Everybody has pet peeves. Mine happen to include technical terms that are commonly used but don't really mean anything. Within the field of OCD, one particular term that I really wish should go away is "obsessive slowness." Researchers and practitioners generally use it to describe the behavior of people who carry out everyday activities in an extremely slow manner. Examples would include someone taking thirty minutes to wash their face, ten minutes to put on one shoe, or two hours to decide what brand of detergent to buy.
The term covering all of these behaviors doesn't really tell you about what is actually happening. There are a great many subtypes of OCD, and many of them cause sufferers to do things slowly or tediously. OCD usually makes sufferers inefficient because of all the extra steps and activities it adds to their lives. However, lumping them all together under the heading of "slowness" makes anxiety caused by the obsessions. When we say "obsessive slowness," it sounds as if we are literally describing the slow-motion thinking of obsessive thoughts. This is obviously meaningless. What we are really talking about is not a thought, but an observable behavior or set of behaviors. To accurately describe what is happening, it would make a lot more sense to call it "compulsive slowness," but even this term is inadequate. It still doesn't really tell us much about what is going on.
There are many reasons why some OCD sufferers do things in what appear to be painfully slow ways. If an OCD sufferer who carries out particular behaviors slowly is to be treated properly, the reason behind their slowness must be identified. Only than can there be a proper intervention. Here are several reasons why this type of behavior is likely to occur. It is to these that we should really be paying attention, rather than coming up with meaningless labels.
Doubtfulness. Doubt is really at the heart of most OCD. There are some sufferers who cannot be sure whether or not they have actually acted in certain ways or performed certain behaviors. In order to be certain, they do things extra slowly so that they can observe themselves. They may also have to perform the same behavior several times, or break down activities into a series of steps that must be performed the same way each time. There are some who count as they perform an activity, believing that if they finish by the time they reach a particular number, the activity must have been completed. These are all really forms of double-checking, which is the usual response to severe OC doubts. Another aspect of doubtfulness that leads to slowness is the attempt to reach certainty by having to always make "perfect" decisions. This, of course, only leads to further questioning, then to indecision, and so on. The final result looks like a kind of mental paralysis, where the sufferer just stands there, unable to act for long periods of time as they agonizingly go back and forth over
The "just right" feeling. This is where sufferers experience anxiety and discomfort if a particular action, motion, or thought doesn't "feel" right in a certain way. No one but the sufferer can actually say what this feeling is, and they even usually find it hard to describe, but claim to know it when they experience it. If it just doesn't feel right as they do something, it may have to be repeated over and over again from the beginning until it does. If this feeling must be there in order to begin an activity, the sufferer may have to wait long periods of time before even starting. Clearly either of these can take up a lot of time, making the sufferer very inefficient, and causing everyday activities to drag on for long periods. This is something also commonly seen in those who suffer from Tourette's Syndrome.
Perfectionism. Perfectionistic behavior can be caused by a number of different things and is a common time waster in OCD. One symptom that can lead to perfectionism is magical thinking. Some sufferers believe superstitiously that if they do not do certain things in a perfect manner, something bad will happen to themselves or to others. The behaviors that they have to carry out are known as rituals. As they frequently become nervous and doubtful about performing their ritual perfectly, they inevitably make mistakes (or worry that they may have done so), and then they have to do it again. This can lead to many repetitions, which also results in slowness. If the rituals are mental, the sufferer may look as though they are moving very slowly, even though they are going through a rapid-fire series of repetitive activities in their heads.
Another form of perfectionism involves the need for closure. If a sufferer with this problem starts something, they must stay with it or wait around until it is absolutely and completely finished. This can apply to both mental and physical activities. They cannot start or do anything else in the meantime, as this would cause them considerable distraction and discomfort. Being able to do or think of only one thing at a time (no matter how long it takes) can also slow a sufferer down.
The need to make "perfect" decisions as a way of combating doubtfulness (mentioned earlier) would also come under the heading of perfectionism, and is another cause of slowness.
As can be seen, there are many reasons why an OCD sufferer may appear to be moving very slowly, and they really cannot be adequately described by a single term. I suggest that we drop the term "obsessive slowness," and stick to describing the causes of the individual's slowness using the more specific terms we already have. What I am doing here, is making an appeal for more precision in the terms that we use to describe the experience of OCD. Accurate descriptions are more likely to lead to the most appropriate treatments, and thus to a lot more recoveries.
Fred Penzel, Ph.D., is a licensed psychologist who has specialized in the treatment of OCD and related disorders since 1982. He is the executive director of Western Suffolk Psychological Services in Huntington, Long Island, New York, a private treatment group specializing in OCD and related disorders. He has written numerous articles that have been featured in many issues of the International OCD Foundation Newsletter.
If you would like to read more about what Dr. Penzel has to say about OCD, take a look at his self-help book, "Obsessive-Compulsive Disorders: A Complete Guide to Getting Well and Staying Well (2nd edition)," (Oxford University Press, 2016).