There is widespread confusion about some concepts on OCD, even in literature. Some literature says distraction is important, and others say distraction is a compulsion. Sometimes people talk about rationalizing the irrational thought and at other times call it a compulsion. Sometimes people stress on the importance of seeking clarification, while at other times call it a compulsion. So, what is it really? Are these things important or are these compulsions?
Welcome to the complexity of OCD, because they are both. They can be either, depending upon how they are used – or more importantly, when they are used. This brings us to the two states of mind – triggered versus non-triggered.
The triggered state of mind is when you are obsessing over something, where you have a sticky thought (often a ‘what-if’), and where you are experiencing direct anxiety over something that you have encountered. In this state, your default response may be to do some compulsion and relieve yourself of the anxiety. In this state, the understanding the irrationality of the trigger is not enough to calm you down. You just want to do your compulsions and be done with them.
Think of having to write an exam. When you are sitting in the examination hall, access to text books and reading material is disallowed. You are not allowed to access Google to search for your answers, or refer to notes or confirm with your friends if your answers are correct. You operate with what you know. This can be considered as the triggered state.
The non-triggered state of mind on the other hand, is when there is no direct trigger or obsessive thought. This is a state of relatively rational thinking. In this state, you can understand the irrationality of your obsessions and also understand the need and sensibility of not doing the compulsions, even if the intrusive thoughts continue to exist in the background. In this state, the resolve to not do the compulsions can be strengthened.
In the example above, when you are preparing for the exam or after you are done with it, referring to your reading material is not only allowed, but also highly recommended; so that you remember the stuff you are going to be tested on. Thus, you can refer to all course material before and after the exam. This can be considered as the non-triggered state.
Hence, in the case of your Harm OCD, all the rationalization and clarification that you would like to do is allowed only outside the triggered state. Doing any of these activities when you are triggered is the compulsion. For example, you may see an axe and think of picking it up and causing harm to people around you, making you wonder if you are a ‘psychopath’. That is the triggered state. In this state, as mentioned, there can be no rationalization. There can be no assessment of the situation for the sake of clarity. There can be no reassurance seeking for the sake of clarity. Doing any of this is similar to cheating in the exam. This is not allowed.
If you do these when you are triggered, they become compulsions. At this point, you need to power through and resist the compulsion without any rationalization. But when you are not triggered, that is, when you understand the irrationality of your thoughts your therapist will engage you in cognitive therapy and rationalize these fears for you. Then, it is a technique to help you get better.
However, there is another important consideration. Harm OCD is not as distinct and compartmentalized as being inside or outside an examination hall. The state of non-trigger may easily blend into the state of trigger. If the rationalization process is on during the transition, something that started off as a technique could easily become a compulsion. Hence, utmost care is needed to ensure that the rationalization is being done only when you are not triggered at all.