Understanding 'just right' OCD, and how to recover

'Just right' OCD is a type of obsessive-compulsive disorder that encompasses several subgroups, including symmetry compulsions and counting compulsions (arithmomania) — but the experience can manifest in many other ways as well.

This type of OCD typically starts with a perfectionist thought or urge: you must do something in a particular way, a certain number of times, or until it feels 'correct' to you. And if it doesn't feel right after you've done it, you must do it again.

While some try to achieve a 'just right' feeling to prevent a specific catastrophe, the goal for others is simply to achieve an inner sense that something is in order, balanced, or correct. Or they aim to remove the feeling that something is wrong, incomplete, or unbalanced.

What 'just right' OCD looks like

Do you recognize yourself in any of these scenarios?

• You touch something or someone with your left hand and must reset by doing the same with your right hand.
• You tap the table 4, 8, or 12 times, because odd numbers feel wrong, dangerous, or incomplete.
• You arrange things on your desk until it feels right – but that feeling is difficult to define and never quite stable.
• You read the same sentence over and over because you didn't take it in properly.
• You must step over thresholds in a particular way, or have specific thoughts in your head when you walk through a door.

Many people with this type of OCD experience what are called 'Not Just Right Experiences' (NJREs) – sensory feelings of discomfort that resemble more of a physical discomfort in the body than a logical fear. It doesn't feel like a thought, but like a sensation that something is wrong. This bodily experience can make it difficult to recognize as OCD.

What is magical thinking in OCD?

For some with 'just right' OCD, the compulsion isn't just about an uncomfortable feeling. It's tied to a (sometimes unconscious) belief that what happens in your head and body can affect what happens in the world around you.

'If I don't place my shoes parallel, something terrible will happen to my partner today.' Logically, you know this isn't true. But the feeling of responsibility and the small, nagging thought of 'but what if?' is strong enough that you don't dare to not do it.

Each ritual is a small safeguard. It feels like a way to protect yourself and those you care about through actions that are invisible and incomprehensible to everyone else. And because it can seem like the rituals work when nothing bad happens, it becomes harder to stop.

Over time, there are often more and more rituals. Or the same rituals grow and take longer. What started with checking the door one extra time spreads to prolonged checking or to other areas of life. The more you give in to the urge to do things according to OCD's rules, the stronger it becomes. Eventually, the rituals can take up many hours, or even most of the day, and it still doesn't feel like it's enough.

Why is 'just right' OCD so difficult to stop?

In metacognitive therapy, we look at which assumptions keep the obsessive-compulsive disorder going. With this category of OCD, there are typically two types of beliefs that play a central role:

Fusion beliefs (certain thoughts are important and have special power) These can sound like:

• 'If I think about something bad happening, it increases the chance that it will actually happen.'
• 'Having this thought means I'm responsible if it happens.'
• 'If it 'feels' dirty, it's probably dirty — even if there isn't visible dirt.'

This is called thought-event fusion: an experience that the thought and the event are intertwined, as if thinking about something dangerous makes it more likely to happen. It's this fusion that makes the urge feel so difficult to ignore.

Positive beliefs about the rituals

• 'My rituals protect my family.'
• 'I must continue until it feels right, otherwise the anxiety will never go away.'
• 'If I don't touch the wall 3 times, I'm responsible if something goes wrong.'

These assumptions make the rituals feel necessary and important, even when they are exhausting and meaningless.

The stop signal: How do you know it's safe to stop?

Another important mechanism to understand is the stop signal. It's the signal that tells you that you're done counting, organizing, or washing, and that you can stop the ritual and move on with your day.

For most people who don't have OCD, stop signals are usually tied to external, objective facts: hands are washed, the door is locked. But with 'just right' OCD, you typically use a rule or an inner feeling as a stop signal.

It's not enough to wash your hands, you must wash for a certain number of minutes, or times. It's not sufficient that the door is locked, it must also feel right.

The problem is that this feeling is unreliable. Something can feel right one moment, and then wrong a moment later. And the more you chase the feeling, the harder it becomes to catch. Then you often end up having to go back and wash or arrange things more and more times, or start the counting over again to get the right feeling.

Can you recover from 'just right' OCD?

The good news? It's absolutely possible to recover, and it can happen quite quickly. The most important thing you need to know is that the thoughts and urges are not important signals that you must pay attention to. They are not instructions you must follow. They are simply unpleasant, but unimportant and temporary events in the brain.

The goal in Metacognitive Therapy is not to get rid of the thoughts or urges. It's to change your relationship to them. You learn to let the urge exist without acting on it.

This involves:

• Treating the thoughts as unimportant: How can you discover that the thoughts aren't important if you always give in to them? It's almost impossible. But if you start treating them as unimportant thoughts, you can figure it out quite quickly.

• Detached mindfulness: Instead of giving in to the thought or fighting against it, you simply treat it like any other unimportant thought. 'There it is again… that thought that I must count, or the urge to do things multiple times.' You register it, but choose not to engage with it.

• Changing the stop signal: Instead of continuing until it feels right, you practice stopping based on objective facts. Hands are washed. The door is locked. You don't need to wait for it to feel right, because that feeling isn't reliable.

• Challenging fusion beliefs: Is it really true that the rituals protect your family? What would happen if you let the urge pass without acting on it? By exploring this gradually, you can discover that the thoughts don't have the power you thought they had, but are actually totally meaningless and unimportant.

Through treatment, the vast majority discover that the urges and obsessive thoughts lose their strength when they are no longer met with rituals.