What is Imaginal Exposure
For many people struggling with OCD and related anxiety disorders, one of the most beneficial treatment tools is imaginal exposure. In order to best understand this technique, it is first necessary to understand the basic idea of Exposure and Response Prevention (ERP).
ERP is a specific type of Cognitive Behavioral Therapy (CBT) that has consistently and repeatedly been found by researchers to be the most effective treatment for OCD. Simply put, ERP is the “B” part of CBT. Using this technique, a client learns to become less afraid of fearful situations by challenging the behavioral compulsions that they employ in an effort to reduce their fear. The basic principle behind ERP is that, by repeatedly confronting their fear (exposure) without doing any compulsive anxiety-reducing actions (response prevention), the client will become less afraid when faced with anxiety-provoking situations. This process is known as habituation, which is really just a fancy way of saying that we become less afraid of things as a result of repeatedly being exposed to them.
For those who are afraid of touching doorknobs for fear of catching a disease, a simple ERP intervention would be to repeatedly touch doorknobs without washing their hands afterwards. Likewise, if they repeatedly check stove knobs for fear of causing a house fire, ERP would have them using the stove without checking the knobs afterwards. In other words, ERP focuses on changing the fear response by challenging the individual’s behaviors – i.e., their compulsions.
But many people with OCD struggle less with outwardly observable compulsive behaviors, and more with distressing, unwanted thoughts and mental images. This is especially true for those suffering with variants of OCD that are frequently described as Pure Obsessional OCD, or Pure O. Common sub-types of OCD that fall into the Pure O category include Harm OCD, HOCD, ROCD, and Scrupulosity. It is in these cases that imaginal exposure is most effective.
The simplest way to conceptualize imaginal exposure is that it is the writing and reading of short stories based on the individual’s obsessive thoughts. But these aren’t just any stories. These are stories based on the sufferer’s scariest thoughts – their deepest, darkest OCD thoughts, taken to the worst possible outcome. In other words, their worst case-scenario!
As you can imagine, many people with OCD are not too keen on the idea of writing stories about their worst-case scenario. It is not unusual for clients to break into tears, or even abandon therapy when we first broach the idea of writing and reading short stories based on their worst fears. For this reason, imaginal exposure stories should not be used until a client feels ready to face their scariest thoughts (or at least as close to “ready” as they are likely to get). Essentially, the client needs to feel safe enough with the therapist, and with the exposure process, to go to a place that feels inherently unsafe for them.
As suggested above, one key reason for using imaginal exposure is that it allows the client to be effectively exposed to obsessional thoughts for which there may not be any outwardly observable compulsions. There are three additional reasons for which imaginal exposures may sometimes be the best approach to exposure:
- Standard behavioral exposures cannot always be easily created for some thoughts. For example, if someone with Existential OCD fears non-existence, it is virtually impossible to create a behavioral exposure that actually replicates not existing.
- Some thoughts cannot be acted on for legal or ethical reasons. We cannot assign someone to kill someone or to molest a child. But we can assign them to write a story about those things.
- For some people, certain thoughts provoke too much anxiety to face with standard behavioral exposures. Some clients are so overwhelmed with anxiety about a particular event, situation or thing that writing a short story about what they fear may be a good intermediate step that helps them to eventually face that fear more directly.
Regardless of the reason, if and when the client feels ready to write and use imaginal exposures, this technique can have a profound impact on their OCD.
Writing Imaginal Exposure Stories
Imaginal Exposure stories are written with the client’s active participation, and based entirely upon their actual obsessions. To be truly effective, imaginal exposure stories should have six specific characteristics that ensure that they will have the most impact:
- Write in the first person – “I stabbed my girlfriend”, rather than “he stabbed his girlfriend”. These stories are not about some other person – they are about you.
- Write in the present-tense – Don’t write it like it happened last year. Write it like it is happening now, or at least write it in such a way that the consequences are occurring now.
- Keep it real – It must be based on an actual thought that is bothering you now. If the thought is not really bothering you, don’t waste your time writing about it.
- Keep it realistic – Nothing too far-out. It has to feel believable to you.
- Keep it succinct – No fluff and no soft-pedaling. This isn’t a creative writing class. For example, if you have obsessions about harming someone, then write a short story in which you act on that thought, and you pay the price.
- Take it to the limit – Make it as bad as you can make it – your own personal nightmare – whether that is life in prison for murder, eternity in hell, or just having to spend the next 40 years living with the knowledge that you’ve sexually molested your own child!
Imaginal exposures stories should be relatively short and to the point – usually no more than ½ to ¾ page. Again, this is not a creative writing class, so nix the fancy adjectives and metaphors, and focus on sticking to the content in all its brutal glory. I have had clients who have written powerful imaginal exposure stories that were only one sentence long. Each situation will vary.
Once completed, the client should read the story repeatedly. Preferably out loud. I often recommend that they read their imaginal exposure stories a minimum of 30 times per day, which can be easily accomplished by reading it ten times before work, ten times at lunch, and ten times after work. And no speed-reading. The goal is to feel the full impact of the story, not to get through it as fast as possible.
Another alternative is to record the story and to listen to it over and over and over again during your commute to work (both ways). Remember, it is just like any other exposure. Just as you will usually need to do behavioral exposures many times to reap the full benefit of ERP, you will likely need to read imaginal exposures many times in order to see significant results. The goal is to read the imaginal exposure story until it becomes much less threatening – until it becomes just a really boring story you have read far too many times. Boredom is good.
Also, if a particular story no longer causes anxiety, but the same obsession remains, write a new story that is somehow even worse! And just as you may need to adapt your standard behavioral exposures to changing compulsions, you may need to adapt imaginal exposures to changing obsessions. When you suddenly find yourself facing a new obsession (and you will), write a new, equally anxiety-provoking story. The sooner you face the new obsession head-on, the less likely it is to get entrenched in your mind. During the course of therapy (and afterwards), you’ll gain the most if you write multiple stories that challenge your various obsessions. Be proactive.
I know all this sounds dark and scary. That is mostly due to the fact that, at first, imaginal exposures are dark and scary. But that is precisely what makes them so effective. By facing your fearful thoughts directly, you learn over time that they really aren’t as scary as you think. After all, you aren’t actually doing the things you fear – you are just allowing yourself to experience unwanted thoughts that don’t deserve nearly as much attention and anxiety as you have been giving them.
Examples of Imaginal Exposure Stories
Below are two examples of imaginal exposure stories. The first addresses a typical Harm OCD obsession, and the second addresses a common HOCD / Gay OCD obsession. Either or both these stories may make you uncomfortable. These stories are not meant to be pleasant – they are meant to effectively challenge OCD, so they are direct and crude by design, with no sugar-coating.
If your obsessions are anything like those described in these stories, you may be triggered by them. That’s ok. Life is full of things we don’t like, and avoiding those things doesn’t make them go away. In fact, for those suffering with OCD and anxiety, avoidance of fear is almost always a far bigger problem than what triggers the fear in the first place. So if your anxiety gets triggered by reading either of these stories, I encourage you to view that as an indication that this is exactly the type of story you need to write for your own recovery.
Here is the Harm OCD imaginal exposure story:
“I am sitting on the sofa with my sister. Suddenly, I grab the scissors from the desk, and lunge them into my sister’s right eye. My father grabs me and pries the scissors out of my hand, but the damage has already been done. My sister is blinded and unable to continue with her profession. I am arrested and convicted of attempted murder and gross mutilation, which carries a sentence of fifty years in state prison. My family cuts all ties with me, and my friends desert me. After forty years, I am paroled, but don’t know a soul in the world. My dream of raising a family is no longer possible. I spend the rest of my life living with the fact that I destroyed my sister’s art career. When I die, my soul is sent off to eternal damnation in hell.”
Do you see how short and simple the story is? It has three very straightforward elements – the event (stabbing the sister in the eye), followed by the immediate consequences (arrest, conviction, and prison), followed by the long-term consequences (the client’s worst fear, in this case, eternal damnation in hell).
Now here is a story based on HOCD / Gay OCD.
“Lately, I have noticed that I find Bill attractive, and I notice that whenever I see him, I can feel a tingle in my crotch. One recent day after class, Bill suddenly reached over and kissed me. I really liked it and kissed him back. His tongue went deep into my mouth, and I started rubbing my body against him. We both were breathing hard, and I could feel his penis hardening against me. We ripped each other’s clothes off, and he started licking my penis. I felt the warmth and wetness of his mouth, and screamed as I came. After that I went down on him and he tasted so good. I realize now that this is what I have always wanted, and for the first time I realize how sex really should be. I finally have to admit to myself that I am gay, and I spend the rest of my life as a gay man.”
Note how this story follows the exact same structure as the first story – the event (sex with a person of the same gender), followed by the immediate consequences (“I like it!!”), followed by the long-term consequences (the client’s worst fear, in this case, having to accept that he is gay, and that he will live the rest of his life as a gay man).
These are simple examples of imaginal exposure stories for two very common sub-types of OCD. This technique can be used to challenge virtually any obsession experienced by those struggling with OCD, and is particularly helpful for treating the Pure O variants of this condition. Imaginal exposures can also be extremely effective for addressing symptoms of other conditions that include significant levels of obsessional thinking, including Body Dysmorphic Disorder (BDD), Health Anxiety (Hypochondria), Social Anxiety, Panic Disorder, and phobias such as Emetophobia. For each of these conditions, the imaginal exposure story should follow the same simple three-part structure, as well as the six characteristics noted in the first part of this article.
It is worth noting that imaginal exposure is not a simple one-size-fits-all approach. Each person’s response to imaginal exposure will vary depending on numerous factors, including:
- Severity of obsessional symptoms.
