A question many people who are experiencing symptoms of Obsessive-Compulsive Disorder (OCD) have is, “why does my OCD keep switching themes?” This is something I have experienced myself in my own recovery journey. In fact, I can clearly attribute periods of my life to particular OCD themes.
As a very young child, I had fears about the safety of my loved ones. I worried about sinning or being bad. I worried about lying and being seen as immoral. As I grew up, my fears shifted to worrying about potentially poisonous items, particularly gas. Later, in my teens, these specific fears weren’t as prevalent, as the content shifted to more age-related concerns. I worried more about taboo themes as I ventured more into contamination rituals. Then came the harm themes—and the list could go on and on.
Just as I would seem to put one fear to rest, an onslaught of others would come. It was like my brain needed something to worry about. It wasn’t even as though the original theme would just disappear; it would just become quieter and seep into the background. This allowed for a different obsession to become louder, making itself known. Even all these years later, this pattern continues.
So why does this happen? Change, feeling less in control, and the unknown are things that seem to impact OCD symptoms. Some members I have worked with will often point out that their symptoms worsen around times in their lives when there is a great change. Some commonalities I have seen are major life events, starting college, getting married, having children, the death of a loved one, and other transitional times. That’s because whenever someone is experiencing change, good or bad, there can be stress. Stress, of course, impacts mental health. Therefore, It makes sense that when an individual is under more stress, an underlying mental health condition would be impacted.
OCD looks for certainty
Many people with OCD are also people who feel on a very deep and personal level. They are likely people that care for many different people and things. Is it bad to care too much? No, of course not—not when it is manageable and within reason. But some people with OCD tend to be individuals who feel a sense of over-responsibility for others and for things that happen in the world around them. They want to “fix” or prevent any perceived issue and find out why it happened in the first place. They want to understand the reason behind the suffering. These characteristics can be seen as good qualities—and yet the flip side is that they can become unmanageable and become a very debilitating way to live one’s life.
OCD isn’t just being overly conscientious and thoughtful, though that often does accompany the person with this condition. OCD can cause a heart-wrenching need to take care of everything and everyone. At its worst, it can blind a person from seeing the truth and from experiencing genuine freedom.
At its core, OCD wants to control every minute of every day, to make you feel as though you are in control. This all-invading sense of responsibility causes deep distress in the person with OCD. OCD demands certainty and doesn’t rest until it finds some semblance of it. Unfortunately, that leaves many individuals caught up in a constant search for something that doesn’t actually exist. It’s a perfect recipe for exhaustion and frustration.
It seems that OCD latches onto the very things that are important to a person and that they value the most. It stands to reason then that these topics would change from time to time. As we grow and develop, our belief systems are challenged, and we evolve. We start to look at the world from different perspectives. We are no longer the same person that we were. This happens time and time again as we walk through life. It is inevitable.
As we change and shift, so does OCD. The way in which it once was able to torment and debilitate you, no longer works, so to speak. This is why I often say that OCD is cunning and creative. This disorder targets what you find important.
At the root of OCD are doubt and uncertainty-OCD causes you to question the very things that bother you the most. Having OCD is like having your very own “build-a-bully”- but with a whole lot less cuteness than a Build-a-Bear store. It is constantly changing as we change. That is why OCD content changes from time to time and from person to person.
What it can look like over a lifetime
OCD will look different for everyone. OCD can be very specific and unique, and it can also be elusive and vague. Some people experience very particular obsessions and compulsions, while others will say there is no specific thought, just a generalized feeling. It is important to recognize that regardless of the way that one experiences it, it is still OCD.
Below are some examples of common, more classical presentations that Alan encountered throughout various developmental timelines:
- As a child, Alan just started school. It is the first time he will be away from his mom for a long period of time. He settles in and starts working on drawing shapes when suddenly he is inundated with thoughts and images about his mom dying. He feels compelled to re-draw every shape until the thought isn’t present anymore.
- As a teen, Alan refuses to continue in his driver’s education classes alongside his peers. This causes conflict with his parents, as they want him to take the class to gain driving experience and set him up for success. They know that this is a rite of passage of sorts for teenagers. They cannot wrap their head around why he doesn’t seem interested at all in continuing. What they don’t know is that Alan has become terrified that he will run someone over or cause a car accident. He has flashes of gruesome car wrecks every time he hears of anything to do with driving.
- At age 18, Alan is soon off to college. Though he’s now a college student, he is ashamed to admit it but he hasn’t ever been on a date before. The reason behind this is even more embarrassing to him: He doesn’t feel certain that he is attracted to anyone. Every time he wants to like someone or pursue more than a friendship, he feels guilty. He worries he is leading them on and that he is being deceitful.
- As an adult, Alan just became a father. He is nervous and excited all at once. The first night that his baby is home, a horrifying thought enters his mind: What if I sexually abuse the baby? He cannot seem to go near his son and makes up excuses why he cannot change the baby’s diaper or feed him.
As the example shows, OCD can be triggered by anything at any time, and in different ways. At the same time, there is hope and help—OCD is very manageable. You can learn how to cope with the underlying core fears that are often hidden under various themes. Ask yourself, what am I really afraid of? Often people will say that others may think they are bad, they are unloveable, they are dirty, etc. The list can go on forever. But once you know what you are truly afraid of, you can begin to tackle the symptoms that are holding you hostage.
Remember the bottom line is that OCD wants certainty, it wants to insert doubt about who you are and what you are capable of. The catch is that it will never be enough. It is an impossible feat. That is why we need to learn that no matter how horrific or distressing the content of the thoughts may seem to us and how strong the pull for certainty is, that we do not need to engage.
The good news is that with the practice of non-engagement of the obsessions, you can live a life that isn’t consumed by OCD. You can learn to manage the symptoms of OCD no matter what form they shift into. You can live a value-based and driven life.
Using ERP regardless of the theme
Getting to the point of non-engagement required exposure and response prevention (ERP) therapy, which is the most effective treatment for OCD. ERP helps you resist compulsions, which only relieve anxiety temporarily, and teaches you to accept uncertainty, no matter how upsetting and distressing the thought, image, or urge may seem. By resisting compulsions as a response, you retrain your brain to recognize that you are not in actual danger. The goal of ERP is to learn to manage OCD effectively and to provide long-term relief.
Regardless of the OCD subtype, or the nature of the intrusive thoughts—whether violent, taboo, sexual, or otherwise upsetting and unwanted—all themes of OCD are treatable with ERP. In most cases, people find that ERP helps their anxiety subside to the point where they no longer experience intense fears related to their thoughts on a regular basis.
That’s why a therapist who is specialty-trained in ERP will know how to treat your OCD theme, whether you’ve seen your subtype many times before, or have never heard of anyone else struggling with your specific subtype or intrusive thoughts. But every individual will have a personalized treatment plan when they begin ERP that will be customized to meet their personal needs.
ERP therapy is an active form of treatment and requires intentional buy-in from the member through participation in exposures, a willingness to feel discomfort and honesty with their therapist about their obsessions and compulsions (even if they believe they are shameful or taboo). ERP therapy has been proven to effectively treat people with OCD. About 80% of people with OCD experience positive results, and the majority of people experience results within 12 to 25 sessions.
At NOCD, all therapists specialize in OCD and receive ERP-specific training. They deeply understand all themes of OCD and how they can switch from time to time. If you have questions or think that you may need ERP therapy for your OCD, I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment.