brain makes up. But there is effective treatment.
By now, virtually anyone with even a passing interest in politics and current events has heard the term “fake news”. If you haven’t heard this term, just turn on a cable news channel on any given day and you are bound to hear a news story (or ten) about how we are being inundated with fake news that is designed to alter our political beliefs (and our votes). Regardless of your political persuasion, a Google search of the term “fake news” will lead you to a multitude of articles that describe somebody (or some country) that is presenting reality in a distorted fashion in an attempt to persuade you to see things their way. So what does this have to with Obsessive Compulsive Disorder (OCD)? Allow us to explain…
The writers and producers of fake news stories manipulate reality, sometimes by taking facts out of context, and other times by entirely fabricating story details (i.e., lying). Fake news stories always build their narrative on what can most charitably be called “unsubstantiated claims”. But even a cursory examination of these claims would lead any objective observer to conclude that these stories are at best misleading, and at worst, utterly untrue. The stories aren’t backed up by facts, but they sound just real enough to seem feasible.
And this is exactly what OCD does – it offers up scary thoughts for which there is no factual support, yet which appear plausible enough to lead one to believe that they may actually be true. OCD takes unimportant thoughts that occur in one’s mind completely out of the context of the real world and who the individual actually is as a person, and fabricates nightmarish scenarios (i.e., obsessions) that are not even remotely based in reality. But because these obsessive thoughts initially manifest in the sufferer’s own mind, they seem realistic, even though there is no compelling evidence to support them. In other words, OCD is fake news written, produced and directed by your own wayward brain.
OCD is a condition in which an individual is barraged by repeated, unwanted, intrusive thoughts that cause the sufferer to experience extreme anxiety. These thoughts often focus on issues that the individual views as terrifying threats to either their well-being or their self-image. Some typical OCD obsessions include:
- “What if I have been exposed to a horrible virus like AIDS.”
- “What if I forgot to turn off the stove and the house burns down.”
- “What if my sexual orientation is not what I want it to be.”
- “What if I molested my child.”
- “What if I am a killer.”
- “What if I committed a terrible sin.”
- “What if I don’t really love my spouse.”
But here’s the thing about these thoughts – they are just ideas that the OCD sufferer’s brain makes up. Of course, there actually are killers and pedophiles in the world, and some people really do get AIDS, and sometimes people do accidentally burn down their house. But for those struggling with OCD, these unwanted thoughts are just baseless obsessions that pop into the sufferer’s head, and which they believe may be true, despite all evidence to the contrary. It’s as if they have been exposed to a fake news story about themselves, and they have bought it, lock, stock and barrel.
So how does this happen? How is it that people come to believe something for which there is absolutely no evidence whatsoever?
The Brain is a Machine For Jumping to Conclusions
In his book Thinking, Fast and Slow
Conversely, System 2 thinking is slow, deliberative, and rational…and usually more accurate. It’s how we would ideally approach any situation – by thinking it through and making a logical evaluation. But we naturally seek the quick fix provided by System 1 thinking. It’s just simpler and quicker, and can be really helpful in a pinch. Unfortunately, it’s oftentimes wrong. Most of the guys you see up ahead on a dark street are not a threat – they’re just trying to get home, like you.
Fake News, Instinct and The Pleasure Principle
Why do we engage in System 1 thinking if we rationally know that it is frequently inaccurate? In a word: instinct. It’s automatic! System 1’s quick judgments keep us safe from threats and lead us toward rewards. System 1 thinking operates in alignment with one of psychology’s foundational precepts, the “pleasure principle”, which postulates that we instinctually seek pleasure and avoid pain. We don’t generally put a lot of mental effort into figuring out why we don’t like pain – we just instinctually avoid it because it doesn’t feel good. That’s the pleasure principle in action.
And so, when a painful, unwanted thought appears in the consciousness of the OCD sufferer, they don’t react with well-reasoned System 2 logic. Instead, their System 1 thinking senses a threat and kicks into gear. Their brain quickly jumps to the conclusion that this unpleasant, uncomfortable thought must mean something terribly important. After all, the thought is present in their consciousness. Why would it be there unless it meant something important? And because the thought’s content is scary, the sufferer’s brain instinctually puts the pleasure principle into practice and tries to get rid of it.
But the truth is that everybody has all sorts of bizarre thoughts that don’t mean much of anything. We all daydream and fantasize about all sorts of weird things that we would never do in real life. And we all have unexpected thoughts that don’t reflect our actual intentions. Nevertheless, System 1 thinking often leads the OCD sufferer to believe that their strange thoughts are extremely important, and that they must be addressed and resolved as quickly as possible. And if there’s one thing that System 1 thinking is good at, it’s coming up with quick, albeit often bad, answers.
For example, if I am on the 405 freeway on a hot summer afternoon during rush hour, and someone cuts me off in order to gain an extra 20 feet of asphalt ahead of me, I may have a passing thought about killing the guy. That doesn’t mean I actually want to kill him – it means I am frustrated by the mercilessly slow LA traffic, and I am having a less than stellar emotional response to someone cutting me off.
While those without OCD will quickly write off this type of thought as being ridiculous, a person with Harm OCD may just as quickly jump to the conclusion that this thought must mean something important about their character and intent. We have treated people with these types of harming thoughts who have stopped driving entirely because they feared they would willfully kill someone on the road. Likewise, we have treated new moms with Postpartum OCD who won’t change their infant child’s diaper for fear that they will molest them. And we have treated many others with HOCD who won’t spend time with members of the same sex because they fear they will act on random thoughts they have had about being gay.
In all of these cases, the thoughts were ego-dystonic, meaning that they were inconsistent with the individual’s true character, values and desires. In fact, those with OCD are often most tormented precisely because their obsessive thoughts are diametrically opposed to how they see themselves and who they really are. The mere presence of these thoughts in their minds tortures them, despite the fact that their experience over time very clearly indicates that these thoughts are not in any way a reflection of who they actually are, or what they want. But once fake news is presented to the brain, the sufferer immediately jumps to the conclusion that these thoughts reflect who they really are, even though the only “evidence” they have to support this conclusion is a thought that made them extremely uncomfortable.