- Level of insight regarding the accuracy and legitimacy of obsessions.
- Willingness to write exposure stories that truly reflect one’s deepest fears.
- Commitment to reading the imaginal exposure stories repeatedly and consistently.
Furthermore, it is critical that sufferers understand that imaginal exposure is not in any way a silver bullet that provides a quick fix – it is just one piece of the puzzle required for effective treatment of OCD and anxiety. For imaginal exposure to be truly effective, it should be integrated into a cohesive treatment plan focusing on Cognitive Behavioral Therapy (CBT) that emphasizes Exposure and Response Prevention (ERP).
If you are struggling with OCD or a related disorder, imaginal exposure is one of the most powerful tools you can employ in challenging your anxiety. It may seem overwhelmingly scary at first, but with consistent effort, you will likely see a significant reduction in your symptoms. Don’t get fancy – just write about what really scares you and keep it simple and direct. Then read that story over and over again until it becomes less scary to you. Better yet, read the story until reading it becomes an excruciatingly boring chore. Boredom is the opposite of anxiety. Boredom is good.
•Tom Corboy, MFT is the founder and executive director of the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (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, and intensive outpatient treatment. To contact the OCD Center of Los Angeles, click here.
Hi I’ve had chronic ocd for over 60yrs. I know exactly what you’re talking about because I’ve had every type of treatment there is including many medications sadly nothing has helped me my ocd is the driving one its also when I’m being driven and has esalated to even when I’m walking I’m checking to see if anyone has been run over.
It’s also about magical thinking. If i have a thought then I think I will make it happen, its ruled my life although I’ve managed to have a great life part of that was living in LA. Wonderful place. Anyway I wish you luck and pray that one day they find a cure for this oh so dreadful condition. Look what it did to Howard Hughes. kind regards, Michael Williams Hove UK.
Thanks for your comment.
Your obsession related to driving is incredibly common in OCD – so common that it is colloquially described as “hit ‘n run OCD” by many. It is generally considered a type of Harm OCD. I encourage you to read our series of four articles on Harm OCD.
Additionally, you may also want to read our article on Thought Action Fusion, which specifically addresses the magical thinking issue you mentioned.
Hey, if your thoughts are of your child dying but you aren’t the cause, is it still ocd? Like I’m always afraid a truck or someone will hit us and my almost two year old will be violently pulled apart or his head smashed in. But I’m not the one hurting him in these scenarios – is it still ocd or is it just parental worry? My husband has them too but then he goes about his day. But I just sit there replaying it over in my head and imagining life without him and repeating the pretend accident.
Great question. The line between normal “parental worry” and “OCD” is crossed when: a) the thoughts are repetitive, intrusive and unwanted; and b) when one does compulsions in an effort to eliminate the unwanted thoughts or quell the anxiety caused by the unwanted thoughts.
For you, the thoughts are clearly repetitive, intrusive and unwanted, and your compulsive response is to ruminate on the thoughts in an effort to get rid of the thoughts and the anxiety they cause. By comparison, your husband has the same kinds of thoughts but he doesn’t ruminate about them. He just shrugs them off as the junk thoughts that they are. I encourage you to follow your husband’s approach. When you have the thoughts (and you will), you don’t need to actively review them – just get on with your day, without reviewing them.
Great article. Thank you. I will definitely try scripting for my panic disorder.
I have a question about when you said, “your compulsive response is to ruminate on the thoughts.” Can you expand on that? I always equated rumination with obsession rather than compulsion. Maybe I’m just confusing it with the everyday definition of “obsession” (thinking over and over). Why I fear going crazy from panic and then can’t stop repeating that thought, would that be considered an obsession or a compulsion?
Thanks for all the time you take answering comments!
When an unwanted thought repeatedly pops into your mind unbidden, that is an obsession. When one responds to that unwanted thought by choosing to analyze that thought repeatedly in an effort to understand it and/or get rid of it, that is a “mental compulsion”. I encourage you to read our article on “the denial obsession” which lists a few of the ways that people do mental compulsions.
A Beautiful artical on erp.
I live in india and I realize erp is missing in my therepy. I am on medication but the deep symptoms remain as the therapist hasnt exposed me to my fears.
I will try writing the article you suggest. However would be greatful if you can send me information about erp if I can practice it on skype.
Thanks for your kind words.
Unfortunately, most treatment providers know very little about ERP for OCD, and as a result, they generally only provide medication. And as you have learned, that approach has limits, as it does not really address the problem.
As for online therapy, you can contact us via the contact page of our website at https://ocdla.com/contactus/.
I don’t fear the compulsion, I fear the result. If discovered, my family and wife would reject me. Compulsive about the male penis with oral fixation.
People with OCD don’t generally fear their compulsions, which they do in order to receive their anxiety. They generally fear their obsessions, which is what I think you meant to say.
As for your obsession with male penises, this is an extremely common symptom of HOCD, also known as Sexual Orientation OCD.
As for your wife and family rejecting you if they discovered your obsession, that may or may not be true. It is also possible that if you explained HOCD to them, they might exhibit compassion and concern rather than rejecting you.
I struggle with OCD in fear of getting pregnant even though I am not having sex. I fear that semen could be on my clothes and even after washing them I cannot wear them again. I just don’t know how to treat this and I’m letting it take over my daily actions.
Hi Person 1,
This is a fairly common contamination OCD symptom. We have had many clients over the years who have been obsessed with the fear of getting or being pregnant, even though they had not engaged in any sexual activity. This shows just how OCD works to convince people of things that are entirely impossible, or at the very least implausible.
The best treatment for this and all forms of OCD is Cognitive Behavioral Therapy (CBT) with an emphasis on Exposure and Response Prevention (ERP). This treatment has been repeatedly researched and has consistently been found to be the most effective treatment for OCD. Unfortunately, most therapists have no idea of how to effectively provide ERP, and in fact, many have not even heard of it. Encourage you seek treatment with a therapist who specializes in treating OCD.
Good article. It clearly describes the issue and treatment method, and also accurately describes what OCD is. The reason we become so disturbed by our thoughts is because their content is so unacceptable to us. Only the worst “sticks”. It makes sense that repeated exposure takes the shocking-ness of the thoughts away.
Thanks for your comment. It sounds like you completely “get it”. Exposure to what we fear is the key component of CBT for OCD, and imaginal exposure is the best form of ERP for challenging obsessions.
I am Christoph from Germany, I am suffering from ocd intrusive thoughts (Pure-O, including all known topics). There are these well-known spikes which trigger the fear and doubt feelings to be evil and weird. In my case this “inner voice”, which tells me everytime I am evil, won’t be lessened only by writing down all these fears and horrible intrusive thoughts in an imaginal way. I think in my case the only way to become cured is to confront me to all real, fearful situations and not to respond to the “inner voices” , but rather without anxiety I admit them to enter without any response of mine, I even try to provoke them to be harder and try to laugh about all these accusations orignating from OCD. This requests so much mental strength and until now there are always throwbacks, but I am suffering for 12 years from this disease (Pure-O) and I am convinced there is a way to control this disease and to live a meanigful and good life. I wish all sufferers the best and I am thankful for all the support, especially offered from the US and UK based OCD help institutions which gave me so much informations and hope to defend myself against OCD. Thank you
Thanks for commenting.
This article is not meant to suggest that imaginal exposure by itself constitutes a full course of treatment for OCD. As I noted in the article, imaginal exposure is but “one tool”, and that “it should be integrated into a cohesive treatment plan focusing on Cognitive Behavioral Therapy (CBT) that emphasizes Exposure and Response Prevention (ERP).”
I encourage you to seek treatment with a therapist who specializes in CBT for OCD. If online therapy with one of our staff therapists is of interest to you, please feel free to contact us.
Very helpful and informative article, and I think it does a great job of explaining imaginal exposure. Also a year ago today I was in the hospital on suicide watch because my Harm OCD had me convinced I was going to kill myself. My anxiety had me shut down, I couldn’t walk more than a few steps without stopping to rest, I lost my job, I was terrified. I could not drive, I never thought I’d be able to hold a gun again because of the fear they brought to me. I even avoided the kitchen because of knives… 1 year ago I went to the OCD center in LA.. and today I have an amazing job, I have a concealed carry license and wear a gun on my hip every day with no fear. Anxiety cannot touch me anymore. And constant imaginal and physical exposure have made this possible. I think this article will help a lot of people…
Thanks for posting, and for your kind words. It is always gratifying to hear that our program is helping people. Keep up the good work!
Truly inspirational, Nathan! So glad to hear how far you’ve come. Stories like yours provide motivation and keep hope alive for so many. Here’s to many years of success using the tools you have gained in your treatment!
Thank you for this article but I had some questions. I am currently in therapy for POCD. Although I do have intrusive thoughts, it is mainly mental images of a very explicit and graphic nature which seem to provoke my anxiety (in comparison with the thoughts). Therefore my therapist told me to hold on the images (through mindfullness) when they come and even imagine a story and to replay that film in my head several times but without a written script. When I asked him if I should use a script to emphasize the response prevention, he said that doing so might be applying OCD to the therapy.
I have read so many articles as well as Mindfullness workbook for ocd and they always talk about written or recorded scripts. I also wonder if I am doing ERP correctly and that it hasn’t become a checking tool (as I have read a lot of articles on the subject and seem to be obsessing about therapy as well)
Can imaginal exposure be done with only mental images? Is a script needed or is trying to focus on the storyline response prevention in itself? What do you actually mean with the phrase: “Level of insight regarding the accuracy and legitimacy of obsessions”?
A few thoughts…
There is no significant difference between intrusive thoughts and intrusive mental images. Both are unwanted mental events, and imaginal exposure should work for either symptom.
