Taking the Power Back When OCD Says My Loved Ones Are Going to Die

Trigger warning: car accidents, death of loved ones.

Obsessive-compulsive disorder (OCD) is defined by mental obsessions followed by a behavior — mental or physical — to attempt to relieve the anxiety of that obsession. Along with 1% of the U.S. population, I also happen to live my life with OCD. Although the average age of onset is 19 years old, I can recall having distressing and unnatural mental obsessions and intrusive thoughts (another key characteristic of OCD) as early as I can remember.

My personal obsessions typically revolve around the people I love most in my life dying. I find myself wondering if this is my final goodbye each time I part ways with family members and assume the worst when receiving any suspiciously early morning or late night phone call. One of my earlier memories is my mother dropping me off at kindergarten during a storm and pleading with her not to leave, as I had utterly convinced myself she would end up in a fatal car accident. (Honestly, over 20 years later I still have the same harsh pang of fear each time I know she’s driving in the rain. And no, I’ve been lucky enough to have never actually faced this type of tragedy.)

The topic of loved ones passing away is something no one enjoys thinking about, regardless of an OCD diagnosis or not. Compared to someone without OCD, I encounter a heightened, untimely, and unfitting level of torment, causing me to change my behaviors to determine certainty and seek reassurance to decrease fears, ultimately interrupting my overall functioning. The day my mom dropped me off at kindergarten in the rain, I cried and pretended I had a stomachache until she picked me up and I could physically see she was alive and well. Once together, even while driving in the rain, my fears vanished.

In addition to these thoughts causing undue stress in a situation not actually presenting with any imminent danger, I experience them much more frequently than somebody without OCD. A common intrusive thought of mine is, “If you don’t do X, Y, or Z, someone you love is going to die.” Think of it as the old, childhood superstition, “Step on a crack and break your mother’s back.” This, of course, is upsetting. It is also a thought I have over about 10 times a day. The thought and feelings of anxiety come and go so quickly it’s hard to keep count. Fortunately, I do have insight into my OCD and I do know these intrusive thoughts are nonsensical and I don’t give into them… most of the time. But here’s the thing — to lessen or even stop the thoughts, I have to intentionally accept they might actually be true.

Exposure response and prevention (ERP) therapy is a specialized type of therapy for people seeking healing from OCD. Here’s how it goes:

If I’m afraid I step on a crack, I’ll break my mother’s back, I’m supposed to say to myself, “That is possible. If I step on that crack, my mother may actually break her back” and force myself to accept that possibility, intentionally step on the crack, and not change my behavior to find out if my fear has been realized or not. This internal acceptance speech may or may not accompany a greater narrative of what might occur following the imagined tragedy.

For example, because of my fears of passing along COVID-19 to my family and thereby causing all of their premature deaths, my therapist and I created a preemptive narrative: “Someone beside me on the train I’m taking to see my family, isn’t wearing their mask. I start to get anxious I will contract the virus and pass it along to my family. I’m wondering if I should hop back onto the next train to return to my own apartment or find somewhere to isolate where I am. Ultimately, I do visit my family and I do pass along the virus. They all get very sick, become hospitalized, and die. I lose all of my family, am alone, and have to deal with the fact that I killed them for the rest of my life.”

Obviously, this is tough to read and it’s tough to repeat back to myself multiple times a day, as my therapist has instructed me to do. The point is to desensitize that scenario and thereby decrease fear surrounding it. It’s also meant to help become OK without certainty. The level of distress this caused to read back the first time isn’t the same as it will cause me the 20th, 50th, or 100th time — and that’s why this therapy works for so many and OCD is actually treatable. None of us can see the future and we certainly cannot always have the assurance that we wish for at any given time.

For people without OCD, I think it’s worth taking note of the ERP principles and consider applying them to their own lives. It’s important we all start facing our fears, even if it means sparking that fear in ourselves little by little, so we can ultimately each live in greater peace and acceptance.