System 1 Thinking and The Obsessive Compulsive Cycle
OCD starts when System 1 thinking runs amok. As the pleasure principle dictates, we instinctually want to avoid discomfort, and compulsive behaviors are an overzealous attempt to do just that as quickly as possible. It is an unreliable, disproportionate response that makes OCD get worse, not better. The process goes something like this:
1) An uncomfortable thought (i.e., an obsession, aka fake news) presents itself to you.
2) System 1 thinking quickly (and incorrectly) leads you to believe that this thought is a significant threat, which in turn leads you to feel anxious,
3) The pleasure principle dictates that you take action against this supposed threat and the unpleasant emotional state of anxiety that comes with it.
4) In an effort to proactively address this threat, you choose to do a behavior (i.e., a compulsion) that you hope will eliminate or at least reduce the threat and the related anxiety.
5) This behavior works in the short-term – your distress is reduced.
6) Unfortunately, this success reinforces the idea that the thought was indeed a significant threat (even though it was just a thought), and that the best way to deal with the anxiety that this kind of thought produces is to take swift action to eliminate it.
7) The next time this, or a similar, anxiety-provoking thought arises in your consciousness, your System 1 thinking quickly remembers that the compulsive behavior worked before, and you once again do that behavior, or some other equally counterproductive behavior.
8) Again, the behavior works…in the short-term. The cycle continues, ad infinitum.
Basically, OCD is like a dog chasing its tail – lots of work going around in circles, never actually catching the object of its pursuit. This tail-chasing process is known as the Obsessive Compulsive Cycle, and can be conceptualized like this:
We would be far better off if we did not over-react to our thoughts, but instead chose to tolerate our discomfort in the short-term, thus giving us the opportunity to discover that it is, in fact, quite tolerable. Then we could use System 2 thinking to logically pursue a more viable response to it. If we were to instead use system 2 thinking, the process would go something like this:
1) An uncomfortable thought (i.e., an obsession, aka fake news) presents itself to you.
2) System 2 thinking leads you to rationally consider the thought’s importance.
3) You are likely to feel some anxiety, but it is less intense and more manageable.
4) Because of the pleasure principle, you might be tempted to run from even this reduced amount of anxiety. But because you are using System 2 thinking, you have the capacity to make a different choice.
5) Instead of doing compulsions, you choose to sit with your discomfort until it naturally dissipates or even disappears completely.
6) When you sit with the discomfort instead of over-responding to it, you eliminate the reinforcement that has been feeding your anxiety. As a result, your anxiety decreases even more.
7) You eventually are faced with another trigger. This is normal. Triggers happen. There is no way to get through life without being exposed to things that trigger you.
8) Your brain responds to the trigger by generating more uncomfortable thoughts (i.e., obsessions). This too is normal. Uncomfortable thoughts are a natural part of the human experience. But you are now getting better at quickly switching to System 2 thinking. As a result, you feel less anxious and you do fewer compulsions. You are learning a new, more effective way of responding to your unwanted thoughts.
When using System 2 thinking, your thought process looks something like this:
When we use System 2 thinking, and give ourselves the opportunity to tolerate discomfort related to unwanted thoughts, we learn four important lessons.
1) The feared event almost never occurs. For example, you are highly unlikely to purposely kill another driver on the road. Yes, some people do kill others in a fit of road rage, but the great majority of people don’t.
2) The anxiety almost always goes down all by itself. Just by sitting with the discomfort, it dissipates – often quite quickly.
3) If the feared situation or event actually does come to pass, it is not necessarily catastrophic. You may get a disease from a dirty doorknob, but it is more likely to be a common cold, not AIDS.
4) You are far more capable of tolerating the anxiety than you think.
This last point is the most important lesson. You are unlikely to ever like feeling anxiety, but if you let yourself feel it without over-reacting, you will become far better at tolerating it. And in so doing, you will break the Obsessive Compulsive cycle that directly feeds your OCD. Simply put, the goal is to become more comfortable with your discomfort so that your actions can serve you, your goals, and your values, instead of serving to compulsively quiet your anxiety.
Over-Reacting to Obsessions
Another way to conceptualize OCD is to see it as a three-step process of over-reacting to thoughts that are not particularly important or meaningful.
Step one in this process is to over-attend to one’s thoughts. People with OCD tend to pay way too much attention to their thoughts, going so far as to actively monitor their thinking in an effort to see if their unwanted thoughts are still present, and whether or not those thoughts continue to upset them. Conversely, people without OCD spend virtually no time at all analyzing their thoughts or their reactions to those thoughts.
Step two is to over-value one’s thoughts. This is where System 1 thinking rears its ugly head. Those struggling with OCD assign meaning and import to what are arguably meaningless, unimportant thoughts. Everybody thinks crazy stuff, but people without OCD laugh off the weird things that pass through their minds, while those with OCD often take their weird thoughts very seriously. Remember, OCD is fake news, and deserves to be valued as such.
Step three is to over-respond to one’s thoughts. This is the “compulsive” part of OCD, where the pleasure principle comes into play. The sufferer takes action to reduce or eliminate the discomfort that arises in response to their unwanted thoughts. This action commonly occurs in any of four ways:
- Overt Compulsions. A physical action done in an attempt to feel less anxious, such as hand washing, or checking locks or stove burners.
- Avoidance Compulsions, wherein the sufferer attempts to avoid situations in which they anticipate unwanted thoughts (and anxiety) might arise.
- Reassurance Seeking Compulsions. For example, asking others to confirm that you did not run over a pedestrian, or molest a child, or commit a terrible sin.
