That Just Right Feeling

A fictitious account pulled from several clients’ encounters. 

“But, I don’t know what to do about it,” she said. “It's like it won’t leave me alone.”  

“Yes,” I said, “I know the feeling,” explaining it had plagued me, especially in my earlier years.

“But, now?” she asked. 

Chuckle. “Well it is there, but I manage it for the most part and it usually leaves me alone, anthropomorphizing (assigning human traits to the non-human) this disorder. 

She’d come to see me after in-patient care at a leading center for Obsessive Compulsive Disorder. And found my name on the OCD Foundation’s website as a counselor with training in Exposure Response Prevention ( ERP), the gold standard therapy for sufferers of this disorder. My bio related that I had OCD.  

She said she learned in her treatment that compulsions are divided into: checking routines, contamination concerns, rearranging / symmetry and ruminations of catastrophic thoughts.

“There seems to be an ever growing number of sub themes too,” I said. “And this feeling you're having is one of those sub themes called Just Right OCD, according to the OCD Foundation.

She hadn’t heard of that type of OCD. I asked her to share with me about her past treatment, telling her we’d come up with a plan about how to contend with this peculiar theme.  

She told me about the nice woman who she shared a room with when in-patient, roughly her age, who had severe contamination compulsions. “It was funny you know, she couldn’t understand my checking and I couldn’t understand her bathroom routines. We did a lot of groups.”  

I got the basic bio on her, then drew out what my basic approach would be to therapy, cautioning her that OCD goes on while life goes on around us. “Many people come to my office wanting a magic bullet. Often a client gets into other concerns such as events that went on in the week, family, work, girlfriend, boyfriend troubles. And off we go in that direction. In fact this can relate to Just Right OCD which is triggered by life. 

“What other pieces of your life do you feel aren’t working for you?” I asked. 

She had no trouble telling me her love life was in shambles, and while her work as a nurse was satisfying, lately, she tossed and turned over decisions she’d had to make.

I advised her that it wasn’t fair to blame all troubles on OCD. But given its doubt-inducing nature, OCD is often called the Doubter Disease. It stands to reason that checking the doors ten times for security might carry-over to other life situations. She seemed to understand.

For the rest of that first session she shared more about what she wanted in a therapist and also in life in general. I told her the next time we’d meet I’d assess her OCD by asking questions from the Yale Brown Obsessive Compulsive Assessment, a self report Questionnaire which would give a better idea of all those obsessions and compulsions she was having. She said she’d taken it before. She left promising to return, but never did. 

Persons seeking counseling do so because something is amiss in their lives. For those who have obsessive compulsive disorder (OCD) who suffer from relentless obsessions followed by torturous, time-consuming compulsions, they are lost in the loop-quest for that just right feeling. And often there is a dire need for certainty in their lives. 

The University of South Florida OCD program research reports that with Just Right OCD, there is a feeling of incompleteness, an undoneness, but not so much a concern that harm will occur if rituals aren’t done, as in other types of OCD. 

With Just Right OCD, as with other types of OCD, comes this pervasive feeling of doubt often regarding everyday functions; did I say the right thing? Is the silverware placed just right?  

Common triggers setting off this need for the Just Right feeling can come from anywhere, but often relate to our senses; sight, sound, touch for example. After touching a table for example a person needs to touch it again and again until the feeling of completeness is felt.

According to the The University of South Florida OCD program there are symptoms characteristic with Just Right OCD, common to many types of OCD such as: perfectionism, (overly concerned with mistakes); obsessional slowness (caught in the loop of Just Right thinking); reassurance seeking (will it be Ok), lack of decision making and inflexibility to name a few.

The question becomes what to do about a disorder. The Obsessive Compulsive Foundation says, Cognitive Behavioral Therapy is the gold standard. Within this model Exposure Response Prevention (ERP) is recommended. 

While this approach is recommended for many OCD types, such as contamination, where prevention in washing one’s hands is recommended when a feeling of contamination arises, with Just Right OCD, this approach might not be effective. Because it tends to be more ruminative, meaning over-and-over again thinking.

Antidepressants might help if the right combination is found. Also, examining what the sufferer avoids doing then going through it, can help diminish the feeling if done consistently.  

If someone is caught in the perfectionist loop, a treatment strategy is to complete a project, correct or not.

If one seeks reassurance, that all will be well, the caregiver should not facilitate this reassurance seeking.  

Just Right OCD often coexists with other OCD themes and other mental disorders. It is important for the client and therapist to work together in determining what disorder to treat first.

While research indicates many themes of OCD are being recognized, regardless of the particular theme of OCD, one has to talk-back the disorder. The key: know that you are not your OCD.