Over the years of working as a therapist who specializes in treating OCD, I have worked with so many people who experience intrusive thoughts. The one question that I get asked the most is, “Why do I have these thoughts?”
The answer is simple: everyone has these thoughts. The difference is that someone without OCD has a “filter” system, so to speak, that works correctly. When this system is functioning properly and efficiently, your brain “weeds out” the less important information and takes in information that is useful or needs attention. Unfortunately for those who suffer from OCD, this is not the case. Information that should otherwise be sifted out is presented front and center.
The truth is that OCD isn’t a “thought” problem; it is an interpretation problem and a response problem. In other words, someone with OCD feels—often very strongly—that intrusive thoughts mean something about them, their desires, or their identity. This is where OCD holds its power: the ability to make a person question who they are and what they are capable of. In most areas of life we trust our thoughts and intuition; we trust our head or “gut.” But this causes problems for people who experience intrusive thoughts that feel very real and meaningful.
What makes a thought “meaningful” will vary from person to person. It will also shift due to life circumstances. Often, the reason that a particular theme or thought gets “stuck” for a person with OCD is because it deals with something especially important to them. Usually, it’s quite negative; they don’t want the thought to be true, but they feel that it must be. Why else would they have the thought? However, when someone has OCD, this typically couldn’t be further from the truth.
The OCD cycle
Intrusive thoughts that occur with OCD are ego-dystonic, meaning that they go against a person’s nature. The thoughts involve something important to them, so their brain falsely sends a message that the thoughts have meaning and are dangerous—they feel like they pose a threat that they have to address. This leads to feelings of anxiety and distress which only strengthen the idea that they are in actual danger. As a result, they feel the need to neutralize the threat in some way: by gaining reassurance about the danger, by making sure they are completely safe from their fear, or by doing everything in their power to avoid an outcome, for example.
These actions are known as compulsions. Since there is no real danger, however, the compulsions do nothing to actually keep them safe or prevent intrusive thoughts, and only reinforce the idea that these intrusive thoughts pose a threat. The next time the thoughts present themselves, the urge to respond with compulsions is even stronger.
What are examples of these thoughts?
If you read much about OCD you will come across the term “taboo thoughts” frequently, referring to any thought that a person feels goes against their values, or against societal norms, morals, or laws. It is vital to note that these can vary and can take on any form—OCD can be extraordinarily creative. Remember that when someone has OCD, they find these thoughts to be incredibly distressing. Many report feeling severely disgusted by or troubled by the thoughts, because the thoughts are so opposed to their identity and values.
Here are just some of the ways in which OCD may manifest through intrusive thoughts:
- Shelby is in a public restroom and sees what looks to be a red speckle on the sink. She is convinced that it was blood that is HIV positive. Even though she understands how HIV is actually spread, she now fears that everyone she comes into contact with will contract HIV.
- Bailey has thoughts that we are all living in a fake universe, and she wonders if we are all just in some huge computer game. The more she looks for proof that it’s not true, the more her worries persist, and the less sure she feels about her life.
- Juan wrestles with the thought that as a child he would chew on his hair. He cannot shake the idea that he has committed cannibalism, and that his hair chewing must mean something about his true nature.
- Mariah avoids being near anyone who is elderly; she has intrusive thoughts that inhaling while near them will cause her to die soon.
- Ken’s wife is pregnant with their first child. One day while hugging her he has a thought that he has molested his unborn child and that he won’t be able to trust himself as a father.
- Lila has just finished 1 alcoholic beverage and is feeling fine, however, she suddenly has thoughts that she is not herself and that she will do something horrible while she’s under the influence.
It’s important to realize that these thoughts are often repetitive. The more someone pays attention to a thought or engages in a compulsion in response, the more likely it is that the thought will return.
ERP to treat intrusive thoughts
Taboo intrusive thoughts often cause people to worry that there is something wrong with them, that the thoughts are simply a part of who they are. This couldn’t be farther from the truth: intrusive thoughts in OCD are disturbing because they oppose your real values, identity, and intentions. The suffering caused by OCD is not “just the way it is,” and you don’t have to live with it the same way forever. OCD is highly treatable with Exposure and Response Prevention (ERP) therapy, a form of therapy that was developed specifically to treat OCD and that is backed by decades of clinical research demonstrating its effectiveness.
ERP breaks OCD’s vicious cycle of disturbing obsessions and compulsions that reinforce them. Working with a therapist who has been trained in ERP, you are guided through exposures, or controlled exercises in which the fears and anxieties related to your obsessions are triggered. With the guidance of your therapist, you then resist the urge to engage in compulsions and simply let the feelings of anxiety and distress pass. Over time, you learn that you are able to tolerate uncertainty and other unpleasant feelings, and that your life does not have to be guided by intrusive thoughts and anxiety. Likely, the intrusive thoughts will cause less distress over time, as well.
If you’re struggling with OCD and want to take the power away from your intrusive thoughts, NOCD can help. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment. 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, bringing the best care to our members.