Obsessive compulsive disorder - OCD treatment and therapy from NOCD

How It Feels to Have OCD: Why OCD Thoughts Feel Real

9 min read
Patrick Carey
By Patrick Carey
  • Obsessive-compulsive disorder, or OCD, is a prevalent mental health condition that can be chronic.
  • OCD is fairly common, affecting 1 in 40 individuals.
  • OCD is characterized by unwanted intrusive thoughts, images or urges (obsessions) that cause distress and drive people to engage in compulsions.
  • Intrusive thoughts represent one major grouping of OCD symptoms. They are recurring and unwanted thoughts that feel impossible to stop and are often scary or disturbing to the person experiencing them. 
  • To learn more about intrusive thoughts (aka “OCD thoughts”), visit the NOCD blog.

Every day, from the time I wake up to the time I finally go to bed, I’m overwhelmed by disturbing thoughts that I don’t want to have. They’re usually about things that matter a lot to me, and I’ve started doing specific things (sometimes over and over) just to make sure the thoughts won’t come true. I’ve also been avoiding situations that might bring the thoughts back. Why do I feel like this all the time?

If you’re asking yourself this, you’re not alone. In movies and on TV, OCD is usually portrayed as perfectionism or germaphobia. People also tend to think of it as an odd or frustrating personality quirk. But OCD is actually a debilitating and usually chronic psychiatric disorder. It’s also fairly common, affecting 1 in 40 individuals.

What is it like to have OCD?

Let’s say you’re a 12-year-old kid and you’ve just gotten home from a tiring day at school. You just want to fly through your homework and go spend time with your friends, but your mom reminds you that you still have to clean your room. You’re not going to convince her, so you’ll do it as quickly as possible. You start to tidy things up, but then a thought pops into your head: “My sister is going to die unless I do this right.”

Instead of focusing on school, work, family, friends, health or recreation, people with OCD end up spending their time and energy on compulsions. Most of them know this behavior is illogical, but this doesn’t convince their brain that it can take a break.

The thought terrifies you. Your head starts to spin: “Oh no, this means I really have to get this right, or she’s going to die and it’ll be my fault.” This is why I always tell mom I can’t clean my room, but she doesn’t get it. Your stomach feels sick, you’re getting dizzy, and you feel like you just have to tell someone about the thought. But it’s a crazy thought, and you know it, so you don’t tell anyone. You put everything back on the floor and try again. You fold your green shirt, and then the blue one, and finally the red. You think, “If I don’t get this right in the next two tries, she’s going to die.” So you start over again, completely panicked.

This isn’t an extreme case meant to shock you. It’s adapted from a real patient’s story, and it’s typical of the condition. In this case, the first intrusive thought is, “My sister is going to die unless I do this right.” The obsessions come next: “Oh god, this means I really do have to get this right.” The bodily distress coincides with the obsessions, and the two build on one another to become seemingly unbearable. Then, to protect the sister and get rid of distress, the compulsion: folding things in a specific way. Although the logic of our world doesn’t suggest any connection between folding clothes and a sister’s wellbeing, the logic of this person’s mind tells them it does.

Instead of focusing on school, work, family, friends, health or recreation, people with OCD end up spending their time and energy on compulsions. Most of them know this behavior is illogical, but this doesn’t convince their brain that it can take a break and stop seeking certainty all the time. That’s why explaining to someone with OCD that their actions are irrational probably isn’t doing them any good. They already know this; in fact, their frustration at the impossibility of controlling their thoughts and compulsions despite knowing that they are irrational is itself a source of suffering.

OCD can wreak havoc on every part of someone’s life. It doesn’t help that the people around them misunderstand their symptoms, calling them control freaks, neat freaks, obsessive, “sort of OCD” or whatever else. As it turns out, people with OCD don’t really want control (in the form of neatness, or cleanliness, or whatever else). They feel like they need control because their mind is constantly telling them things aren’t all right, and because lacking control leads to overwhelming distress.

In some cases, OCD symptoms can become so severe that people consider suicide. If you ever consider suicide, please call your local emergency number or go directly to a hospital. In the United States, you can also call the Suicide Hotline at 1-800-273-8255.

What are OCD thoughts? How to know if your intrusive thoughts — or unwanted thoughts — are from OCD

Here are examples of intrusive thoughts, images, urges, sensations and memories. Photo via Valentin Salja/Unsplash

You hear an awful lot about “intrusive thoughts” as one of the key components of obsessive-compulsive disorder (it’s the “obsessive” part). But did you know that intrusive thoughts can show up in many ways beyond just words in your mind? They can take the form of unwanted images, sensations, ideas, memories and urges.

These can take many forms. Some people are preoccupied with excessive thoughts about germs or contamination, some with rigid morality, some with a need for symmetry, balance, or numerical patterns. One common form of OCD involves intrusive thoughts of terrible things happening.

