Intrusive Thought OCD
Obsessive-compulsive disorder (OCD) comes in a variety of shapes and flavors, but there are primarily four main types. These four types are contamination OCD, checking OCD, “just right” OCD and intrusive thought OCD. Many people believe that OCD is primarily concerned with being organized and tidy, and while this certainly is one of the flavors of OCD, it is by no means the only or even the main type of OCD. In this post I will talk about the intrusive thought version of OCD and in subsequent posts I will talk about the other three varieties. Intrusive thought OCD is one of the less easily recognized versions and most people haven’t even heard of this kind. Even many professionals that I have met and worked with are not familiar with this kind of OCD. In intrusive thought OCD the sufferer is plagued with horrific thoughts involving doing something that is completely foreign to their value system. Whatever is most opposite to what they value and whatever is dearest to their heart this is what the OCD targets. The two primary versions of intrusive thought OCD are inappropriate sexual thoughts and harming thoughts.
The sexual thoughts can involve thoughts such as having sex with an inappropriate partner (such as mother, father, grandparent, sibling or child), having sex with animals, having sex with a cherished person (such as a minister or priest or Rabbi, or even figures such as Jesus), forcing sex on an unwilling partner, or almost any type of sexual act that could be considered inappropriate. The harming thoughts follow much the same pattern and usually involve thoughts of hurting or even killing a family member, loved one, stranger, etc. The person with OCD is typically horrified by these thoughts.
Once the person with OCD notices that he or she is having these kinds of thoughts, how they typically react to the thoughts actually perpetuates the problem. Understandably, a typical response would be to try to resist or get rid of these thoughts, which actually has the paradoxical effect of making the thoughts more “sticky” and harder to get rid of. What we resist tends to persist. So the more the thoughts are resisted the more they keep coming back and the stronger they get. The more these thoughts come back the more they are resisted and so the sufferer becomes even more convinced that there’s something terribly wrong with them because these thoughts won’t go away. Ultimately they fear they could lose control and act on their thoughts. The sufferer then might engage in a variety of rituals all designed to either prevent the thoughts from showing up or trying to neutralize the thoughts once they do show up, and neither of these strategies is effective at all and in fact they both lead, once again, to having more of these thoughts in the long run. This resistance to thoughts occurs because the sufferer is horrified by them and afraid of what these thoughts might mean about them. They may believe that because they have these thoughts that on some deep level they really want to do the acts they’re thinking about and that having these thoughts reveals their “true character” and that they really are at risk of acting on their thoughts. Of course, none of these beliefs are accurate, but once the sufferer is caught within the web of the OCD it is difficult to see a way out. It is somewhat like getting caught in quicksand: the more you struggle the deeper you go. Or as Sharon Davies has said “the more you think the deeper you sink.”
There are multiple ways in which this kind of OCD is insidious and devious. I have often used the metaphor with my clients of facing a martial arts expert with a 10th degree black belt who is extremely skilled and knows just how to penetrate my clients defenses. My clients search in vain for reassurance that these horrific thoughts do not mean what they fear they could mean and since they are unable to find this reassurance they become more and more anxious and may become quite depressed as well.
Most people try to think their way outs of these dilemmas and are quite distressed when they are unable to do so. I have never had a client successfully think their way out of these thought dilemmas. As with all kinds of OCD, Exposure with Response Prevention (ERP) is the best solution. However, I also think that, particularly with this kind of OCD, getting perspective on these thoughts is necessary. Being able to stand back from these thoughts and recognize them as OCD in addition to the ERP process is a good combination. However, standing back from these thoughts as I’m suggesting is no easy task. These thoughts create an anxiety spike which makes it feel like there is some real danger that demands immediate action of some sort. One of the tricks that OCD plays on suffers is the idea that because there’s anxiety spike there must be real danger. This is simply not the case. A useful metaphor might be of a fire alarm that keeps going off but there is no fire. At first when the fire alarm goes off it is responded to as if there is some true danger, but if the fire alarm keeps going off repeatedly and there is no fire eventually we learn to simply not pay attention to the fire alarm even though it is ringing very loudly. This, in a sense, is what I think suffers must do in response to the anxiety spikes. The spikes are experienced as very “loud” but there is no real fire and thus no response is required. Understandably it is extraordinarily difficult to not respond.
A typical obstacle to viewing these scary thoughts as a fire alarm when there is no fire, brings us to another aspect of OCD which is important to understand. Within OCD thoughts are assumed to be dangerous unless proven safe, which is the exact opposite of the way most people approach their thoughts. Without OCD, thoughts are assumed to be safe unless less proven dangerous. How can you possibly prove that these thoughts are safe and that you will not engage in the feared behaviors? How can you prove you will not do something? OCD demands you be sure something won’t happen, which is impossible Thus, OCD presents the sufferer with a challenge: prove that you will not do something in the future – Impossible! If one is to overcome intrusive thought OCD understanding the impossibility of this task is crucial. I will cover ERP for intrusive thought OCD in a future blog post.