Generally, there is no reason why one should avoid using a written imaginal exposure script to address mental images. But it sounds like your therapist suggested you avoid a written script because he is concerned that you will use it as a compulsion. And the fact that you are spending so much time trying to be sure that you do ERP correctly suggests that he may be right.
The phrase “level of insight…” means just that – success is directly correlated to the client’s insight into the fact that their obsession is not an accurate reflection or reality, and that it is basically just mental noise that deserves no attention whatsoever.
Thanks so much for sharing your knowledge about ocd with us. You are the expert.
I am obsessed with a specific driving event, worried that I hitted someone with my car without knowing it. I would review it over and over again in my mind trying to determine that I didn’t hit anyone.even believed that I might actually have hit a pedestrian. What should I do?????
Can you please give me some tips???? Thanks so much.
Your obsession with the possibility of having hit someone when driving is extremely common in OCD, and is just one of many manifestations of Harm OCD. Michael’s comment above indicates that he too suffers from “hit’n run OCD”.
My best tip is that you seek treatment with a therapist who specializes in treating OCD with Cognitive Behavioral Therapy (CBT). Your goal in treatment should be to drive despite the obsessive thoughts, and to do so without doing any compulsions. That means no avoidance of driving, no checking to see if you ran someone over with your car, no reassurance seeking, and no mentally reviewing in an attempt to prove to yourself that you did not hit anyone.
Thanks so much for the reply.
The thing is that I believe I did hit a pedestrian at that specific past driving event. Feel so guilty. I should turn myself to the police. I can’t let it go.
Of course you believe you hit someone with your car – you have hit ‘n run OCD!
Many people with hit ‘n run OCD “believe” they have hit some one with their car. However, I am willing to bet that you did not hit anyone. If you had hit someone with your car, you would “know” that you did so. It would be very loud – not just a bump that surprised and confused you. There would be blood all over your car, not to mention a very large dent. And possibly a broken windshield, or some bits of flesh and bone, or maybe some torn clothing. There would also be a badly injured or dead person lying in the road. There would also likely be witnesses and news stories about the dead guy on the side of the road, and the hit ‘n run driver who fled the scene.
Unless you have some genuine evidence to support your thesis that you hit someone, I doubt you hit someone. Your thoughts and beliefs are not evidence of anything but a brain doing what brains do, which is to think about stuff.
Thanks so much. I so appropriate your advice. It wouldn’t be that bad even though it did happen. The disturbing part is trying to figure out whether it happened or not.(hitting a pedestrian)
Thanks so much,sir
“Trying to figure out whether it happened” is the very definition of a mental compulsion. This will get you nowhere, except to worsen your OCD. I suggest that you stop trying to figure out whether it happened, and to instead live with not having certainty either way.
Hi there!!great article!!!
Would you recommend this technique on someone with self harm ocd?and what kind of story could someone had on this type of odd?thank you!!
If one’s self harm obsessions are part of Harm OCD, and not legitimate suicidal ideation, then imaginal exposure is a great tool. Nathan’s comment above attests to this. Self-harm obsessions in Harm OCD are just like any other Harm OCD obsessions, the only difference being that the target of alleged potential harm is the self, rather than others.
An imaginal exposure story should be structured just like the examples in our article above. In your script, you would harm yourself and experience all of the consequences that upset you when you have these obsessions. Each person is different, so what bothers you the most about self harm (both short-term and long-term) should be in your story.
These stories can be difficult to integrate into treatment by one’s self, and it may be best for you to discuss imaginal exposure with a therapist who specializes in treating OCD with Cognitive Behavioral Therapy (CBT). Finally, allow me to note that if you are legitimately suicidal, you should go to your local emergency room immediately.
I suffer from Pure O OCD, and have been dealing with it for the last 15yrs. Till now. I finally started to get the proper help, as most places, were talk therapy, and they actually said to do the compulsions? weird… but any who my OCD has morphed around a lot throughout the years, and now weaves itself on things that are interchangeable ex: My husbands height, moles, my nose, bodily noises, sleep. If i worry to the slightest bit my OCD latches on for life. I learned the weaving is OCD’s way of spiking to remain alive. I am in the process of writing an imaginal story as well. I am starting to recognize that the “content” doesn’t really matter, but found it hard to detach from at first, then even more especially since my compulsions are all mental. Pure O is a tricky one, maybe even a little ROCD too…All I know is to remember to take it one day at a time and do the work. I am combating years of faulty thinking and if I fall its part of learning and I
am willing to continue my journey to mastering this…. Thank you sir.
Yes, OCD does tend to “weave itself on things that are interchangeable”, and as you put it so well, this is “OCD’s way of spiking to remain alive”. We call this morphing, and it happens with the great majority of those struggling with OCD. Keep doing what you are doing, namely taking life and OCD treatment one day at a time while continuing to do the work consistently. Take care.
Thank you so much for writing this article. It’s very interesting. I always have obsessive thoughts about death which make me feel uncomfortable to spend my daily life. Also, I’m easily worried too much about what the other people think or feel about me if I don’t do things they’d like me to do. I couldn’t even express my feelings to my friends because they would think I’m overthinking about what I feel towards those uncomfortable situations and they always feel like I’m moody all the time. It makes me upset because I wish they could understand me but they never cared about what I feel. I had some traumatic childhood which led me try to commit suicide once. The event still haunts me sometimes like the way I like to count things or compulsively adjust things if it doesn’t get it right. I always try to seek help from therapists or psychiatrists but it seems like my parents didn’t want me to get involved with treatment. I think it’s because they’re afraid or worried if I’ll be called a mad person in our society but I wish I could be cured someday. Thank you in advance.
If your parents are not taking your suffering seriously, you need to do everything in your power to get them to understand how much you are struggling. OCD is a very treatable condition. If you are a child, I encourage your parents to wake up to the fact that their child is suffering. If you are an adult, you don’t need their approval to get help.
I liked the article, thank you. I have Pure O in that I see traumatic images of injured animals suffering horribly or already dead in sick twisted scenarios. I am so afraid of writing it down, I would cry and feel like I’m evil, and if anyone saw it I’m sure I’d be arrested or committed. I’m also afraid that I won’t get into heaven or God will judge me for these sick thoughts.
My other issue, not sure if it’s related, is dermatillomania, where I pick my face, neck and scalp, searching for anything that doesn’t feel right. I spend hours doing this waiting til I either bleed or the blemish is gone. I know the images can trigger it but also other anxious thoughts, family, money, etc. Is there a way of applying imagination therapy to that so I can get my skin to fully heal?
Thank you for any help you can offer.
Sincerely, Susan from Canada
A few thoughts…
The images you describe sound very much like typical obsessions seen in Harm OCD, which is generally considered a type of what is commonly called “Pure O”.
Your images are not evidence that you are evil. Everyone has had thoughts like this. And if anyone says they have never had a sick and twisted thought, they are a liar.
If writing it down means that you should be arrested or committed, then Stephen King, Michael Connelly, and all sort of other very successful writers need to be arrested and committed because have these thoughts on a pretty regular basis. The only difference is that they write their horrible thoughts, get them published into best-selling novels, and make millions of dollars.
If there is a God, I am guessing he/she already knows what you are thinking. After all, God is supposed to be all-knowing. And what kind of God would create you, give you a mind that thinks up this stuff, and then judge you to be unworthy of entry into his/her heaven. That sounds like pretty sick God to me. I encourage you to read our series or articles on Scrupulosity.
Dermatillomania is not the same as OCD, but it is considered a “related disorder. It is quite common for people to have both OCD and Dermatillomania.
Hey Doc, I suffer from Pocd. My ocd generally tells me I don’t have ocd. Is that typical? My obsessions revolve around any young kids I’m around and particularly my nieces..I have 6 of them. Ranging from 13 to 3. It’s difficult for me because I am very omni sexual as it is, kinky by nature and am very sex positive. I struggled with hocd a few years ago, it turns out I an heteroflexible so when I finally accepted that I do find men erotically stimulating it seemed that ocd left. This one’s a bit me difficult. I have started erp in my own with setting aside time to forcefully bring on thoughts on they morning and have ventured into reading erotica of hebophilia and pedophilia. I don’t read much of those, more forcing the thoughts. It also seems that sometimes there is no thought, just obsessive sensations, like shame and or guilt. It’s up and down. When I first started doing erp on my own I was like yea a solution this is awesome! Now I’m getting s a bit disheartened, its it’s really tough day in day out. I live in San Diego. Any suggestions would be great. I’m going to try this writing exposure exercise.
A few thoughts…
It is quite normal for people with OCD to have thoughts that they don’t really have OCD, and that their thoughts are signs that they really want (fill in the blank).
We do not recommend reading erotica related to pedophilia / hebophilia. Such writing is illegal in some counties. Furthermore, while you do not mention doing so, I want to preemptively warn you against looking at pictures of children in sexual situations. This is explicitly illegal as it involves the exploitation of minors who are not capable of giving consent.
You ask of my suggestion, so here it is – doing ERP on your own is NOT suggested, especially when it comes to POCD. As my concerns above indicate, ERP can get you into illegal areas if you do not know what you are doing. Proper ERP does not need to be illegal to be effective. I also encourage you NOT to do an imaginal exposure on your own. I encourage you to instead find a therapist who specializes in OCD treatment with Cognitive Behavioral Therapy (CBT).
Hi, thank you very much for the article. I’m struggling with anxiety, panic disorder and agoraphobia. I’ve always had anxiety problems since childhood and now they are almost out of control
About 3 years ago (21 years old) I started to have panics attacks out of the blue. Altough I have a lot of simptoms when I have a attack, what is worse is the abdominal disconfort. It’s so bad that I need to go 4-5 times to the bathroom (even before going out, just thinking “I need to go to the supermarket, or to the bakery”, when I start to dress myself to go out, etc).
