Obsessive-compulsive disorder takes on a lot of forms, but everyone has a few common symptoms according to DSM-5, the diagnostic guide for clinicians working with mental illness. There are also recognizable themes in the content of people’s obsessions, and these tend to promote solidarity between those struggling with OCD.
When people talk about “OCD thoughts,” they’re actually practicing a helpful technique called defusion– a deliberate separation from your own thoughts that can help with a number of mental health issues. Defusion can be practiced in a number of ways, like labeling the thoughts (It’s just my OCD) or personifying them (There’s the monster in my mind trying to make me hide from the things I’m scared of again).
The idea of OCD thoughts also builds community between people struggling constantly with intrusive thoughts. We see a lot of interaction on social media and in the NOCD app between groups of people who’ve all faced similar thoughts. So let’s look into a few common ones and how a few of us on the NOCD team might deal with them.
Please note: These ideas come from NOCD team members with OCD. This post is not intended to diagnose or make therapeutic recommendations.
1. "They might think I'm a horrible person because of what I just said"
Made a mistake in a social setting? Said something jokey to a coworker because you didn't know their cat just died? When you've got what some people call Responsibility OCD, any social misstep seems like a sure sign that you're a bad person and that everyone probably knows it.
What we might do: Try making social mistakes more often. Once or twice a day, we'd take a risk and see what happens. Not necessarily anything unkind– maybe when a waiter asks you how your food was we can tell them it wasn't great. The goal is to do this until we can tolerate the idea that someone else is a bit hurt (and might not like us as much).
2. "How can I be sure my life has any meaning?"
We've all wondered about that eternal question: what's the meaning of life? Because none of us have figured it out, there's nothing conclusive to say about it. But people struggling with Existential OCD think about it a lot. The idea that there might be no resolution seems unbearable; in an attempt to escape this possibility, people will constantly try to prove to themselves that life is both worthwhile and meaningful.
Note: This isn't the same as true contemplation of life's meaninglessness. If you're experiencing thoughts of suicide, call 911 or go to an emergency room. If you're having trouble differentiating between the two, consult a licensed mental health professional.
What we might do: Write out all the reasons life is meaningless and actually can't be meaningful. We'd carry it around in our pocket or backpack for a week and read it out loud twice a day.
3. "What if I can never stop noticing my breathing all day?"
We usually think about OCD as a condition of the mind, but it's closely connected to the body and often involves hyperawareness of bodily sensations. In Somatic OCD, people can't stop noticing and thinking about their bodily functions or other people's bodily functions. In most cases, these are "normal" everyday functions like breathing, blinking, swallowing, ringing in the ears, and so on. Unsurprisingly, this hyperawareness of such constant phenomena can get very frustrating and might even lead to a feeling of hopelessness.
What we might do: It sounds strange, but an interesting exposure for this grouping of thoughts is to find ways to watch other people performing these bodily functions. Rather than stare at people in public, we'd find YouTube videos and focus on the specific function, taking note of our anxiety level every 3 minutes and watching videos until our anxiety peaks and then reaches 3 or lower again (on a 10-point scale).
4. "What if I just jumped in front of this train right now?"
Pretty much everyone has had sudden, disturbing thoughts about harming oneself or someone else. But people with Harm OCD don't feel capable of simply moving on– it seems extremely important to "deal with" the thought in some way by convincing oneself that it would never happen. This subtype of OCD often involves guilt, avoidance, and a nagging sense that one isn't actually a good person.
Note: This isn't the same as true contemplation of a suicidal act. If you're experiencing thoughts of suicide, call 911 or go to an emergency room. If you're having trouble differentiating between the two, consult a licensed mental health professional.
What we might do: It might not be wise to do exposures at a train station without professional help, so we'd again turn to the sea of online videos we're lucky (or unlucky) to have at our disposal. By watching a video of trains flying past a station and imagining ourselves jumping in front of one, we'd hopefully begin to get used to those terrifying thoughts and feel more confident in our ability to face them later, in person, with the help of a therapist.