This is a guest post by Alegra Kastens, a licensed Marriage and Family Therapist, founder of The Center for OCD, Anxiety, and Eating Disorders.
“But isn’t this evidence that it’s no longer OCD?” It’s a question I get so often in my work with clients who fear that what they’re experiencing, whether it be command-like intrusive thoughts (i.e. “stab them!”) or groinal responses to sexual obsessions, can’t possibly be a symptom of OCD. They worry that they are the one person to seek treatment with me who is actually the content of their obsessions.
In reality, they are one of many people with OCD who carry this faulty cognition. Furthermore, the reasons people often cite for worrying about their symptoms not being OCD are not so unique. Below, I explore five of the most common ones.
OCD is convincing and knowledge is power. This is not to say that logic makes a person’s symptoms go away, but that understanding the myriad of ways that OCD presents itself can help us see it for what it really is: a liar, a false alarm, and something we don’t need to attend to.
1. The backdoor spike
When an obsession and/or trigger begins to bother you less over time, and OCD realizes that it is not getting the compulsive engagement it desires, it might take another route to hook you (the back door):
“Well…if you’re no longer bothered by this, it must mean that you align with the obsession—that it’s not actually OCD.”
“You’re no longer anxious about changing your baby’s diaper. This must mean that you want to touch them inappropriately…that it’s okay with you.”
“You aren’t as bothered by sexual intrusive thoughts about men as you used to be. This must mean that you really are attracted to them and that you have been lying to everyone about being a lesbian.”
This OCD trap is referred to as “the backdoor spike.” Since you’re not falling for OCD’s usual way in (the front door), it tries another angle (the back door) to trick you into engaging with it again. You may now worry that the lack of anxiety, reduction in intrusive thoughts, and overall symptom reduction is a sign that these thoughts were never OCD, and commence rumination, checking of bodily sensations and emotions, mental reviewing of the past, etc.
In reality, the backdoor spike is often a sign of progress in treatment. It’s a trap that you don’t have to fall for. Knowing that this exists can put you a step ahead of OCD and, if it does arise, you can see it as another false alarm/faulty message from OCD and move on with your day.
2. Groinal responses
Many people with OCD experience intrusive and unwanted sexual thoughts and images about animals, children, family members, and other unwanted subjects. As with all obsessions, sexual obsessions are ego-dystonic: opposite to a person’s desires. So why, as is common, do people experience sensations in their groinal area in response to thoughts that abhor them? It’s called arousal nonconcordance, and it can be incredibly disorienting for people with OCD.
Arousal nonconcordance, popularized by sex educator and researcher Emily Nagowski, refers to a mismatch between a person’s physiological arousal (in the body) and their subjective feelings of arousal (in the brain).
A person might experience sensations, wetness, an erection, etc., in their genital area to something that disgusts them because our bodies are trained to automatically respond to stimuli that are sexually relevant (ex. thoughts of a sexuaI nature), regardless of whether the stimuli are appealing to a person (obsessions are not enjoyable for people with OCD).
Emily likens it to the experiment with Pavlov and the dogs, in which Pavlov paired meat with the sound of a bell, causing the dogs to salivate. Over time, the dogs began to salivate to the sound of the bell alone because they were trained to relate the bell to food. The salivating to the bell was a trained response and did not mean the dogs wanted to eat the bell.
Similarly, experiencing a groinal response to an unwanted thought about a dog does not mean a person is attracted to the dog. It means the body has produced a trained physiological response to content that it has learned is related to sex.
A groinal response is not automatically indicative of desire, nor is it evidence that you align with obsessions.
3. Command thoughts
Intrusive thoughts don’t always come in the form of “what if…” For many, they show up as what I call “command intrusive thoughts”—thoughts that sound like directives to do something:
- Stab them!
- Push them in front of the train
- Touch their boobs
- Kill yourself!
Since these thoughts show up in the form of commands, people tend to misinterpret them as more dangerous and truthful than “what if” thoughts. This is not the case. Whether a thought starts with “what if” or “do it,” it is still a thought. It is still a string of words in the mind.