- Mental Compulsions. For example, repeatedly reviewing a past event in your mind, compulsively fretting about something you fear you may do in the future, purposely calling up a “bad” thought to check if it still causes you distress, or compulsively praying in an attempt to eliminate an unwanted thought.
If done in an effort to control one’s thinking, all of these compulsive behaviors will consistently backfire by reinforcing the importance of the thoughts, causing OCD to worsen rather than improve.
Mindful Acceptance and Cognitive Behavioral Therapy (CBT) for OCD
Just as fake news is unlikely to stop showing up in your Facebook feed, the intrusive, unwanted thoughts experienced by those with OCD are unlikely to spontaneously remit. The first step in better managing your anxiety-provoking thoughts is to accept their presence. Many people with OCD struggle with this concept, thinking that it means resigning themselves to a life of constant, unmitigated misery. But acceptance is not resignation – it is accepting reality as it is, instead of fighting what is out of your control. Resisting reality does absolutely nothing to change it, just as becoming upset by every fake news story doesn’t change the fact that fake news exists. A more useful reaction is to accept the existence of whatever life presents to you – whether it be fake news or the unwanted thoughts that pop into your mind – without reacting impulsively or compulsively.
It’s important to stress that this doesn’t mean accepting that your obsessive thoughts are meaningful or accurate. It only means accepting that they exist without fighting them so much. In other words, it means accepting the presence of fake news without accepting the content it offers. We liken it to accepting that it is raining on a day that you had planned to go to the beach. You can get upset about the presence of the rain, but that will do nothing to stop it. The most helpful reaction is to accept the presence of the rain, and to choose to spend the day doing something else despite it. Mindful acceptance of reality is a shift in consciousness away from fighting what is out of your control, and towards focusing on what is in your control. Rather than over-responding to your thoughts, choosing instead to accept their existence without a struggle, and getting busy living exactly as you would if you weren’t experiencing them.
At the same time, you can challenge the content of your thoughts. This is the “cognitive” part of Cognitive Behavioral Therapy (CBT). Gently reminding yourself that your OCD thoughts are nonsense with no real evidence whatsoever to support them can help you to reframe these thoughts as being unworthy of your attention. This is the essence of System 2 thinking – vetting the fake news that your brain is presenting to you, considering whether the information is realistic and accurate, and then formulating a more objective appraisal of, and response to, the situation. The goal is to move from a default stance of blindly accepting that your obsessions are meaningful, and towards a place where you are more likely to quickly reject these unwanted thoughts without getting drawn down the rabbit hole with them. The key is to be sure that you don’t use this cognitive step compulsively in an effort to reduce your anxiety. Compulsively challenging your thoughts is every bit as much of a problem as any other compulsion.
The most important tool in challenging the fake news generated by your mind is called Exposure and Response Prevention (ERP). This is the “behavioral” part of Cognitive Behavioral Therapy. The simplest way of describing ERP is that it focuses on purposely exposing yourself to the very situations that cause you to be anxious, without doing any compulsive or avoidant behaviors to ameliorate your discomfort. Many people with OCD are extremely resistant to this technique, believing that they will be overwhelmed by unbearable anxiety. But ERP done with a compassionate, well-trained therapist isn’t torture. It should be done gradually, in a structured manner, and at a pace that works for the sufferer. Any attempt to jumpstart your recovery by taking on more anxiety than you can reasonably handle is likely to lead to a spike in your anxiety, and a subsequent rejection of ERP. Done correctly, ERP will be the cornerstone of your recovery from OCD.
Just as you don’t believe everything in your newsfeed, you’d be wise not to believe everything that you think. While our thoughts sometimes directly and objectively reflect reality, they are often nonsense that makes us unnecessarily afraid and behaviorally overprotective. Using CBT, you can learn to implement System 2 thinking – to slow down and consider your thoughts instead of jumping to the conclusion that they are universally accurate and important. As you begin to practice this more measured response to your thoughts, your actions will no longer be dictated by the fake news generated by your brain, and you can begin to free yourself from enslavement to OCD.
•Tom Corboy, MFT, and Lauren McMeikan, MFT, are psychotherapists at the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of OCD and related anxiety-based conditions. In addition to individual therapy, the center offers five weekly therapy groups, as well as online therapy, telephone therapy, home visits, and intensive outpatient treatment. To contact the OCD Center of Los Angeles, click here.
65 Comments
That’s a great summative article about various facets of the dreadful OCD. Well-written. Thank you!
Thanks Luke. Always happy to hear that people find our articles helpful.
Tom, this is unbelievably awesome! Right on the money again. I will be using and sharing this at group tonight. Thank you. Please keep sending.
Gregg Sansone
Thanks for the kind words Gregg! I’m glad you found the article meaningful. I hope your group enjoys it as well.
Thank you for a clear description of the mechanism of action that maintains OCD and also that which reduces it.
Thank you Allie. Glad to be of service.
I found the discussion between System 1 and System 2 thinking very informative.
The hardest thing with OCD is that something you have ocd over doesn’t creep up on you slowly, giving you a chance to prepare, it just is in your face and you feel you need to react then and there to it.
Using System 2 thinking will no doubt take practice but purposefully making yourself take that step back would be very helpful.
Fake news indeed!
Tarielle,
Agreed – it takes practice to learn that we can resist the urge to react impulsively and compulsively to unwanted thoughts. But if we allow ourselves to mindfully feel our discomfort, and as you put it, take a step back, we can learn that we are quite capable of handling that discomfort. And with practice, we get better and better at not taking the bait.
This is great! Although how would you relay some of this same information to someone with neutral obsessions? I, for instance, have an obsession with being aware of my mind. So my obsession isn’t really distressing content-wise, but it’s distressing in that it is something I am repeatedly reminded of and “can’t get away from”. I am not scared of this awareness, but the amount that the awareness pops up during the day is distressing for me.
Thanks so much!