I had almost a “natural disaster” (inside a car and a bus) because of the panic atack and now I can’t go to places where there isn’t a bathroom.
Or where places I think the bathroom is too close where are the people, like my friend’s house, where her bathroom is very close to the living room. I don’t feel at ease.
I feel terrified only thinking of some “disaster” happening, because I don’t know when I will have a panic attack! Imagine trying exposing myself to places where really there is no toilet! A movie horror!
This is awful. I even thought about using diapers, just to feel safe if something happens. How bad is that! 🙁
I disagree with your thesis that it would be a “disaster” if you lost control of your bowels in public. It would likely be very embarrassing, but not a “disaster”. Nobody would die. And from the sounds of it, you have never actually lost control of your bowels in public – you merely “almost” did, which is hardly a catastrophe.
The symptoms you describe are fairly common for those struggling with Panic and Agoraphobia. You don’t need diapers – you need therapy. These conditions are very treatable, and I encourage you to seek treatment with a therapist who specializes in the the treatment of Panic Disorder.
Hello everyone. I just wanted to write to encourage everyone struggling with OCD. I have Pure O of the existential and HOCD variety and when it really gets going I become scared to death that I’ll kill myself. I ruminate over life’s meaning and things that are simply left unexplored.
Still, I know I’ll make it because, well, I know OCD is a thing and I know it is super treatable. I think conceptualizing OCD as a thing and sort of objectifying it helps us remember that OCD is not who we are, just what we have. My OCD spits out all kinds of unexplained thoughts regarding my life and not one of them really fits with the evidence. It’s the most bizarre thing and I don’t know that I’ll ever completely understand it. But I’ve accepted that I have this and that sometimes there are periods of weeks when I feel like I’m locked in a struggle. But I’ll overcome it and put it in “remission” again with therapy because that’s just what’s going to happen.
Another thing to remember, whatever thought or experience you’re having right this minute, it won’t last. It ALWAYS passes. This has helped me in numerous uncomfortable situations.
Keep fighting the good fight.
Thanks for your comments. I particularly like when you wrote “OCD spits out all kinds of unexplained thoughts regarding my life and not one of them really fits with the evidence”. That is a perfect description of OCD thoughts.
i have a fear from ugliness, and hence reject any physical imperfections of my partner, i tend to generalize any imperfection to be full ugliness, which is black or white. to protect my self from ugliness i tend to verify, double check, generalize, reject… this happened to me when i decided to commit to my partner… what is the best treatment for this, i am sure the exposure work above will help
If I’m understanding you correctly, it sounds like you obsess about the possibility that your partner is unattractive, and you do compulsions in an effort to prove or disprove this possibility. This all sounds very much like a type of OCD called Relationship OCD (ROCD).
Imaginal exposure is not something one should attempt by themselves. It should be done within the framework of structured
This article is very eye opening. I haven’t been diagnosed with OCD, but my therapist brought up the possibility and now I’m trying to learn more. It isn’t her area of expertise, so she recommended a psychiatrist for me to see. I find it impossible to tell if the sensations in my body are cause for concern, even though I have been told my many doctors and neurologists that I am fine. I still feel like they are missing something or that I might have something now, but maybe not when they tested me. Even though it sounds very scary, I might try this technique to conquer these fears. I’m so tired of this anxiety and these thoughts ruining my personal and professional life, I just want some peace. Thank you again for this article, I hope this is a step in the right direction for me.
If you have OCD, then you need a therapist who specializes in OCD treatment using Cognitive Behavioral Therapy (CBT). A psychiatrist is unlikely to have this speciality, and will almost certainly prescribe medication as their first (and possibly only) treatment approach. I strongly encourage you NOT to try imaginal exposure on your own – you have no background in CBT, and have never even been treated appropriately for OCD. You should instead seek proper treatment, during which you could use imaginal exposure under the guidance of your OCD therapist
Could you tell me if doing this imaginal exposure is suitable when my obsession is with a real event that really happened?
I am giving it a try.
I am writing briefly (in past tense) what I remember happening but am then writing in the present tense the worst possible consequences of the event. Mainly that I am condemned to a life tormented with guilt forever knowing that I killed someone. I am trying to do this on my own as I am unable to afford any therapy but am trying to stay positive it will help.
If you actually killed someone, imaginal exposure is not an appropriate technique for helping you address your guilt. I encourage you to seek treatment to help you better manage your guilt.
I suffer from a form of OCD called Retroactive Jealousy. My partner was extremely promiscuous before we met and I have never been able to cope with this knowledge. Are there any special treatments for this problem. I am on Lexapro and Wellbutrin.
Retroactive jealousy is just a term for obsessing about the past of one’s partner. It is not particularly unique or different from other forms of OCD, and there are no “special treatments” for it. It is just OCD, and the best treatment is Cognitive Behavioral Therapy with an emphasis on Exposure and Response Prevention (ERP). This treatment has consistently been found to be the key component for effective treatment of all forms of OCD. Medication alone is unlikely to fully manage the problem.
Thank you so much for this article! 35 tears ago I developed insomnia, which again led me to OCD, with endless checking of doors, cooker, lights, candles etc. All major checking is done in the evening, before going to bed. This does not help my sleep, of course, often I am awake all night, but somehow I just can’t stop the checking. At least it used to keep me feeling a fair amount of safety around bedtime. Now that feeling has gone, but I still can’t stop the checking. I applied for treatment about 5 years ago, but gave up before I started, as I felt too much fear around my issues.
Last December I become very, very dizzy, and have concluded that this is linked to my anxiety issues. I have therefor made up my mind and started OCD treatment.
Today I followed your suggestions writing a script about my worst fears. I have started with my anxiety around sleep (or the lack of it). I intend to carry on with issues around fear of causing harm by not checking cookers etc.
Have you any experience with what is the most effective way of treating OCD/checking issues around bedtime/sleep? Or sleeping disorders in general where huge amounts of checking is involved?
OCD related to sleep and the fear of having insomnia is actually fairly common. And checking behaviors are among the most common compulsions done by those struggling with this issue.
Treatment for this variant of OCD is the same as for all types of OCD, namely
not checking. As you noted above, your checking does not actually help to improve your sleep. Simply put, checing is a compulsion, and your best approach is to stop the checking and accept the possibility of insomnia.
I enjoyed your work on Invisibilia and found myself coming across this site multiple times in my own battles with OCD related intrusions. While I understand the underlying philosophy in terms of what to do for these thoughts, I still wonder if doing imaginal exposure – which I’m currently engaged in – doesn’t also legitimize my thoughts by causing me to focus on them. I was wondering if you could expand a bit on that.
I also wanted to ask you about why does OCD jump around from obsession to obsession. I know you talked about this in certain posts, but I’ve found that to be one of the most challenging aspects of having this condition, with how much energy and willpower it takes to battle these intrusions over and over again every day. It can get very de-motivating after a while.
Glad you found the interview on Invisibilia helpful.
Many people with OCD fear that purposely thinking certain thoughts will somehow “legitimize” the thoughts, but there is no evidence to support this contention. Imaginal exposure doesn’t legitimize unwanted thoughts – it helps to desensitize you to them. Simply put, repeated exposure to things that we irrationally we fear makes them less scary. It is the same as if you were afraid of heights – the more times you go to high places, the less scary they become.
I think it is a waste of time to try to figure out “why” the focus of OCD often “jumps around” from one obsession to another. That is just the nature of OCD – it flits from one thing to the next, focusing on what scares you. Rather than trying too figure why your OCD morphs, I think a better option is to accept that it morphs, and to accept that the unwanted thoughts exist in your head without reacting to them. They are just thoughts, regardless of the content.
Hi, awesome article about OCD, i’ve being suffering from HOCD about 5 months, and when i read the story about HOCD i was desperate, but when i finished i started to laugh about my reaction, was a really cool thing because i kind of reassure myself that what i have is HOCD, i was so scared reading the text, but now i feel better, fearless, you have any other exercises like that? Thank you so much.
Glad to hear that our article has helped you. Laughing at your OCD thoughts is a great response. After all, they are just weird thoughts that your brain comes up with.
Great article. Ive had just about every type throughout my life. Existential O, Gay Ocd, Pocd etc. It runs in my family. Ive had long periods of remission or lessening of symptoms. Now with a new wife and family, I shift between Rocd and Pocd. Some days i feel great and have no symptoms and some days its bad. Ive been to a lot of Psychologists and counselors and nobody within 3 hours of where i live does CBT ( I live on an island. Tough life right?). After a year of struggling i finally told my wife (she thought it was just anxiety) and she is supportive and wants me to find help. I am highly functioning but this disorder greatly saps my happiness. What do you suggest as far as tackling it on my own or online help? I would love to go to a CBT Counselor but like i said, i dont see any in my area. Thanks.
It sounds like you have struggled with various forms of OCD over the years. This is quite common, as OCD often morphs to new obsessions. Is is also fairly common that your symptoms are worse on some days.
Thanks a lot the great article! Kindly help me & reply; I’m emotionally hurting badly.
About 3years ago, I suffered from Retroactive Jealous RJ. I just went to a “talk-therapist” for one session, read an article online, & was fine within 4days – involved changing attitude. About 4 weeks ago, I began getting intrusive thoughts about my wife’s ex. I couldn’t remember what my remedy had been earlier (it had been long since I experienced it the first time). I got online & this time, I’ve been led to believe that ERP is the most effective therapy. So, I didn’t go back to the previous “talk-therapist” (the only one in the area – I’m currently in Africa doing charitable work). I devised an ERP therapy based on a framework from National Center for Biotechnology Information (similar to yours). However, unlike the previous time, the thoughts have gotten worse each passing day and yet I’m applying ERP. I can’t function well to deliver service. It’s the worst emotional experience in my life. Never thought I would wake up & have no strength to help helpless children in poor communities. Could it be that ERP is not for me? Should I go back to earlier confessions & the talk therapist.
