Organized Chaos - Volume 8
Need to Know OCD
by William M. Gordon, Ph.D.
Upper Montclair, NJ
What’s under that carpet? Who’s on Dave Letterman tonight? What’s inside of that paper cup on the side of the road? What’s the name of that tune on the radio? What’s inside the wall? What’s the name of the bus boy? All of these questions are innocuous enough when considered separately. However, when they become part of a chronic pattern that consumes hours of time every day, they are no longer so innocent. They become symptoms of a relatively uncommon type of OCD called “Need to Know OCD.” Although it is a less discussed form of OCD, it still can teach us a lot about OCD in general.
The individual feels compelled to acquire useless knowledge
Unlike idle curiosity, “Need to Know OCD” (NTK-OCD) demands an answer. It has a driven, compulsive quality that is disruptive and distressing. It differs from healthy curiosity in that the person with NTK-OCD has no genuine interest in the content of the question. Instead, the individual finds himself compelled to acquire useless, pointless knowledge. Like most other forms of OCD, NTK-OCD is a two-part procedure with an obsession and a compulsion. The obsession is usually in the form of a question. The compulsion is all subsequent behavior performed to answer the question. We can say then that there is a question and a quest. The quest, i.e. the compulsion, consists of overt and mental rituals. The overt rituals are the research done to get the answer. The person might ask other people, eavesdrop, make phone calls, look in the newspaper, or search the internet. The mental rituals consist of wracking one’s brains to try to remember or imagine the correct answer.
Interestingly, NTK-OCD usually has no connection to danger, aggression, safety, religion, or sexuality. The missing information generally is rather boring. There is no imagined external threat or lurking catastrophe for the individual or his or her loved ones, as in the classical obsessions. Still, the person feels driven to find the answer. The acquisition of the answer immediately quiets the distress and unsettled feeling. The person feels normal again and able to resume other activities. As in other forms of OCD, the sense of relief after performing the compulsion reinforces the tendency to believe that rituals are necessary to feel okay. By performing the rituals, i.e. by desperately seeking to answer the obsessive question, the person never finds out that the sense of urgency will decay naturally. Most people suffering from this type of OCD will admit the next day that the question has lost its appeal whether answered or not. Yet even with good insight, it remains very difficult to resist its initial lure. By trying to answer the question, its presumed importance actually increases. Patients report that their distress rises and their self control falls as they focus on it and begin trying to get the information. They get sucked into an OCD whirlpool. Thus it becomes critical to avoid the entire process. I tell people, “Don’t react to the urge. Nip it in the bud.” Otherwise too much obsessive thrust is generated to resist. This principle, that it’s easier to resist an obsession in its early stages, applies to other types of OCD as well.
The person ends up ritualizing in order to avoid ritualizing
When I ask patients why they try to answer these silly questions that they know will generate an OCD loop, they mention their fear of OCD itself. They are frightened that if they ignore the question, it will come back to haunt them. They are scared that they might start to obsess about it later on. It seems easier to get the answer right away than to face the possibility of wanting to answer it later and not being able to. Thus the compulsive search is done not just to quiet the initial distress but also to prevent future distress. This assumed preventative function of the compulsion occurs in most other forms of OCD too. (For example, a person might spend five minutes every night checking to see that the toilet seat is in the down position. He does it not to avoid germs or urine but to avoid the possibility of being worried about it later at night.) The irony of course is that the person ends up ritualizing in order to avoid ritualizing. Ritualizing then becomes a preferred coping strategy which generalizes to new areas. The individual then feels less able to ignore later obsessions.
One can compare NTK-OCD with hoarding. In both instances, people amass useless junk. With hoarders, it’s actual objects or “stuff.” With NTK-OCD, it’s information. Unlike hoarders, people with NTK-OCD do not have an emotional attachment to the information. Once acquired, it loses its value. Its sole value is in being able to calm the person by quieting the obsession. Occasionally, though, people might take notes to save the information for future use.
In treating NTK-OCD, its seeming innocence can become an obstacle. After all, what’s the big problem in asking that bus boy his name? Why not ask a few people to help identify that tune on the radio? Isn’t it easier to ask one question now than to worry about it later on? All of these rationalizations ignore the fact that OCD feeds on itself. The more you do it, the more you want to keep doing it. It’s like eating potato chips.
Another problem in the treatment of NTK-OCD is its widespread, pervasive nature. Every day there are hundreds if not thousands of unknown pieces of information that can be sought. Trying to resist all of them can be overwhelming. “Why fight one when so many others will be there to replace it?” It can seem futile. To counter this reality, it helps at first to concentrate on resisting one well defined area. For example, you might start out trying to focus only on unknown melodies. Then you could broaden your resistance to include names of men or of women. Very gradually, you expand the range of items you can ignore. By working slowly you avoid getting discouraged and you start to build up confidence in your ability to fight OCD.
ERP is used to help people ignore common triggers
Exposure and Response-Prevention (ERP) is used to help people get used to ignoring common triggers. In using ERP you purposefully try to engineer situations where there’s missing information. An example would be to deliberately turn off the TV before finding out who said something. Then of course you need to refrain from seeking the information by other means. Doing these exposures repeatedly helps you resist these triggers when they occur naturally. It teaches you that obsessions erode spontaneously without the need for you to do a thing.
NTK-OCD can be episodic and unpredictable. You can be going along quite well for a few weeks and then suddenly feel tremendous urges to search out junk information. At times like that, remember that these new urges, too, will pass. Discussing the upsurge with a knowledgeable friend, therapist, or support group can also be helpful. Treating OCD can be difficult; not treating it is even more difficult. So persevere and stay strong.