Meredith,
From what you write, it sounds like your distress is not so much the hyperawareness, but rather the fear that the thought will keep coming back over and over again. This sort of hyperawareness, and distress about not being able to get away from it, is quite common in OCD, especially in what is sometimes called Hyperawareness OCD, or Sensorimotor OCD, or Somatic OCD.
A good way to conceptualize obsessions is as “what if…” statements. For people with hyperawareness OCD, their obsession can often be conceptualized as “what if I have this awareness forever and it never goes away and ruins my experience of life”. While this obsession may seem very different from a thought like “what if I get AIDS from touching that doorknob”, the goal is the same – to accept the thought’s existence without assuming it is meaningful or accurate, without taking it seriously, and without responding to it. Just let the fake news exist in your brain and get on with the business of living.
Thank so much Tom!
Do you guys get into sensorimotor obsessions….like obsessing about eye contact……being too aware of it versus just leaving the act of eye contact alone like any other involuntary function.
Gregg,
Sensorimotor obsessions are quite common in OCD. My response to Meredith above discusses this issue in some detail.
Hi,
I’m particularly interested in the section where you said cognitive challenging can become another compulsion. I’ve experienced this problem before, where I kept labelling the thoughts as a product of OCD whenever they came to mind. Funny thing is by doing it that way, the thoughts constantly pop up in my mind for me to label and disregard, and I feel like I’m reinforcing the thoughts.
Shawn,
Yes, compulsive challenging of one’s thoughts is just like any other compulsion in that it is an ill-fated effort to resolve the unwanted thought and its attendant anxiety. Just like any other compulsion, this backfires and actually increase one’s anxiety. This is illustrated in the System 1 graphic in the article.
While some challenging of the importance of a thought is appropriate and helpful, if you find yourself repeatedly challenging the importance of your thoughts, you are in fact reinforcing the thought and reinforcing the idea that repeatedly challenging your thoughts is the best way to deal with them. Labeling a thought as “unimportant” once is a good idea, but labeling repeatedly is counterproductive. Of course, learning to respond effectively to one’s thoughts is not necessarily easy. If it were, OCD would not exist.
What you said is so true! Correct me if I’m wrong, but I feel that mindful acceptance of the thoughts is the best solution. This means that I am aware of the thoughts and urges, I allow them to be exist and be present in my mind, but I choose not to get involved by dwelling and spending any mental energy on them.
It’s quite interesting how my OCD also makes me obsess about doing recovery the right way. I am disturbed by thoughts of not doing recovery right and will as a result, will never recover. One example is when I’m refocusing on meaningful things and not thinking about the OCD, my mind tells me that I’m trying to suppress the thoughts, which we know are detrimental to recovery.
Shawn,
You are absolutely correct – the best response to obsessions is, as you put it, to “allow them to be exist and be present in (your) mind, but choose not to get involved by dwelling and spending any mental energy on them.”
As for your other point, it is quite common for people with OCD to obsess about doing treatment “the right way”. The is really no different than any other obsession about doing things exactly right. For example, many people obsess about locking their doors perfectly, needing to hear the sound of the door closing in just “the right way”, and having to see and feel that the door in closed “completely” and “correctly”. And the goal with these types of thoughts is the same – to accept the presence of the thought that things must be done the right way, without doing any compulsive responses to the thought, and without devoting any time or energy to it.
What an interesting article! I do have the following few questions/concerns in reaction to reading this:
1. Aren’t dividing and labeling thoughts as fake and real problematic because it feeds into OCD’s game that some thoughts are important and need our immediate attention and action?
2. I recognize the place for cognitive therapy in OCD treatment, but I thought its purpose is to challenge the rigidity of the feared outcome instead of accumulate evidence to reject the fear’s content as nonsense.
3. I agree that part of the problem OCD sufferers find ourselves in is responding to the urge to provide immediate, complete attention to resolving, figuring out or preventing harm from their obsession. Yet, isn’t System two also unhelpful in responding to an obsession as it still is giving it attention and importance? Doesn’t System two suggest delaying, ruminating or drawing out as the response to an obsession and aren’t these unhelpful and even potentially harmful responses to an obsession as logic isn’t a useful response as OCD isn’t a problem of logic and consequently, logic and analysis only makes OCD worse as we can’t think ourselves out of the OCD trap?
Sarah,
We are not suggesting that some thoughts are actually “fake” – we are using the term “fake news” as a metaphor in an effort to illuminate a very real issue – specifically that people with OCD overvalue unimportant thoughts. It is not playing “OCD’s game” to evaluate thoughts. In fact, some thoughts actually do need our immediate attention, while others do not. If I am walking across the street and I see a car speeding towards me, it is in my best interests to respond very quickly. This is where System 1 thinking comes in handy. But many thoughts are, in fact, unimportant, and judging them as such is helpful. The problem is that those struggling with OCD over-react to thoughts that deserve virtually no attention whatsoever.
It is impossible to separate “the rigidity of the feared outcome” of a thought from “the fear’s content”. They are one and the same. The goal of cognitive restructuring is to help the client learn to reject the automatic System 1 thinking that they have been using as their default response to unwanted thoughts, and to instead make a well-reasoned System 2 response to these thoughts.
System 2 thinking is not about “delaying” or “ruminating” or “drawing out” obsessions. It is about making a reasonable effort to counter the automatic System 1 thinking that says “RED ALERT! This thought is a major crisis that I must address right now!”. We are not suggesting compulsive analysis of one’s thoughts, as this would be, as you note, a foolhardy attempt to “think ourselves out of the OCD trap”. We are merely suggesting that OCD sufferers look at their irrational thoughts from a different perspective, rather than just blindly reacting to them.
This article was really interesting. To follow up on Sarah’s question, do you have any advice for people who obsess about whether to label a thought as fake news or real? Some examples are obvious, like the car coming towards you versus being a killer, but there’s a large grey area. Most of the things I worry about are right in the middle of the grey area, and when I engage system 2, it leads to endless rumination. I understand that it’s all just guesswork and there’s usually no definitive answer, but how do you learn to make reasonable guesses in an ambiguous situation when system 1 is sending out danger signals and system 2 gets stuck trying to decide if those signals are legit?
