Nishmat's Women’s Health and HalachaIn memory of Chaya Mirel bat R' Avraham

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Obsessive Compulsive Disorder (OCD) & Niddah Observance


Partially adapted from work in Hebrew by Yoetzet Halacha Sarit-Chen Krotaryo, BSW. Learn more here.*

OCD affects roughly 1-3% of the population. Some women experience OCD in a range of contexts, while others experience it only with respect to taharat hamishpacha.

A man may also experience OCD related to taharat hamishpacha (for example, repeated doubts about whether his wife might be in niddah).

In this article, we define the disorder and discuss some of its common implications for niddah observance. Sometimes, doubts and related behaviors that don’t meet the diagnostic criteria for OCD can still lead to undue stress and pressure when observing the laws of niddah. Women who find that any aspect of their niddah observance leads to stress, anxiety, or self-doubt should not hesitate to turn to a halachic authority for advice.

Obsessions are frequent and involuntary thoughts, urges, images, or physical sensations that often lead to anxiety or to emotional distress. They can also cause self-doubt. When the obsessions in OCD center around religious matters, it is called Scrupulosity.

Obsessions around the laws of niddah are relatively common. Everyone who observes halacha meticulously will sometimes have questions. If, however, these questions become constant and intrusive doubts, then they may be signs of obsessions. Some common examples include obsessions about:

  • Becoming niddah. A woman may experience repeated doubts about stains, even those that present no halachic issue (e.g., stains on colored surfaces, or red threads that are clearly not blood). Or she may repeatedly ask herself whether she might have glimpsed something in the toilet before flushing, or whether she might have felt a hargashah (sensation of menses).
  • Becoming tehorah. A woman may repeatedly worry about slight discolorations on bedikot, or second-guess whether she remembered to perform a bedikah.
  • Mikveh. A woman may frequently second-guess whether her immersion was valid, either suspecting that she omitted some required preparation or finding an item after mikveh and worrying that it was there beforehand and was a chatzitzah.

 

A Compulsion is a behavior, thought, or mental activity that a person feels compelled to perform in response to an obsession. In many cases, the person tries to ignore, suppress, or neutralize obsessions and doubts through alternative thoughts or actions. Often, a compulsion includes seeking external validation for one’s actions.

In the context of niddah, there are women who perform extra bedikot, regularly spend especially long periods of time (in excess of ninety minutes) in preparations for immersion, immerse again and again, or continuously turn to halachic authorities for reassurance regarding their doubts.

Avoidance of situations that might arouse obsessive thoughts or sensations is also typical among those with OCD. For example, some women regularly choose to push off performing bedikot or having relations, or declare themselves niddah rather than having to cope with halachic uncertainty.

Additional Consequences

OCD related to niddah observance can affect an individual’s religious worldview in general, making mitzva observance a struggle or overshadowing other, important aspects of religious life.

There can also be significant repercussions for the couple, whether adding tension to mikveh night or intimacy, reducing the amount of time the couple can be intimate, or expecting the spouse to ask multiple halachic questions.

Treatment of OCD

Today there is increasing awareness of OCD. A number of effective professional treatment methods have been developed. In particular, exposure and response/ritual prevention (ERP or EX/RP) is a type of Cognitive Behavioral Therapy (CBT) considered a first-line treatment for OCD. It can be applied with full effectiveness in a way consistent with one’s religious values and beliefs.

Yoatzot Halacha are happy to assist in finding relevant treatment professionals. Many religiously-observant professionals are listed at nefesh.org.

In Israel, a family physician can provide a referral for treatment through one’s health fund. In some cases, a person may be eligible for recognition by Bituach Leumi for OCD.

In the US, it is best to clarify coverage and providers with one’s insurer prior to beginning treatment.

Help for OCD around Taharat Hamishpacha

Although OCD concerns may present in connection to halachic questions, their root causes are emotional. Therefore, resolution of difficulties typically depends on professional counseling or other treatment.

Yoatzot Halacha offer halachic support for couples struggling with OCD, and work with couples and therapists to serve as a halachic resource during the treatment process.

Halachic guidance can help to reduce halachic concerns as couples move to address the deeper issues raised by OCD and work to develop the capacity to fulfil this mitzva with joy.

Rabbi Dovid A. Kaufman has prepared a workbook to guide women experiencing anxiety or Obsessive-Compulsive Disorder about niddah observance through an evidence-based step-by-step program using proven cognitive-behavioral therapy techniques. The Taharas Hamishpacha Workbook (Lakewood, NJ, 2017. 144 pages.) can be used as a self-help book or as a treatment manual in a therapy setting.

Ideas and Tips for Women with OCD

A Cautionary Note: The following ideas and strategies may be functionally helpful to women with OCD. At the same time, learning to move away from avoidance and live with more uncertainty is a treatment goal, so some of these tips may prove insufficient or unhelpful. In treatment, a woman may be introduced to different strategies more oriented toward learning to observe these halachot as those without OCD do.

Try to remember that God is forgiving, and Torah was handed over to human beings with the understanding that we are human and imperfect.

  • Education in taharat hamishpacha often does not distinguish between stringent custom and the fundamental halacha. When a concern arises, try to clarify if it is a matter of law or stringency.
  • In cases of OCD, halacha often dictates that stringencies do not apply.

 

Becoming Niddah:

  • When medically permitted, consider using hormonal manipulation to spread out cycles and make niddah less frequent.
  • Consider using dark-colored undergarments, pantiliners, towels, and sheets to make it harder to notice discharge that might raise questions for you.

 

Becoming Tehorah:

  • Perform the minimum amount of bedikot required (a hefsek taharah and one each on days one and seven, omitting the moch dachuk).
  • Give yourself a limited amount of time to check over each bedikah cloth.
  • If you determine that a bedikah is valid, dispose of it immediately in a way that will prevent you from retrieving it later.

 

Mikveh:

  • Many stringencies are built into the laws of chatzitzah, so that immersion is often valid even when a question arises.
  • If there is something on your body that is hard to see and you are not certain that other women would be particular to remove it, you should not consider it a chatzitzah, regardless of whether you find it before or after immersion.
  • Try to limit preparation time to ninety minutes total and to complete it in one location, so that you are not tempted to start over.
  • There is no halachic issue with touching the wall of the mikveh with any part of the body when immersing.

 

*We thank Dr. Jedidiah Siev for his comments on an earlier draft of this piece.


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