was hereditary but now they’ve found solid proof of a link. It’s not only more likely to run in families, with 25% of those afflicted having an immediate family member who is as well, but it’s also extremely genetic in twins. If one twins has it, the other usually does too (especially if the twins are identical).
Even with the strong genetic component, behavioral conditioning weighs in heavily too. Genetics lay the foundation, but compulsions give the disorder life. And the compulsions are what makes the disorder unyieldingly persistent as well.
The Concept of Dysfunctional Beliefs
An important part of OCD is the concept of dysfunctional beliefs. These dysfunction beliefs are what give the OCD thoughts power. They validate thoughts that are silly, impossible, meaningless, and egodystonic.
According to the Obsessive-Compulsive Cognitions Working Group, there are six types of dysfunctional beliefs common in OCD, including:
- Hyper-responsibility: OCD sufferers believe that they are responsible for things outside of their control or outside of their true realm of reasonable duty. This comes from a place of terror rather than a self-important sense of omnipotence.
In Checking OCD, the sufferer may spend time checking stairwells in a hotel for any faulty wires. They believe that, if they don’t, the entire hotel could burn down and it would be their fault.
- Giving the meaningless, meaning: Also called “thought-action fusion,” this involves the idea that thinking of something is the same as doing it.
In Checking OCD, the sufferer may type an email to their boss and have an intrusive thought of calling her a “bitch.” They’ll then read, and re-read, the email to make sure it is free of obscenities. They fear that thinking about it made it true.
- A desire to control thoughts: Nobody can control their thoughts but not everybody is aware of this. That’s because many people have no desire to control their thoughts – they’re able to let the unpleasant ones come and go without interfering with their life. The OCD sufferer, on the other hand, wants desperately to control what they think about, an impossibility they’ll never reach.
In Checking OCD, this belief may manifest as the sufferer trying to stop images of a fire ravaging through their backyard because they failed to properly secure the propane tank.
- Overestimating threats: OCD sufferers, by rule, tend to overestimate the risk of an actual threat.
In Checking OCD, for example, the sufferer may believe that leaving a candle lit while they run to the grocery store will cause their entire living room to burn down. While this is a technical fire hazard, it’s highly unlikely that a candle could do much damage unless a cat knocked it over or it was near some sort of flammable material or accelerant. This doesn’t matter to the OCD brain and any semblance of a threat can turn into a likelihood of tragedy.
- Perfectionism: Perfectionism is not exclusive to OCD and many people in the general population identify with being perfectionists. But it is among the most common features in Obsessive Compulsive Disorder and sufferers often fear that being less than perfect will have terrible consequences.
In Checking OCD, this belief may manifest as the need to make sure everything in the car is running just as it should and to the specifications of the manufacturer. If the sufferer doesn’t do this, they fear they’ll cause an accident.
- A need for certainty: OCD sufferers constantly feel like they “have to know,” which is why OCD is referred to as “the doubting disease.” OCD sufferers want to neutralize this doubt, the reason why they seek reassurance that their fears won’t come true (or haven’t come true already).
In Checking OCD, this belief may manifest as the sufferer checking that they shut their garage ten or twenty times a night. If they don’t, they may fear that they’ll get robbed or that someone will find a way into their house. They might even fear that someone will wait for them inside their car, shooting them as they leave for work in the morning (OCD is only limited by the sufferer’s imagination).
Factors that Influence the Onset of OCD
OCD most commonly appears during two periods of life, the ages between eight and 12 and between late adolescence and early adulthood. Boys with OCD are more likely to experience early-onset whereas women most often start to experience symptoms around 19 or 20. Of course, this is not a hard and fast rule and OCD can appear at any age. However, it’s unusual for it to appear around middle-age or later unless it was, at least in part, present at younger stages.
In fact, it’s not uncommon for people who are diagnosed with OCD later in life to look back and see that they’ve always had it, even if they didn’t realize it for years.
But, even with all this, no one is sure as to the straw that breaks OCD’s back and causes it to interfere so dramatically in the sufferer’s life.
There are, however, a few things that act as triggers, including:
- Head injuries
- Strep throat (This is called PANDAS and should be considered in children who appear to get OCD overnight.)
- Transitions (Transitions won’t “cause” OCD if it’s not already there, but they can worsen symptoms, theoretically making it seem to appear for the first time. Transitions, even happy ones, can cause relapse as well.)
