Maybe you find yourself starting to nod off during a particularly dreary day at school or work, only to become gripped with the fear that you’re going to utter an offensive slur while you’re half asleep. You’re disturbed by the phrase, but no matter what you do, you can’t get it out of your head. Or, you’re at a barbecue, sipping a beer in the sun, when you suddenly become afraid that even this small amount of alcohol could lead you to lose control of your behavior and do something awful. While you’re getting ready for bed, you might find yourself worrying about the dreams you might have and whether they’ll feature your intrusive thoughts. Or you’re worried that, once you fall asleep, you’ll utter one of your intrusive thoughts out loud.
Whatever the specifics, fear of losing control is a common concern for people with obsessive-compulsive disorder (OCD) across many subtypes. The idea of the scary and upsetting intrusive thoughts that characterize OCD being unintentionally shared or coming true is a nightmare for many people, and although OCD doesn’t actually put people at risk of acting on their intrusive thoughts, loss of control can make this possibility feel more real. Situations that can involve a loss of control or consciousness, like drinking alcohol, sleeping, or going under anesthesia during a surgical procedure, can seem incredibly high stakes if your mind is filled with OCD-fueled fears that you could say or do something terrible at any moment.
For this reason, people with OCD will often do whatever they can to avoid the feeling of losing control—but avoidance is often a compulsion. And while avoiding situations where a loss of control seems more likely may create a sense of relief in the short term, doing so ultimately only keeps you stuck in the OCD cycle and reinforces the fear that you really are at risk of acting on your intrusive thoughts.
How fear of losing control can manifest for people with OCD
OCD often demands total certainty about the “truth” of what might have happened in a specific situation, or what you might have said or done. Situations where you cannot closely monitor and control your actions can worsen existing feelings of doubt, or introduce new doubts that make it even more difficult to attain that idealized level of certainty. These can include:
- Falling asleep, especially around another person: If you’re afraid to lose control because of your OCD, the idea that you absolutely must be unconscious for a certain amount of time each day in order to stay healthy might sound like a sick joke. This is especially true if you share your bed with a partner, which can lead to fears that you might hurt them, unintentionally share something you would rather keep private, or say something awful and untrue to them in your sleep.
- Fear of going under general anesthesia: General anesthesia, or the combination of medications used to make a person unconscious so that surgery can be performed, can seem like an intimidating prospect even if you don’t have OCD. And if you do, and you’re afraid of what might happen if you’re not totally in control, the prospect of what you might do or say as you’re waking up from anesthesia and not yet feeling like yourself can be terrifying.
- Fear of drinking alcohol or using other substances: By definition, intoxicants like alcohol and other recreational substances change the way you feel and lower inhibition. For many people, this leads to a feeling of being out of control. You might want to have a celebratory glass of champagne at a friend’s wedding, but be afraid that you’ll become intoxicated and do or say things that you regret or can’t remember. Of course, this is a valid concern to consider whenever you’re drinking alcohol—and a good reason to remember to drink responsibly. But if you have OCD, then you may find that the concern feels “sticky,” or hard to shake, and disproportionate to the actual amount you’re drinking.
How fear of losing control impacts people with OCD
The fear of losing control due to OCD can have a serious impact on both your mental and physical health. Fear of anesthesia can cause people to postpone necessary medical treatments and surgeries, leading to serious complications down the road. People who are afraid to lose control might also be afraid to take certain medications, even if they’re prescribed by a doctor. For example, refusing to take pain medications after a serious injury because you think they will make it harder to control your behavior can cause unnecessary suffering.
People who are afraid of what they might do or experience while asleep often struggle with insomnia and other sleep disturbances—research shows that people with OCD are seven times more likely to be diagnosed with or medicated for insomnia. While everyone needs sleep and rest, people with OCD in particular can experience a worsening of symptoms while sleep-deprived, creating a vicious cycle. The compulsions you perform to try to quiet obsessive intrusive thoughts ultimately worsen your OCD. If you refuse to sleep next to a partner even though you’d like to, or avoid drinking a glass of wine purely out of an OCD-driven fear of accidentally sharing intrusive thoughts or causing harm, the fears that cause these behaviors will only intensify in the long run.
You can confront your fear of losing control and regain your agency
One of the most important things to understand about OCD is that the intrusive thoughts and fears it produces are ego dystonic, meaning the obsessions oppose your values and beliefs. It’s exactly what makes them so upsetting and part of why they stick in your brain so effectively. You’re not ruminating about the possibility of shouting something inappropriate in your sleep because you want to do it; you’re scared that it will happen because it’s the last thing you’d ever want to do, which is also what makes the fear of losing control over what you do or say so potent. Having these kinds of thoughts does not mean that you’re a bad person, nor does fearing that you might act on them.
A therapist who specializes in OCD can help you learn to confront your fear of losing control in a safe environment, moving at a pace that you’re comfortable with. Exposure and response prevention (ERP) therapy is the most evidence-based form of treatment for OCD, and can be used to help you work through fears of being unconscious and losing control. It focuses on facing triggering stimuli head-on while resisting compulsive rituals.
For example, if you are afraid to fall asleep and set extensive phone alarms to rouse you throughout the night, an ERP therapist might recommend decreasing the number of alarms until you get to a place where you only set the ones necessary to wake up. Or, if your dentist has told you that you need to have your wisdom teeth removed, and you’re terrified of losing consciousness, your therapist might focus on helping you work up to scheduling the surgery and going under anesthesia instead of compulsively avoiding it.
By gradually facing triggering stimuli head-on while cutting out compulsive rituals, the goal is to learn safety, that your brain is lying to you, that obsessions are not helpful to attend to, and that compulsions are not necessary. Another goal is desensitization: Through repeated exposure to a feared stimulus, the stimulus becomes less activating over time. ERP can help take the power out of intrusive thoughts and obsessional doubts.
OCD can make your world so much smaller. But you don’t have to stay stuck in its trap. If you’re struggling with OCD and find yourself relying on avoidance or other compulsions, NOCD can help. Our therapists understand the subtle ways OCD can show up—including avoidance—and use ERP to help you respond more effectively. To learn more about getting started, book a free call with our team today.
