What is Just-Right OCD?

Just-Right OCD is characterized by the presence of recurrent obsessions pertaining to things feeling “not right” and/or incomplete in some way. These obsessions are more likely to provoke feelings of tension and/or discomfort about things not “feeling” right, as opposed to anxiety about feared outcomes (as seen in other OCD subtypes). The compulsions associated with this subtype of OCD primarily consist of redoing/repeating actions in order to dispel the “not right” feelings and allow the person to feel as though the task was completed the “right” way. The obsessions and compulsions present in OCD are excessive, cause a great deal of emotional upset, and have the potential to impair the person’s functioning in important life areas such as work, school, relationships, community engagement, etc. Generally, those who have Just-Right OCD recognize that their obsessions and compulsions are excessive and often express frustration that they “can’t stop” engaging in repetitive behaviors. Individuals with Just-Right OCD may find that a greater variety of their day-to-day activities are impacted by their symptoms (compared to people who have other types of OCD) because the feelings of incompleteness tend to be more pervasive, instead of focusing on a particular situation/concern (e.g. germs, contamination, harm, etc.).

Common Obsessions in Just-Right OCD

Common obsessions include (but are not limited to):

• Something not looking “right” (not facing the correct direction, not spaced appropriately from other objects, not replaced in the right spot, etc.)
• Something not sounding “right” (too loud/soft, the note was held for too long/short, the inflection was not on the correct word, etc.)
• Something not feeling “right” (sitting down, walking, touching items, packing bags, or combing hair the “right” way, etc.)
• Something feeling as though it was not expressed “correctly” (blinking, a comment made, laughter going on for too long, etc.)

Common Compulsions in Just-Right OCD

Common compulsions/rituals/safety behaviors include (but are not limited to):

• Repeating/redoing certain actions/activities until they feel “right”
• Rewriting/retyping (to use the “correct” speed or exert the “correct” amount of pressure when putting pen to paper)
• Rereading
• Repeating oneself to speak at the “right” volume, tone, pace, etc.
• Asking others to repeat what they have said until it sounds “right”
• Lining items up in the “correct” order
• Repositioning items so that they are facing the “right” way
• Touching items until it feels “right” to stop
• Walking past mirrors numerous times
• Standing up and attempting to sit back down “correctly”
• Entering and exiting rooms until it feels “right”
• Striving for “perfect” symmetry between the right and left sides of the body (putting on makeup, applying lotion/sunscreen, clipping nails, washing body, putting on clothing, etc.)
• Flipping light switches, resetting alarms, putting the tv back on, restarting the computer to turn them off the “right” way
• Replaying a video or song until it sounds “right” and/or ends at the “right” time
• Counting rituals to make sure that tasks/activities are completed the “right” number of times. Counting is often used as a measuring stick to standardize the “right” way of completing a task or activity. The person may also have rules about “good” numbers, which often indicate a number preference for ending a task (e.g. needing to turn the lights on and off four times since four is a “good” number)
• Avoidance of tasks that will provoke the urge to engage in redoing actions
• Reassurance seeking and asking for others’ feedback about whether something looked, sounded, felt, and/or was done “correctly” or “right”