I honestly have no idea how a program from the National Center for Biotechnology could be adapted to treat OCD. If you have OCD, then I encourage you to use a program that is designed specifically for the treatment of OCD. It is also worth noting that trying to self-administer ERP is not highly recommended. I encourage you to instead consider online therapy with a treatment provider who specializes in OCD. If you would like to discuss online therapy with one of our staff therapists, please email us via the contact page of our website at https://ocdla.com/.
Thanks a lot for your guidance & kind response.
I’m going to contact your center. One quick thing for which I seek your clarification, though, is that in your response above to Anne (who asked how imaginal exposure is applicable to events that actually took place), you stated that if the event she cited actually happened, imaginal exposure would not be appropriate. In the case of my wife’s sexual past, it actually happened. Would your answer (to Anne) be applicable to this (my wife’s sexual past) as well i.e. that imaginal exposure is not appropriate?
PS: Again, thanks a lot. I have been desperate till I found your article and website. I had never found a place as organized, authoritative, & resourceful as this, before.
Anne was referring to an event in which she claims to have actually killed someone. I don’t know if she actually killed someone, because she did not provide enough information, and sometimes people with Harm OCD believe they may have killed someone when they haven’t. If Anne actually killed someone, then her guilt would be an expected and reasonable response – I suspect all decent people who kill someone experience tremendous feelings of guilt. So in Anne’s case, I don’t think imaginal exposure would be appropriate, as she appears to have experienced a genuinely traumatic event that she needs to address therapeutically.
Your situation is entirely different. You are not obsessing about anything you have done, but rather about what your wife may or may not have done. The goal of imaginal exposure is to help the obsessing individual became less sensitive to irrational obsessions, so in your case, I think imaginal exposure could be a valuable tool.
Your wife’s sexual history is her business, not your’s, just as your sexual history is not her business. You are both entitled to your past. Furthermore, your wife’s sexual history is not even remotely analogous to having killed someone.
Thank you very much for this article. It was very insightful and teaches me a great deal on how I need to manage this condition.
I believe I have suffered from HOCD for 11 months now but like other sufferers I doubt on whether I do have it when my OCD is at its worst.
My question is, when doing imaginal exposures, is it normal to feel groinal and physiological responses. I have tried to think of things that are my worst nightmare but I feel a lot of movement in my groin, heart palpitations and shortness of breath so my mind instantly process that as I’m ‘enjoying’ these thoughts.
Also, I can’t seem to stop the checking especially when I’m anxious. I worry that the imaginal exposures are only going to lead to more and more checking and keep going in a cycle.
I’d very much appreciate a response.
It is not unusual to have a groin response when doing imaginal exposures, or any kind of exposures for that matter. The problem is not your groinal response, but rather your over-attending to it, and your over-valuing of it. If you pay close attention to any body part, you will start to notice sensations that you would not have noticed had you not been paying attention. In other words, your attention makes you notice sensations that you may not have noticed, and to evaluate those sensations as being important and meaningful.
Checking your penis is not going to have any result other than to worsen your OCD. Step number one is to stop checking your self for groinal response. If you do imaginal exposures but then check for groinal response, you are completely undermining the goal of the imaginal exposure. Step number two is to let your penis and other body parts and bodily functions do whatever they want, without spending anytime at all analyzing and judging them.
I’m glad I came across this article. My anxiety has just dropped about 15%. I’ve had OCD since I was 9. It subsided but hit me like a ton of bricks after having my baby. I feel like I’m missing out on important aspects of motherhood bc of my intrusive thoughts. I just want to be normal. I say this because the ritualizing was the easy part. I suffer from unwanted thoughts that paralyze me. At first my thoughts were very postpartum OCD (yes I still hide knives and scissors) related to like harming my baby, then it switched to someone else harming my baby, now it switched gears to religious thoughts that somehow I’ll be possessed. I’m writing this because one of my thoughts is keeping me awake & my heart is beating out of my chest. Once a thought appears I start analyzing what it means-this is the worst. It eats you alive. I’ve seen therapists, I started reading Freedom from OCD by Dr Grayson, and I just scheduled an appointment with my doctor to be placed on an antidepressant. I feel like I’m running out of solutions. I also started going back to church. I feel like a schizo. Once I get a thought in my head it hurts so bad, I cry.
Any response would be so greatly appreciated.
It’s important to note that Perinatal / Postpartum OCD is really no different than OCD in general – it is just OCD that either starts or is exacerbated during pregnancy and after giving birth. All of the intrusive, unwanted thoughts you mention are quite common in OCD. The problem is the over-analysis that you mention, which is nothing more than a compulsive search for certainty this will always backfire.
It’s great that you are reading books and going to a physician with the plan to possibly try medication, but your best approach would be to seek treatment with a therapist who specializes in treating OCD with Cognitive Behavioral Therapy (CBT). You mention that you have tried therapy in the past, but unless your therapists were trained specifically in CBT for OCD, the chances are that they had no idea how to help you. Rest assured that you are not out of solutions – you just need the right solution, which is specialized CBT.
Hi, what I’m experiencing is known as false memory OCD, where I feared I have killed someone at a particular place where I had been.
Is this type of OCD common? And how do you think imaginary exposures can be incorporated into such experiences?
Thanks for reading!
What you call “false memory OCD” is nothing more than a common Harm OCD obsession. We have treated many clients who fear that they have harmed someone. Imaginal exposure would help by repeatedly having you expose yourself to a story in which you actually harm a person in the exact way that you obsess about.
I see. Well I think writing imaginary stories surrounding my scariest obsessions will help. I will bring it up to my therapist next time I see him.
Thanks for your swift reply!
If your therapist specializes in OCD, then they should be able to help you with creating imaginal exposure stories. On the other hand, if your therapist does not specialize in treating OCD with CBT, they will likely have no clue as to why you would want to write such story, and no understanding of the clinical rationale for imaginal exposures. And as noted in the article above, imaginal exposures are not something that should just be thrown into traditional talk therapy, but rather should be a part of a structured course of CBT.
Hi, yes my therapist is trained in CBT, and I am currently listening to my script on a regular basis to expose myself.
Is it common for sufferers of harm OCD to think that they have harmed/killed strangers instead of being afraid that they might do that in the future?
I have these thoughts and it’s scaring me. This particular thought is one of the first few OCD thoughts I have and it’s scaring me because it’s been with me for so Long. I don’t know if I could ever recover and get over this thought.
Also, the script has habituated me to the content of the thoughts. But it hasn’t allowed me to habituate to the uncertainty of whether I had carried out those acts that I fear of. Will the imagination exposure help me achieve the latter objective?
There is no significant difference between obsessing that you have committed a horrible act in the past vs. obsessing that you will commit one in the future.
Habituation does not mean that an issue goes away – it means that you no longer overreact to it. Uncertainty is not going to disappear – it is a fact of life. Your job is to accept it.
You note that your therapist is trained in CBT. As such, I encourage you to discuss these matters with him/her.
I’ve just found your website (via Invisibilia on NPR), and wish I had discovered it 6 years ago when my life fell apart (though in reality the obsessive thoughts started at least 20 years before). As I’ve been looking around at all the sub-types of OCD, a question occurred to me: is it possible to have more than one kind of OCD at the same time? I saw my self all over the place, obsessively worrying about all the things.
I am happy to hear that you found the segment on Invisibilia to be helpful. And yes, it is not only possible, but quite common for people to experience various sub-types of OCD. Sometimes people’s obsessions morph over time from sub-type to another to another, while others experience multiple obsessions simultaneously.
First, thank you so much for sharing this article. It can be really useful to start ERP without seeing a therapist. Could you please advise me on somebody specialized in ERP for OCD, who could provide Skype sessions?
I have high anxiety for HIV, thinking about it most of the time. ERP scenarios would be a great plan I guess. Then listening to the records on the way to work. Is HIV OCD common and treatable with imaginal ERP?
Fear of HIV is extraordinarily common in OCD, and is treated just like any other obsession.
I was wondering if you could help me, follow through with the exercise. What happens after the person writes the paragraph? In classic ERP, the active ingredient is habituation to anxiety (at a behavioural level) and a disconfirmation of the worst case scenario ( cognitive shift). What’s going on after or during the writing?
Imaginal exposure is the same as “classic” exposure – the only difference is that you are using the story as the exposure. Upon repeated reading of the story you write, habituation should occur. Of course, this assumes that you have written the story properly. I encourage you to pursue treatment with a therapist who specializes in OCD treatment, rather than trying to do this yourself.
Hi!I’ve dealt with intrusive thoughts since I was 8 years old,I’ve had songs stuck in my head that talked about satan and and I felt like by doing this I was invokating him, that caused me extreme anxiety but I couldn’t help it, then later on I was tormented by the image of having sex with Jesus Christ, I and couldn’t get rid of it, I would cry and pray and I thought I was being possessed by the devil. I got pregnant and my thoughts and anxiety stopped and they were gone for about 5 years until all of a sudden it hit me all over again, I started thinking the worst about my family members, I would see my mom and just think “you’re stupid old lady” etc, but the worst happened when those thoughts became about my son, I would imagine him dead without his head and that would terrify me I became depressed and wanted to kill myself I never actually looked for help because I thought all of this had to do with the devil, and again out of nowhere the anxiety stopped, the thoughts were kinda still there but without the anxiety they didnt bother me bc I knew they’re not real. 3 years later it’s starting again, now with imagines of my 2 kids doing sexual acts. Why does it come and go.
