OCD Help From a Muslim Therapist

What is OCD?

Obsessive-compulsive disorder (OCD) is a disorder in which people have recurring, unwanted thoughts, ideas, images, or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). Repetitive behaviors, such as hand washing, checking on things, or cleaning, can significantly interfere with a person’s daily activities and social interactions.

It is very normal for distressing, repetitive thoughts to enter anyone’s mind, at any time. The difference is that they typically don’t remain in the mind for too long and they do not cause distress to the point of disrupting daily life.

Individuals who suffer from OCD have thoughts that are persistent and, as a result, they begin to engage in rigid behaviors; they often will have the family engaging in their behaviors as well because it’s easier to deal with if they just comply. When a person suffers from OCD, the distress is so great that they find themselves consumed for sometimes hours in a day, or many hours over the course of a day, trying to gain relief or satisfaction from the distressing thoughts or images. They may feel not performing behaviors (rituals) is nearly not an option, or if they do manage to ignore the thoughts and move on, they often suffer through it. For some individuals, they do not engage in an external behavior, or perhaps they are unaware of that external behavior. For example, if a distressing, intrusive thought comes, they may mentally negate it – while showing nothing externally to witness. For this reason, individuals may suffer for quite a long time without anyone knowing that anything is actually occurring. Sometimes individuals suffering aren’t aware at all that they are suffering. They may have strong beliefs that what they are doing is correct and may even see it as being the best version of themselves.

The Think-About

Struggling with OCD can feel like being stuck on a roundabout where some cars are able to exit the roundabout, but individuals with OCD cannot without great distress. They might look at the exits of the roundabout and wish to exit, but they just keep circling around and around the center, which I call the theme. It feels like a loop, and the sufferer really struggles to get off. I call this roundabout a “think-about” because the individual keeps thinking and thinking, and they get enough reassurance and satisfaction to get off, but then after a short period of time, they find themselves right back on that same think-about.

Getting help with OCD from a Muslim therapist can be helpful because we can learn how to get off of this negative think-about and onto a healthier one, which incorporates moderate views of Islam and other attributes of Allah in a more balanced way. Allah (subhanahu wa ta’ala) isn’t just the One who will punish us. He is so many other things, like the One who has mercy, provides, nourishes, and loves us. Getting help with OCD from a Muslim therapist will help you to balance these views, in sha Allah.

What are Obsessions?

Obsessions are recurrent and persistent thoughts, impulses, or images that cause distressing emotions such as anxiety or disgust. Many people with OCD recognize that the thoughts, impulses, or images are a product of their minds and are excessive or unreasonable. However, the distress caused by these intrusive thoughts cannot be resolved by logic or reasoning. Most people with OCD try to ease the distress of the obsessions with compulsions, ignore or suppress the obsessions, or distract themselves with other activities.

A Few Broad Areas of Obsessions:

• Religious or moral scrupulosity
• Relationship obsessions (current or previous)
• Obsessional jealousy
• Fear of making a mistake while reading the Quran
• Uncertainty about not being clean (for prayers, reading, etc.)
• Uncertainty of completeness or correctness
• Fear of not saying or doing something just right
• Fear that not saying a particular dua or phrase will cause harm
• Fear of getting contaminated by people or the environment
• Fear of food getting contaminated
• Obsessive worries about food being halal or haram
• Disturbing sexual and/or violent thoughts or images
• Fear of harming self or someone else (stabbing, killing, running over, punching, kicking)
• Excessively doubting oneself or others’ intentions about anything
• Fear of blurting out obscenities or insults
• Extreme concern with order, symmetry, or precision
• Recurrent intrusive thoughts of sounds, images, words, or numbers
• Fear of losing or discarding something important
• Constant thoughts about a particular part of the body
• Excessive concern with having an illness
• Excessive worry about breaking rules
• Repeating numbers or phrases

What Individuals With OCD Say

OCD can appear in one specific area or many areas of one’s life. Below are just examples of what clients might say, to give you an idea of what an obsessive thought or fear might sound like. Please keep in mind that everyone has the same thoughts, but an individual with OCD struggles with those thoughts, believing they are real or valid to the point of engaging in other behaviors to calm down that fear or thought (known as a compulsion or ritual; we will talk more about that coming up). OCD help from a Muslim therapist will be beneficial because all of my clients are Muslims, and I have the benefit of knowing exactly where some of the issues are religiously, culturally, and interpersonally.