Special Considerations for Just-Right OCD

• Since people with this type of OCD are not necessarily concerned about the occurrence of a worrisome outcome, treatment does not focus on challenging an anxious prediction, but rather, treatment focuses on increasing the ability to tolerate feelings of being uncomfortable with incompleteness. Over time, this increased tolerance leads to less fixation on things not seeming “right” and an enhanced ability to move through tasks without getting stuck, thereby increasing productivity and reducing compulsive feedback loops.
• The term “obsessional slowness” is often applied to the observable actions of people with Just-Right OCD. Obsessional slowness refers to the deliberate slowing of speech, movement, and other actions in an attempt to say or do things “right.” Sometimes people move at a slower pace as a way to reduce the doubts that they may experience about the situation once it is over. The thought here generally tends to be: “If I move through this situation more slowly, I will have better recall later. If I rush, I may make a mistake or forget important details and have to start all over again.” In this case, slow execution of behaviors is serving as a sort of checking mechanism (checking behaviors are common compulsions across the subtypes of OCD). Sometimes “obsessional slowness” tends to manifest as difficulty with decision making, or in other words, “analysis paralysis.” The person may be so concerned about making the “wrong” decision that his/her anxiety precludes him/her from making any decision at all.
• Just-Right OCD is commonly associated with perfectionism and is sometimes referred to as Perfectionistic OCD. In attempts to do things “perfectly,” the individual may take inordinate amounts of time to complete daily routine tasks. Individuals who struggle with perfectionism have an incredibly difficult time coping with uncertainty and tolerating loose ends. They are extremely reluctant to delegate tasks to others or to ask for help with completing a task due to concerns that others will not do things the “right” way. Their perfectionism may cause them to miss the actual point of the activity and to become stuck in “perfecting” the act of doing the task until it feels as though they have done it “right.” These individuals struggle to divide their attention and despite working very hard, they may not have much to show for their efforts due to the amount of time that was consumed by their compulsions. The tremendously time-consuming nature of redoing compulsions not only exhausts the individual but may also lead him/her to procrastinate beginning a task because of how much time and effort the task will require. The juxtaposition between the person displaying both perfectionism and procrastination may confuse people in his/her life, but these two tendencies are sourced from the same origin: Just-Right OCD, which is exacerbated by these two tendencies simultaneously pulling the person in opposing directions.
• For some individuals with Just-Right OCD, their obsessions of needing things to be “just-right” may be connected to beliefs about needing to prevent a negative or scary outcome through their repetitious actions. In this case, the person may be contending with another subtype of OCD (aside from Just-Right OCD). This sort of belief is referred to as magical thinking: “If I do/don’t do _______, then this “bad” thing will happen. In these cases, treatment must not only target the just-right obsessions, but also the intrusive thoughts related to the feared outcomes.

Treatment of Just-Right OCD

The gold-standard treatment for Just-Right OCD is Exposure and Response Prevention (ERP). ERP is an evidence-based treatment, which means that there is a significant amount of research, empirical studies, and data that consistently demonstrate the efficacy of employing an ERP treatment protocol to successfully ameliorate the symptoms of OCD. In the context of Just-Right OCD, the goals of treatment are to both reduce distress associated with triggering stimuli and situations and to decrease functional impairments in daily living and significant areas of life. Through ERP, individuals engage in exposure to their feared/uncomfortable anxiety triggers in order to help them to learn become less reactive to and more tolerant of their obsessional worries and/or feelings of incompleteness. ERP facilitates opportunities to challenge uncomfortable feelings and to decrease engagement in compulsive behaviors. Another goal of ERP is to increase the individual’s ability to tolerate the uncertainty, discomfort, and doubt that their OCD creates. Please see our previous blog entry — What is Exposure and Response Prevention (ERP) – for more information about this treatment.

Exposures can include anything that provokes anxiety, discomfort, and/or uncertainty related to concerns about things not being “right” or somehow being incomplete. Exposures that are conducted in the context of ERP treatment for Just-Right OCD focus on reducing the repetitious behaviors and building tolerance to allow things to feel incomplete.  Examples of exposures may include:

• Typing the entire email until the information intended to be relayed is all typed
• Speaking at a faster pace and not correcting verbal mistakes
• Practicing allowing things to be uneven, such as tying the right shoelace tighter than the left shoelace, only applying lotion to one arm, taking an uneven number of steps when walking down the hallway, etc.
• Intentionally scrambling the order of items on the desk, the books in the bookcase, the socks in the drawer, etc.
• Picking up the phone before it reaches the preferred number of rings
• Turning off a song before it is over
• Packing a bag in no particular order
• Ending a task on an uneven number (stirring batter an uneven number of times, putting away an odd number of grocery items, petting the dog five times instead of six, pressing nine laptop keys instead of ten, etc.)

In addition to participating in exposure work with triggering stimuli, treatment must also include Response Prevention, which involves eliminating compulsions and deconstructing rituals. As comparted to other types of OCD, Just-Right OCD treatment typically has a heavier emphasis on refraining from engaging in compulsions. In this case, resisting urges to engage in re-doing behaviors doubles as an exposure by omitting the repeat behaviors and tolerating the resulting discomfort. Since the behaviors are distressing to refrain from doing/redoing, response prevention and exposure work significantly overlap in treating this variant of OCD. Examples of Response Prevention include:

• Sending emails and only rereading once (or not at all)
• Allowing a picture frame to remain slightly off-center
• Refraining from touching an item with both hands
• Sitting down in chairs without getting up to reposition
• Entering rooms only once
• Turning off devices (tv, computer, video games, etc.) only once
• Pouring without measuring liquids or foods to have the “perfect” amount
• Engaging the brain in another activity to prevent engagement in counting compulsions
• Refraining from cutting tags off or removing stickers from items to make them more visually appealing
• Refraining from rereading text messages before sending them
• Not “fixing” the way that others have done things (set the table, locked the door, positioned items, set down their keys, etc.)
• Crossing out written mistakes and continuing to write the rest of the sentence, despite the mistake, instead of rewriting the entire sentence, paragraph, or page
• Reading an article, book, or a set of instructions without engaging in rereading
• Tolerating a lack of physical symmetry between the left side and the right side of the body, a surface, a room, etc.