What Doesn’t Cause Checking OCD?
As more is learned about OCD, more is also learned about what does not cause it. Turns out, many of the theories of the past no longer hold water.
It’s now known that OCD is not caused by the following:
- Parents (outside of the genetics they pass down)
- Toilet training
- Stress (while it won’t cause OCD if it doesn’t already exist, it almost always makes OCD worse)
- Families (like stress, families can make OCD worse by enabling the sufferer or criticizing them)
- Past trauma (Trauma alone doesn’t usually “cause” OCD but it may influence subtype and severity. For example, someone whose house was robbed when they were a child may be especially predisposed to Checking OCD.)
Misconceptions About Checking OCD
OCD, regardless of subtype, is extraordinarily misunderstood by members of the general population. Often, it’s castoff as a minor quirk or an anal-retentiveness driven by someone’s desire for organization.
But, in reality, OCD is a devastating illness that controls and ruins people’s lives. In severe cases, it’s all-consuming and people may revolve their lives around it.
Overall, some of the most common misconceptions about OCD include:
- OCD is something driven by neurosis
- OCD is just a quirk or a minor illness
- OCD is always about germs, cleaning, or organization
- OCD sufferers see their compulsions as beneficial
- OCD is obvious and it’s always apparent when people have it
- OCD sufferers can just get over it
- OCD sufferers are uptight (people with Obsessive Compulsive Personality Disorder (OCPD) (which is different from OCD) may be rigid and non-compromising but those with OCD generally are not unless they’re trying to perform a ritual)
- OCD is a phase
- OCD sufferers believe they’re being rational (OCD sufferers know that performing their compulsions isn’t rational, but they perform them anyway because of their need for absolute certainty)
In Checking OCD, there are some unique misconceptions that exist as well. These include:
- People with Checking OCD are conscientious: While people with OCD are certainly conscientious, their disorder is not driven by a desire to do what is right or to act thoroughly and diligently. It’s driven by fear. For instance, someone who is conscientious may make sure that their smoke alarms are always in working order. Someone with OCD, conversely, may check these alarms compulsively, regularly testing them or changing the batteries weekly.
- People with Checking OCD are just worry warts: There is no argument that people with OCD worry…..a lot. Yet people can be worriers without having OCD. For example, someone prone to worry might arrive at work only to question whether or not they locked their backdoor. Someone with OCD takes this further – they don’t only wonder if they locked the backdoor, but they worry that someone will sneak into their house when they’re not home. They might leave work early as a result, go back to their house, and search room by room for a possible intruder.
- People with Checking OCD are forgetful: While people with OCD may certainly fear that they forgot to turn the stove off or forgot to put their car into park, they don’t need the element of forgetfulness to cause worry. In other words, someone with OCD can check the stove twenty-one times and they’ll still worry that, somehow, it wasn’t off.
Treatment for Checking OCD
OCD isn’t curable, but proper treatment helps sufferers reduce symptoms so they can live productive lives. While they might not be completely normal, the goal is to get them normal-adjacent. Usually, getting the anxiety under control requires professional help.
Finding an OCD Therapist
Finding a good OCD therapist isn’t as easy as it sounds. Unfortunately, many clinicians treating OCD are not fully qualified to do so, which can worsen the symptoms of sufferers or leave them traumatized.
When looking for a therapist, sufferers should chose someone who specializes in OCD and has completed specific training in the condition.
An excellent place to start is the International OCD Foundation directory of OCD providers. Search by location or zip code to find nearby therapists or those who offer virtual therapy.
Generally speaking, some of the most common forms of treatment include:
CBT with ERP: Cognitive Behavioral Therapy (CBT) is usually necessary when treating OCD with a particular focus on Exposure Response Prevention (ERP). During an ERP exercise, sufferers are asked to expose themselves to their intrusive thought and then refrain from performing their compulsion. These can either be intentional exposures or those that arise in everyday life.
For instance, someone with Checking OCD may be asked to imagine their front door unlocked. They may even be asked to picture something bad happening, such as a bad guy entering in (though this addition would be a higher level ERP). The sufferer is then instructed to refrain from checking to make sure the door is locked.
While this undoubtedly makes them anxious, their anxiety begins to go down as time goes by. Eventually, they realize that nothing bad happened because of their thought and this helps desensitize them to the thought.