People with OCD tend to get stuck on thoughts that relate to things that are important to them – in your case, your faith and your family. I suspect that you have had lots of other weird thoughts over the years (we all do), but you did not get stuck on them because they were not related to things or people that are important to you. For example, one might have the thought “My toothpaste tastes like pea soup”. That thought would likely not become obsessional because the content is not about something “important”.
These thoughts come and go because all thoughts come and go. You are just getting stuck on these particular thoughts. As you noted in your comment, some thoughts have become less upsetting to you because you “knew they’re not real”. None of your thoughts are more or less “real” than other thoughts, but you are taking some thoughts way too seriously. I encourage you to view all of these weird, unwanted thoughts as if they are thoughts about pea soup flavored toothpaste.
I’m pretty sure I suffer from moral scrupulosity. I have been realizing more than ever that I have OCD. Reminiscing over all of my life (all 20 years of it), I think I have been a perfectionist in everything. My first year of college was a good example of this (stress, straight A’s, lack of desire for social life because of seemingly pressing assignments), and my current moral situation may put a crown on its reality. For the past month, I’m in my bishops office trying to confess something (usually different) every Sunday. Previously, I reminisced nearly 8 months over a past sin my bishop assured me I had taken care of, and as a result I took it to other bishops who told me the same thing. Now, with this behind me, I find other things that could be “sins.” I think a part of my problem is that I’m not completely sure on the rules of what needs to be taken to a bishop in my church, which drives me crazy. So I confess “to be safe.”
Bottom line, I fear that I’ll be barred from doing things in the church because I feel guilt. My problem is more with repetitive guilt and fear than anxiety, so do you recommend imaginary exposure for someone in my situation?
Moral Scrupulosity refers explicitly to ethical and moral obsessions outside the framework of religion. From what you write, you are struggling with obsessive fears of sinning, which would fall more naturally into Religious Scrupulosity.
As for Imaginal Exposure, there is no reason that this technique can’t be done with Scrupulosity. That said, I encourage you to do this not on your own, but rather with the guidance of a therapist trained in Cognitive Behavioral Therapy (CBT) for OCD.
Hello, I have been suffering with HOCD on and off for 3 years. What really gets me with HOCD is that everything seems so real. my brain typically likes to make me challenge myself by looking at breasts and seeing if I enjoy looking at them or not. And what always makes me anxious, is that I always feel groinal responses, my heart flutters, and my lips tingle. I have always been an imaginative person, and I always imagine myself in sexual situations to try and prove to myself I don’t like it. But I always do. Then my brain spirals into “this isnt HOCD, this is denial type of thing.”
Just then, I wrote down a paragraph of myself in a sexual situation with a female, and I have never felt such intensive groinal responses. I feel this is making me much worse as now my brain is like “you enjoy it, thus you must be gay”.
What you call “challenges” and being imaginative are what therapists call “doing compulsions”. No good will come from this checking behavior.
I encourage you to stop trying to self-treat your symptoms, and to instead find a therapist who specializes in treating OCD and knows how to appropriately implement imaginal exposure (hint: you are doing it wrong).
Thank you for the post.I have been suffering from pure ‘o’ type of existential OCD.I am afraid that i’ll kill myself .I keep browsing about meaning and purpose of life Out of Mental compulsion For 2 years without doing anything at all in my college.I can’t balance my Academics .The OCD keeps morphing Day to Day.Certainly I’m facing Insomnia.
I have no therapist or no help nearby.I am having a psychiatrist who prefer medication for it.I tried numerous spiritual practices but none has worked out for me.can I Try imaginary exposure by myself.? or is there any self help Practice available.?
Please help me .I feel like i’ve exhausted
Trying to figure out the “meaning and purpose of life” is a waste of time. You will never find the answer, as it does not exist. Furthermore, it is a compulsion that is making your OCD worse not better.
I do not recommend self-help, including self-assigned imaginal exposure. I recommend you seek treatment with a therapist who specializes in treating OCD.
I have OCD and are there any support groups in Northern California, San Francisco Area or the South Bay Area? Also, are there any treatment centers for OCD?
I encourage you to look into online therapy as an option.
Hello i have hyper awareness of breathing and recently aware of swallowing. I do self-help by using the internet because i think the psychologist told just i must not notice it or i must be thankful because i breathe. So i just search the internet. And do erp and mindfulness in my breathing just aware of my breathing and no judgement. And also in my swallowing when i have to swallow i just do it. Over time my anxiety lessen because i put on my mind that i will forever thinking of this and i have to accept what it was. But my sleep is shallow. I want my sleep to become complete again. Im becoming worried or thinking only if i have a few hours of sleep. But i always put on my mind that i will forever be thinking my breathing and swallowing and thats normal so that my anxiety will be lessen and everyday i give time for erp and mindfulness for my breathing like aware and no judgement. Thank you!
The fear that one will forever be thinking about normal bodily experiences is the primary obsession in what you call Hyperawareness OCD, which is also sometimes referred to as Somatic OCD, or Sensorimotor OCD. Unfortunately, your psychologist’s suggestion that you treat this issue by just not noticing it tells me he knows virtually nothing about treating OCD. And while I agree that you should be happy to be breathing, that is an equally ridiculous suggestion for treating your obsessions. So my main suggestion to you is that you find a therapist that actually knows something about OCD.
Hi do you have any examples of Imaginal Exposure for existential worries? Ie. The universe is the product of my imagination or of some other manifestation, or I’m in a coma or something like that. I find it somewhat more difficult to write a story for obsessions like this. Thank you
Imaginal exposure for Existential OCD is no different than any other variant of OCD. Just follow the six steps described in the article above. If you continue to struggle with this, I encourage you to seek therapy with a treatment provider who specializes in treating OCD.
I was wondering if you had any experience with “Real Event OCD” or obsessing about events or past mistakes. I suffer from this immensely. I punish myself harshly for mistakes I have made in the past (specifically revolving around mistakes made in my relationship). I have been through a rollercoaster of rOCD before and now it is sorta on the same track but more so obsessing about mistakes I have made (i.e., how could you EVER do that to him? He is perfect and you don’t deserve him whatsoever. You ruined your relationship etc etc.) If you have any advice for specifically how to address these thoughts, I would be so eternally grateful. As of now, I try to just accept the thoughts, accept that I am human and make mistakes and/or agree with the thoughts…. what is your expert opinion?
Thank you from the bottom of my heart!
Based on the little information you have provided, and having never conducted a formal assessment of you, I don’t think it would be wise for me to provide “specific” clinical interventions. That said, the general approach you should take is to accept the presence of uncomfortable thoughts (including thoughts like “how could you EVER do that to him? He is perfect and you don’t deserve him whatsoever. You ruined your relationship” etc etc.), without taking these thoughts so seriously, and without assuming that these thoughts are 100% accurate descriptions of what occurred as being so important. Likewise, I think it would be advisable to accept the fact that you are like everyone else on the planet in that you have made mistakes in your relationships. Other than that, I encourage you to seek treatment with a therapist who specializes in treating OCD.
Thank you very much for this really useful article! I do appreciate your job!
I am suffering from HIV-related OCD for 3 years I think. I’m not from the USA and local doctors put me on typical antipsychotics. I’m not agreed with this decision and switched it to escitalopram which is more effective and less harmful I think. Am I right? And they didn’t even suggest me to undergo CBT. Do you think I can do it myself using your article?
May I right down my story? I think I have pure obsessions but I’m not sure. That problem that I’m a gay guy and when I’m performing some activity with another guy I feel very tense afterwards. I do not experience and penetrative contact but still very horrifyed that I could catch hiv while mutual masturbation and frottage. What story would you recommend for me? I’m I right that imaginary exposure is what I need as doing exposures in my sutuation is to meet with random guys which is not acceptable?
What should I also do to cope with my OCD except taking escitalopram and this imaginary exposure.
By the way my obsessions is thinking about hiv and it’s rates of transmission, thinking again, it’s cyrcling in my head after each meeting with guy…
Unless you are trained and experienced in providing ERP, self-treatment is a terrible idea. The same goes for trying to implement imaginal exposure.
You ask what you should do and the answer is simple – find a therapist who specializes in treating OCD.
Hi, I have a question. I have hit and run OCD, and I believe my thoughts / memories are true when I do Imaginal Exposure. What should I do not to believe that’s true?
The believing that one’s thoughts are true, despite having no evidence to support that contention, is quite common in OCD. I encourage you to pursue treatment using imaginal exposure under the guidance of a therapist who has specific training and experience in Cognitive Behavioral Therapy (CBT). Simply put, you are unlikely to be your own best therapist.
My OCD started when I was around 13/14. I remember watching things on TV/seeing articles about potential natural disasters, and obsessing over them and worrying that my family and I would be killed. Then, after reading a horror story and watching the movie I began obsessing that I would murder my Mom or other members of my family. The thoughts caused me so much distress that I would actually vomit. Then, the thoughts turned into sexually perverted thoughts. Sexual thoughts about children/family members. The thought that I might molest my younger cousins or any other children I’m around has me afraid to be around kids or even have kids of my own one day. The sexual thoughts about family members bother me as well, but nothing bothers me more than the thoughts about kids/babies. I know that I’m not really attracted to children. I’ve tried medication and nothing has really helped. I did CBT a couple years ago and had temporary relief, but I feel as if I’ve relapsed. The thoughts now are worse than ever, and I can’t afford to go back to CBT because my therapist doesn’t accept my insurance (Medicaid-based plan). I’m not sure what to do. I’m now 26 and still suffering.
Unfortunately, the American medical system is designed to provide profit to insurance companies, not to help people like yourself who are unable to afford treatment. The best advice I can provide you is to either try to find an OCD specialist through Medicaid, or to join a low-fee OCD therapy group.
