Avoidance in Obsessive Compulsive Disorder
We tend to think of OCD as handwashing, checking stoves, ovens, door-locks, arranging and organizing and other ritualistic behaviors. But there’s a more subtle and quiet compulsion called avoidance.
Avoidance in OCD is when an individual intentionally chooses to stay away from a feared stimulus or trigger. A trigger can be internal or external, a situation, thought, object, or person that causes doubt, intrusive thoughts, and anxiety. When someone’s OCD is triggered, avoidance is seen as a way to safeguard or protect oneself from the feared outcome.
Examples of Avoidance among varying subsets of OCD
Those with contamination OCD fear the spread of germs or chemicals and may engage in compulsions like excessive washing or cleaning. Avoidance here looks like dodging bathrooms or public spaces, as well as avoiding touching door handles, objects, and surfaces. They may avoid anyone who is sick or may be sick and be hypervigilant about coughing, throat clearing, or sniffling in others, avoiding co-workers, neighbors, or customers in a store.
Harm OCD involves fear, in the form of intrusive, distressing thoughts of harming oneself or others, either accidentally or intentionally. Though there is never any desire or intent for people with OCD. The thoughts, nevertheless are very frightening. These individuals may avoid sharp objects such as knives, scissors, razors, physical contact or affection, dangerous substances such as chemicals found in cleaning products. They may also avoid activities like driving, out of the fear they may hit someone by accident, isolated areas, window ledges, and roof-tops out of the fear that someone may jump out and harm them. They may keep a distance from people they deem “vulnerable” such as loved ones, the elderly children, or pets.
Individuals with Relationship OCD have constant doubts about their relationship… “Is this the ‘right’ person?” “What if their feelings have changed?” “Am I really attracted to them?” They may avoid spending time with their partner, talking about the future, physically intimate moments for fear that it won’t be “enough, They may avoid making eye contact or looking at other attractive people, watching romantic films, weddings, or love songs that may cause them to judge, assess, and compare.
Individuals with Health Anxiety may fear physical sensations or anything that reminds them of illness or medical threats. Although there is a tendency to google/research, check with doctors, hospitals, and ER’s, This can develop into avoidance of those same places as well as TV shows, movies, or books that mention disease. Avoidance is highlighted by foregoing activities that may bring on physical changes such as exercise, drinking caffeine, or sexual activity. Individuals may limit or avoid activity that could increase their heart rate or create a rise in body temperature for fear of triggering intrusive thoughts about their health and a potential medical crisis.
Mental Avoidance
Thoughts themselves may become so distressing that individuals try to suppress them. Individuals or untrained health care providers might overlook this level of avoidance. Some may try to replace a “bad” thought or image with a “good” one, push away a disturbing thought, attempt to reassure themselves mentally, “try to figure it out” when there’s no definitive answer or review memories to “make sure” nothing bad happened. They may avoid using certain words in a conversation or shut down, to avoid hearing something that might trigger their fears.
Emotional Avoidance
Individuals may have less tolerance for intense feelings such as anger, disgust, shame, or guilt, because of intrusive thoughts. As a result, they may engage in mental compulsions or. avoid situations that may trigger these emotions. Individuals struggling with Relationship OCD may avoid deep intimacy because it stirs up uncertainty that is difficult to tolerate. Those with Harm OCD may avoid the feeling of anger, because of intrusive thoughts about the possibility of losing control. People with contamination OCD will avoid feelings of disgust, or the fear of illness by engaging in cleaning rituals. Individuals with Body Dysmorphia, an OCD- Related Disorder, will avoid feelings of shame, disgust, or the perceived judgement of others, by hiding or “disguising” the part of their appearance that they perceive as significantly flawed or avoiding social interactions altogether.
Emotional Contamination
Individuals may fear an emotion, memory, person, or “negative energy”, worrying that it could spread throughout their lives. It can be described as a vibrational toxin they feel vulnerable to. They don’t fear a physical illness but an emotional sensation they might get “stuck” in. They may avoid interacting with people they judge as “bad, unlucky, or immoral,” objects such as clothes, shoes, or other possessions they associate with a difficult time in their lives, or visiting places associated with those memories.
Short-Term Relief vs. Long-Term Cost
Avoidance may provide a reprieve or a temporary escape by keeping triggers at bay. However, the more an individual avoids, the more it re-enforces their anxiety and the idea that these objects, people, places or activities may be dangerous. The longer the list grows of what’s dangerous or a potential “threat.” the smaller their world becomes. The continual search for safety and certainty is exhausting and isolating.
Bravery and Courage in the face of Avoidance
Thankfully, we have Exposure and Response Prevention, the gold-standard treatment for OCD which involves confronting feared mental thoughts, emotions/feelings, and physical sensations without acting on compulsions or avoiding triggers. Individuals lean into their discomfort rather than running from it. Through the collaboration of the client and therapist, a hierarchy is formed with a range of triggers from least to greatest and discomfort is measured to determine tolerable behavioral experiments, agreed upon together. Incrementally and gradually the client’s nervous system learns through repetition that the fear or discomfort that comes from triggers is manageable after all. This recognition provides the momentum necessary to carry people through to recovery.
Mindfulness and Distress Tolerance
Individuals learn through awareness of physical sensation, breath, and a noticing of thoughts and feelings without judgment or attachment to them; starting to objectify what is happening and observe it without doing anything about it. They may notice the urge, impatience, and patterned thought but allow it to be there. Through distress tolerance they build capacity to ride out the mental, physical, or emotional wave of discomfort without searching for answers or acting on the urge for immediate relief. Through this practice we’re able to cultivate a level of compassion and quiet strength that overrides any shame or criticism.
Working Together toward Healing
In our work with clients, we gently nudge them toward their fears with support, compassion, and pacing that favors their nervous system. Together, we build trust, flexibility, and expansiveness in a world that has slowly been shrinking. The healing that we see begins with gradual steps, patience, and teamwork that’s guided by compassion and understanding.’