Followup,
As we point out in the article above, “The key is to be sure that you don’t use this cognitive step compulsively in an effort to reduce your anxiety. Compulsively challenging your thoughts is every bit as much of a problem as any other compulsion.”
Identify the thought as “unimportant”, and get on with the business of living. Don’t look for “definitive answers”. I believe that in most cases, people know that their OCD thoughts are bullshit, and it is only their OCD that leads them to think otherwise.
many thanks for this Amazing Website .
It’s Assem From Egypt and i’m suffering from OCD regarding bad thoughts about the another gender.
it is very effective way and Unfortunately we know nothing about this kind of techniques in Middle East .
so i am very grateful for what you are doing .
i will stick to these steps and i have 2 Questions :
1) My OCD is movable , means that i cure from one type and it shifts to another.why is this happening ?
2) i may have OCD insomnia , i can’t go sleep easily and i take meds.
but there is very good note :
i joined an event for 15 days and i was very busy in my mind too and i forgot everything about my insomnia even i forgot taking mi pills.
after finished the event and back to my home the insomniac thoughts pop up again .
and this is very interesting and prove so much of things that in the World of Thoughts we can overcome the bad thoughts by ignoring them and to stick hardly to keep ignoring more and more and more .
Can i overcome my insomnia following “Mindfulness” ??
thanks a lot for your Great efforts .
Rgrds
Assem,
It is extremely common for the focus of OCD to shift from one topic to another. Sometimes, this change occurs spontaneously, and other times it occurs when the sufferer becomes successful at managing a particular obsession more effectively. It is important to keep in mind that the content of one’s OCD obsessions is not really the issue – the most effective response is always to accept the presence of the thought without assuming it is meaningful and accurate, and to not do any compulsive behaviors in response to it..
Unfortunately, insomnia is frequent for many with OCD. But as you noticed, when you are busily engaged with life (instead of with your OCD thoughts), you slept better. Generally speaking, the more you are engaged with real life, and the less you are engaged with OCD thoughts, the better.
I have experienced OCD a few different times in life. The fear of germs and the fear of contracting AIDS, but here about a month ago I just got this thought in my head that my five year old was going to turn out to like the opposite sex. She shows zero signs of being this way and I don’t know why I have this thought.
I have since battled with this horrible thought and tried to figure out if it’s OCD or what and how to get it out of my head. Like is it a mothers intuition or OCD and I have read so much information and talked with so many people to try to help me understand but the thought still is there. It seems so scary to me and everyone else just thinks I’m nuts. HELP.
Mandy,
A few thoughts…
1) I am assuming you meant that you feared your daughter would turn out to like the same sex, not the opposite sex. Most parents have no problem with their children turning out straight.
2) That said, having a thought about your child’s potential sexual orientation, regardless of whether that thought is about them being straight or gay, is not “horrible”. It is just a thought.
3) Likewise, your daughter’s sexual orientation, regardless of whether she turns out to be gay, straight, bi, or whatever, would not be “horrible”. I assure you that you will be able to cope with whatever sexual orientation your daughter exhibits. Besides, you will have no choice – it will be her sexual orientation, not your’s.
4) You don’t need to get this thought out of your head. In fact you need to do just the opposite – you need to stop trying to get the thought out of your head, as doing so actually makes the thought get more entrenched. Telling yourself “I must get rid of this thought” is a surefire way to make the thought stick. I encourage you to read our article “Thought Suppression and OCD”.
5) Stop trying to figure out if the thought means something important. It doesn’t.
Fake News! I love it. Excellent, informative article.
Thank you Richelle!
I have a particularly insidious form of Pure -O OCD causing me to question the nature of reality. I’ve heard it called existential or philosophical OCD. I know my ultimate fear is to be alone in the universe (solipsism based fear) and from this fear my OCD has latched onto philosophical quandaries that have no answers such as “what if I’m a brain in a vat?” or what if I’m living in a simulation created by some evil genius. As there is obviously no way to prove or deny these kinds of questions my mind sets out obsessively to try and use reason and logic to arrive at an answer that puts these questions to rest for me. I’ve come up with all sorts of elaborate explanations to try to put these fearful obsessions at bay only to always figure out a way around my “solution” leading to a new search for an even more proof solution. Going down the rabbit hole is an understatement sometimes as I can spend an entire day attempting to solve the philosophical problems about the nature of my reality. Sometimes I just compartmentalize these disrupting thoughts when I’m working only to pick up where I left off later in the day. It is so mentally exhaustive.
Gary,
Existential OCD, also known as Philosophical OCD or Solipsism OCD, is actually fairly common. And as you point out, “there is obviously no way to prove or deny” your existential questions, and your OCD will “always figure out a way around my solution”.
Knowing this, I see no reason for you to chase these questions. The better response to your “philosophical quandaries” is to make no effort whatsoever to answer them. In other words, let the thoughts exist without an answer. Seeking answers to questions you know have no legitimate answers is not only a compulsion, but also a complete waste of your time and energy.
Your system 1 thinking is telling you “OMG, I must figure out an answer to these questions”, but that is just a lie. You DON’T need to figure out answers to these questions, and attempting to do so is ruining your life. I encourage to remind your self of this when the urge to go down the rabbit hole arises, and to instead get busy focusing on something more useful.
What is a good way to handle this type of ocd but with magical thinking. Automatically trying to find proofs if the OCD thought is valid etc.
Reuben,
I am a bit confused. You ask “What is a good way to handle this type of ocd”, as if the article is addressing some specific sub-type of OCD. This article does not address a specific subtype of OCD – it addresses all forms of OCD.
