When You Doubt Your OCD Diagnosis—Fears debunked
This is a guest post by Alegra Kastens, a licensed Marriage and Family Therapist who founded the Center for OCD, Anxiety, and Eating Disorders.
OCD is a disorder full of doubt. Repetitive and persistent unwanted thoughts, images, and urges (obsessions) that those with OCD experience cast immense doubt and uncertainty on the sufferer. What if I’m not in the “right” relationship? Could I be a sexual predator? Am I going to snap and harm someone? What if my baby dies in their sleep? Am I not really gay and lying to everyone?
Obsessions are full of doubt, but the doubt does not end there. Many people with OCD end up doubting their diagnosis, which is frightening when they consider what that could mean for them. If the diagnosis is inaccurate, does this make the content of my obsessions true? There is likely nothing scarier for the person with OCD who is so horrified by their obsessions! OCD defies logic much of the time. Even when a person has been diagnosed by a mental health professional, they (and their sticky, creative brain) may come up with a myriad of reasons as to why that diagnosis could be inaccurate.
As a therapist specializing in the treatment of OCD, I see the following fears arise frequently in my clients. I also experienced some of them firsthand when I was in the depths of my own suffering with OCD. Let’s debunk them!
Intrusive Thoughts – Phrases and Commands
Common fear: “I get intrusive thoughts that are more like commands. Thoughts like ‘Shove that person!’ or ‘Drive off the bridge!’ pop into my mind. Is that still OCD or does that mean I actually want my thoughts?”
Fear debunked: Intrusive, unwanted thoughts do not just arise in the form of “What if?” They can arise in the form of command thoughts such as “Do it!” or “You enjoy this!” It can be a terrifying experience for the person with OCD who falsely interprets these thoughts as more meaningful and dangerous, or fears they are experiencing psychosis. The truth is that there is no limit to what the creative OCD brain will come up with. One person with OCD may have repetitive “What if I hurt someone?” thoughts whereas someone else with OCD experiences repetitive “command-like” thoughts such as “Stab them!” While the command-like thoughts feel different, the truth is that they are not inherently more dangerous or worthy of our attention than a “What if?” thought.
A thought is a thought, which consists of words in the mind. Thoughts are not threats. They are not commands that we must act on. They are not actions. They are quite literally words. We get to decide what we do with these words, which gives us the power. Our brain can tell us to put our hands over the stove fire all day long, but the thought has no power so long as we do nothing about it. We do not have to listen to all of the noise our brains produce.
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It’s important to note that intrusive thoughts of OCD are not auditory command hallucinations that people with psychosis can experience. The person with OCD is not hallucinating. The thoughts are coming from inside of them and the person with OCD can recognize that the thoughts are ego-dystonic: opposite to their values, beliefs, and self-concept. The person with OCD is not experiencing a break from reality that a person with psychosis is.
Feelings That “Support” Thoughts
Common fear: “I was really angry at my spouse and had an intrusive thought about stabbing them. This must be evidence that I actually want to harm my spouse. It’s more than a thought. I was actually angry.”
Fear debunked: Intrusive thoughts know no bounds. They pop in when we’re happy, sad, angry, mad, excited, content, bored, and so on. Having a violent intrusive thought arise amidst real anger is not evidence that it is more than a thought, nor is it any more dangerous than when a thought arises when we are joyful. The anger may be real, as all human beings get angry, but feeling angry does not mean a person desires harming someone based on an unwanted thought that has arisen. The key word here is desire. Obsessions of OCD are ego-dystonic, meaning that they are opposite to a person’s values, desires, and self-concept. The person with harm OCD does not desire harming someone or enjoy the thought arising, even amidst real anger.
Intrusive Images/”Mental movies”
Common fear: “I don’t just experience intrusive thoughts. I get scary mental images/mental movies that pop into my mind. Is this not OCD?”
Fear debunked: People with OCD may experience repetitive, unwanted intrusive thoughts and/or repetitive, unwanted intrusive images. Instead of a thought arising about harming one’s spouse, a person with OCD may experience intrusive images of them harming someone. As with command-like intrusive thoughts, this can feel more credible to the person with OCD. But it’s not! It can also feel like psychosis, but an image in the mind that someone with OCD experiences is not a visual hallucination. It’s an image in the mind, which is basically a thought that we experience in a visual format. Intrusive images are common for people with OCD and are inherently no more meaningful or dangerous than an unwanted thought.
Only One Obsessional Theme
Common fear: “My OCD has only ever latched onto the fear of being a pedophile. It has never switched to something else, which must be evidence that it’s my true identity and not OCD.”
Fear debunked: Obsessional themes are nicknames that help people better understand their symptoms of Obsessive Compulsive Disorder (OCD) but at the end of the day, it’s all OCD. It doesn’t matter if you have one obsessional fear or 15 obsessional fears. It is still OCD. Your obsessional theme does not need to switch for your diagnosis to be valid. Many people have one predominant obsessional fear. That’s OCD. It’s all OCD.
Length of Time Suffered
Common fear: “I’ve struggled with this obsessional theme for 10 years and haven’t been able to move past it. This must be real.”
Fear debunked: The amount of time spent suffering does not make obsessions more or less valid. There are countless reasons why someone has had difficulty recovering from an obsessional theme. Maybe a person has not received evidence-based treatment. Maybe they have, but the treatment didn’t stick or click. Maybe they have not found the right medication, if that’s the route they have chosen to take. Maybe they went years undiagnosed and without treatment, as so many people with OCD do. We also know that OCD is a chronic condition. This does not mean that it is not treatable, but symptoms may arise throughout the lifespan if someone has a lapse or relapse.
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OCD Latches Onto One Specific Person
Common fear: “My relationship OCD only latches onto one specific person. My POCD makes me scared of little girls, not boys. This must mean something deeper in my subconscious. Maybe it’s not OCD.”
Fear debunked: OCD is irrational and obsessional fears differ widely depending on the person. One person might get triggered by all children, no matter the age, while someone else might be triggered solely by little girls. Another person might get triggered by all people of the opposite sex, whereas someone else might get triggered primarily by their partner’s best friend who is the opposite sex. At the end of the day, regardless of how many people OCD latches onto, it’s all OCD. You don’t need to be triggered by everyone of all ages and have 15 different obsessional fears for your OCD to be valid. OCD is not diagnosed by the number of obsessional fears or the number of people that fears latch onto. It’s diagnosed by the presence of obsessions and compulsions. An obsession can quite literally be about one specific person. It counts.
You can overcome OCD’s myths
Even when doubts like these feel impossible to get rid of, that doesn’t mean they’re true—and you don’t need to be ruled by them. Recognizing the sneaky traps and tricks that OCD may utilize to try to suck you back into compulsions can help you resist falling for them.
In exposure and response prevention (ERP) therapy, you can work with a therapist to build the skills you need to find freedom from OCD, even when OCD’s myths try to knock you off course.
Alegra Kastens is a Licensed Marriage and Family Therapist and received her master’s degree in clinical psychology from Pepperdine University. She is the founder of The Center for OCD, Anxiety, and Eating Disorders, and practices in CA and NY, and 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.
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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.
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.
Licensed Therapy, LMHC
I've been a licensed counselor since 2013, having run my private practice with a steady influx of OCD cases for several years. Out of all the approaches to OCD treatment that I've used, I find Exposure and Response Prevention (ERP) therapy to be the most effective. ERP goes beyond other methods and tackles the problem head-on. By using ERP in our sessions, you can look forward to better days ahead.