I sit in the front row at church next to my best friend, Alana,* clutching the steak knife in my purse. The minister is leading the congregation in prayer, but I cannot focus on any of his words. I concentrate on my own murderous thoughts.
I am going to kill her. I am going to take this knife and stab her in church. There will be blood and the prayer will have to stop because they will need to call 911. And then they will take me away and I will go to prison and my family will be disappointed in me. But I’m going to do it anyway. I’m gonna kill her.
Alana knows about the knife in my purse. She knows that I am thinking about killing her. And she also knows that I had rehearsed these lines with my therapist, whose graphic suggestions earlier this week almost had me running out of the session in discomfort. But here I am, gripping the knife in its handbag hiding spot, following his directions.
Before you call the police on me—or him, for that matter— I should clarify that neither of us are murderers. In fact, the very idea of possibly being classified as a wrongdoer is one of my biggest fears. And during my sophomore year of high school, I spent roughly eight to ten hours per day worrying about it. The reason? I was mentally ill.
For most of my childhood, I was obsessed with being the “perfect” daughter. The oldest grandchild and great-grandchild on both sides of my close-knit family, my identity centered on being a good example to my sisters and cousins who depended on me. I was everyone’s favorite babysitter—at thirteen, the toy bag I brought with me to babysitting jobs would beat Mary Poppins’ in a second. And in school, I was a model student—hardworking, polite, and, according to my teachers, a “natural leader.” When I started high school, the lowest grade I had ever received for an assignment was an A minus. And that, in my mind, was barely tolerable; I remember crying the entire bus ride home one day when I received a 92 on a test.
It turns out, though, that it’s not always possible to be perfect. And unlike my equally high-achieving friends who could accept the occasional setback, any hiccup in my self-imposed expectations put me on high alert. I spent hours writing and rewriting handouts and reorganizing my planners because I wanted the handwriting to be perfect. I started dozens of new projects, only to abandon them because they weren’t flawless—but even that gave me anxiety because I worried I would be judged by my teachers and parents for the unfinished work. So I would start a completely new project—the night before it was due—and stay up until the last possible moment trying to reach perfection.
The same went for relationships. My unreasonable standard for being the perfect friend morphed into perverse fears about harming them. The fears ranged from physical violence—I worried that I wouldn’t be able to control myself around knives, for example—to mental concerns, like the worry that my words would be misinterpreted as hurtful or even sexual. And because I treated each worry with equal importance, even the smallest concern had the potential to take over my entire day. By tenth grade, these intrusive obsessions had replaced the time that I should have been spending asleep.
It was then that my parents realized I needed professional help. Several tests and doctor appointments later, and I was officially diagnosed with a well-known but often misunderstood anxiety disorder: OCD.
Contrary to what Target’s OCD sweater may have conveyed back in 2015, the abbreviation does not stand for Obsessive Christmas Disorder. Nor is it a term to describe someone who is highly organized or who likes things to be clean. It’s not a mood either— people cannot feel “so OCD” one moment and not be OCD the next. Rather, those who have Obsessive Compulsive Disorder experience legitimate, debilitating symptoms leading up to a formal diagnosis. And these symptoms are much more nuanced than the average person realizes; there are actually many different subtypes of OCD.
For me, the disorder manifested itself around the same time that I became more invested in my faith. The Christian congregation that I grew up in is a place of refuge, love, and community. It is also a place of many traditions— monologue sermons, veils in church, and modest dress. Though not the intention, these conservative traditions can sometimes translate into strictly-enforced rules rather than common practices. And for a girl with a propensity for ritualistic behavior, this environment became a breeding ground for OCD.
Religious-based OCD has its own sub-category: Scrupulosity. As the OCD Center of Los Angeles says in this article, “those afflicted with Scrupulosity fear that their effort to live according to their spiritual values not only isn’t good enough, but is in direct violation of God….for the scrupulous, the content of their thoughts hit painfully close to home.” My fear of killing Alana was exacerbated in the knowledge that doing so would land me in Hell.
Because my faith is so important to me, OCD was that much more agonizing. Thou shalt not kill. It’s a fairly straightforward commandment, one that most people would agree with. Yet my world revolved around it more than the average person. So how does one separate religious conviction or belief with obsessive-compulsive rituals when the two often overlap and look so similar? In an environment where prayer is a daily practice, my pleas with God to forgive my murderous thoughts and help me control my unwielding hand didn’t seem all that out of place.
