Some claim to hate uncertainty while simultaneously chasing it, spending their lives being pulled by the hope of ultimately conquering it. At bottom, it isn’t people or things they want; it’s a victory over the forces of life. The tussle with uncertainty has several manifestations. We can pursue romantic prospects that appear unavailable to us, feeling alive and valuable only when loved by these angelic beings. We may become fixated on achieving a degree of status in a chosen profession, failing to register the reality of how much we even enjoy it or find it meaningful. Or we may wish to become saints, pursuing goodness as a remedy to an overwhelming fear of being fundamentally bad.
The thread running through all of these is a need for certainty. Perfectionists tend to avoid uncertainty and the anxiety of confusion, emphasizing their need for clarity. Yet, in treatment, we additionally discover their tendency to, for example, pursue goals that seem unattainable. Perfectionists can become consumed by limerence, the state of infatuation marked by an overwhelming sense of uncertainty due to the romantic prospect’s indirectness. In the extreme, some may even become submerged by erotomania, the delusional belief that a love interest reciprocates one’s feelings without any evidence supporting it or with evidence proving the contrary view. (Fundamentally, the delusion, and, despite it, the associated desperate need for reassurance in the form of reciprocity, are defenses for an underlying sense of self-doubt about the relationship’s viability and one’s own value.)
Obsessive-compulsive disorder (OCD) is marked by extreme self-doubt, often entailing a fixation on resolving once and for all the question of whether one is essentially worthy. From it, the eternal battle against uncertainty springs. Yet, this individual frequently fails to acknowledge that uncertainty will always remain undefeated. They may choose to challenge it in one or multiple of the above-noted ways, but each victory always leaves one feeling deficient. A material victory may entail the pressure to win again. A new romantic partner may elicit critical feedback from others, who may fail, at least seemingly, to understand the attraction. And a new professional title may include unsustainable responsibilities.
Many of our patients enter treatment to defeat OCD and, fundamentally, effectively challenge the force of uncertainty. A patient may say something along the lines of, “Isn’t therapy meant to help me become decisive?” The answer is no. In this respect, therapy can only help one become better equipped to tolerate uncertainty, which is an inherent aspect of life. When each decision is related back to one’s sense of self, each representing one’s innate value, paralysis becomes inevitable.
Our OCD patients tend to be deep thinkers, which fortunately and unfortunately means that they’re meaning-makers, weaving threads together to form general patterns, which also tend to be personal. The question of “What does this say about me?” is asked often internally, as well as “Who am I really?” aka “What is my essence?” So, if a patient can accept defeat with regard to uncertainty, they can begin to make choices while easing into experimenting with their anxiety. Can we live with this choice if our fear of making a mistake is at 50 percent? Or how about 40 percent? Do we think we’ll be able to properly understand some specific rejection without personalizing it? Can we accept that while we may love our partner, no amount of reassurance is ever going to make us feel certain about their intentions? And can we live with self-doubt, no longer taking seriously the idea that it will invariably escalate into hopelessness?
The most difficult aspect of treating OCD is addressing the stubborn belief that one, with enough willpower, can corral at least some of these abstract forces. There’s something both beautiful and tragic about that. On the one hand, obsessiveness can help us reach impressive heights. On the other, it often contributes to a sense of excessive pride.
What seems to help our patients most is stepping away from themselves, at least momentarily, and working to better understand how their actions influence others without attempting to use that insight to try to become perfect. People don’t want perfect friends or perfect partners; they want to be considered and cared for. And, most importantly, they expect accountability. Always remember: If you can control it, you don’t need to obsess over it. And if you obsess over it, you’re only deluding yourself into believing you can control it.