Furthermore, “magical thinking” is an obsession that is common to many types of OCD. And trying to find “proof” that an OCD obsession is “valid” is a typical OCD compulsion.
Also, note that proof-seeking is not “automatic” – it is a choice. You can choose not to seek proof about the validity of your thoughts. With all forms of OCD, the goal is to accept the existence of the uncomfortable thought (in this case, the magical thinking), without valuing that thought as being meaningful or accurate, and without responding to it with compulsions (in this case, proof-seeking).
Thank you so much for this article! I suffer from HOCD and ROCD and it’s been a major debilitating factor in my life. Starting a new relationship and I just want it to be calm and enjoyable. Reading this piece, and going back to CBT techniques, helps. Keep up the good work. We all really appreciate it. Kevin
Thanks Kevin. Glad to hear that our article has helped.
Thanks so much for this Article!! One thing I struggle with a lot are Mental Compulsions, and Avoidance Compulsions. I’ve had intrusive thoughts about my family and especially my 4 year old sister. I’ve had intrusive thoughts about her, and impulses. Of course I have never acted on them etc. I purposely avoid being around children, out of fear of being a pedophile. When I was 12, I did questionable things that didn’t hurt ANYONE in any way but since then I’ve felt like I’m a pedophile. This terrifies me though, I Don’t want to hurt a child, etc. I have POCD, HOCD, and Scrupulosity. I feel like God won’t forgive me etc…. Thanks again for this Article though. I’m a 13 year old girl and though my mother refuses to take me to an OCD specialist, I think I can figure this out on my own. I’ve actually had OCD since i was 3 years old, because I did anxious things, like biting my nails, fidgeting, and clearing my throat, as well as doing some weird eye compulsion. I believe It’s genetic in my case, since my Grandfather, Great Aunt, and Mother have it. And as a child/toddler It was trivial things, but now It’s mental and emotional. Anyways, thanks for this. ~Blessings, Renata 🙂
Renata,
A few thoughts…
1) Everything you write sounds like OCD.
2) Everyone did “questionable things” when they were 12. In fact many people do a fair amount of questionable things throughout their lives. But your comment makes very clear that you did not hurt anyone in any way, and your unwanted thoughts are NOT the same as ACTIONS. They are just thoughts.
3) I’m sorry to hear that your mother refuses to take you to a treatment provider who specializes in OCD. I encourage you to continue requesting treatment until such time as she relents.
This is great! This really cleared some stuff up for me with mine. I hear all the time that OCD attacks our values in life. So mine generally latched onto my romantic relationship with my boyfriend, and then i got more intrusive thoughts of me falling in love or being secretly in love or having romantic connections with another. I got this image of my boyfriend and i and then the other person lingering in the shadows, and i feared i had to be with him because we get along well but the thing is- i don’t care if that person is out of my life. I spent hours ruminating on compatibility and a part of me knew you could be compatible with someone in life and be friends with them but it still scared me. I can’t be around that person as it gives me panic attacks, and i feel a compulsive urge to actually punch him in the face. I generally have the core fear that I’m in the wrong relationship because this person talks to me about personal stuff a lot which i don’t mind but we’re too much alike and there’s seriously nothing there… no romance, desire, anything. I don’t want it to be there either. And then i remembered that “if it’s unwanted to this extent it’s ocd and not real.”
Brooke,
This all sounds like classic ROCD. I encourage you to read our article “ROCD: Relationship OCD and The Myth of ‘The One'”, which addresses this subtype of OCD in-depth.
I have been dealing with harming and checking OCDs as well as HOCD and ROCD since I was fifteen. By the time I was in my twenties, I started to just disassociate to escape the “pain”. That’s how I existed for the next two and a half decades. Then, I started to implement what I think is a System 2 type thinking–basically acknowledging the thoughts as they come, letting them “wash over me” like waves–without judging them or engaging in any type of compulsive behavior to try and correct them or “ward them off.” Just experiencing the pain as part of life. The biggest problem I have been dealing with since incorporating this type of thinking and addressing the OCD in this way, is that the constant waves of thoughts end up leaving me feeling dirty, traumatized, and distant from God’s love. Effectively, I feel “dead” inside all the time. The medicine I am currently on has helped to stem some of the constant OCD thoughts, but I still feel kind of dead inside–depressed, scarred, and traumatized by the thoughts that do still come. Is there a better way?
Drew,
A few thoughts…
1) You say that you have been acknowledging your unwanted thoughts without judgment, and it sounds like you really have been doing so…to an extent. True acceptance for you will mean accepting feelings of being “dirty, traumatized, and distant from God’s love”. In other words, acceptance is not just about unwanted thoughts, but also about unwanted feelings, including feeling “dead inside”. Nobody likes these types of feelings, but they are just feelings, and there is no need to resist them or take them as being extremely important. That is not the same as dissociating – it is true acceptance of what you are feeling.
2) Some people report these exact sort of “dead inside” feelings as a particularly undesirable side effect of taking antidepressant meds. I encourage you to discuss this issue with the physician who prescribes your meds.
Hello Tom.
Thank you very much. The article is amazing.
I have one question: when Im trying to jump into system 2 way of thinking rational about my intrusive and egodystonic thoughs (which I realize are fake news) I cant avoid to over analize what the thought produce in me (compulsion). In other words, analizing and trying to think rational about my thoughts leads into testing what does the thought makes me feel (compulsion and reassurance)
Thank you and sorry about my english
Rebecca,
As you note, the analyzing is a compulsion. And like any other compulsion, it only makes matters worse in the long-term. You say you “can’t avoid” over-analyzing, but it is important to remember that analyzing is a choice and a behavior. I believe you actually can< resist the urge to analyze. Of course if that were easy, nobody would have OCD.
When you find yourself wanting to analyze your thoughts, or catch yourself already in the process of analyzing your thoughts, gently remind yourself that you are doing a compulsion and then choose to stop. It will take practice, but I am confident you can become better at quickly turning off the compulsive analyzing. The same goes for any “testing” that arises related to the analyzing.