ERPs are much more difficult to perform than they sound as they cause all sorts of anxiety in the sufferer and, because of this, many ERPs fail. It helps when the ERPs are done gradually, with sufferers asked to expose themselves to less-triggering thoughts before moving onto more potent ones.
As treatment progresses, ERPs become more challenging to the sufferer but they also become easier for the sufferer to do because of the confidence they’ve built up.
Medication: Unfortunately, there is no magical pill that sufferers can take to make their OCD go away. But pharmaceuticals are effective to some degree, with 70% of people responsive to medication. Even in those who respond, OCD meds aren’t designed to treat the disorder on their own. They’re designed to work together with ERPs. Essentially, medication makes ERPs easier to complete, upping the odds of people finding success in the overall treatment.
OCD medication is rarely straight forward. Some people can’t take certain meds because they have preexisting conditions whereas others can’t take them because they’re taking other pills that are contraindicated. Age may weigh in as well as some antidepressants are known to increase suicide risk in young adults and teens.
Having said all that, there are common drugs that are most often used for OCD treatment. Serotonin Specific Reuptake Inhibitors (SSRIs), a class of antidepressants that increase serotonin in the brain, are usually used first. These types of drugs include:
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs that are essentially cousins to SSRIs) enhance serotonin and norepinephrine. They’re commonly used if SSRIs fail (though they may alternatively be used as a first choice treatment).
Anafranil (or Clomipramine), a tricyclic antidepressant, is commonly used too. Anafranil is known as one of the more effective OCD treatments but it tends to have some of the most annoying side effects, which may make some sufferers refrain from using it.
Off-label medications are sometimes prescribed, a practice that has increased in recent years. While these are FDA-approved medications, they’re not FDA-approved for OCD. But research and anecdotal reports suggest that they can act as effective treatment in some.
In general, the most commonly off-label drugs used for OCD include:
A person’s response to medication is largely dictated by their genetic makeup. Because medication is designed for those who have normal pharmacological metabolisms, having a slower or faster response to meds can dramatically lessen their usefulness (while increasing their side effects).
Ultra-rapid metabolizers, for example, won’t respond to some SSRIs because their bodies chew up the drugs before they can kick in. Poor metabolizers may metabolize the drugs too slowly, which not only makes the drugs less potent but puts the sufferer at risk for unsafe levels of that drug inside their bloodstream.
If a sufferer knows their metabolizer status, they can refrain from taking certain drugs while opting to only choose the ones to which they’re most likely to be responsive. Anyone can figure out their metabolizer status through a genetic saliva test. This has to be ordered by a doctor but it’s often covered by insurance.
ACT Therapy: Acceptance and Commitment Therapy (ACT) has become increasingly popular in treating OCD. It’s usually not used on its own and often combined with more traditional ERP therapy. In ACT, OCD sufferers are taught to look at their thoughts as thoughts and accept them without reaction. To do this, they’re asked to rely on visual imagery, such as imagining their thoughts on a TV screen that they can “shut off” in their mind. ACT relies on psychological flexibility, mindfulness, self-compassion, and nonjudgmental acceptance.
For example, in Checking OCD, the sufferer may have an intrusive thought that their Christmas lights will cause their front porch to catch fire. Instead of checking the wires, turning off the lights, or reassuring themselves, the sufferers is instructed to say, “I’m having a thought that my front porch has gone up in flames.” By labeling it as a thought, and nothing more, the sufferer is able to detach from it and move past it.
Lifestyle: OCD can’t usually be controlled by lifestyle alone, but there are simple steps people can take to help decrease symptoms. These include:
- Eating diets rich in fruits, vegetables, and whole grains and low in processed foods
- Exercising regularly, which helps the body release endorphins (chemicals that act like natural antidepressants)
- Practicing mindfulness, meditation, and/or yoga
- Limiting coffee, alcohol, or tobacco
- Seeing a therapist weekly
- Joining support groups (either online or in person)
- Maintaining social relationships, hobbies, and activities
- Establishing a daily routine
- Practicing good sleep hygiene
TMS: A new type of treatment is Transcranial Magnetic Stimulation (TMS). This is often used in the treatment of major depression, but it may be used to treat OCD as well. This usually only happens in severe cases where other forms of less intrusive treatment fail
TMS involve a non-invasive procedure where magnets are used to regulate the deep areas of the brain, areas often associated with OCD. The procedure typically involves daily treatment for a period of six or so weeks followed by maintenance appointments.