Addressing the Self-Doubt of OCD

It's a misconception to consider perfectionism altogether bad. When myopic and all-encompassing, it can be.

People are often stunned to discover that they don't have to abstain from their perfectionistic tendencies but only need to be more discerning about when to apply them. Individuals struggling with obsessive-compulsive disorder (OCD), characterized by an intense need for certainty and chronic self-doubt, may find the concept of discernment hard to grasp. More often than not, they believe that one ought to be great, and put in the most effort possible, in everything they do. Yet, this extreme standard may betray an even more intense dread; for if you're always on, never letting up, you can't be challenged or, worse, ridiculed, for poor judgment.

Fundamentally, the particulars of OCD protect its captives from an ever-present yet ego-dystonic (i.e., somewhat emotionally distant) sense of shame.

As noted in another post, patients often can only tolerate tweaks to their personalities as opposed to wide-ranging changes. But accepting that perfectionism doesn't have to be abandoned, while a relief, presents the dilemma it was created, in part, to hide. How do we begin to consider what actually matters and take responsibility for our judgments? Here, issues of trust (i.e., Can I trust that I'm not expected to be perfect?), ownership (i.e., How can I live with knowing how much time I wasted on something insignificant?), and meaning (i.e., What are my actual values?) can be explored.

Trust

Consider how much time you spend hyper-fixated on emails others likely only skim. Due to the OCD tendency to catastrophize, people worry that mistakes will cause them to get demoted, lose respect, and even get fired. Yet, if they explore the general atmosphere in their office, they may realize that even their bosses rarely pay attention to the details of the plethora of emails they receive. Here, we may examine how mistakes are treated, how often people are punished for them, and how valued precision in writing emails really is. We may even compare expectations from past employers to the current one, exhibiting the contrast between the more and less rigid standards. The perfectionist is asked to differentiate between absolute perfectionism, wherein she believes she has to be perfect everywhere, all the time, and to everyone, and relative perfectionism, which is the most harmonious adaption to her environment (becoming a better fit for it by improving), where absolute perfectionism may be counterproductive. Because perfectionists struggle with accepting that they can trust others to be reasonable, it takes time to integrate the belief that others don't expect them to be perfect. (Additionally, perfectionists sometimes believe the opposite: No reasonable individual would ever lower their standards, which may be a way to accept past punishments.)

Ownership

This aspect entails acknowledging regret. For the perfectionist, who spends most of her time obsessing over details that don't affect her life (outside of the compulsions meant to soothe her), regret may be the most challenging part of therapy. In shattering the illusion of self-importance, believing a significant amount of her decisions mattered, she faces the emotion she fears most. To perfectionists, who believe they have to "always be useful," wasted time is anathema to a well-lived life and, more specifically, indicative of wasted space, as the two are inextricably entangled. Purpose is tied up with a positive, yet shaky, self-image; as long as there's one, the other follows. So, to look back and consider one's life as, in large part, wasted, she may begin to believe that she didn't deserve to live. To her, life is only for the truly grateful, those who've provided a meaningful service as an expression of their gratitude. (They also expect gratitude toward them to be expressed in a similar manner.) Regret, then, in essence, is a searing branding iron, marking one's debt to life, which may now feel eternal.

Meaning

Here, the perfectionist is asked to explore his values. What does he want to spend his life doing? This can be a service and, also, something he finds to be intrinsically rewarding. The perfectionist may learn that, again, he needs to be extremely responsible in some ways but no so much in others. When one believes he ought to always be useful, he fails to consider how not being useful is, in reality, meaningful as well. Consider how often your partner just wanted you to listen and you preferred to fix her problem. Or how often you burned out because enjoying life wasn't part of the deal that granted you an understanding of what it meant to earn your keep. Contrary to intuition, meaning is created as much as it's provided. Thus, the perfectionist, in part, is tasked with choosing what may give him a sense of satisfaction, accepting that, all being existentially equal, he will have to live with regretting many of his choices. We don't know what we can't know. But what’s apparent is: being the best isn’t synonymous with what’s best for you.