Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Why does OCD feel so real? An expert’s perspective

10 min read
Stacy Quick, LPC

On a daily basis, your mind is hijacked by intrusive thoughts that seem to go against everything you believe to be true about yourself or the world. You hold your baby and an unwanted thought tells you to drop him on the floor. You go to bed and an intrusive thought tells you to “double check” the door you’ve already made sure was locked 12 times already just in the last hour. While sleeping over at a friend’s house, you have to go to the bathroom every 10 minutes to make sure your bladder is completely empty so you won’t wet the bed.

Rationally, you know that there’s no reason to believe any of these thoughts—so why do you feel like there is? 

If this all sounds familiar, rest assured that so many other people feel just like you. “With every person I treat for OCD, the first thing we talk about is the fact that this feels real, and we’re going to need to figure out together how to react, because OCD feels real to everybody who has the condition,” says Tracie Ibrahim, LMFT, CST, Chief Compliance Officer of NOCD, the leading telehealth provider for OCD. “There’s not one person ever who’s like, ‘No, it doesn’t feel real,’ because then they wouldn’t even care.”

The truth is, no matter what your obsessions or compulsions or subtype of OCD, your thoughts feel real. I can tell you this as an OCD specialist who also struggled with OCD for decades—and learned to manage it through treatment.

But here’s the good news: No matter how real your OCD feels, you can manage it through treatment. In the meantime, learning why your OCD seems so real can offer insight into your condition and why you feel the way you do. Let’s take a closer look.

The real effects of OCD

In the most literal sense, OCD is very real, and so are its effects. It can disrupt many areas of your life including your education, career, and relationships. You might experience physical damage from your compulsions, such as bleeding skin from washing your hands too much. 

Either way, mental health is no less important than physical health. Your experiences are real and they’re valid. With that said, if you’re asking why OCD feels real, you’re likely thinking of your fears and why they feel true even if you know they likely aren’t. 

Ways intrusive thoughts can feel real

Here are some ways OCD can cling to your thoughts and make them feel real:

It plagues you with endless what-ifs. You may know there’s only a slim chance that your thoughts are true. But even a slim chance can be more than enough to have your brain weighing the potential consequences. 

  • What if someone breaks into my home if I don’t check the door for the fifth time tonight?
  • What if I lose control and hurt someone?
  • What if I’m no longer attracted to my partner?
  • What if I get sick from touching this bathroom handle?
  • What if I can’t control myself and want to touch a child?

It demands you to take action. OCD can flood you with unwanted urges. Often, it feels as though the disorder is commanding you to take action, using your worst fears as leverage. It tells you that if you don’t submit to its demands, something bad will happen—and that your “what-ifs” will turn into reality, and you will be responsible when it does. 

Those “what ifs” make you feel like you have to…

It attaches meaning or value to intrusive thoughts. While you’re driving, an image could pop into your mind of swerving your car into another one. You see a cemetery and get an image in your head of kicking a tombstone. You envision shoving someone in front of an oncoming train.

To your OCD, these thoughts aren’t just thoughts. Even if they’re completely out of line with your values, unwanted thoughts like these feel like they must mean you’re a bad person. There’s no separation between your thoughts and who you actually are. In reality, though, OCD is ​​ego-dystonic, which means your obsessions and compulsions generally aren’t in line with your core values.

It paints a twisted picture of real events. If you have OCD, it won’t let you leave the past in the past. You make a simple mistake—perhaps not even a true mistake—and suddenly you’re an awful person. For instance, you see a restaurant closed and remember you left a middling review a few months ago. Your OCD tells you that your review is what destroyed their business, and you’re responsible for employees and their children going hungry. You can’t shake off the possibility that maybe, if you hadn’t left that review, those employees would still have jobs.  

Intrusive thoughts don’t have to feel real

People who don’t live with OCD can have the very same thoughts, images, and urges as those who do have OCD. In fact, one study found that about 94% of participants who weren’t diagnosed with a mental disorder had intrusive thoughts. Yet people without OCD are mostly unphased by these thoughts, simply because their brains don’t attribute a false sense of meaning, urgency, or “reality” to them.

In fact, if you asked someone without the disorder whether they experienced these same thoughts, they might say they don’t. That’s because without OCD getting in the way, your brain is designed to weed out unhelpful, unneeded information. When your brain filters out unnecessary and faulty information, it can determine what actually needs your attention.

If you don’t have OCD, you can observe your thoughts and pay so little attention to them that they may not even register. Even when you do notice an intrusive thought, you can very readily dismiss it as “silly” or “weird.” You might think to yourself that it came out of nowhere and shrug it off, having enough confidence that it didn’t mean anything.

But if you have OCD, this process doesn’t work the same way. When you have a thought, image, sensation, feeling or urge that goes against your values, you stop and pay attention. You get stuck on these thoughts and OCD attributes meaning to them, and are left feeling like your thoughts are real, because you don’t feel 100% certain that they aren’t true.