Again, a very clear written and helpful article! Thnx so much. Deep down I know for years that I am dealing with ROCD for years now, before I was suffering from HOCD, which I did overcome with exposure. Altough I know I have a quite obsessive mind, there is often this sneaky voice in the back of my head; “what if its not really ocd, but you want to keep believing it is, to have an excuse not deal with the reality you are trying to avoid”?.. Leading to thoughts of doing harm and quilt to my beloved one. I’m getting better in dealing with toughts and live my life anyway, but this is always at the background, hinders me to fully enjoy my life. I would be very grateful if you would spend some of your thoughts about how to deal with this ‘sneaky backfire’ in my mind..
Paul,
The thought “what if this is not really OCD, and my claim that it is OCD is just an excuse” is quite common in OCD. I encourage you to read our article “Doubt, Denial, and OCD”, which addresses this very issue in-depth.
I’ve suffered from OCD for as long as I can remember, and it dominates my life. For the last six years I’ve suffered from self harm OCD which is a terrifying thought of ending my life in the most horrific way imaginable. Sometimes acceptance works, but other times the thought comes with such force that I seem to physically get a frightening urge to actually carry out the act. It’s so strong that it feels if I don’t calm myself down, I will get up and do it. What is the urge and how do I deal with it?
Cathy,
You seem to be overlooking the fact that for six years, you have been experiencing a thought and NOT acting on it. That is what I call pretty good “evidence” that having a thought does not automatically mean you are going to act on that thought. You have six years of evidence that one can have a thought and not act on it!
Of course these thoughts come with force – you have spent many, many years telling yourself that these thoughts are important and scary and must be controlled. But here is the truth – these thoughts are not important. They are just meaningless thoughts that you have built up into a monster.
Acceptance means allowing the thoughts to exist, and reminding yourself that they are just thoughts, but that they are present anyway, and that the best approach is to <>actively choose to shrug them off as no big deal (because they really are no big deal). Calming yourself down is nothing more than a compulsion that actually serves to make you more anxious in the long-run. The two graphics above that focus on the Obsessive-Compulsive cycle address this very issue.
Thank you for replying. My biggest fear is that the urge will become uncontrollable and I will lose control of my actions and carry out the thought. The thing is I have very low self esteem and don’t trust myself that I won’t do it.
Cathy,
This notion of people suddenly losing control of themselves is a common, yet thoroughly unrealistic obsession that comes with OCD. I reiterate what I wrote in my reply to your prior comment – you have six years worth of evidence that demonstrates that you are not likely to act on your obsessions.
Thanks for such a good article, this website has helped me immensely. Is it possible that ocd thoughts can be true? For example, I’m struggling with exstistential ocd and when I’m doing something that I enjoy I get intrusive thoughts such as ‘this doesn’t matter’ ‘nothing matters if I’m just going to die anyway’ ‘what’s the point?’ ‘Nothing I do will really matters to anything’. These thoughts cause me great sadness and distress because I just want to enjoy life and get on with things without these horrible thoughts. But what stumps me is that these intrusive thoughts are technically true. What should I do when my ocd, i guess, isn’t fake news?
Lucy,
A few thoughts…
1) All thoughts are “true” in that the thoughts truly exist when you experience them. I think a better question is “are they accurate“ or “are they important“.
2) I would argue that these sorts of existential quandaries are completely unimportant. Furthermore, there is no way to answer many of them in a way that is meaningful. I cannot foresee a point in life when you or I or anyone else will be able to come up with objective evidence that anything in life “matters” (whatever that means).
3) Since there is no way to answer these questions, why waste even one minute of your life fretting over them. Instead, accept that your brain likes to generate these types of existential questions, and make no effort to answer them. Let the thoughts exist without assuming they are important or meaningful. They do not warrant an answer, or even an attempt at an answer.
4) As for accuracy, yes, we all are going to die. That’s a given. And while there may not be any objective meaning to our lives, you can create meaning for yourself in the work you do and the people you love.
5) Psychologist Jim Claiborn ends his comments on OCD discussion boards with a great quote that I think applies. Here it is:
“Contrary to popular opinion, meaning is not discovered. It is not something lying around on life’s road waiting to be tripped over. One makes meaning.”
~ E Davies & J Burdett
This is great!! Definitely agree with the System 1 and System 2 thoughts. I have suffered from ROCD symptoms for 7 years now and have learned to manage it through CBT from a self help book. But now I suffer from the obsession that anxiety or some brand new mental illness that I can’t control is going to ruin a special experience. This has left me hyper aware of my anxiety and develop fears of specific mental illnesses- currently it’s sensorimotor OCD, but sometimes it can be panic disorder. And I want to really manage this before it ruins an upcoming trip in 2 months.
Ginger,
There is no significant difference between un unwanted ROCD thought and an unwanted thought about developing a mental illness, or an unwanted thought related to Sensorimotor OCD. A simple metaphor to keep in mind is this – these thoughts are like different flavors of ice cream. They may taste different, but aside from the specific flavor, they are the same. Chocolate and vanilla and strawberry ice cream are the same except for the specific favor. All three are ice cream. And all of these unwanted thoughts are OCD.
Likewise, all of these thoughts are just fake news generated by your brain. So don’t waste any time or energy trying to figure out how you should respond differently to them. You should respond to them in the same way – by allowing them to exist, while not assuming that they are important. Because they aren’t important.
All of the tools you have learned to help you manage ROCD can be applied to these and any other forms of OCD you may experience over time.
I am going through an obsession at the moment which focuses on the way I feel. I am always mentally checking how I feel and if I feel ‘right’ in certain environments. I know that I feel fine until I start checking but when I start checking i start having that ‘feeling off and not right’ kind of feeling. This then makes me worried about always not feeling ‘right’ because whenever I check and think about it makes me feel that way. Basically I’m worried about obsessing over that thought because even though I know it’s not true, the thoughts always make me feel this way. Is this a type of hyper awareness ocd?
