Sarah Smile's blog: "Squeekenclean's world is CRAZY"

This can be something that can cause serious issues in your life, with the help of my physician I am realizing I can relate and carry many of these traits. I have lost jobs over it and have suffered in personal relationships. If you know someone or deal with this yourself, you are not alone. But please take the first step to see your doctor.

“Just Right” OCD SymptomsWhat is “just right” OCD?• “Just right” obsessions are thoughts and/or feelings that something is not quite right or that something isincomplete. For example, a “Just Right” obsession would be a person feeling that their hands are not quiteclean when washing them. An example of a “Just Right” compulsion is a person washing their hands until thesense of “incompleteness” goes away.• On average, those with “just right” symptoms experience more problems in their day-to-day lives than thosewith more typical OCD symptoms.• Those with “just right” symptoms are also more likely to have other (“co-morbid”) conditions like tic disordersor skin picking that can make treatment more difficult.How “Just Right” OCD is Different than More Typical OCD“Just right” OCD symptoms involve more of a sense of “incompleteness” rather than the need to “avoid harm” seenin more typical OCD symptoms. “Just right” symptoms are more likely to be experienced as discomfort or tensionrather than anxiety.How “Just Right” OCD is Similar to Other Kinds of OCD• Both “just right” and other kinds of OCD involve an overwhelming sense of doubt that leads to compulsions.• People with either “just right” or other kinds of OCD both know that their thoughts are unwarranted, but can notshake the nagging feeling that ‘perhaps they are wrong.’• In both “just right” and other kinds of OCD, doing the compulsion reduces anxiety, making the person morelikely to seek relief through their compulsion the next time the feeling happens.How can you tell the difference between “just right” OCD, disruptive behavior and tic disorders?In children, it may be difficult to tell the difference between “just right” OCD symptoms and disruptive/oppositionalbehaviors. For example, if a child with OCD has a temper tantrum because a classmate sat in ‘her’ chair, it isbecause he or she feels an overwhelming sense that something is ‘not right.’ This reasoning is usually notrecognized by others. Limited communication in children can add to the confusion.Because ‘urges’ in “just right” OCD and tics feel similar, it can also be difficult to tell them apart. While “justright” obsessions are less evident than in other OCD subtypes, the urges tend to be more thought-based than tics. Inother words, an individual with “just right” symptoms may say that something does not ‘feel right’ – and that he/sheperforms certain rituals to try and get rid of that feeling, whereas a person with tics would tend to show lessvoluntary control over his/her actions.How are “just right” symptoms triggered?A list of possible triggers could be endless. But, the following are some general categories of common triggers:• Sight. Example: A person feels that his/her comb is not in ‘quite the right place’ on the dresser, and mightproceed to pick it up and put it back down – repeating until the feeling of incompleteness is gone.• Sound. Example: A person practicing piano feels that a certain note is ‘off’, and needs to play it over andover until it sounds right – even though tuning of the note has not changed in any real way.• Touch. Example: After touching a table, a person feels a sudden need to touch it again (and again) until afeeling of tension/distress goes away.• Personal Expression. Example: A person might need to express himself/herself ‘precisely’ in written orspoken words (even in his/her own head) – ‘working through’ wording until it meets their own standards ofbeing ‘just right’. 

How much do “just right” symptoms interfere with life?How much “just right” symptoms impact a person’s life can vary from person to person. The following are somecommon ways that “just right” OCD can cause problems:• Daily Life: Those with very specific triggers might find interference with daily life to be minimal.However, people with more severe “just right” OCD can become ‘stuck’ in every step of their day – fromturning the alarm off in the morning (... ‘I didn’t turn it off right; I need to do it again…and again…andagain’) to getting out of bed (…‘that felt ‘wrong’…I’ll have to do it another time’); walking out the door;picking up objects, etc., etc., etc.• Academic/Work Life: Again, those with more severe “just right” OCD may become stuck in manyactivities – for instance, writing messages (may need to reword – or rewrite, if individual letters seem‘off’); organizing tasks (i.e., unable to begin, because required objects are not in quite the right place); etc.Productivity can be greatly affected – as can attention (e.g., if the individual is more focused on the soundquality of a speaker’s voice, or the rhythm of the words being spoken, than the content of a presentation).• Social Life: The compulsions needed for a sense of ‘completeness’ can take up a lot of time – leaving littlefor social interaction in more severe cases. As well, the oddity of one’s compulsions (e.g., picking up anobject and putting it back down, over and over again) may make friendships difficult. Or, as withacademic/work life, divided attention can greatly impact performance.What is associated with “just right” symptoms?Over 50% of those with OCD experience “just right” obsessions or compulsions. Those with “just right” OCDsymptoms are likely to have:• perfectionism (e.g., concern over mistakes) • counting rituals• ‘obsessional slowness’ (i.e., loss of time due to obsessional‘loops’)• repetitive behaviors• a need for control/predictability • checking behaviors• ordering/arranging/symmetry behaviors/evening-up • procrastination (i.e. “putting off” tasks)• a sense that the mind does not rest (i.e. a mental ‘broken record’) • trouble delegating tasks• greater difficulty making decisions • general inflexibility• reassurance-seeking (i.e., comparing notes with others, todetermine whether their sense of something being ‘off’ is valid)Treatment of “just right” symptoms:Cognitive-behavioral therapy (CBT), with exposure and response prevention (ERP), is a first-line treatment forOCD. Antidepressant medicines can help, either together with CBT or before starting CBT (to reduce overall levelsof anxiety). However, “just right” symptoms can make treatment more difficult for two reasons:• First, it is often more difficult to address obsessions of “incompleteness” because they are less concretethan those of “harm avoidance.”• Second, complete response prevention may be difficult for those with severe/very generalized “just right”symptoms. More typical OCD symptoms are triggered by specific things, while “just right” symptoms canbe affected by virtually every part of the day.