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How uncertainty can make OCD feel real

“Many people with OCD say that their fear feels so strong that they become almost convinced it may happen,” says Kimberley Quinlan, LMFT, who specializes in OCD. Even if you know you have OCD, your uncertainty is so powerful that you feel you have no choice but to do compulsions to try to prevent your fears from coming to fruition.

In other words, your obsessions can have a strong pull and the “what-ifs” can be overpowering. Even if you know that something is highly unlikely or even impossible, you might feel that there is a possibility that some feared outcome could happen, even if it’s a one in a trillion chance—and that’s enough for OCD. it can take hold of the slightest uncertainty and magnify it.

To understand why OCD feels real, it’s important to understand the role of your body’s alarm system. When you have OCD, you often want to get rid of distress. To be clear,  anxiety like this is not a bad emotion. It may feel unpleasant, but it serves an important purpose. You need your stress response. It helps you survive.

Stress feels intense. Your brain is trying to get your attention. It is screaming at you to do something, to fight, flee, or freeze. You’re flooded with chemicals such as adrenaline to prepare you for the worst. That’s an advantage when there is a real danger present. “So if you hear a glass breaking in the next room and somebody screams, the way we are built as humans is that we get the alarm, like ‘That was shocking and terrible and I have to solve it quickly, my life might be in danger,’” says Ibrahim.

However, this reaction is not useful when you have OCD and are experiencing intrusive thoughts. ​“You get a false alarm that something is urgent or terrible and that you have to react, and you get a natural release of chemicals because of your fight-flight-freeze response,” says Ibrahim. Your mind sends you signals that you need to do something, even though there is no real risk. It is yelling at you that you need to take action. This is why OCD feels so real. “It’s actually a chemical response that happens after the alarm goes off.”

It is a very real process taking place in your brain and body. So when you’re in the grips of worry that you’ll get sick and die if you don’t wash your hands again, the same alarm is going off as if you were actually in danger. “​​Your brain doesn’t know that it has OCD. It can’t be like, ‘Oh, that’s an OCD alarm. I’m gonna ignore it.’ So it feels exactly like a real emergency,” says Ibrahim. “It feels real because it is real in your mind. The thought or image or urge may not be in your reality, but your response and how you feel is that it’s real.”

The problem is that it is a faulty alarm; there is no actual danger. When you have OCD, you are left feeling all of the signals that there is imminent danger. And by doing compulsions, you’re not giving your brain any evidence to the contrary. Instead, it reinforces the idea you need to do compulsions to stay safe. 

Specialized treatment can give you a new perspective

The only way to convince your brain that your fears aren’t warranted is to act like they aren’t—by not giving into your compulsions—and allow your brain to learn that intrusive thoughts and worries aren’t actual threats. That is the core of exposure and response prevention (ERP) therapy, the a specialized form of therapy that was developed specifically for OCD.

The best way to practice ERP and manage intrusive thoughts is to work with a therapist who has specialized training in ERP.. This type of therapy retrains your brain to know that there is no real danger. It teaches you that thoughts, feelings, and urges do not have to have meaning. They can just be background noise. “You can have your alarm go off. You can have all those feelings happen, and you can still choose not to freak out. You can choose to accept that that’s what it is,” explains Ibrahim.

Through ERP, you face your fears in a safe environment under the guidance of a trained therapist, and you resist the urge to do compulsions. You start with fears that only bring a small amount of distress, and as you build confidence, you work your way up to bigger ones. In doing so, you learn that although it may not be comfortable, you can tolerate the distress.

“Once you’ve gotten some ERP success under your belt, that same alarm might go off, but it’s not going to set off at a 10 out of 10 freakout,” says Ibrahim. “It’s going to set off maybe as a two or three freakout which is not a freakout. It’s just a little alarm saying you’re uncomfortable, and you’re like ‘what else?’ and it goes away quicker.” She has many different themes of OCD—such as checking, contamination, harm, and more—and ERP has helped her manage all of them. “My OCD is like, ‘What? React!’ and I think, ‘Let me see here. Nope, that is clearly unreasonable.’ And I just go on with my day because I’ve been doing ERP for so long that it keeps me well,” she says.

NOCD Therapists specialize in treating OCD

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Taylor Newendorp

Taylor Newendorp

Network Clinical Training Director

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.

Gary Vandalfsen

Gary Vandalfsen

Licensed Therapist, Psychologist

I’ve been practicing as a licensed therapist for over twenty five years. My main area of focus is OCD with specialized training in Exposure and Response Prevention therapy. I use ERP to treat people with all types of OCD themes, including aggressive, taboo, and a range of other unique types.

Madina Alam

Madina Alam

Director of Therapist Engagement

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.

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