Avoidance in OCD: It’s Never the Answer

Janet Singer's son Dan suffered from obsessive-compulsive disorder (OCD) so severe he could not even eat. What followed was a journey from seven therapists to ...Read More

One of the common ways that people deal with a variety of anxiety issues is through avoidance. Afraid to fly? Well then, don’t. A large crowd of people too much to deal with? Just stay away from parties or large gatherings. Too anxious to ever give a presentation? Don’t apply for that job you’d otherwise love.

So what’s the problem? In isolated instances, avoidance may work. But as Dr. Charles Elliott, a clinical psychologist and a Founding Fellow in the Academy of Cognitive Therapy, says in reference to this behavior: “It makes your world smaller and fosters your fears. The more you avoid, the worse things get.”

I believe this is especially true when talking about avoidance and Obsessive Compulsive Disorder. OCD is characterized by unreasonable thoughts and fears (obsessions) that lead the sufferer to engage in repetitive thoughts and/or behaviors (compulsions). Obsessions are always unwanted and cause varying degrees of stress and anxiety, and compulsions temporarily alleviate these feelings. In an attempt to reduce anxiety, those with OCD often try to avoid their intrusive thoughts altogether. Unfortunately this rarely, if ever, works for anyone. If you tell yourself, for example, not to think about jumping off of a bridge, chances are all you’ll be able to think about is jumping off of a bridge. It’s just how our brains work. The more we try not to think of something, the harder it is to get it out of our minds.

I think it is worth mentioning here that the intrusive thoughts of those suffering from Obsessive Compulsive Disorder are often no different than the thoughts of so called “normal people.” But instead of just accepting their thoughts as “just thoughts” and letting them go, those suffering from OCD may attach too much validity to them, to the point of becoming distraught at the realization that they could even think such horrible things. This reaction can fuel the strong desire to avoid these thoughts at all cost.

In my son Dan’s case, he had obsessions which involved unwillingly harming those he cared about. These thoughts were extremely disturbing to him because, in reality, Dan could literally not even hurt a fly. So it is often not the thoughts themselves that are really the problem; rather it is the OCD sufferer’s reaction to them.

In addition to trying to avoid unwanted thoughts, OCD sufferers may also avoid situations that might trigger their obsessions. For example, if intrusive thoughts revolving around germs and contamination are the issue, the person with OCD may avoid going anywhere where they may have to use a public restroom. This avoidance may then expand to not being able to eat anywhere outside of his or her home, or not being able to be in a social situation where handshaking is expected. In extreme cases, the OCD sufferer may become totally housebound. My son Dan, as I’ve mentioned, had obsessions centered around “fear of harm.” At the time, he was in college where he had a lot of great friends, but he began avoiding them in certain situations. His avoidance snowballed to the point where he was totally isolating himself from everyone he cared about. So it is true: “[Avoidance] makes your world smaller and fosters your fears. The more you avoid, the worse things get.”

Unfortunately, avoidance in OCD may extend to treatment as well. In this article on Recovery Avoidance, I discuss some possible causes of this situation, but one of the main reasons those with OCD avoid treatment is fear; fear of having to give up their compulsions, fear of having to surrender their, albeit false, “safe way of living,” and even the fear of getting better.

So if avoidance doesn’t work to quell OCD, what does? Exposure Response Prevention Therapy (ERP Therapy), which is really the opposite of avoidance, has been shown to be a very effective therapy for the treatment of Obsessive Compulsive Disorder. In a nutshell, ERP Therapy involves facing one’s fears. Instead of avoiding using a public restroom, you force yourself to use it, and then you resist whatever compulsion you have developed to assuage your anxiety (in this case, most likely excessive hand washing). While this therapy is anxiety producing initially, the OCD sufferer will eventually get used to, or habituate, to the task at hand until it is no longer anxiety provoking.

It is clear to see that avoidance and ERP Therapy are at opposite ends of the spectrum. The more those with OCD use avoidance as a way to deal with their disorder, the more deeply entrenched their OCD will become. But if they can find the courage to engage in ERP Therapy with a competent therapist, they will then be going in the right direction on the road to recovery, leaving avoidance by the wayside.