When OCD Meets Another Diagnosed Medical Condition

While OCD is often associated with more intangible themes or hypothetical concerns, the Obsessive-Compulsive pattern of thinking in those who have the disorder can latch on to more present issues, such as a difficult, and very real, medical diagnosis. What can make this feel different from other OCD themes is the ability to point to something that has actually been confirmed by a medical provider. OCD can then begin to focus on a specific symptom, the accuracy or outcome of a diagnosis, or needing to be certain about the perfect treatment protocol to follow. I have often had clients tell me “But I’m not uncertain about this, my doctor confirmed it. So this is different from my other OCD themes.” In cases like this the uncertainty is not around IF there is something medical happening, but rather around some other aspect of the diagnosis such as:

• How did life feel before this?
• Are my symptoms getting worse?
• How far do I have to go to protect myself/follow treatment protocol?
• Do I have the right doctor/treatment option?
• Is my experience the same as others with this condition?

Could my doctor be wrong, and this is actually something worse?

It is not hard for OCD to make the leap from “I’m supposed to avoid gluten” to “I should probably read the ingredients on that an 8th time”. Or for OCD to take the general advice of “one should take precautions around loud music to avoid worsening tinnitus” and turn it in to “I should completely avoid anywhere with live music”. 

Everyone has their own threshold for how far they will go to take precautions, but those with OCD may have a more difficult time drawing that line. That line can feel even more blurry when it involves a confirmed medical diagnosis. But remember, the threshold for safety should be decided on with the guidance of your medical provider and not your OCD! 

Some examples of diagnoses that can become part of the obsessive-compulsive cycle:

• A difficult diagnosis such as cancer or an autoimmune disorder: This can show up as excessive rumination around ‘did I cause this?’, seeking reassurance about past behaviors/occurrences that could have caused it, excessive online research, etc. 
• Tinnitus/eye floaters: This can show up as hyperawareness OCD involving checking to see if it has gotten worse, excessively avoiding situations that could hypothetically make it worse, frequent visits to the doctor, etc.
• Celiac disease/food allergies & intolerances/substance use disorders: This can show up as contamination (or cross-contamination) OCD fears involving excessive checking of ingredients, excessive washing, excessive checking for symptoms, or asking for reassurance beyond what is typically recommended, etc.
• Mild cognitive deficits or age-related memory decline: This can show up as excessive checking/testing of one’s memory (beyond what is recommended), frequent comparing to how one felt in the past, reassurance seeking, excessive rumination about the future, obsessively trying to hold on to and savor good moments (in a way that makes it difficult to actually be present), etc.
• Other diagnosed mental health conditions besides OCD (e.g. major depressive disorder, PTSD, bipolar disorder): This can show up as rumination/checking around the symptoms, comparing to the experience of others, excessive online research, reassurance seeking from providers, etc. 
• A diagnosis that doesn’t have clearly defined symptoms or a clearly defined trajectory (long covid or chronic pain for example): This can show up as rumination around if it will ever go away, obsessive online research about cures or comparing to the symptoms of others, frequent comparing to how one felt in the past, excessively talking about the symptoms with others, etc.
• A physical symptom that exists but OCD says it could be something more: This can show up like any other health anxiety OCD obsession. In this case there is a recognized symptom that has already been assessed to be benign, but the OCD continues to cause doubt (GI issues, muscle twitches, or frequent headaches for example). It often includes checking for changes in symptoms, excessive online research and reassurance seeking, frequent visits to the doctor, etc. 

Treating The OCD Part of This Equation

The most notable difference in the treatment approach for obsessing about a medical diagnosis is an additional emphasis on seeking input from other medical providers. The current primary treatment for OCD is Exposure Response Prevention (ERP), a cognitive behavioral intervention that helps sufferers gradually confront their fears while reducing their compulsive behaviors. It is important for OCD providers to communicate with their client’s other medical providers to ensure that ERP is being designed safely and to help determine which OCD safety-related behaviors might be considered excessive or unnecessary. For example, it would be important for an OCD provider to hear from a client’s allergist what a person with that food allergy should be doing to avoid their allergen. But in some cases, it could also be helpful for the allergist to be aware of their patient’s OCD diagnosis when answering their questions. With this exchange of knowledge both providers can create a united front that meets the patient’s need for medical safety while also supporting them in managing their OCD symptoms.

Take one dose of mindfulness and call me in the morning

Mindfulness is the practice of being present without judgement. The “without judgement” part can feel particularly difficult when there is a life-altering diagnosis present. This is why mindfulness is a practice and not a one-time antidote. It involves making space for the sadness/anger/distress, while also teaching the brain to be accepting. And remember, accepting doesn’t mean not caring. It means tuning in to the body with curiosity rather than resistance. 

You have every right to be angry at the unfairness of a situation, but that anger does not need to run the show. Teaching the mind to accept the presence of unwanted things also teaches the mind that it doesn’t need to be paying attention to those things constantly. Allowing the awareness of your medical condition to be in the background lets you choose to turn your attention elsewhere (to the really great cup of tea you’re drinking perhaps?) It gives your brain permission to shift its attention to the rest of what is present, including to more pleasant things. This can feel irresponsible or like “giving up”—especially if you haven’t processed any anger that is present—but it is actually just choosing to stop fighting against what is out of your control.  

Default Setting

Think of OCD as having a brain with a default setting that puts perceived problems on repeat. By this definition really anything can get stuck in that obsessive-compulsive loop. OCD’s job is to try and outsmart you, so it may be hiding behind the confirmed diagnosis or symptom as a way to keep you wrapped up in its game. Your job is to identify the doubt that OCD has created and treat it like any other OCD theme, using your OCD therapist and medical team as your guides. OCD goes after what you care about most, so it isn’t really a surprise that it can interfere in processing a real diagnosis. While the presence of OCD does not make your diagnosis any less real, the reality of your diagnosis does not mean OCD gets to take the wheel. Once you learn how to kick OCD out of the driver’s seat (ok so you can’t really kick it out of the car, but maybe throw it into the trunk?), you can get back to doing the things that really matter.