What to Read
What is “Just Right” OCD?
“Just right” obsessions are thoughts and/or feelings that something is not quite right or that something is incomplete. For example, a “Just Right” obsession would be a person feeling that their hands are not quite clean when washing them. An example of a “Just Right” compulsion is a person washing their hands until the sense of “incompleteness” goes away. On average, those with “just right” symptoms experience more problems in their day-to-day lives than those with more typical OCD symptoms. Those with “just right” symptoms are also more likely to have other (“co-morbid”) conditions like tic disorders or 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” seen in more typical OCD symptoms. “Just right” symptoms are more likely to be experienced as discomfort or tension rather than anxiety.
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 some common 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 – from turning the alarm off in the morning (… ‘I didn’t turn it off right; I need to do it again…and again…and again’) to getting out of bed (…‘that felt ‘wrong’…I’ll have to do it another time’); walking out the door; picking up objects, etc.
- Academic/Work Life: Again, those with more severe “just right” OCD may become stuck in many activities – 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 sound quality 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 little for social interaction in more severe cases. As well, the oddity of one’s compulsions (e.g., picking up an object and putting it back down, over and over again) may make friendships difficult. Or, as with academic/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” OCD symptoms 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, to determine 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 the first-line treatment for OCD.
Adapted from Jeannette Reid, M.S., Eric Storch, Ph.D., and Adam Lewin, Ph.D., University of South Florida OCD Program.
What to Watch
Please watch the videos below relating Just Right OCD.
[VIDEO]
What to Do
Create your ERP hierarchy following the example and instructions below.
- [Just Right Hierarchy Example]
- [ERP Instructions]
What to Measure