Lana,
Yes, what you describe sounds very much like what is sometimes called Hyperawareness OCD.
The bottom line is that there is no reason whatsoever to monitor how you feel. Besides, your comment implies that one must always feel “right”. That sets you up for misery, as there are many times when a person feels “off”.
So long as you are devoted to feeling “right” you will struggle. A better option is to stop checking your self for how you feel, and to accept that you feel however you feel. For example, I feel tired today – I only slept about four hours last night. If I over-attend to how I feel, and over-value the crappy way I feel, I will just make myself miserable. Feeling crappy is a part of life, and doesn’t merit lots of attention or evaluation.
Thanks for the reply. The checking is the issue itself, and it’s so easy to check on my emotions and it’s more mental than physical. How do I stop checking how I feel? because it always makes me doubt and question if I’m feeling okay or not.
Lana,
Even mental checking is a behavior. Your checking is a learned behavioral response to discomfort, and you can unlearn that response. The best way to do this is with the assistance of a therapist who specializes in treating OCD.
Does the phenomena of anxiety about having anxiety also fall into this category? Every time there is a good moment coming up I start fearing that anxiety will ruin everything. This leads me to feeling even more anxiety and just makes me desperately wonder why I can’t get rid of this feeling. I’m slowly working on it, but still
Ginger,
There is nothing particularly special about being anxious about having anxiety. People can get anxious about all sorts of things, including the feeling of being anxious. In fact, fear of the feeling state of anxiety is a common experience for people with OCD and other anxiety disorders – indeed, some would say it is the defining characteristic of anxiety disorders. There is no reason to think that this particular obsession (“OMG…what if I feel anxious”) is experientially different from any other obsession, and as such, it is “fake news” – just one more way that your brain tells you that something unimportant is important.
Thank you Tom for the great article!
Long time sufferer here, I’ve dealt with various OCD themes, like Harm Ocd and fear of schizophrenia. Now I’m dealing with existential OCD and this article is spot on. What I wanted to ask is: does OCD provide false “proofs”? Let me explain myself: I’m struggling with solipsism OCD where I fear reality is fake and I’m dreaming it up, or some sort of supernatural being is creating my reality (like Descartes evil genius). My OCD sometimes makes me hyperaware of everything going on around me that seems different from usual (e.g. someone saying something he couldn’t possibly know) and says to me “See? That’s a proof that your reality is fake”. I perfectly know that there’s a rational answer to every fake “proof” and that’s why I’ve a constant battle in my mind to shut up my OCD side. So, is it normal for OCD to behave in this manner? Thank you again.
Viezel,
Yes, this is typical of OCD. I’ll go one step further and note that trying to prove or disprove whether or not your experience of reality is “real” or “fake” is a complete an utter waste of your time and energy. You will NEVER find an answer which provides you with 100% certainty.
I encourage you to accept that your brain likes to pester you with these types of thoughts and to view them as being pointless and unimportant. I also encourage you to re-read the section of the above article that describes how OCD is related to how we over-attend, over-value, and over-respond to thoughts.
That’s an absolutely amazing article, Mr. Corboy! I was thinking, like, to implement system 2 thinking, because i have this enormous fear that i might get TB if someone coughs of sneezes near me (even typing that line was very difficult). I have very elaborate rituals to perform if my avoidance compulsions don’t work and i’m exposed to such. But i’m thinking and thinking and i feel that this is a very contagious illness and of course it can be contracted very very easily. It’s absolutely rampant! I have to do everything possible to not get it. Why is my system 2 thinking not working? I cannot function because all the time i feel that everyone might have this disease. So much time spent on thinking how to avoid this illness. I can’t even begin to explain how debilitated and helpless i feel. I cannot even see reason. I feel that it’s very contagious. How do i go about this? Thank you so much, Mr. Corboy.
A.,
I assume there are many ways that TB bacteria can be spread, and that humans are not 100% able to prevent transmission. Taking that as a starting point, I think it is pointless to devote your life to preventing this illness. You have better things to do.
A better alternative is to take reasonable steps to avoid transmission (i.e., steps that a person without OCD would take), and then take your chances. Live with the possibility that you might get TB. Every person you have ever met in your life is living with that possibility right now. Certainty is impossible and chasing it will ruin your life.
Hi Dr. Corboy,
Is it possible to tell me how to go about this? I’m not even sure what lesser steps a person without OCD would take, because whatever precautions i take come so naturally and i can’t fathom anyone not taking them. I live in a country where diseases are rampant and no precautions are taken to curb them. Of cancer and all i’m not scared because thy’re not contagious. My life is like a living hell. I implore you, please see if you can help me. I’m very sorry for troubling you.
Thank you so much.
A.,
I cannot provide therapy via blog. If you are open to online therapy, please email us via the contact page of our website at https://ocdla.com/. If treatment with us is not an option, I encourage you to seek treatment with a local therapist who specializes in treating OCD with Cognitive Behavioral Therapy (CBT).
Hey Tom I’ve taken your advice and have stopped visiting the site and it has made my life ten thousand times better I came back because I have a legit question this time. The shooter at Thousand Oaks bar said in a tweet or something while he was doing it that he was bored and this kinda worried me because my OCD attacks the most when I’m bored and I started thinking what if he suffered from harm o and never got help and this was the result, surely he didn’t suffer from harm O did he?
Joe,
A few thoughts…
1) I have not seen or heard any evidence that suggests the Thousand Oaks killer had Harm OCD.
2) Lots of people get bored. Pretty much everyone in the history of the world has been bored at some time or another.
3) Being bored does not correlate with murdering people.
4) The simplest answer is sometimes the best. In this case the simplest answer is that the Thousand Oaks killer was a deeply disturbed person. That does not mean he had OCD.