In reality, though, the prayers were about as compulsive as a ritual can get. In an attempt to neutralize and reduce my worry and guilt, I would “make deals” with God, ask for reassurance from my mom that I hadn’t sinned, or repeatedly apologize to my friends. Sometimes, I would even avoid going to church or being with friends because I knew doing so would trigger more anxiety.
These compulsive tactics proved futile; any relief I felt from avoidance and reassurance seeking behaviors was temporary. In fact, they only reinforced the validity of my obsessive thoughts and continued the OCD cycle. I was stuck in a hamster wheel of obsession, anxiety, compulsion, and temporary relief. Nothing I tried could set me free.
Thankfully, there is a therapeutic solution. As with all forms of OCD, the most effective method for treating scrupulosity is Exposure and Response Prevention (ERP). ERP has its roots in Cognitive Behavioral Therapy, an approach that places emphasis on mindfulness— helping people to recognize unwanted thoughts as the obsessions that they are. For me, this meant learning how to identify the distinct difference between my spiritual beliefs and my distorted obsessive thoughts. This cognitive restructuring is a painstakingly slow process; it’s hard to convince a person that his or her own thoughts are illegitimate.
But ERP goes beyond mindfulness. This behavioral therapy involves intentionally creating experiences that will trigger OCD episodes— for example, forcing myself to sit next to a drawer with knives—while not doing any compulsive or avoidant behaviors. By preventing my normal response to this exposure— in the same example, not allowing me to throw away the knives—my therapist was able to prove to me that my fear was just a fear.
It wasn’t quite that simple, though. My therapeutic sessions also involved imaginal exposure, where I had to pretend to do the things that scared me until I realized that my worries were irrational. Take the babysitting example. I was an exceptional caregiver, but I often spent unhealthy amounts of time hyper-focused on newborns’ fontanelles— the “soft spot” on infants’ skulls that harden several months after birth when the sutures fuse together. This obsession tormented me because I knew how important it was to be careful when holding an infant. One afternoon, I was doing my math homework and holding my sleeping two-month old cousin in my arms when I suddenly became paralyzed by fear that I would take my pencil and stab her, piercing the fontanel’s membrane. To relieve me of this pain, I threw away the pencils, prayed feverishly, and kept checking my cousin to make sure I hadn’t stabbed her. After that incident, I avoided holding babies.
The corresponding imaginal exposure for this specific fear involved pretending to follow through with it. For thirty minutes straight, I sat across from my therapist with a baby doll on my lap, stabbing the top of its head with a pencil. Ten minutes in, the therapist started playing screaming child sounds at full blast. He covered the head with fake blood, increasing my anxiety to an almost unbearable level. I wasn’t allowed to throw away the pencil, run out of the room, or try to assure myself that I wasn’t committing murder. Out loud, I repeated the same sentences: I’m stabbing this baby. I’m killing it. Nothing is stopping me.
It may sound like torture— or even insanity— to hand an unstable person a “weapon” and force her to destroy a doll. But it worked. Eventually, my anxiety hit its peak and then began to decline on its own, without the help of compulsive response. This fear subsided, and almost like magic, I no longer felt plagued by the worry that I would hurt my little cousins. I had powered through, and felt free to babysit again.
Exposure Response Prevention Therapy is an effective but lengthy process. My weeks were filled up with back-to-back sessions like the one I just described. Each session addressed a different fear; my therapist created an intensive plan that catered directly to my specific obsessions. We worked our way up from minimal anxiety-inducing exposures— such as sending an email with a typo—to more intense exposures— like chanting curse words in the hospital chapel. Eventually, it was time to step out of the closed walls of the clinic and bring the imaginal exposure into my real world.
Which is why I was sitting next to Alana with the steak knife.
Today, five years post-diagnosis, four years post-ERP therapy, and three years post-hospitalization, I can sit in church without panicking. I can hold my baby cousins without worrying. And I can call up Alana without fearing she will be mad at me. Most importantly, I can practice my beliefs more freely and authentically.
But there are others who haven’t overcome OCD. Scrupulosity is not partial to any one Christian doctrine or even Christianity in general. Rather, it “custom fits its message of doubt to the specific practices and beliefs of the sufferer.” Check out this website for more information about scrupulosity across religions. For more information about general OCD, check out the International OCD Foundation: https://iocdf.org/about-ocd/finding-help/
*name has been changed