Engaging in ERP treatment helps individuals to learn new ways to respond to stressful situations and, after engaging in repeated practice of treatment interventions, they will likely experience a reduction in anxiety/discomfort and/or learn that they are able to tolerate the stress and uncertainty while still engaging in enjoyable and meaningful activities.

Although ERP is the first-line treatment for Just-Right OCD, Acceptance and Commitment Therapy (ACT) can often serve as a beneficial adjunct. Within ACT, individuals are introduced to the concepts of mindfulness and acceptance, which aid them in being present with their anxious thoughts without trying to “fix” them or engage in compulsions. Interventions that focus on increasing the acceptance of uncertainty related to things being “right” and tolerating doubts about “completeness” are necessary to supplement ERP work in the treatment of Just-Right OCD. Such interventions often overlap with Response Prevention work and may include refraining from mental or physical retracing of steps, actions, conversations, etc. as well as refraining from seeking reassurance about whether others thought something looked, sounded, or felt “off” or different.

In the context of ACT, acceptance is making space for thoughts, worries, and uncomfortable feelings to be present without giving in to the perceived need to react or respond to them. Struggling against unsettling thoughts is likely to exacerbate feelings of distress and create more emotional suffering. Through ACT, individuals come to learn that having an awareness of their thoughts without trying to change them (i.e. refraining from engaging in compulsions or rumination) is not a confirmation that the thought is true. They come to recognize thoughts as just thoughts, instead of viewing them as facts or assigning an inappropriate level of importance to them. Being able to make this distinction enables people to decrease their emotional reactivity to such thoughts, thereby reducing the perceived significance of the thoughts. Using ACT-based strategies, individuals are better able to differentiate their thoughts and values from their OCD and identify if the behaviors they are engaging in provide them with joy and pleasure (which is the goal), or if they are behaving in response to the anxiety and uncertainty stemming from their OCD. They are able to learn to be aware of their thoughts and fears while not paying undue attention to and/or over-engaging with them.

ACT helps to increase acceptance about unanswerable questions and facilitates the development of an increased tolerance for the uncomfortable feelings that are often associated with doubt. ACT also enhances individuals’ abilities to step back from the pull of the obsessive or ruminatory thoughts without trying to figure them out and aids them in redirecting their focus to something more constructive. The goal is to learn to live life and participate in activities that are important and valuable, even if the thoughts are present. Thus, ACT is employed to increase psychological flexibility and reduce the cognitive rigidity seen in OCD. ACT aims to help people to defuse from their obsessive/intrusive thoughts and to maintain a present-focused awareness. This awareness will enable them to engage in the activities taking place in the moment and to live their lives in the here-and-now, rather than retreating into obsessive worries and withdrawing into repetitive compulsions. In addition to psychotherapy, individuals with Just-Right OCD may also benefit from medication.

Need help or support?

If you or a loved one are struggling with OCD or any other mental health concerns, know that you are not alone. If you are a parent or a caregiver and are seeking additional information about these diagnoses and how you can best support your child, our office provides parent training with the SPACE program. Please see our November 2021 Newsletter for more information on SPACE.

For these or any other mental health concerns, please contact The OCD and Anxiety Center at (630) 522-3124 or info@theocdandanxietycenter.com. We have offices located in Oak Brook and Orland Park, Illinois and our clinicians specialize in helping individuals overcome anxiety disorders, Obsessive-Compulsive Disorders, and other co-occurring mental health conditions. We provide telehealth services that are available in Illinois, Indiana, Iowa, and Georgia.

At The OCD and Anxiety Center, we can provide treatment both in the office and at off-site locations (your home, mall, school, work etc.). We will work closely with you to create an individualized treatment plan and discuss the appropriate frequency of appointments (once a week or more, if needed). We look forward to working with you and facilitating your therapeutic journey!

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Dr. Ashley Butterfield is a licensed psychologist at The OCD & Anxiety Center in Oak Brook, IL.  She specializes in Cognitive Behavioral Therapy and Exposure and Response Prevention Therapy for anxiety, OCD, and anxiety-related disorders. She is comfortable working with children and adults and is able to provide treatment both in the office and outside of the office, wherever anxiety happens.