Making Counting Manageable: When OCD and Compulsions Become a Problem Later in Life

by Hannah Green

I’ve always counted. From steps to bites of food to the number of letters in words, counting is a habit I never thought much about. It didn’t occur to me that I had OCD until my late twenties, and I wasn’t officially diagnosed until my early thirties. By then, that lifelong habit had become a restrictive system of rules and rituals that were both safe and suffocating.

I counted stairs as a kid. It didn’t matter if I was going up or down, or taking them two at a time, I’d count each time my foot touched a stair. It was a fun, harmless habit; just a game I never questioned until much later in life.

As I grew older, I counted more actions, like the number of steps I took on different surfaces, how many times I bounced a ball, or the clicks a turn signal made when driving. You see, counting an even number of steps or bounces or clicks made those actions “better.” Counting gives a sense of control over both the action and the outcome: if you take two steps, you’ll have two steps. Knowing this eased a lot of anxiety when I was uncertain.

You see, counting is good. It is ordered, familiar, and secure. Even numbers are especially good. For me, they are balanced, comforting, and necessary. Even numbers ensure that a task or action will be completed safely.

All this doesn’t seem like a big deal. And it wasn’t. Until I reached a point where I had to keep performing an action until I got an even number or I’d get stuck. It’s no big deal when you’re playing basketball, but a definite problem when you stop your car in traffic because you lose count of the turn signal clicks.

Counting is hard work. The constant vigilance and calculations are mentally and emotionally exhausting. They also detract from enjoyment and awareness of your surroundings. As I got older, I saw how counting made me lose control. The weight of all those digits starts to drag you down and makes even the simplest of tasks that much more difficult. It’s difficult to hide obsessive step-counting when you’re walking, especially with other people. When you’re young, those hops and taps are maybe a game or a stumble. As you get older and your patterns become more defined, it’s challenging to hold conversations as you walk or to keep your head up and watch for traffic.

Only in my late twenties did I admit that counting was a problem. I remember the exact moment: I had returned to my apartment door for the fourth time in ten minutes to double-check it was locked. Only eight turns of the handle could confirm this, and only four times of checking was enough to confirm the door was indeed locked. All that checking made me miss my bus which made me late for the class. I was the teacher.

Soon, it was easier to just not go anywhere than it was to navigate my rigid obsessions and exhausting compulsions. I could force myself to go places I’d been before like my university’s campus or my therapist’s office because the step patterns were familiar; I knew the best times of day to go to these places because there would be fewer people to navigate around. But going anywhere new was off limits and this shrunk my private and professional lives. Despite the damage to my professional reputation, I’d canceled presenting at an academic conference with my professor the night before we were due to present. In the weeks leading up to the conference, I’d obsessed about how unfamiliar I was with the venue. I didn’t know how far apart the main hall and conference rooms were or what the fastest exit route was in each of those places. I didn’t know what type of flooring they had, and whatever patterns and textures they had would make a world of difference in how I got from one place to another. Without knowing these, I couldn’t be sure that my step counts would be consistent and even-numbered. And I couldn’t be sure that my professor wouldn’t notice. He was dismayed but seemed to believe my shameful lie about being sick. Neither of us spoke about it again.

The worse my symptoms got, the more I tried to hide them. I became secretive and unreliable under the weight of my shame. I was embarrassed about my symptoms. Counting seemed so simple, almost child-like, that I couldn’t tell people first, that I counted, and second, that I couldn’t stop. I also couldn’t explain why I couldn’t go to that new restaurant or dog park when I promised I would. It was easier to fake a headache or a stomach bug than to be honest and risk them asking “What’s wrong with you?”

Besides the professional and social consequences OCD has caused me, it’s even landed me in the ER. The worst incident took place on a city bus. As my stop neared, I walked toward the door. I didn’t notice that instead of pulling up to the curb as usual, construction on the sidewalk led the bus driver to stop in the road. I was too concerned with my step count, making sure that both feet touched the yellow warning strip on the edge of the exit, to notice that the door happened to open right above a pothole. I didn’t realize I’d fallen until I heard the loud pop-pop of my ankle popping out of joint and back in again. I scrambled to safety and, while my foot swelled in my shoe, tried to remember if both my feet had touched the warning strip. I didn’t break any bones, but that severe sprain landed me a trip to the ER and a six-month limp that made it more difficult to keep up with my counts.

