Obsessive compulsive disorder - OCD treatment and therapy from NOCD

I’m afraid I’ll randomly say a racial slur. What’s happening?

By Grant Stoddard

Sep 4, 20237 minute read

Reviewed byApril Kilduff, MA, LCPC

What does it mean to be racist? The label might be applied in many different ways—one’s views can be bigoted against people of other races, one’s behaviors can be intolerant of specific racial groups, or one can even be inadvertently biased, or participate in systems that perpetuate harm toward underserved populations.

It’s good to be conscious of these things in your life, and even to put effort into thinking about them and working on your own behaviors and beliefs. However, if you’re plagued by unwanted, distressing fears or urges related to racist behavior, even though they go completely against your values and intentions, this could be a sign of a theme of Obsessive-Compulsive Disorder (OCD)

In this article, we will examine this rarely-discussed OCD subtype, describe the impact it can have on people’s lives, and introduce you to a type of treatment that can help reduce the distress caused by fears of blurting out a racial slur—or exhibiting any other form of racist behavior, for that matter. 

Wait—This could be OCD?

If you’re reading this article after searching for answers about the distressing thoughts you’re having, you may wonder why we’re talking about OCD—that’s about washing your hands, checking and rechecking your locks, or having a tidy workspace, right? The truth is that OCD can involve those things, but it can also show up in many other ways, often attacking people’s central values—including their faith, loved ones, or even their belief in racial equality and antiracism. To understand why OCD targets these themes, let’s take a step back and get a high-level view of how this condition operates. 

OCD is a serious mental health disorder characterized by intrusive thoughts, urges, sensations, or images that cause distress—these are called obsessions. This distress provokes people to engage in physical and/or mental behaviors in order to feel better or avoid an unwanted outcome—these behaviors are called compulsions

Avoidance, checking, reassurance-seeking, and other compulsions can and often do temporarily reduce that discomfort or fear. However, by engaging in these behaviors, people with OCD unwittingly strengthen and perpetuate a vicious cycle, making their fears feel more real and reinforcing a vicious cycle over time. 

Contamination, symmetry, and order are among the most well-known OCD themes, but many people’s obsessions can be violent, sexual, and racial. It’s these more taboo OCD subtypes that are most often misdiagnosed by physicians and mental healthcare professionals who have limited familiarity with OCD. This misidentification is one of the key reasons why people spend 14-17 years on average before receiving proper treatment for the condition. 

I would never say that. Why am I so worried?  

The obsessions that kick off the OCD cycle are ego-dystonic, meaning they directly contrast with an OCD sufferer’s true thoughts and feelings. In fact, that’s why they cause so much distress and anxiety in the first place.

Many people are perfectly aware that racial slurs are the last possible words they would ever want to escape their lips—and they generally go through the day without worrying that they could blurt out something horrible. OCD, on the other hand, makes people fixate on exactly the things they fear most, convincing them that even the slightest theoretical possibility of something bad happening is unacceptable: “How can I know for sure that I’d never say that? After all, it’s not impossible.”

The truth is that your worries demonstrate nothing more than your strong aversion to saying something racist. Studies have proven that people with OCD are no more impulsive than others, but they tend to believe that they are, even though that isn’t the case. Dr. Nicholas Farrell, Regional Clinical Director at NOCD, explains: ​​”The prospect of saying your intrusive thoughts out loud is highly unlikely. People in our field have found that having something extremely obscene or offensive on your mind confers no risk of blurting it out.”

Racism-themed OCD

If they have little insight into their condition, people with OCD may convince themselves, regardless of overt racist activity, that they are morally flawed. But if your brain responds to OCD triggers with disgust, worry, or shame, rather than justification, denial, or agreement, that’s a sign that these thoughts or urges are ego-dystonic and oppose your actual values or intentions.

Triggers for racial-themed OCD can vary from person to person, but some common ones may include personal experiences of racism, exposure to racial stereotypes or discriminatory content, fear of offending others, or a heightened sensitivity to issues of race and identity. When these random, unwanted, and ego-dystonic thoughts pop into their heads, people with OCD will feel that they are highly significant, obsessing over questions like: 

  • Am I racist? 
  • Have I recently done something racist? 
  • Am I capable of doing something racially insensitive or harmful? 
  • Can other people tell that I thought that?
  • What if I somehow lost control and said something racist?

As we’ve already discussed, someone whose values or intentions align with racist thoughts or urges wouldn’t grapple with these sorts of questions or feel ashamed, but in people with OCD, these obsessions cause extreme distress. OCD can make them uncertain about their very identity, as the condition is often called “the doubting disorder.”

Someone with racially-themed OCD might fear that they could actively discriminate against a person of another race, cause a person of another race harm, or yell out a racial slur at any moment—even when this is the last thing they would ever intend to do. 

To reduce the anxiety these fears provoke, they may engage in one or several compulsions, whether to reduce their distress and shame or to feel sure that they won’t do something they don’t want to do. These could include:

  • Singling out people of another race to be kind to and going out of their way to do so 
  • Avoiding people of another race for fear of saying a racial slur or some other overt racially-motivated behavior
  • Spending hours on the internet researching whether they could harbor racist feelings
  • Asking friends and family members for reassurance that they are not racist
  • Avoiding public places or other people entirely

Compulsions like the ones listed above may help reduce their anxiety about the possibility of being racist. However, as with all manifestations of OCD, they have the unintended effect of strengthening the OCD cycle. The person may become increasingly anxious that they can’t trust themselves, retreating from social spaces altogether. If they work with people of other races, they may go out of their way to minimize—or maximize—their interactions with them, potentially upsetting them in the process. 

Fortunately, as with all of its subtypes, racial themes of OCD can be treated effectively with exposure and response prevention therapy (ERP), allowing them to live life according to their values, even in the face of uncertainty and doubt.

Exposure and Response Prevention Therapy (ERP) 

Developed specifically for the treatment of OCD, ERP works by exposing you to the uncomfortable feelings caused by your obsessions, while breaking the vicious cycle of OCD as you resist the urge to rely on compulsions for short-term relief. Here’s how it works:

  • Assessment: A specialty-trained therapist will work with you to identify all the racially-themed fears, thoughts, or urges you’re experiencing, along with the associated compulsions or avoidance behaviors you engage in. 
  • Exposure: You’ll be gradually exposed to situations, thoughts, or stimuli that trigger your fears of blurting out a racial slur. These exposures can be imagined or triggered by pictures, videos, or real-life situations, which can be as simple as going for a walk in a public place. 
  • Response Prevention: During the exposure, you’ll be instructed to resist engaging in any and all compulsions. This includes refraining from seeking reassurance, mental rituals, self-isolation, or any other overt or covert behaviors that are done to reduce distress from your obsessions.
  • Habituation: With repeated exposures and prevention of compulsions, your anxiety and distress gradually diminish over time. This process is known as habituation, and it’ll help you learn that their fears and anxieties don’t have to rule your life. As you find that you won’t blurt out offensive obscenities just because you’re worried that you could, you’ll feel more comfortable in the scenarios that once caused you such distress.

ERP therapy for racially-themed OCD can be challenging and emotionally intense. It requires commitment and close collaboration between you and your therapist, who will provide a supportive and non-judgmental therapeutic environment. The goal here is not to make you comfortable with racial insensitivity—quite the opposite: ERP can help you live with confidence in your values, despite your scariest “what ifs.”

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