Clients often say things like:

• I have blasphemous thoughts about Allah or the Prophet ﷺ and I may go to Hell.
• I don’t think Allah will forgive me.
• If I don’t pray just right I will go to Hell, and I don’t want to be sinful.
• I think I need to do everything 3 times or I’ll be sinful or not accepted.
• I am never really sure if I did things right.
• I don’t know if I have wudhu or ghusl.
• Maybe I didn’t clean myself properly.
• Maybe I made a mistake in reading Quran and I should start over.
• Does my spouse or family really love me?
• Do I really love my spouse or family?
• Did I marry the right person, or is this the right person to marry?
• Maybe I need to fix this a bit more.
• I need a lot of reassurance from others or my spouse. I am not sure how others really feel.
• I have too many thoughts and sometimes I just want to drown them out.
• I have disturbing, violent thoughts or images.
• I have intrusive sexual, sexually aggressive, or seemingly inappropriate thoughts or images.
• I have a lot of very embarrassing thoughts and sensations happening in my body.
• I have intrusive doubts about my sexual orientation.
• I am afraid I might hurt someone or myself.
• I feel like I am never saying my prayers correctly.
• I never feel sure I’ve cleaned myself properly.
• I am not sure if I have wudhu.
• I check and often recheck things a lot to make sure it’s off, a person is still alive, or a person is unharmed.
• I have thoughts or images of stabbing someone, running over someone, or pushing, kicking, punching someone.
• I think someone will get hurt or ill and it’ll be my fault.
• I need to make sure everyone is safe, because if someone were to get harmed or sick, it will be my fault and I can’t bear that.
• I need to make sure there are no germs, residues of chemicals, or contaminants that might make me or someone else ill or poisoned.
• I count, line up, repeat, re-read, make lists, make things symmetrical, keep things in a certain way.
• I am sure I’ve committed sins that Allah won’t forgive.
• Maybe I didn’t ask for forgiveness properly or sincerely enough.
• Maybe because of these thoughts I am going to be punished.
• Maybe my spouse is in love with someone else or not in love with me.
• Maybe my spouse wishes he had married someone else.
• What if I made a mistake and now my children and their future are at stake?
• Do I owe money to people?
• Did I steal something because of a coupon, discount, or misunderstanding of a sale or promotion?
• Did I pull one over on someone?
• Did I cheat on my taxes?
• Is this part of my face symmetrical compared with the other?
• I just need to fix the nails or skin on my fingers or toes (leading to biting, picking, with and without tools).
• Maybe this hair is not matching with the other (leading to hair pulling or perhaps a part of safety-seeking).
• I need to tell someone I did something wrong or broke a rule.

About Compulsions

Compulsions, also called rituals, are usually performed in order to reduce distress related to an obsession. Compulsions are often repeated either by certain outward actions or mentally. Compulsions can either be directly related or unrelated to an obsession. These compulsions can take up a significant amount of time in a person’s day, resulting in other consequences like other disorders or interruption of functioning at work, school, social, or other areas of life.

Compulsions look like: checking, seeking reassurance, redoing, rereading, making sure, getting things ‘just’ right or balanced, trying to undo what has been done, negating, and many others. OCD is unique, and what it looks like in a sufferer’s life is unique. But the core treatment for all is the same. Getting help with OCD from a Muslim therapist will be beneficial because as Muslims, we know what rituals should look like in our deen – not the ones we create ourselves.

Common Examples of Compulsions:

• Repeating ablutions (wudhu) due to feelings of incompleteness, incorrectness, or some defect in it
• Doubting if one still has ablution (wudhu) to the point that the uncertainty causes them to repeat it
• Repeatedly watching the body or things, not being sure a proper shower (ghusl) has been completed, which compels a person to repeat the ghusl or complete it in a certain way “to be sure”
• Repeating prayers (salah) or doing sajda sahw unnecessarily
• Not being certain where one is in prayer, which is not due to a neurological memory issue, so one might repeat the prayer or a part of it
• Doubting if one recited the Quran correctly and then repeating the verses or starting all over
• Repeating dhikr or tasbih because you think you didn’t do it correctly or the right number of times, often following a routine you assigned to it, until it feels just like it should be
• Thinking that something forbidden (haram) or disliked (makrooh) might have dropped into the food, which compels the person to throw the food away and start fresh
• Doubting ingredients of a food or drink product although sound opinions are given, which compels them not to purchase or consume it
• Excessive or ritualized hand washing, showering, brushing teeth, or toileting
• Repeated cleaning of household objects
• Ordering or arranging things in a particular way
• Repeatedly checking locks, switches, or appliances
• Creating lists upon lists so as not to forget, or to make sure everything is listed or organized
• Making sure mistakes are not made and even apologizing just in case
• Constantly seeking approval or reassurance
• Repeatedly counting to a certain number
• Picking skin, biting nails, pulling out hair
• Drumming, tapping, making throaty sounds
• Making sure one part of the body does not contaminate another part
• Making many doctor appointments or getting a lot of labs to make sure there is nothing wrong
• Researching or googling different topics to make sure the information is right or complete
• Repeatedly asking in different ways to make sure the person understands the question correctly, so the wrong answer or result doesn’t come
• Getting up or turning toward something the same number of times
• Getting divorced or moving out because of relationship obsessions, to prevent the spouse from getting hurt, contaminated, poisoned, or otherwise ill
• Seeking reassurance by checking a spouse’s clothing, email, browsing history, video watch history, social media accounts, or popping in at work
• Saying a particular dua or verse of Quran with the conviction that if it is not said, someone will get hurt and you will be blameworthy
• Keeping a particular routine to ‘ensure’ nothing harmful happens, with the conviction that if it’s not kept, something bad will happen and you will be blameworthy
• Doing different things to block or drown out sounds, images, or thoughts of any kind