My therapist liked to talk about making what I was going through manageable. It took more than a year for me to stop using air quotes every time we spoke about my “OCD” because I refused to accept that it was an accurate diagnosis. But acceptance is the first step in healing and I eventually, even if shamefully, admitted what I knew all along: I have OCD. My therapist didn’t want to try to cure my OCD or force the symptoms to go away. She only wanted to help make the obsessions and compulsions easier to handle so that I could feel content and be more productive. This felt dangerous to me. I didn’t want any part of OCD. I wanted to fight my OCD. Like if I let any part of it live, it would consume me and one day I’d be stuck for good. It blew my mind when my therapist said that it’s okay to perform some compulsions.

“If they don’t cause harm or distress,” she said, “then why not?”

She asked me, “So what if you count the number of stairs?”

I struggled to answer at first. So what if I did count stairs? My brain just couldn’t process accepting an action I’d fought for so very many years. I didn’t want to entertain even the smallest obsession or compulsion. I wanted to raze my OCD to the ground with flames of fury so no trace remained. But that’s not what happened. When I realized, and finally accepted, that I didn’t have to fight this formidable OCD monster every second of every day, treating my OCD became much more manageable.

How did I come to accept my OCD and make it manageable? Grounding, acceptance and commitment therapy (ACT) and exposure response prevention (ERP).

I found grounding activities, where you use your senses to refocus your mind on the present, useful in reorienting me. If I got too caught up in an obsession, I’d refocus on that present moment. My OCD is often future-thinking, worrying about the house potentially burning down. But if I could draw myself back to the present when I knew that an appliance was turned off, I would find myself much calmer and level-headed. Distractions and sensory activities like body scans and progressive muscle relaxation are effective. These tasks help you focus your mind on parts of your body to ground both in the present. I find it works well for both the mental and physical symptoms of anxiety.

ACT taught me to accept all of my thoughts and feelings. I learned not to stifle or push back on thoughts I didn’t want, and this was the most difficult part for me. I had to learn to embrace the discomfort that came with these. Imagine getting caught in the rain. That downpour of unwanted thoughts wets your mind like rain soaks your clothes. Now you’re indoors where it’s warm and dry, but your wet clothes stick to your skin. You might feel overwhelmed or trapped or like you’ll never get dry. But that’s okay. Embracing discomfort means sitting in those wet clothes, acknowledging that you’re cold and uncomfortable, but knowing that this is temporary. Feelings pass and soon you’ll be able to get home and change your clothes.

No therapies, however, were as uncomfortable as ERP. My therapist referred me to a no-nonsense psychologist for psychotherapy and that woman pushed me to my limits. The purpose of ERP is to expose you to your triggers so that you can change your response to them. It forces you to face what makes you uncomfortable and then makes you sit with those feelings. It doesn’t sound great, and it wasn’t in the beginning. But ERP taught me that my compulsions don’t affect the outcomes of my obsessions. There’s no magical link between how many steps I take and if my partner will make the drive home safely, or between the number of clicks on my turn signal and if the driver behind me will brake in time.

SSRIs were a game-changer for me as well. I’ve run the gauntlet of trial and error that is psychiatry, tried more types of pills than I’d like to admit. Some SSRIs did little to help, but after many tries, one settled the static of obsessive thoughts and made my compulsions, well, less compelling.

Now and then OCD still, in good and bad ways, takes me by surprise. I occasionally find myself walking to work and realizing that I stepped on a crack or that I had no idea if I’d taken seven or eight steps. It’s always a bit of a shock, but I remind myself that it’s a good sign. Then there are days when I struggle to leave the house without double- or triple-checking that all the lights are off and the appliances are unplugged. Before, I’d be angry with myself and my illness, but now I take those moments in stride and try to pinpoint which anxieties are rearing their head.

Overall, I’m okay now. I can admit I have OCD to those who want to know. I can get up, go to work, and have a productive day without getting stuck. I can handle most of what OCD throws my way. Though I wouldn’t say that it’s all sunshine and roses. I have OCD flares and have to sit with that metaphorical wet shirt on, but on those days I think about how my therapist loved to tell me to “embrace discomfort” and I do.

Making OCD manageable means learning to pick your battles. It means a bit of give and take with your obsessions and compulsions. It’s okay for me to count my steps, as long as I’m not getting stuck or injuring myself. What’s important is for me to recognize when an action turns from an action I want to do into an action I have to do, because then it’s not a choice, it’s a compulsion.

Today, I say my counting is manageable. I’ve accepted that I always have and always will count, and, within reason, that’s okay, too.

​EXECUTIVE DIRECTOR: Gabriel Nathan | EDITOR: Evan Bowen-Gaddy | DESIGN: Leah Alexandra Goldstein | SITE ORIGINATOR: Bud Clayman