Pathological doubt, a specific form of obsessive disorder

Pathological doubt

The thought process of doubting is part of everyone's life. When we are presented with a crossroads or a crossroads relating to important choices, it is healthy and useful to doubt and ask questions. Just as it is healthy to sometimes question the choices already made, in order to decide to change direction. Questions and doubts can concern concrete choices, but also aspects of one's personality, attitudes, feelings and emotions, to arrive at a greater understanding of ourselves and others.

When making a choice or forming an opinion, information, as well as mental and emotional resources, are used to make a decision, come to a conclusion, and move forward.


Doubt that becomes pathological
However, when you are unable to figure it out in a reasonable time and you are unable to make a decision or give an answer to a question that haunts us about ourselves, about others or about the world, when thinking about the subject and seeking the answer becomes omnipresent and makes us live in constant anguish, we are in the presence of a pathological doubt. Some questions creep and settle in the mind like a virus, which ends up absorbing most of an individual's mental resources, leading to a constant state of distress with high anxiety spikes.

The subject tries with infinite and subtle arguments to find the answer to the question that haunts him; and as soon as he has found an answer, immediately in his mind a contrary argument is ready to refute the conclusion he has just reached, in a vicious circle without end between opposing arguments that chase and clash incessantly.

The questions that most of all can lead to obsessive doubt are those whose answers appear most strongly connected to decisive implications for one's future and one's identity. A professional choice, a sentimental relationship, sexual identity, to name the most frequent, but there are also others that appear more extravagant and original.

The emotion that unites all the consequent questions and doubts is fear. Fear of making the wrong choice, fear of not being psychologically healthy, fear of having made some fundamental mistake in the past, all conditions which, in the perception that the subject has, can irremediably influence all life and the possibility of present and future happiness .

Some of the questions that result in pathological doubt present themselves as sane and legitimate questions about oneself, relationships, and the world. Examples of such questions are: "I have to continue studying law or change faculty? - Am I really in love with my boyfriend? - Do I really like my girlfriend or not? - Was my career choice the right one for me or should I change? - Is what I do the result of what I want or is it the result of pressures from which I cannot free myself?".

These are in fact questions that could legitimately be asked as a starting point for a hypothesis of change, which moves from a situation of dissatisfaction to a situation of greater well-being.


Pathological doubt devours the mind
When they take the form of pathological doubt, such questions end up taking on a weight and a disproportionate meaning, as if the subject's entire life and happiness depended totally and irremediably on the solution of the question. The activities of daily life, the mood and the quality of relationships end up being constantly conditioned by the anguish of reflecting on the unresolved doubt.

In addition to rational and logical questions, there may also be doubts and questions that appear from the beginning more imaginative and vicious. Examples of these questions could be: "Maybe I'm homosexual? - Maybe I could commit suicide? - One day I might become a drug addict? - What if I sold my soul to the devil that time I thought it?"

Such questions are fundamentally nonsensical because a brief analysis reveals, in the case of the examples cited above, that the subject does not feel homosexual, does not intend to commit suicide, has no reason or wants to become a drug addict and does not want or believe it is rationally possible to sell soul to the devil.

This means that on the level of the intentions and immediate feeling of the subject, the questions are stupid and senseless, while the level on which the question and doubt seem to make sense is the rational level, that is, that of abstract reasoning and pure hypothesis. conceptual. Thus begins a series of logical arguments to try to arrive at a certainty, a rational and definitive conclusion that reassures us that the much feared event does not exist, has not occurred or will not be able to occur.

This process, however, is destined to have no end, because for every reasoning that seems to lead to a definitive reassurance, a new objection is ready to creep into the mind, to refute the previous conclusions.

In pathological doubts, reasoning does not help to find the solution, but rather distances it further and further. Sometimes we begin to talk about it with others too, in exhausting attempts to try together to solve the dilemma, but this only makes the situation worse.

Doubt begins to invade the mind. It grows like a cancer, which gradually invades the conscience and which is substantially nourished by all the answers offered to it; like a very bad and insatiable god, doubt devours all the answers, opposing a thousand arguments and demanding more and more tests and verifications, pushing the subject to despair.


An example: the doubt of being homosexual
The question may perhaps have arisen in a boy who has suddenly expressed a positive appreciation of the physical features or character of a peer. Hence the sudden doubt: "How come I think about these things? Am I homosexual?". Then a sudden jolt, a fright: "What if so?". From that moment a reflection begins, to try to dispel the even remote probability that this may be true.

