In the first year of my experience as a biblical counselor the Lord sent several counselees my way who struggled with the diagnosis of Obsessive Compulsive Disorder (OCD).1The American Psychological Association defines OCD as “a disorder characterized by recurrent intrusive thoughts (obsessions) that prompt the performance of neutralizing rituals (compulsions).” https://dictionary.apa.org/obsessive-compulsive-disorder?amp=1 I felt very inadequate for the job, but God faithfully enabled me through His Word to minister to these souls. To better care for these women it was necessary to understand and view OCD through the lens of Scripture.2The biblical view of OCD understands that the human heart, filled with sinful desires and motivations, fuels the obsessive and compulsive cycle. Therefore, OCD is a cycle of habituated and engraned or hardened behavior involving one’s thinking and behaving. https://biblicalcounseling.com/resource-library/podcast-episodes/idolizing-certainty-in-obsessive-compulsive-disorder/ Knowing that all behaviors spring forth from what resides in the heart (Proverbs 4:23), it was most helpful for me to better understand the heart issues that typically fuel the OCD cycle and to look to God’s Word to address these root causes. The people I have been privileged to counsel who suffer with OCD have truly endured hardship and thankfully God’s Word speaks to their suffering and transforms lives through a true knowledge of Him. For these women, their daily, and even minute by minute, battles have taught them to trust God more and depend on Him in a deeper way. I have learned so much from my time with each counselee about how God can use OCD for His good purposes. Such is the story of my friend Tracy.
Tracy’s mom called me one fall afternoon desperate for me to meet with her 30-year-old daughter. The main presenting problem was Tracy’s overwhelming fear that she was going to lose her salvation and be condemned to hell. The previous year Tracy had experienced the horrors of being a teacher at a school shooting. In the wake of that difficulty, she was under severe stress and pain at home with multiple miscarriages and a marriage to a harsh, controlling and unfaithful husband. The first time I met with Tracy she cried and shook the entire time we met together. She told me of the words she hears all day long and throughout the night of condemnation, telling her that she is going to hell because she had committed the unpardonable sin. Tracy was so overcome by these fears and the frequency and intensity of them that she had not slept in days.
By God’s grace and through His help, I was able to discern early on that Tracy was suffering with OCD. The OCD was manifesting in extreme and foreboding intrusive thoughts3unwanted, persistent, reoccurring thoughts that fuel fears. For more, see: https://biblicalcounseling.com/resource-library/podcast-episodes/idolizing-certainty-in-obsessive-compulsive-disorder/ of a spiritual nature (sometimes called Scrupulosity or Religious OCD). Those who suffer with this form of OCD will often experience obsessions,4“a persistent thought, idea, image, or impulse that is experienced as intrusive or inappropriate and results in marked anxiety, distress, or discomfort.” https://dictionary.apa.org/obsession which fuel their fear that they have sinned, have lost their salvation, or are going to hell. Common among this struggle is a morbid introspection5For more, see: https://biblicalcounseling.com/resource-library/podcast-episodes/ungodly-introspection-in-ocd-part-2-feat-keith-palmer/ that looks intensely on one’s own spiritual condition and dwells on and believes Satan’s lies and accusations instead of looking to Christ. Such was true for Tracy, and as the weeks progressed so did the obsessive thoughts which consisted of hearing blasphemes in her head all day and night long. She was convinced she was going to hell and the fear of separation from God and His wrath increased. Before we could have much fruitful time in counseling it was imperative that Tracy get some sleep and so the first goal was that she sees her doctor for help in this regard. I started her slowly with reading Scripture and needed to choose wisely which Scriptures to have her read because she easily became more fearful when reading certain verses. We started out with specific Psalms to offer her comfort and the assurance and promises of Romans 8:31-39 that she could not be separated from God’s love. Additionally, in the early days she clung to Romans 8:1 which was a promise to her that there was no condemnation for her because she was already in Christ Jesus. Once Tracy was able to sleep more, we were able to spend the next year together digging down to the root of what heart issues were fueling her obsessive and fearful thoughts.
Central to all of our counseling sessions was a better understanding of the gospel. She needed help to better understand and accept God’s grace and His salvation that comes through faith alone. From early on in her life she held the misunderstanding that she could do something to lose or gain her salvation which perpetuated her obsessive thoughts. She grew in her understanding of her salvation being God’s work. We studied Ephesians chapters 1-3 together and she was encouraged to look less at herself and more at Christ and what He has done. We spent time in Scripture to better understand imputed righteousness (2 Corinthians 5:21) and how we are sealed by the Holy Spirit and our salvation is protected by God until heaven (2 Corinthians 1:21-22).
Who Is God?
Another source of her fearful thoughts was a misunderstanding of who God is. Tracy saw God as a God full of wrath and punishment looking to strike her down. We spent many weeks studying God’s character and a better picture of who He is through the life of Jesus. She needed help to understand and accept His grace, mercy and love to her even when she made mistakes.
We read verses on God’s promises to her in suffering and how He intends to use her sufferings to produce fruitfulness in her life. He promises to walk through her pain and suffering with her and never leave or forsake her (Isaiah 43:2; Deuteronomy 31:6).
How to Read the Bible
Tracy had a destructive habit of taking verses out of context and reading into them her own interpretation. She started learning how to read the Bible as a whole and how to balance with truth all of God’s attributes. She needed help to read the warnings and admonitions in the Bible with the promises of His grace and mercy.
Deny the Compulsions
It was important that Tracy better understand OCD and how the cycle was perpetuated by her giving in to her desire to complete compulsions.6As a result of giving credence to the intrusive thoughts and obsessions fear and anxiety are heightened and the OCD sufferer pursues relief through compulsions, which are repetitive behaviors, rituals or mental exercises self designed to bring relief from the distress that is created by the obsessions. https://biblicalcounseling.com/resource-library/podcast-episodes/idolizing-certainty-in-obsessive-compulsive-disorder/ In an effort to quiet the anxiety and fear brought about by the intrusive thoughts, she would compulsively do things she thought necessary to protect herself from losing her salvation and experiencing God’s wrath. This included compulsively confessing sin or looking for reassurance in Scripture numerous times a day. She slowly and painfully learned to deny the desire to complete the compulsions and instead take God at His word and trust Him for her ultimate protection. This process took months and we set weekly goals for less compulsive behavior. Tracy started to trade her compulsive and ritualistic way of reading the Bible, confession and prayer for a more thoughtful, slow and sincere time with the Lord. Over time this proved to be very beneficial in weakening the intensity of the obsessive thoughts and desire to complete compulsions.
Trust God and Relinquish Control
We learned the main thing fueling the anguish of Tracy’s obsessive thoughts and compulsions was her desire for absolute certainty and control. She wanted to know for certain that she was forgiven and was going to heaven through her own means of assurance instead of believing God’s Word. It brought her momentary assurance to perform well, engage in spiritual rituals, and rely on her own external or internal affirmation of her salvation. At the core of it was a lack of trust in God. She grew in her desire to not seek control and rely on self, but to relinquish and trust God for the promise of her eternal security in Him.
Through God’s faithful care and intervention in Tracy’s life, she is in a much better place today. The obsessive thoughts and compulsions have significantly lessened, and she is living with more peace and assurance. As the pressures and stress of life increase so can a recurrence of the OCD struggles, which causes her to cling again to what she knows to be true about the gospel and God’s promises to her. Overall, Tracy has experienced relief from the overwhelming despair and hopelessness she was in and has instead learned of God’s faithfulness to her and that He alone can be trusted.