Imagine yourself in a situation that really matters to you. Maybe you’re in an interview for your dream job, or meeting your infant nephew for the first time. Now imagine the very worst, most disturbing, outcomes your mind can come up with. You get a phone call during the interview and find out you’ve got terminal cancer, you go crazy while meeting your nephew and stab him to death. For most of us, these thoughts seem “messed up” or funny, because they’re so out of place. But for someone with OCD, these disturbing thoughts might feel like real possibilities — even if that person knows their thoughts are probably irrational. The more they fight their own thoughts or try to protect against them, the more they tend to get “stuck.”

As you might guess, these thoughts make people feel deeply uncertain about some of the most important aspects of their lives. Unable to feel like their thoughts are just thoughts, people with OCD develop a strong distress response — their mind and body go on high alert. Tolerating this distress is extremely difficult, so people feel the need to do something about the thoughts. Sometimes it’s about trying to make sure the thoughts don’t come true, and other times it’s about escaping the pain of having the thoughts at all.

Examples of intrusive thoughts, images, urges, sensations and memories

OCD and unwanted thoughts

When it comes to intrusive thoughts, this example is the most common: simple statements that come to mind in basic sentences or even just highly charged words. Example: “I’m contaminated after touching that public bathroom door with my bare hand!”  

OCD and unwanted images

If you are a more visual thinker, your intrusive thoughts may appear as extremely vivid static images or mini-movies playing on the screen of your mind. Example: A flash of a scene of your loved ones bloodied on the floor as you murder them with a knife. 

OCD and unwanted sensations

Perhaps you have noticed a sensation somewhere in your body that gave you pause, something that felt out of context or caused you to worry about what it meant that you felt it. Example: A sudden irregularity in your heartbeat while you are sitting on the couch watching TV.

OCD and unwanted ideas

These intrusive thoughts tend to show up as those pesky “What if?” questions that our brains just love to dream up and pitch to us at any given moment. Example: What if I pushed the guy in front of me into the oncoming train?

OCD and unwanted memories

Real events can be part of OCD, in addition to imaginary scenarios the disorder dreams up for you. This is a particularly sneaky trick that OCD tries to play, because if it can root itself in something that actually happened. The real-life basis of an idea makes it seem like a more real problem for you to pay attention to (Hint: It’s not). Example: Recalling over and over the time you made a social blunder in elementary school.

OCD and unwanted urges or impulses

Sometimes intrusive thoughts aren’t verbal or visual but more physical. You may feel an urge to do something or act out in some way that is inconsistent with who you are as a person and the values you hold. Example: You’re standing on your roof deck and suddenly have the urge to jump.

Your intrusive thoughts may show up in just one form or in a mishmash of forms. Either way, there’s relief: Exposure and response prevention (ERP), a type of cognitive behavioral therapy (CBT), is considered the gold standard of treatment when it comes to OCD. Read on for more information about ERP therapy.

How to treat and overcome OCD intrusive thoughts

Intrusive thoughts make OCD feel inescapable. They’re in your mind and body, but you feel like you can’t control them. Photo via Tachina Lee/Unsplash

Intrusive thoughts are a commonly known symptom of obsessive-compulsive disorder, or OCD. These unwanted thoughts pop up in your mind, whether or not they’re rational or in line with your values and beliefs.

Everyone has this kind of thought once in a while. They picture having sex with a coworker, even though they’re married. They look at an annoying fellow commuter and think, “I could push him in front of the bus and no one would notice.” For people without OCD, those moments pass as quickly as they come, but OCD forces you to fixate on those intrusive thoughts. The thoughts feel inescapable. They’re in your mind and body, but you feel like you can’t control them. You know they’re not rational, but you feel compelled to let them direct your behavior. They demand that you do something to make them go away — often a compulsive behavior.

The gold standard for OCD treatment, and for dealing with intrusive thoughts, is exposure and response prevention therapy, or ERP. This powerful behavioral approach teaches you how to tolerate intrusive thoughts without turning to compulsions.

In ERP therapy, you work with a trained therapist who works with you to design exposure exercises specifically geared to your needs and goals. Each exercise puts you into a situation that usually generates anxiety-provoking intrusive thoughts. Instead of doing a compulsive action, you sit with the anxieties and worries and choose a different, more adaptive response.

As you work through your ERP exercises, you learn that you can handle intrusive thoughts and the anxieties that go along with them. In time, most people find that their anxiety decreases and their intrusive thoughts become much less problematic. Sometimes, those intrusive thoughts even fade into the background.

At NOCD, you’ll find a skilled team of therapists who can help you overcome your intrusive thoughts with ERP therapy. Schedule your free 15-minute consultation today and start taking intrusive thoughts out of the driver’s seat.

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Taylor Newendorp

Taylor Newendorp

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.

Madina Alam

Madina Alam

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.

Andrew Moeller

Andrew Moeller

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.

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