If you’ve read about OCD online or heard about other people’s experiences, you may have seen a lot of discussion about themes, or subtypes, that people experience in OCD. People’s obsessive fears and compulsions often focus on similar topics, such as contamination, harm, sexuality, and false memories—but these only scratch the surface.
The good thing about identifying and discussing OCD themes is that it circulates more education about what OCD is and what it isn’t, showing that OCD can involve a wide range of fears and symptoms, not just the few that are stereotyped. The world is learning more and more about the true nature of OCD, and it’s a major step in the right direction.
The downside to themes
OCD is already a very misunderstood condition, and it can take people many years to get an accurate diagnosis and treatment. If people feel like they don’t fit into any clearly defined “theme” of OCD, it can lead to increased feelings of anxiety and distress, and cause them even more doubt about their experiences.
On the one hand, knowing there are others who struggle with the same fears as you do can be encouraging. But on the other hand, if you cannot identify or relate to a specific theme, it can leave you doubting if you really have OCD. OCD can cause doubt about absolutely anything, and one’s own diagnosis is no exception.
The problem is that not everything can be captured neatly in a box or a category. We all know how creative OCD can be. OCD can take any fear or doubt and turn it into an obsession that feels impossible to let go of. As a result, anyone’s obsessions and fears can be entirely unique, difficult to capture with imprecise “themes.”
That is why I find it much more helpful to explore the underlying fears that OCD focuses on, rather than solely focusing on the themes. We know that doubt and uncertainty are always at the root of any OCD theme: when you have OCD you can never quite feel certain or safe enough about something. You can doubt or mistrust yourself, your memories, your capabilities; nearly anything. You end up in a constant cycle, seeking relief from the distress of your obsessions, only for it to return even stronger.
Distress intolerance in OCD
One thing we know about people with OCD is that they tend to be highly intolerant of distress. While nobody enjoys feeling anxious or uncomfortable, people with OCD often feel that these emotions are completely unbearable, especially with regard to specific fears—they feel that they must get rid of these uncomfortable feelings, rather than allowing them to exist.
We might understand this in relation to the concept of “core fears.” People with OCD tend to be able to tolerate normal levels of distress in many areas of their lives. But with certain topics, OCD preys on one’s distress intolerance, making one’s fears and distress become greater over time. OCD targets specific doubts that cause anxiety, making them feel impossible to accept.
What are some of the most common core fears?
- Being abandoned or rejected
- Being unlovable
- Not knowing oneself
- Being responsible for harm to others
- Being a “bad person”
- Living inauthentically
- Feeling permanent shame
- Lack of control
Of course, there are others—so many that it would be impossible to scratch the surface. These are just some of the most common types of fears that many people with OCD may experience.
How do we identify people’s core fears? In therapy, we often have people imagine one of their obsessions being triggered, then play out the entire worst-case scenario. What do they fear may happen if they don’t address their fear and anxiety? Often this starts with a general theme and eventually finds its way to a more specific core fear. This worst-case scenario can be a common feature to many obsessions someone experiences in OCD.
Let’s imagine a person who comes to therapy with persistent fears that they may be in the wrong relationship. They have identified that they experience ROCD, or relationship-themed OCD. This is helpful information to help them and their therapist come up with ERP exercises to face these fears head-on: they can use situations involving their relationship in order to target their fears.
As they continue to discuss what they are experiencing they mention that they obsess over whether the person holds the same values as they do. When asked what would happen if they were to be married for decades with someone whose values they feel are incompatible with their own, the answer: “I would have wasted my life.” Their therapist asks them to delve a little further into what this would look like, and what it means to them. They explain: “I would have wasted my entire life living a lie, not being who I really was supposed to be.”
You can see through this example that their core fear is related to inauthenticity, rather than specifically focused on their relationship. That is how many core fears appear: they make themselves known through specific areas of life, but they might reappear in any number of other presentations. In treatment, it would be most impactful for this person to target their core fear specifically, using relationship-based exposures—as well as other situations—to gain a tolerance for uncertainty, doubt, and anxiety related to living inauthentically or being unsure of their identity.
By focusing on this underlying fear, a person can develop a greater willingness to face their fears and live with uncertainty, even when the themes of their obsessions change over time. A fear of living inauthentically or not knowing one’s true self, for example, could be involved in many areas of life, such as one’s career, one’s sexuality, gender identity, or faith, to name a few. By addressing the core fear of living inauthentically, one has an opportunity to learn how to live with uncertainty and anxiety in all of these other areas, as well, and learn to manage OCD in any form it may take.
ERP helps you face your core fears
Core fears and deeply held doubts can feel impossible to overcome, and you may think that they’re simply a part of who you are, but OCD is highly treatable, no matter what fears it targets. With the help of a licensed mental health professional with specialty training in OCD, you can investigate your OCD symptoms to gain insight into the core fears that lie at the heart of your struggles.
At NOCD, we specialize in treating all types of OCD, no matter what core fear or theme you’re experiencing. Our licensed therapists deeply understand OCD and are specialty-trained in treating OCD with ERP. We work side-by-side with the OCD experts and researchers who designed some of the world’s top OCD treatment programs, all to provide the best possible care for the OCD population. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment and get started with OCD treatment.