Breaking OCD's Rules: Answers to Your Most Challenging Questions

You had questions, and I've got answers. From the health anxiety reassurance trap to relationship confessions and existential doubts, let's tackle some of the most challenging OCD scenarios with practical, actionable strategies.

The Health Anxiety Reassurance Trap

Question: "I have health anxiety OCD. I call my doctor constantly asking for reassurance about my health. Even though she's reassured me, I keep thinking of more questions to ask."

This is the ultimate trap - and exactly why reassurance doesn't work.

Here's what happens: You get a few minutes with your doctor, tell them everything on your mind, and they say "You're good. Stop worrying. You're fine. You don't have this disease." You feel good for a tiny bit.

Then your brain cycles back: "Oh no, but you didn't mention this detail. You forgot to talk about this one mole. You forgot this symptom. If you shared this with just a little more intensity, would they change what they said?"

So you go back, ask something else, add more details. The answer tends to be the same until they're like "Stop it. You're good."

The ERP Approach to Health Anxiety

We're not seeking short-term relief because it is short-term. When it comes to health concerns, I say "Sure, go to your yearly physical, get everything checked out." They say you're good. Maybe they missed something, maybe they didn't. Maybe you missed something, maybe you didn't.

But that's our goal with health anxiety: Maybe, maybe not. Those are the magic words. "I really don't know."

Unless there's something so obvious you don't have to think about it - like you're on the ground with your heart exploding - then you know there's a problem and you take care of it. But if you suddenly get a weird feeling and wonder if something's wrong: "I don't know. Guess I got to keep moving forward."

It's got to be super obvious. And when people hear that, they ask "Is this obvious or not?" Don't get stuck in that either. Obvious means you don't have to think about it.

Living Normally with Intrusive Thoughts

Don't act on the thought, but also don't run away from it. Just acknowledge it and keep living normally.

We don't have to act on thoughts. I give phrases like "maybe, maybe not," "sure," "cool," "thanks for the thought," but we don't even have to say the phrases. We can just let the thought be.

Not running away doesn't mean we have to keep it present - it means we don't push it out. You're opening the gate: if it wants to leave, let it leave. If it wants to stay, let it stay.

You can say "Hi, thought" or "Glad you're here" (even for awful thoughts you're not actually glad about). The brain doesn't like that response. It's saying "This is dangerous" and you're saying "Okay, cool. Welcome."

It has to learn from that experience: "Wait, what? This is supposed to be dangerous. Maybe I need to stop warning you that these thoughts are dangerous because you're not giving into them anymore."

Living normally means living just the way you want to live. Nothing holds you back, even if you have tons of thoughts during your wedding, during events, during whatever. Let the thoughts be there.

Relationship OCD and Past Confessions

Question: "The anxiety keeps finding more things in my past for me to reveal to my partner or make me doubt if I even did that or not. I feel like I'm constantly overanalyzing everything."

This reminds me of that health anxiety pattern. There's so much uncertainty. You want to make sure your partner needs to know things about you, but your brain doesn't want to stop: "You didn't mention this detail about your relationship. You didn't mention this one thing."

I'm always curious about the core fear. What's the point if you didn't mention it? Is there somewhere in there where you want to get out of the relationship? Maybe you don't feel deserving of the relationship, so if you give them enough information, they'll break it off?

The Self-Worth Approach

Can you love yourself enough to say "I am worth this person. I'm only going to reveal things to them if they ask"? And even then, you get to pick and choose what you reveal.

If your brain says "If they knew this about me, they wouldn't want to be with me" - maybe, but they didn't ask. Also, your past is your past. Your present is your present. You're living life right here, right now.

Practice enjoying the relationship. Only share because it's interesting, it's who you are, or they ask. Other than that, sit with that uncomfortableness: "I don't know. Maybe it's right, maybe it's wrong."

Existential OCD: When Everything Feels Fake

Question: "When existential OCD hits, everything seems unfamiliar and fake. I often obsess about reality and my mental health. Sometimes I feel like I'm going crazy."

These feelings of everything seeming unfamiliar or fake - we respond with "Cool, awesome." I have thoughts that come up like "Are you really here right now? Is this real? You're driving this car - is that really happening?"

How I respond: "I don't know, maybe this is all fake, but this burrito I'm eating is super good. So whether it's fake or not doesn't matter. Cool, I'm driving this car. That's neat."

I don't give it any value and don't try to problem-solve it. Don't try to figure it out.

Building Courage Through Action

OCD is tough to deal with, but people get better when they stop fighting it. They stop trying to figure it all out. Instead: "How can I live the life I want to live? Even if I don't feel real, even if whatever?"

Building courage means doing the thing you don't feel like doing. Do exposure and response prevention because that's what helps with OCD. Come up with a very structured plan you can do every single day.

When Compulsions Have a "Correct" Way

Question: "What do you do when compulsions have a correct way to do it? The fear is that if you do it wrong, something bad will happen."

We want to break OCD's rules. When something feels like you have to do it a certain way, we do it wrong. When we "have to" do a compulsion, guess what? You don't actually have to.

If people are doing compulsions the "right way," we do them the wrong way. I've seen people who feel like they have to do their exposures the right way - guess what we do? We do them the wrong way and say "Something bad might happen. Maybe, maybe not."

Following Your Rules, Not OCD's

If something bad happens, we'll problem-solve when the time comes. Right now, I'm not following OCD's rules - I'm following my rules.

If something bad happens, can you 100% tie it back to that one moment where you did your compulsion wrong? There's no certainty with that either. All of it is uncertain.

The idea is you don't have to follow anything. You get to choose what you do. What are your values? Move towards that.

As long as you're not breaking your own morals, not breaking the law, not harming someone else or yourself (and that's different from thinking "I could harm somebody"), you're moving forward.

Real Safety vs. OCD Safety

Some people might have the "correct way" to check every knob on the stove to make sure the flame isn't on. But did you actually have to do that? If all the flames were on and that's your job every day, your boss told you to do that, then you do it - that's a rule of life, not OCD.

There's always risk of bad things happening. We have to count on our body and brain to know "This is important to pay attention to. This one's not." And it's not through distress or anxiety - that's not the indication that there's a real problem you need to correct right now.

Key Principles Across All Themes

Whether you're dealing with health anxiety, relationship doubts, existential questions, or compulsion rules, these principles apply:

• Embrace uncertainty: "Maybe, maybe not" becomes your default response
• Don't fight or flee: Acknowledge thoughts without acting on them or pushing them away
• Break OCD's rules: Do things the "wrong" way when OCD demands perfection
• Focus on values: Ask what matters to you, not what OCD demands
• Live normally: Don't let thoughts dictate your actions or limit your life

Remember: you get to choose what you follow. OCD will always have rules, demands, and "correct" ways to do things. Your job is to follow your values instead, accepting the uncertainty that comes with being human.

The goal isn't to eliminate doubt or achieve certainty - it's to live your life regardless of what your brain is telling you.