Obsessive compulsive disorder - OCD treatment and therapy from NOCD

OCD themes that can be hard to talk about

9 min read
Stacy Quick, LPC
All types of OCD include obsessions and compulsions. Obsessions are unwanted and intrusive thoughts, feelings, urges and doubts, while compulsions are repetitive physical or mental actions performed in an attempt to relieve distress and anxiety

I like to think of OCD as a very large tree with several branches: each branch is representative of a theme or the subject matter that OCD latches onto, and each branch has several smaller branches—intrusive thoughts, images, feelings, and fears. The tree’s trunk wants 100% certainty about the content and has a sense of hyper-responsibility for others. The roots of the tree are fear, doubt, and uncertainty. To take down the tree, the trunk has to be uprooted—it doesn’t matter what the branches are. 

The branches sometimes do, however, stand in the way of getting the treatment needed to uproot the tree. Some themes are especially difficult for people to share with others, as they may be highly taboo, shameful, disturbing, or embarrassing. Harm OCD (or themes involving violence), pedophilia-themed OCD (POCD), and other sexual fears, to name just a few—we know that OCD can latch onto absolutely anything. We also know that the more disturbing an intrusive thought is to someone with OCD, the more likely they are to focus on finding meaning behind it, and the harder they are likely to try to assure themselves that it isn’t true. 

When I work with therapy members who are suffering from especially frightening, taboo, or shameful themes of OCD, I can bring a unique perspective: throughout my life, I have suffered from some of these themes myself. Let me share with you what these thoughts and fears can feel like, from my own life and from the lives of the people I’ve worked with.

Fear of being a murderer

When I was young, maybe 9 or 10 years old, I was constantly afraid that I would poison someone I loved and they would die. Of course, I would go to great lengths to prevent this, but I was haunted day after day by the fear. I didn’t want to hurt anyone, but I was terrified by the fact that I could

I remember it like it was yesterday, being so sick to my stomach after watching just a few minutes of an episode of America’s Most Wanted. It was a story about someone missing, presumed dead. This show caused me so much agony. Intrusive thoughts flooded my mind, ranging from what if this happened to me? to what if I was capable of doing that someday? I felt nauseous, and I couldn’t sleep—I felt like I needed to know with 100% certainty that I would never be a murderer, and it felt impossible for me to talk to anyone about it. What if they misunderstood? Would I be taken out of school? What if they took it as a sign?

Later in my life, these fears turned darker. Someone I knew was actually attacked and held captive for days. Thankfully they survived. During this time OCD planted intrusive thoughts: “How do you know it wasn’t you who did that to someone?” This was followed by self-reassurance: “You would never do that.” But it felt like OCD was always one step ahead: “What if you convince yourself you did something, confess to it, and people believe that you did actually do something terrible? What if these fears ruin your life?” Once again, it felt like sharing my experiences simply wasn’t an option; the risk was too great.

That is at the heart of this disorder. The mere possibility of being something awful, doing something unforgivable, not knowing or ever feeling “sure enough” about anything; that is what drives it. It feels impossible to share with others, and it only grows worse as you continue suffering in silence.

Fear of becoming violent

This one is a familiar one for many who suffer from OCD, and can present in many forms. Like many OCD themes, it tends to start with a “what if”: What if I “snap” and hurt someone? What if I come across as angry and violent to other people? What if I become so angry that I kill someone and go to prison? What if I can’t trust myself and lose control? 

People who experience these fears may also have specific fears in response to in-the-moment intrusive thoughts: swerving into oncoming traffic or pushing someone in front of a moving car or train, for instance. They may have unwanted images of stabbing people. They may worry about poisoning someone on purpose. The list goes on and on, because OCD is so creative in producing and exploiting fear. 

Fear of being a pedophile

I have worked with so many people over the years, of different ages, different backgrounds, different genders, who have experienced intense fear that they may molest or sexually abuse a child. When you think about OCD, it makes perfect sense: OCD tends to anchor on worst-case scenarios, and harming children is often one of the worst things a person feels that they could do. 

When I was a child I worried that I myself had been molested and had “forgotten” or “blocked” it. In my mind, that would have made everything in my life unbearable. I became consumed for years by this fear. 

Of course, it doesn’t bother me now, but those themes remained. When I was pregnant with my first child, I had the thought, “What if I somehow molested the baby in utero and didn’t know it?” I quickly reassured myself I would never do that. Again, OCD was a step ahead: “What if you convinced yourself that you did and you confess to others?” I was repulsed. What would people think of me? What would people think if they knew that I had even had that thought? Visions of being labeled “crazy” and being hospitalized flooded my waking moments. I had one of the worst panic attacks of my life following that thought. That’s the kind of fear that OCD can produce from the simple fact that I cared so much about the safety of my future child. And again, I felt like I had nowhere to turn—the stakes were simply too high.

Fear of bestiality

Another common and misunderstood form of OCD is the fear of sexually abusing animals. They often come up when people learn about or are exposed to knowledge about others sexually abusing animals. That is what makes it so scary: the possibility that it could happen, and that you can never know for certain. 

People who suffer from these intrusive thoughts often are tormented by images or thoughts of having done something sexually to their beloved pets, on purpose or inadvertently. They may worry that even thinking about it means that they want to have sex with an animal or are likely to. They will often come to treatment in despair, sometimes even having given away a beloved pet because their thoughts felt too heavy to bear, and the uncertainty felt too great. People suffering from this tend to avoid their pets, fearing they may act on the intrusive thoughts that pop into their brain. 

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People suffering from this may replay every encounter they have had with their pets in their minds. They may wonder if they touched an area that was inappropriate. They may question whether they were enjoying petting the animal or if it felt sexual in any way. The more they engage with their thoughts and fears, the more real and insurmountable they feel.