We begin to reason and seek confirmation of the fact that such thoughts have never been thought of, that we have always been attracted to girls, that the first experiences were made with the opposite sex and were pleasant, etc. But then, however: "Why did the thought come to me? Can such a thought come to a person who is not homosexual and can never become one? " In short, a whole series of reasoning begins, to solve on the theoretical level what becomes an increasingly distressing dilemma.

We sift through our past life, evaluate all the signs and indications, we read on the internet. A research is begun that can also cross over into a "scientific" research in the field. For example, you can begin to observe boys to see what they feel, or imagine performing sexual acts, to evaluate the effects. It may also happen that one begins to control one's behavior and spontaneous bodily movements, for fear that these could betray the terrible "truth" in the eyes of others.

In this way, what should simply be felt as true based on desires, emotions and feelings, is trapped in a search for evidence, reasoning and reflections, with the result that the evidence of the answer moves further and further away, because the immediacy of feeling is buried under the mountain of evidence, reasoning and reflections.

The days are filled with anguish with peaks of panic and, the more the doubt fails to be dissolved with reasoning, the more we try to use even more what is already not working, that is, further reasoning, tests and reassurance. To the point that, even when occasionally you feel freer and more distracted, you suddenly "remember" that you have the "problem", the unsolved Hamletic doubt, the sword hanging over your head; and falls back into darkness and anguish.


Finding by stopping to search
What we do not realize is that the problem is not represented by the content of the doubt and therefore by the answer to the question. The problem lies entirely in the activity of the constant search for the answer. Here, as in all similar cases, the solution is not to reflect and reason more, but on the contrary to stop thinking and reasoning about the problem. The answer to doubt, in its pathological form, is not found in complex reasoning, but appears on the contrary precisely when the search for the answer itself is stopped.

It is like moving the water continuously to look for a ring that has fallen to the bottom of a pond; the more the water shakes, the more the sand from the bottom rises to the surface, blocking our view. Only by stopping and waiting for the sand to settle will the ring appear very clear on the bottom.
It is found by ceasing to seek.

In treatment of pathological doubt, the most common therapeutic mistake is that of trying to help the patient make the choice that he does not know how to make, make more sensible arguments than his own, which demonstrate the groundlessness of the doubt and indicate the answer. In this way, however, there is no hope, because he is an expert in this type of reasoning, and even offering him new arguments does nothing but fuel the tendency to reason even more.

To eradicate the patient's belief in the need to resolve the doubt with reasoning and evidence, it must be conducted through therapeutic tricks to stop reasoning, to allow him to access the corrective emotional experience of the greater serenity that occurs when he stops brooding.

In the treatment of pathological doubt it is necessary to lead the subject, through specific prescriptions, to stop the incessant thinking, since this is in reality the real reason for the suffering and discomfort that he manifests. His attempted solution to remove doubt through reasoning was the trap he got himself into and that it has in fact become his prison and the labyrinth from which he can no longer get out.

He will then be suggestively induced to fear to answer questions on that subject, or he will be instructed to write the flow of reasoning throughout the day according to a pattern of ways and times, to hinder the anarchist automatism of his continuous brooding. In this way, a decrease in anxiety is experienced and the doubt gradually ends up losing its importance.

A doubt, however much it may have the appearance of a sensible question at the beginning, becomes pathological when its weight and importance is exaggerated, until the problem is no longer the initial one, but becomes the fact that the person is oppressed and invaded by the anguish of continuous brooding.

The questions appear as love lowered in front of the subject, to which he continually bites with his attempts to answer. The more answers are offered, the more other hooks to bite will appear, in an endless process. Only by ceasing to continually bite the insidious questions, the pathological process can be interrupted, restoring mental serenity.

And then your sexual identity will be clear without having to think about it; it will be accepted that if one chooses one faculty, one must necessarily leave another; that even if a certain physical or psychological characteristic of a partner is not wonderful for us, we are not willing to lose everything else that we like so much; that in life it is not given to us to know if unforeseeable future circumstances will make us find ourselves in situations that we would never have imagined, etc.

Simply, one resumes living, far from that search for perfection, control and absolute certainty that characterizes the form of obsessive thought in all its variants.


Dr. Antonio Iusto (Official Psychotherapist of the Strategic Therapy Center)


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