Your Most Pressing OCD Questions Answered: Health Anxiety, AI Compulsions, and More

You sent me hundreds of questions, and I'm diving into some of the most common struggles people face with OCD and anxiety. From health fears that won't quit to the new world of AI-powered compulsions, let's tackle these real issues with practical solutions.

Health Anxiety: "I Keep Doubting I Have Alzheimer's Every Day"

Question: "I was convinced I had Alzheimer's, and yet I keep doubting I have it every single day."

This is classic OCD and health anxiety. Often we might wonder if we have a disease, go get it checked by a doctor, and the doctor says "You're good, you're fine." Yet someone still worries about it constantly.

Whether it's health anxiety or OCD fears, we treat them the same way: through exposure and response prevention (ERP). Your job is to say "I just have to risk it. Risk that I might actually have this thing."

The ERP Approach

Use your daily doubting to your advantage: "Cool, maybe I do have it, maybe I don't. What an interesting experience that would be if I had it."

We're not making light of the disease itself, but of the OCD or health anxiety throwing out false signals. Unless there are glaring red flags where you don't even have to question that there's a problem, we're not playing doctor (unless you are one) or investigator (unless you are one).

Your job isn't to figure this out. Your job is to go to school, be a dad, be a mom, be whatever you want to be. When that doubt comes up, have the same response every time: "Yeah, cool thought today. Love that. Maybe I have it, maybe I don't."

The "What If I Miss Something Real?" Fear

There's always that thought: "But what if I actually have something and I missed it because I'm trying not to pay attention?" That's always the risk, but we're all taking that risk. We're all willing to live life.

Sometimes we lean into exposures: watching videos of people who have the disease and saying "Yep, maybe that'll be me. Maybe not." Drawing pictures, writing certain words, purposely doing things that make you feel like you have that disease - all to take power away from it.

AI and OCD: Compulsions vs. Therapeutic Benefits

Question: "Would you talk about AI's potential for compulsions? On the other hand, could there be therapeutic benefits?"

AI is interesting because it can get a lot right and a lot wrong. Compulsions can definitely be a big piece because AI really doesn't know any better.

AI as a Compulsion

If you have a specific fear, you might chat with AI about it. AI is almost always on your side, even when you're wrong. I've noticed whether I'm asking for ideas or making changes, it's like "You're absolutely right! That would look really good there!" even when it was fine before.

AI is a "yes computer" - it'll tell you whatever you want to hear. Those compulsions are very short-term because how does it really know? You might think "It told me I'm fine," but you're still doubting.

AI as a Therapeutic Tool

I've used AI for exposures, especially script writing. You can prompt it: "Write me a story about walking to a grocery store, accidentally bumping into somebody, them making a huge scene, police coming and asking 'Why did you assault this person?' ending with me in jail losing my family."

AI writes elaborate stories, though it usually wants to provide reassurance at the end ("and the person realized they're a good person and it was just OCD symptoms"). I just cut that part out.

We read those stories over and over saying "Yeah, that might happen. Maybe we'll see. What a cool experience."

AI can be great in this context, but if you catch yourself using it for compulsions - don't.

Reassurance Seeking vs. Problem Solving

Question: "Is there a way to tell the difference between reassurance seeking and problem solving with another person?"

Yes! Here are the key differences:

Problem Solving:

• Not urgent most of the time
• Not mixed with distress or anxiety
• "Let's talk through this. How does this work? What do you think?"
• You need to be okay if you never talked about it - would that be fine too?
• You talk about it, come up with the best answer you can, and move on

Reassurance Seeking:

• Feels urgent - "I need an answer right now"
• Mixed with distress or anxiety
• Looking for comfort and a specific answer
• Asking the same thing time after time
• You get an answer but think "Maybe I didn't give enough details, let me ask again"

Often if you're questioning "Is this reassurance seeking?" it probably is. Example: Problem solving is "How do I build this redstone Fibonacci binary number thing in Minecraft?" Reassurance seeking is repeatedly asking "Am I a good person?" with urgency and anxiety.

Building Eye Contact Skills

Question: "What advice for maintaining eye contact during conversation?"

I used to struggle with social anxiety, and eye contact was difficult. It becomes a habit over time, but you have to make it a point to practice.

Practical Eye Contact Plan:

• Plan it out: "I'm going to make eye contact with multiple people"
• Go to the grocery store - every person you talk to, look at their eyes for at least 5 seconds (or whatever your goal is)
• Pay attention to your thoughts: "I'm making them uncomfortable," "What if I look at something inappropriate?"
• Respond with uncertainty: "I don't know, maybe it will happen, maybe not"
• Make it a goal: at least five people today
• Treat it like a game - you can look away then look back

It's going to feel uncomfortable - it's not supposed to feel comfortable. You don't know what the other person's thinking, but just practice being uncertain about all the fears and keep practicing.

Start with a hierarchy: your dog, cat (cats make eye contact), parents, siblings, then strangers. You can even practice with images or videos - just the idea of practicing matters.

OCD About Current World Events

Question: "How to help with OCD focusing on current world events? How to stop thinking about things that are actually happening?"

My first thought: we don't need to stop thinking about it. We can just let thoughts be.

Setting Healthy Boundaries

We can prefer not to have certain material come across us. I don't watch the news, read newspapers, or seek out news reports. Usually they're negative things about the world, and current events will find us anyway.

We don't have to problem-solve them all (or most, or really any) unless that's your job or what you want to do.

When Current Events Do Come Up

When you hear a story, you can say: "Bummer, this sucks. This stuff's happening in the world. Let me sit with this uncomfortable feeling. I don't need to push thoughts away. I don't need to problem-solve. I don't need to do anything. Let's just let it be."

Sometimes set a timer for 5 minutes: "Let me sit with this feeling. Feel sad for these people or whatever's happening."

If we say "I don't want to keep focusing on these things," we'll probably focus on them more. Focus on what you do have control over.

Values vs. Avoidance

If news isn't your thing, make it more inconvenient to run into - not for avoidance, but because it's not part of your value system or something that makes you happy. It's okay to set boundaries with ourselves.

But when things do pop up, handle it: "Hey, you're here. Let's just be here." It's tough, but that's how we process difficult realities without getting stuck in compulsive problem-solving.

Key Takeaways

Whether you're dealing with health anxiety, AI temptations, reassurance needs, social fears, or world events, the principles remain consistent:

• Accept uncertainty with "maybe, maybe not"
• Don't try to solve what isn't yours to solve
• Practice uncomfortable situations deliberately
• Set boundaries aligned with your values
• Let difficult feelings exist without fixing them

Remember: exposure therapy is difficult, but it's how we train our brains to respond differently to anxiety and obsessions. The discomfort is temporary, but the skills last.