Last week, a colleague consulted with me on a challenging case in which his client cannot enjoy sex unless he is engaged in smoking. The client, who also struggles with obsessive-compulsive disorder (OCD), specifically cites the feeling of being addicted to nicotine as the most arousing aspect of this behavior. In other words, he is aroused by addiction.

In trying to make sense of this, I think the first thing to understand is the role that this person’s OCD plays in his everyday experience of life. Many would argue that OCD is some sort of inborn disruption of the neurochemicals in the brain, and maybe there’s some truth to that in some cases, but the first things that I look at are the themes of anxiety and control. Specifically, how do this person’s obsessions and compulsions help him to gain a greater sense of control over his anxiety?  In my experience, an individual experiencing either obsessions (incessant thoughts) or compulsions (incessant behaviors) inevitably uses either or both of these as strategies to manage and control anxiety. Unfortunately, they often only serve the purpose of making the anxiety worse.

Often, other people will categorize those who suffer with OCD as “anal” or “control freaks,” but this controlling behavior can best be understood as an antidote to the overwhelming feeling of anxiety that these folks experience on a regular basis. The constant ruminating (obsessional thinking) and ritualized behaviors (compulsions) can come across as overly controlled, but this is the only way that these folks have learned to defend against constant and intense anxiety.

This is where I think the […]