Piety or OCD?

I do wish there was a way to definitively write down a checklist of whether it is piety or OCD. One issue is that there is a narration that, in part, says that sin is that which wavers in the soul and causes unease (Sahih Muslim 2553). On the other hand, Allah (subhanahu wa ta’ala) does not put on us more than we can bear, nor does He encourage excessive, rigid, or polarized thinking or behaviors.

For this reason, we have to take the whole person into consideration along with the thought and behavior processes. Getting help with OCD from a Muslim therapist will help because as Muslims, we can decipher between excessiveness, rigidity, and piety.

Rigidity often shows up in many areas of life, and with rigidity comes intolerance of oneself and others and their behaviors, as well as other emotions like anger, outbursts, overwhelm, despair, and others.

In order to differentiate whether a thought-behavior pattern is being kept out of piety or is perhaps excessive due to OCD, we need to examine the cycle in more detail. Most likely you will need help from a qualified therapist to differentiate. If you are reading through this and you’re not sure, reach out.

Please keep in mind that I usually get a lot of background information and then analyze it in totality to help you determine if you are a very pious person or if you are unfairly excessive in one area. I absolutely do not judge and wholeheartedly invite you to explore this. Understanding OCD often needs help.

1. When you have the thought, how distressing is it? Does your mind try to write one outcome and ignore perspectives and possibilities?
2. When you don’t engage in compulsions or rituals, what do you do or how do you cope?
3. Are you engaging in safety behaviors such as avoiding, seeking reassurance, checking, repeating, etc.? Ask yourself what you do as a result of these thoughts.
4. Are people at work, school, family, or social domains noticing something may not be ok or perhaps suggesting you should talk to someone?
5. Are you asking other people to engage in your safety behaviors or rituals (to make sure everything will be ok)?
6. Do you spend a lot of time trying to get through the distressing thoughts, images, or behavior?
7. Are you feeling negative, disempowering emotions as a result of the thoughts, images, or behaviors?
8. Would you say that you are equally pious in other areas of your life except for these couple of things? For example, a person does not eat halal, zabiha food regularly or doesn’t mind that much, but on the other hand struggles with prayers or wudhu and is overly meticulous in comparison.
9. Are others feeling it is really difficult to live and be around you?
10. Ask yourself what will happen if you do not engage in that safety, ritualistic behavior. What comes up for you?

Diagnosing OCD

To diagnose OCD, I use the criteria specified by the American Psychiatric Association (APA). Additionally, I use one or more assessment instruments to create a baseline of symptoms and their severity. This helps us know where we are starting so that we know if we are progressing. However, as a Muslim therapist who has experience in treating OCD, I will look at the totality of a person in relation to religious practices. Not all clinicians will know, without lengthy explanations, what would be considered excessive or creating a hardship for oneself.

In summary, the DSM-5-TR criteria for OCD (F42.2) are:

To be specified:

Summarized in plain language from the American Psychiatric Association’s DSM-5-TR. Only a qualified professional can make a diagnosis.

Treating OCD

Clients with OCD who seek treatment will often experience improvements in their quality of life across all domains. For example, people who were previously late, lacking in focus, losing relationships, avoiding events, struggling in relationships, etc. may notice they improve their functioning and are able to reengage in areas of life they value, and improve their relationships with people and with ideas, which often helps them improve their spirituality and relationship with Allah (subhanahu wa ta’ala).

Several types of therapies may be used to help clients with OCD. As a Muslim therapist working with Muslim clients, per my client’s comfort level, I offer an integrated therapy helping them with Islamic principles and values that most find liberating. Please note that clients absolutely have the option of electing therapy without Islamic principles and values.

Other Resources

• Expert Q&A from APA
• Read a Client Story from APA
• International OCD Foundation
• Journal Articles: references and abstracts from MEDLINE/PubMed (National Library of Medicine).
• OCD Statistics: Adults: information on the prevalence of OCD among adults.

Common Questions About OCD

Below are common questions which are frequently asked.

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