I suffer from scrupulosity, or religious OCD. I fear that if I think about bad words such as Satan, devil or deal, or any other number of sinful words that I will go to hell and not be with my family in heaven. I had what I would call overly religious grandparents that I stayed with when I first started college, that were so judgmental that they made me feel bad every time I did something for myself or bought myself anything but life’s bare necessities. It became hard to do anything for myself that I enjoyed as these words would pop into my mind. Then if it was something I purchased I would have to return it to the store.
Yes, this sure sounds like Scrupulosity.
I have been facing health anxiety (mostly cancer related) for more than 10 years which often includes worries about my wife’s and children’s health. Some of these thoughts move on with medical assurance while some tend to linger on. At a broad level I can see that it’s “all in my head”, yet whenever a thought comes it’s so real and scary. I’m on 10 mg of escitalopram which has helped, but I still keep having such thoughts. I liked your articles on CBT, ERP and imaginal exposure for health anxiety very much and it has opened a new line of hope.
However, the very thought of writing/ reading about my family being stricken with cancer is so terrible, that I don’t really know if I could bring myself to do it. Unfortunately knowledgeable therapists are not available where I live and costs of online therapy is prohibitively high for me. Would be good enough to please share some tips on how someone in my condition could take forward imaginal exposure and cognitive restructuring? Thanks in advance for all your wonderful articles.
Our website and blog contain over 100 articles about OCD and its treatment. You can view these article at https://ocdla.com.
Thanks for this very informative article. I suffer from OCD–pure obsessions. I’ve dealt with it since I was a child. My OCD has morphed through the years. In grade school, I had obsessive thoughts of kissing boys in my class or yelling while the teacher was lecturing. In high school it was obsessions of killing myself. For several years, my OCD seemed to improve. After the death of a family member, it came back–with a vengeance though. I started having obsessive, horrible thoughts of hurting my loved ones. My current obsession is that I will purposely drive my car off the road and hurt my family or hurt someone else by driving into oncoming traffic. It’s deeply depressing as I avoid driving to keep the obsessions at bay. I feel chained to the community I live in because I don’t like to drive on the highway. I also get depressed thinking about a family member getting ill and not being able to drive them to and from doctor appointments because of my OCD. I’ve tried medication in the past, but it doesn’t seem to help much. And what’s worse, the nearest CBT Doctor is an hour and a half from me. I feel guilty asking family members to take off work to drive me around.
Everything you write suggests that you are currently experiencing Harm OCD. When you avoid driving, you are doing the exact wrong thing, as avoidance will only make your obsessions worse.
Unfortunately, you are not alone in being unable to find qualified treatment providers close to home. If you are notable to get yourself to a nearby CBT therapist, your best option is intensive outpatient treatment. This will allow yo u to get a full course of treatment in a compressed period of time.
Thank you for your great article.
The type of intrusive thoughts I have are not classified in any type of Pure O. I used to do a lot of mental rituals however. They were (or still are) of two types: 1. My, or a loved one’s body being infested by different types of insects, worms or spiders. 2. Images of my classmates of school time harrassing me all the time. After trying to do ERP and not doing compulsions in my mind, a new obsession appeared: Images of the above mentioned classmates doing sexual assault to my mother. It was so intolerable that I gave up ERP.
As you see, in all of these obsessive images, “I” do not do anything. So I don’t know if it is Harm, Contamination or what category of Pure O. What kind of script should I write now that the first person does not have any initiatives in the images.
By the way, I live in Turkey, and it seems that your website doesn’t offer any online therapies for me.
Thank you in advance for your reply, I appreciate any help.
None of the specific obsessions you mention are unusual. And remember, OCD can seize upon any thought. So I encourage you not to get to focused on whether or not any specific thought fits perfectly into a specific category of OCD.
Hi Tom, About 4 months ago I discovered that my white girlfriend was having a casual sexual relationship with a black guy (that relationship happened immediately before we met, their last sexual encounter happened 2 weeks before our 1st date and they didn’t use a condom and he almost impregnated her). For the last 4 months I’ve been obsessing over this immediate past relationship of hers. The theme is constantly on my mind, always present in my consciousness (either in the foreground/ background) – I don’t know his name or looks, but my mind constantly “fills in gaps”. I realize that I have personal insecurities – and this past of her has completely unraveled my life. I can’t sleep well and have anxiety – not to mention the obsession. I am “triggered” by every black man that I see. My mind has unprovoked intrusive thoughts/images of them/associations and shifts from one detail of her past to another and keeps “churning” and “rehashing”. (“How could she do this ? How could she cheapen herself ? Why did she do this ? Did she have more fun with him”) – keeps trying to find “answers”.I am mentally traumatized and compare myself to him constantly. This is ruining me…
A few thoughts…
1) There is no such thing as “almost” getting pregnant.
2) The reason your girlfriend did this is because she wanted to and it was her right to do so.
3) She didn’t cheapen herself, but your racism is cheapening you.
4) This does not sound anything like OCD to me. Not all obsessions are OCD. That said, it sounds like you might benefit from examining why the race of your girlfriend’s previous partner is so important to you. That might help you feel less insecure about this matter.
Very good article. I wanted to ask you something, I’ve been about 8 years with fears of damage to myself, cut, ropes, heights … fear of suicide. It all begins when the thought comes to my mind that it can give me the impulse and commit suicide. It’s like a movie that goes through my mind and make me feel very bad and very anxious. I wanted to know if it would be advisable to do at home write the fears as you propose in the article.
As noted in the article, we do NOT advise people to attempt self-therapy using imaginal exposures. There is no way that this article has provided you with the expertise to effectively implement imaginal exposure. Further, imaginal exposure should be part of a structured course of Cognitive Behavioral Therapy (CBT) with a strong focus on Exposure and Response Prevention (ERP).
Hello.I have pure o sexual ocd about everyone and more about family members since last two years.Another recent problem is I am obessed with every opposite genders from kids to grannies.Every random opposite gender passes by me or i see ,i only feel and see reproductive organs moving by me.Like literally everyone.Every opposite gender on the street or tv, i see and feel oh a person with dick is moving and i see his dick moving, i only see.This give me urges.every opposte gender and i see oh he has a dick.I am ashamed.I didn’t knew this was ocd for past two years,but i recently found out.I am a girl who have never watched any porn,never masturbated,never was in relationship.I don’t know how i ended being this.I live in a small country where people have no idea about ocd. It is imposssible to get help here.Your help will help me to get out of this.Please can you help me how can i do erp in this case?please help,sir.I am ruining my life.It’s pure hell.I am just a teenager.i am dying everyday infact every second.
Unfortunately, many people who live outside of major cities in economically developed countries find that getting effective treatment for OCD is almost impossible. We can provide you with online ERP. As you are still a teen, the next step is to have one of your parents email us via the contact page of our website at https://ocdla.com./
Hi, Few years back i realized that i’m suffering from OCD, where i had both obsessions and compulsions.
I visited a doctor and he suggested to take some anti-depression tabs. Worrying the side effects, i didn’t take it & started reading more articles about self help & healing and it worked for few years. Last month, suddenly from nowhere i have started getting repetitive thoughts and random images & my anxiety levels have gone really high and those thoughts are making me feel more worried.
The thoughts i usually get are: I might go mad, i might pass out, some random screaming faces, my own face like screaming and acting like mad. I have convinced myself that these thoughts are unreal.
However, i still think about those thoughts. Sometimes, i feel really good with no symptoms, but unfortunately back of mind, that is still running and i call for those images.
I’m confused about what i’m undergoing. Is it OCD?
I still have mild compulsions like washing hands and checking door all that. But these images and thoughts are really making me feel anxious all the time. It is always running back of my mind. Even when i get up first thing i call these thoughts. Please Help
This sure sounds like OCD to me. My suggestion is that you stop over-valuing these thoughts and mental images. They are not particularly important, and they only become a problem when you over-attend to them, over-value them, and over-respond to them. The best response is to ignore them, as they are not important.
Hi there , I have been suffering with this for a few months but quite recently it has taken a turn for the worse. I started talking to a girl who has been my friend for years and it has developed into something about more serious however when we were kissing a thought came into my head saying “you might be gay” this caused slight panic but I just shrugged it off. The following week I had a dream where I was particping Ina. Sexual act with another man and this is what properly started the OCD. I was constantly trying to prove to myself that I wasn’t gay . For example me and my girlfriend went to the cinema and whilst watching the film I was trying to prove to myself that each male character was attractive and when we held hands I got an erection so that proved to me that I wasn’t gay. Eventually I couldn’t watch the tv without feeling anxious so I started to read books to try and keep my mind of it as well as this I deleted my social media apps because I couldn’t face looking at gay people who I had on my Facebook as it put me into a panic. It has affected my sex drive and I believe it is because I may be gay. The anxiety has passed and I don’t know what I am.
A few thoughts…
1) This all sounds like classic HOCD.
2) Thoughts pop into people’s minds all the time (really, ALL the time). Many of these thoughts are ridiculous and completely unrelated to reality.
3) Likewise, dreams are in no way an indicator of reality. Most dreams are just nonsense.
4) Stop trying to “prove” anything. This attempt at certainty is the real problem, as it worsens your OCD.
5) You say you don’t know what you are. Here is the answer – you are a human, and as such, you are far more than whatever your sexual orientation is. Stop paying so much attention to something that is really not all that important.