Having a command thought doesn’t mean you desire it more than a “what if” thought. It merely means that the words in the mind are presented in a different format. They’re still words.
It is important to note that command intrusive thoughts are not auditory hallucinations that those with schizophrenia might experience. If you have OCD, you know that the command thought is ridiculous and unwanted. You are not experiencing delusions.
4. “Urges”
Unwanted “urges” are common for people with OCD and can show up as an unwanted pull to carry out the obsession. I put the word urges in quotations, because I don’t believe the word accurately portrays the OCD experience. Urge implies desire: having the urge to eat chocolate, dye one’s hair, book the trip abroad, etc. People with OCD do not align with or desire to carry out their obsessions. As noted above, it’s quite the opposite. Obsessions are in direct opposition to a person’s desires, beliefs, values, and self-concept.
When someone with OCD experiences an “urge,” what is really occurring is an intense emotion or bodily sensation paired with a scary thought that may present as an inward “pull” to carry out something they don’t align with. For example, those with violent obsessions might feel a pull toward the person on the subway platform. Those with sexual obsessions might feel a pull toward their baby’s genital area. Those with sexual orientation obsessions might feel a pull toward the lips of another person. It’s akin to standing at the top of the Grand Canyon and feeling a pull toward the edge, even though the thought of jumping terrorizes you.
The idea that you could do these things, paired with the feelings and bodily sensations that arise, can create the disorienting feeling of a pull internally. But OCD “urges” are not evidence that a person desires to carry out their obsessions.
Many people with unwanted urges worry that they’re more likely to lose control and carry out their obsessions. This can become an obsession in and of itself. Those same people will often report that they’ve never snapped and hurt someone or lost control of their body. They’re not struggling with impulse control issues. They worry they’re struggling with impulse control issues. There’s a difference.
5. The byproduct of compulsions
Compulsions can backfire and create what feels like evidence for OCD. Checking your feelings about your partner over and over again can chip away at your organic feelings and lead to numbness, causing you to worry that you must not actually love your partner. Checking your groinal area for arousal in response to a sexual obsession can bring on tingling, making you fear that you align with the obsessions. Mentally reviewing the past repeatedly can distort and warp memories, potentially leading to “false memories” that you fear actually occurred. Hypothesizing about sex with someone unappealing to you, to make sure that you’re feeling disgusted by it, can bring on feelings and bodily sensations that seem to support—rather than oppose—your obsessional fears. None of this should be misconstrued as evidence that what you’re experiencing is not actually OCD.
Whatever is brought forth through compulsion is a byproduct of that compulsion, not a reflection of organic reality. In the examples above, the numbness is a result of the checking. The tingling is a result of the focus on a particular body part.
OCD is the world’s biggest gaslighter. Through its convincing lies, false alarms, and visceral symptoms, it can lead you to doubt yourself and the world. After all, OCD is called the doubting disorder for a reason! But when we better understand how OCD operates, we are more equipped to disengage from the lie…to call OCD’s bluff.
If you’re struggling to escape the OCD cycle, you don’t have to feel shame or suffer alone. At NOCD, you’ll find specialty-trained, non-judgmental OCD specialists who deeply understand all the ways OCD can show up—including the sneakiest ways it can try to keep you stuck. NOCD Therapists can help you take back the power from intrusive thoughts with exposure and response prevention (ERP) therapy, the most effective treatment for OCD. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment, and how it can help you start living life according to your true values again.
Alegra Kastens is a Licensed Marriage & Family Therapist and received her master’s degree in clinical psychology from Pepperdine University. She specializes in the treatment of obsessive-compulsive disorder (OCD), anxiety disorders, eating disorders, body-focused repetitive behaviors (BFRBs), and body dysmorphic disorder (BDD). Her passion for OCD treatment, education, and advocacy comes from her own personal experience with the disorder. She understands firsthand the relentlessness of OCD and how painfully it holds one’s life captive. She also understands that relief and recovery are real with a large dose of evidence-based treatment and an equally large dose of willingness.