Fear of raping someone

The intrusive fear of raping someone or having somehow been inappropriate sexually with another adult is also very common in people with OCD, and these fears, too, can come in many different forms. Sometimes people wonder if they didn’t get proper consent from another person, or if the person was actually “of age”. They may wonder if while they had been drinking they could have done something sexually violent or inappropriate and they don’t remember. Naturally, as these fears depend on memory, often in the distant past, it is easy for doubt to creep in, and people may spend countless hours consumed by these intrusive thoughts. 

These thoughts may be in relation to specific incidents but they may also involve what-if thoughts about things in the past: “What if I was 19 and they were 17?” They may repeatedly reach out to past partners and “make sure” that their involvement was indeed consensual. They may avoid sexual contact with anyone because these fears are so intense. They may even avoid going out and being around people altogether. 

OCD is your personal poison

These are just a few of my personal accounts of how OCD can present in different forms. Any specialist who treats OCD has heard similar stories from people they have worked with—experiences like these are actually pretty common for people with OCD. The problem is that many of these intrusive thoughts are not talked about because of how shameful, embarrassing, or horrible they feel. They may not fit neatly into the popular definition understanding of OCD, but intrusive thoughts about sex and sexuality, harm, violence, etc. are actually far more common than many think. 

The truth is that everyone (even people without OCD) may have taboo intrusive thoughts pop into their mind once in a while, but they are unlikely to pay attention to them. People with OCD, on the other hand,  get stuck on these thoughts, images, and urges, and feel like they can’t move on. The truth is that intrusive thoughts are just thoughts and feelings, and do not necessarily have any meaning whatsoever. 

OCD thoughts are known as ego-dystonic, meaning that they go against someone’s identity, values, and intentions. That’s why they can cause so much distress and anxiety: the topics that people with OCD get stuck on are often the very things that they find most disgusting and horrifying. It is as if OCD knows the things that you are appalled by and uses them to taunt you. It is like your own personal poison, designed specifically for you. 

That’s why people with taboo or disturbing thoughts in OCD will do anything to feel better about their fears, prevent them from coming true, or reduce the anxiety and distress they feel. People who experience violent intrusive thoughts may often avoid anything that could potentially cause harm to someone else, or even avoid their closest loved ones so they can be certain they’re never in harm’s way. Similarly, people experiencing pedophilia themes of OCD will go to every extent not to act on these thoughts, staying away from every possible situation that could present even the slightest possibility of harming a child. 

Sadly, far too many people suffering from OCD themes like these have no idea that what they are experiencing is a form of OCD, and many will suffer for years without a proper diagnosis and without life-changing treatment. They can spend years not knowing that they are not bad people, that they are not the monsters that OCD would have them believe they are, because it feels impossible to share what they’re going through. Even mental health professionals don’t always understand the many themes of OCD. That is why it is so important for people experiencing these thoughts and fears to know that they are not alone, and that there are people who understand what they’re going through and can help.

ERP is your first aid 

If you are suffering from intrusive and unwanted thoughts, images, and urges about taboo or disturbing themes, you could be suffering from OCD. You are not alone, and you are not your thoughts. Let a specialist help you regain your freedom and take back what OCD has tried to steal. 

Exposure and response prevention (ERP) therapy is the gold standard treatment for OCD, with decades of clinical research proving its effectiveness. ERP helps people suffering from OCD to sit in the anxiety and discomfort of their thoughts, even those that are highly disturbing or embarrassing, and learn that they don’t need to do any compulsions to rid themselves of this perceived danger or feeling of shame. They can learn that although it may not be comfortable, they can actually tolerate the distress, and they can live with uncertainty about their intrusive fears. 

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If you’re struggling with intrusive taboo thoughts and themes, NOCD can help. 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 – and that means the best care for our members. You can book a free 15-minute call with our team to get matched with one and get started with OCD treatment.

Stacy Quick, LPC

Stacy Quick LPC, is a therapist at NOCD, specializing in the treatment of OCD. She has been working in the mental health field for nearly 20 years. Her goal is to help members achieve skills to help them live a more fulfilling life without letting OCD be in control. Ms. Quick uses ERP and her lived experiences to help her members understand it is possible to live a life in recovery. She is a mother of 3 children, 2 of whom are also diagnosed with OCD. Ms. Quick is also a writer and content creator. Learn more about Stacy Quick on Instagram: @stacyquick.undone

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Taylor Newendorp

Taylor Newendorp

Licensed Therapist, MA

I started as a therapist over 14 years ago, working in different mental health environments. Many people with OCD that weren't being treated for it crossed my path and weren't getting better. I decided that I wanted to help people with OCD, so I became an OCD therapist, and eventually, a clinical supervisor. I treated people using Exposure and Response Prevention (ERP) and saw people get better day in and day out. I continue to use ERP because nothing is more effective in treating OCD.

Madina Alam

Madina Alam

Licensed Therapist, LCMHC

When I started treating OCD, I quickly realized how much this type of work means to me because I had to learn how to be okay with discomfort and uncertainty myself. I’ve been practicing as a licensed therapist since 2016. My graduate work is in mental health counseling, and I use Exposure and Response Prevention (ERP) therapy because it’s the gold standard of OCD treatment.

Tamara Harrison

Tamara Harrison

Licensed Therapist, MA

I have personally struggled with OCD and know what it's like to feel controlled by intrusive thoughts and compulsions, and to also overcome it using the proper therapy. I’ve been a licensed therapist since 2017. I have an M.A. in Clinical Mental Health Counseling, and practice Exposure and Response Prevention (ERP) therapy. I know by experience how effective ERP is in treating OCD symptoms.

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