Like many who struggle with OCD, I am intimately familiar with its tricks and the seemingly infinite masks it wears as it seeks to disrupt and disturb. It took many years of confusion, self-judgment, and anxiety before I learned that what I had dealt with for so long had a name and that I was not, in fact, a terrible person. Since OCD is so often undiagnosed or misdiagnosed (the average time between symptom onset and receiving appropriate treatment is 17 years), I want to offer a brief primer for those of you who recently received a diagnosis, suspect you might have OCD or are just curious. Here are five things I wish I knew about OCD a long time ago:
Intrusive thoughts do not make you a terrible person. This is a tough one to grasp because OCD has a way of latching onto the things that we care most about or fear above all else. A core facet of intrusive thoughts in OCD is that they are “ego-dystonic,” or at odds with one’s sense of self or values.
In the whirlpool of repetitive, repulsive thoughts, it is easy to feel that you are the *only* person who has ever thought such terrible, appalling, or unspeakable things. It is crucial to know that, as humans, our subconscious mind is always churning out bizarre, odd, and sometimes disturbing thoughts. These thoughts can strike with such intensity that it feels like they must illuminate some profound truth about one’s self. As terribly significant as some intrusive thoughts may feel, they do not actually say anything about who you are; if anything, the very act of being disturbed or repelled by intrusive thoughts puts you on the opposite end of the spectrum from someone who seeks out or enjoys such thoughts.
In his powerful book The Imp of the Mind, Dr. Lee Baer discusses just how commonplace such thoughts are in the general public. I don’t mention the prevalence of intrusive thoughts to minimize their distressing nature, but to serve as a reminder that having OCD does not make you a terrible person any more than having an occasional thought of violence, blasphemy, or sexual transgression makes a “normal” person a monster.
The things that seem like they will help in the moment will only set you back.
With OCD, the odd, distasteful, or downright disturbing unwanted thoughts that the average person occasionally experiences are elevated to existential threats. In the face of such fear and pain, it’s no wonder that we try to fight or flee. The quest for relief from such torment can take endless forms, from visible, overt behaviors to private, covert thoughts or rituals.
As anyone who deals with OCD can tell you, these approaches can offer relief! The problem is, they don’t work for long and when their relief fades, you are left with an intrusive thought that is now immune to all prior compulsive behaviors or rituals. I think of compulsions like drugs: with repeated use, you develop increasing tolerance to their desired effects until seeking that relief becomes a problem. For example, washing your hands twice after taking the bus might quell worries of contracting an infectious disease, but soon it takes three times, then four, and eventually washing almost constantly in order to fight off the ever-growing fear of infectious disease.
This progression shows how the things that seem most helpful often end up magnifying the very thoughts we want to avoid. By seeking relief through avoidance, distraction, reassurance, or ritualizing, we reinforce the idea that these thoughts are to be feared and that we must be ever vigilant to protect ourselves from another “attack.” In my own life, I know that the less I seek reassurance, the faster my anxiety diminishes, even as it takes great trust and acceptance to do so.
Treatment is not supposed to get rid of all disturbing intrusive thoughts.
Who among us has not said, “I would do anything to never have this thought again!” Of course, we want to get rid of that which torments us, drags us down, or gets in the way of living the life we know we are capable of. However, expecting to “pull a Men in Black,” as one astute client put it, and erase every distressing thought from our experience is a recipe for disappointment, as weird, odd, or taboo thoughts are just part of being human.
The goal of treatment is to learn that these disturbing intrusive thoughts are just that—thoughts-- they pose no danger other than that which we assign to them. The primary way to achieve this is through exposure and response prevention therapy or ERP. The “exposure” element is self-explanatory: you gradually expose yourself to increasingly anxiety-provoking stimuli either in your imagination or in real life. The second part, “response prevention,” is crucial. It involves sitting with the anxiety and discomfort that accompanies the imagined or lived situation and *not* engaging in whatever compulsions or rituals you would normally turn to for relief.
Through repeated exposure and response prevention, you learn that you can endure the intrusive thought or anxiety-provoking situation without engaging in the internal or external behaviors that have fed the very thoughts you’ve tried so hard to avoid. This means that, while you will still experience intrusive thoughts, they have become a nuisance that you can ignore rather than an imminent threat to be feared and avoided. One of my favorite phrases is “what you resist will persist:” by not fighting distressing intrusive thoughts, they often become less frequent or intense. ERP can be challenging, but it is nowhere near as difficult as continuing to live with OCD as so many of us have known it.
Compulsions include far more than hand washing, checking, or counting.
Beyond the harm of portraying OCD as a charming personality quirk or the butt of thoughtless jokes, pop culture depictions of OCD tend to ignore all but a few highly visible aspects of the disorder. Prior to being diagnosed myself, I thought of people who struggled with OCD in just such a limited, superficial way, like people who can’t stop checking to make sure they didn’t leave the stove on, or those who scour every surface with antiseptic wipes to avoid germs. While OCD that manifests in these ways can be debilitating, I profoundly underestimated the immense variety, intensity, and function of compulsions, and I know that I am not alone in this.
The compulsive side of OCD can show up as the well-known overt rituals of hand washing; picking at or repeatedly examining areas of somatic concern like a cut, a mole, or a pimple; counting or tapping in a particular order until it is done “just right;” or checking behaviors like repeatedly ensuring that a door is locked. Hiding behind these more readily recognized behaviors is an entire world of less known compulsions. These rituals can seem ridiculous, distressing, or just plain odd, and I believe this makes them more difficult to talk about or to recognize as part of OCD. These can include overt behaviors like turning your car around to check an intersection to ensure that you didn’t cause an accident, avoiding sharp or dangerous objects out of fear of perpetrating violence or saying words or phrases aloud to “neutralize” an intrusive thought.
Private, internal, or covert compulsions can be even more difficult to recognize. These can include checking for signs of sexual or physical arousal in response to an intrusive thought, endlessly rationalizing or arguing with intrusive thoughts, seeking reassurance via the Internet or other people, mentally reviewing past actions to try and figure out if you are “safe” from a perceived threat, or silently repeating mantras or prayers “just right” in order to avoid a feared thought or event.
Above all, OCD is far more diverse than many of us may have thought. If you have experienced some of these lesser-known compulsions, please know that you are not crazy, nor are you a bad person; you are dealing with distressing obsessions and intrusive thoughts in a way that feels useful, even though these rituals or compulsions may not actually help (see point #2).
You are not alone, and there is hope.
I understand how difficult it is to talk about distressing intrusive thoughts or sometimes irrational things we do to avoid them. Because of the unsettling nature of intrusive thoughts and compulsions, OCD both encourages and thrives on remaining silent about those things that cause us guilt, shame, fear, or intense anxiety, creating a self-perpetuating cycle of isolation among people who deal with OCD. Opening up about my own OCD was one of the most difficult things I’ve ever done; it was also one of the most important. The relief I feel at knowing I’m not alone continues to help me live my life even when OCD tries its best to get in the way.
If you have ever felt helpless or hopeless in the face of OCD, please know that there is a way forward. Therapy can be an immensely powerful tool for breaking the bonds that tie us down, and while it takes work, you have already proven that you can face great challenges. Above all, I want to tell everyone struggling with OCD that you are not alone, and that there is hope.
Brooks Canaday is a therapist at South Platte Counseling Group in Englewood, CO. He received his Master’s degree in Clinical Mental Health Counseling from Regis University and is a licensed professional counselor candidate. He believes in helping others through sharing compassionate acceptance, reducing shame, and connecting with personal values in order to thrive and find meaning in life.