Would this work for generalized anxiety? I’ve made a lot of progress on my OCD using ERP. But I still have a lot of excessive worry and rumination “real life” problems like aging parents who need care, kids struggling in school, a jerk of a boss, etc. I have to do *something* to address these real problems, so I can’t just ignore the thoughts and go on with my life. I have to spend *some* time thinking through options and even planning for some “what ifs” … but it quickly turns into rumination. I’ve never figured out how to do ERP with this. Would writing out a story of my feared scenarios help here? (I kind of feel like that’s what I’m already doing – I’m constantly playing our worst case scenarios in my head!)
I do not suggest you try imaginal exposure with Generalized Anxiety Disorder (GAD). Further, I do not suggest you self-treat OCD with imaginal exposure. As noted in the article, imaginal exposure should be done as part of a structured treatment program implemented by a trained therapist who specializes in treating OCD.
Interesting article. I’m in the middle of having ocd related to an exposure I did in ERP a couple months ago with my old therapist . My therapist for pocd told me to write an imaginal exposure of me molesting my niece. To add to it I used names which made it more traumatic. Now, six months later I’m freaking out bc I’m equating it to me writing and reading child porn. In a previous comment you said these type of stories are illegal in some countries. But in the article you also said that writing a story about child molestation could be an exposure. What’s the difference?? I feel like this therapy was very difficult, I’m getting OCD about my past therapy which is very frustrating.
Writing a story about molesting a child is a great imaginal exposure for someone with POCD. But that doesn’t make it child porn. The difference is that you are not writing your story for dissemination to others so that they can read it for sexual excitement – you are writing it as a private, therapeutic exercise for POCD.
Yes, therapy can be emotionally difficult. That said, I encourage you to return to treatment with the therapist who was helping you a few months ago.
Does ERP ever result in individuals “enjoying” their story or “becoming” their story? I resist ERP due to this doubt. I can’t help but think “What if these ERP stories are repeated & the person actually starts to enjoy the thought of ‘stabbing their sister’ or ‘being with Bill’?” or “What if repeating this story to ones self causes it to become a subconscious desire aka making it worse?” (PS: I know someone wouldn’t actually enjoy the thought of stabbing their sister – just using it as an example).
Your fear that ERP will lead to you actually enjoying your unwanted thoughts is actually a common concern for those with OCD. I have been treating OCD for over 20 years, and I have never seen a client come to enjoy their unwanted thoughts as a result of ERP.
ERP works by helping the client become less afraid of a scary thought, not by helping the client enjoy a scary thought.
I have a “pure O” OCD. I’m currently under stationary treatment. The therapy is based on the ACT-Approach. I talked to my therapist about the option of “imaginative Exposure”. He answered me, that the problem about this method lies in a paradox: I go into my fears in order to habituate to them or rather to get rid of them, wich stands in opposite to the approach of acceptance. He told me that exposure in ACT means allways basing my action upon my values, even if the OCD doesn’t want that.
To but it simply, your therapist is wrong. Scores of studies have repeatedly and consistently found that Cognitive Behavioral Therapy (CBT)with a focus on a specific CBT technique called Exposure and Reposes Prevention (ERP) is the key component to effective treatment for OCD.
Furthermore, your therapist doesn’t seem to have an understanding that ACT is not in opposition to CBT, but rather is a variant of CBT. One can do ACT and ERP at the same time. In fact we do both with virtually all of our clients.
If your therapist continues to reject imaginal exposure, I strongly encourage you to find a new therapist.
I’ve been thinking of doing Imaginal Exposure for quite some time, but I’m not sure.
I have some idols that do YouTube. I’m afraid that if I don’t like their videos everyday that they’ll get sick, be kidnapped, die, or hate me. Could Imaginal exposure help with this??
Your liking YouTube videos recorded by other people has absolutely no impact whatsoever on whether or not those people get sick, get kidnapped, die, etc. Your belief that there is a connection between your thoughts and these events is what is known as “Thought-Action Fusion”.
As for Imaginal Exposure, I encourage you to only pursue this under the guidance of a therapist who specializes in treating OCD.
Hey just want to say GREAT article, extremely helpful. I’ve had OCD for 12 years (they believe it’s PANDAS) and after 7 years of suffering and trying all these different therapies (plain old talk therapy, EMDR) I finally found actual help at a CBT intensive outpatient program at UCLA. Those exposures are the hardest thing I’ve ever done. The compulsions were way harder to kick than my severe substance abuse.
I’ve been OCD free for about 3 years and as of last week it’s sprung up at full force. I had forgotten the specifics of imaginal exposures, so your article was very insightful and enlightening. I don’t know if you’re familiar with it, but my OCD takes on the form of immense guilt and continuous confessions. I’m also wondering what your take is on DBT? It being half CBT and half mindfulness
A few thoughts.
1) Talk therapy and EMDR are useless for OCD. Any therapist who utilizes these approaches for OCD has no idea what they are doing and is wasting your time and money.
2) Glad to hear that you found effective help using CBT at UCLA.
3) It is quite common for OCD to occasionally re-rear its ugly head, even after years of effectively managing it with CBT. The good news is that, if you use the tools you learned before, you should have quick success in managing this recent spike in symptoms.
4) Guilt and compulsive confessing are quite common in OCD, especially in religious and moral Scrupulosity.
5) DBT is a helpful “third-wave” treatment augmenting strategy for OCD, but without exposure, you are unlikely to see the same level of success that you would have with good old-fashioned CBT. Keep in mind that DBT is essentially a type of CBT. Think of DBT as something you do in addition to traditional exposure based CBT (i.e., Exposure and Response Prevention, or ERP), not in place of CBT.
I have been diagnosed with OCD–I went through ERP. I have a lot of perfectionism. One time they gave me an assignment to buy a coat, and not take long doing it. I bought one, never liked it since–wrong color red on me. Since then I have somewhat given up on it. What’s the point of making a quick decision just to decide and not like what you get? Generally I keep my coats about five years, so the answer now is give it away and buy one I really like. As a Christian, the place I went for six weeks, really didn’t understand me–because some of my thoughts–I didn’t know if it’s the Holy Spirit directing me. So now I prefer a Christian counselor if I see one again. I don’t think all doctors I see have to be Christian, but in cases of the mind, I definitely prefer a Christian that can understand my problem in that way.
A few thoughts…
1) Buying a coat that doesn’t look good on you is not a catastrophe. But OCD makes you think it is. It is just a coat. I believe you can live with making a rushed decision about a coat. Your decisions do not need to be perfect.
2) The “point” of ERP is to learn to tolerate unpleasant thoughts without letting them control you.
3) You don’t need a therapist who is a Christian – you need a therapist who specializes in treating OCD with Exposure and Response Prevention.
I’m new to researching about harm ocd. I believe that as a child I had some form of ocd and maybe have learned to work with it as an adult. I find myself lost on this site looking for answers for my 11 yr old boy. Based on what I have read he definitely talks and shows all the symptoms of harm ocd. Even word for word on some examples. He feels comfortable talking to me about all his intrusive thoughts and just now getting him professional help. I really don’t feel that the professional help really helping. In fact sometime it feels like he is getting worse. What can I tell him or what tools can I use to help him tackle each worry one by one? His biggest fears seem to be going to jail and going to hell. I apologize for this long msg but I feel lost and I just want him to stop worrying.
You sound like a good father who truly loves his son and wants to do what is best. That said, there is a limit to how much you can help your son without specialized treatment. While taking your son to a therapist is the best approach, the sad truth is that the great majority of therapists have no idea how to effectively treat OCD. I encourage you to seek out a treatment provider who specializes in treating children and adolescents with OCD using a specific type of Cognitive Behavioral Therapy (CBT) called “Exposure and Response Prevention (ERP)”. This approach has repeatedly and consistently been found by many research studies to be the most effective treatment for OCD.
Thank you so much for the article and replies. I went 3 days ago to my first therapy session. She recommended that I write a short scenario of my worst obsessions and then read it and live it for 15 minutes without reassuring myself.
I did that the last 3 days alone, but my anxiety levels don’t go up with the script. I tried multiple scenarios with details, but it didn’t work. I’m thinking maybe I just needed to expose them?
I have triggers during the day that make me feel anxious, so then I made the worst scenario in my head when that happened. Is this correct? It seems to work for the moment, I don’t know for the long- term. I am a bit confused, and I will be seeing my therapist again in one month.
I do feel more depressed now since I’ve been purposely thinking about my worst fears, but not really my normal ocd.
I hope it makes sense what I wrote. Thank you.
You have only had one session with this therapist. I am surprised that she just immediately jumped into imaginal exposures. While the assignment she gave you is a good one, it seems rather premature to dive into imaginal exposures so quickly. Keep in mind that imaginal exposure should be a component of a structured CBT treatment protocol, not just something that is tossed out willy-nilly. I encourage you to discuss your concerns with your therapist, and request a structured approach to handling your obsessions.
Help. Had OCD since a teen, started as a “dust/dirt on objects” type compulsion(no NOT germs)…in other words I would clean things to shining such as my bike and not even enjoy riding it as to not dirty it. I still have that problem. But as life has gone 30 years along, it has expanded to tapping in cycles of three, tapping light switches, turning off faucets twice. Checking that doors are closed and look at them and look away and look back and blinking a pattern to verify everything is “in position” aka “taken care of”. Basically a neat/orderly “type” of OCD style. Exhausting!
So my FEARS aren’t really the FEARS I read about from others such as “fridge door might be open and ruin the food” or “the door has germs”..nope, I have no worry about the food or germs, all is well and I KNOW it. It’s the repetitive action, tap, blink.. ITSELF, which is the obsession. It’s the ritual itself that I am stuck on. I have no idea how to treat.
I now finally admit my OCD, my growing bad moods. I have read a bit, NOW I fear that I figured out that I have OCD as a primary indicator to Huntington’s or Lewy Body other degen brain disease which both show OCD/anxiety…
A few thoughts…
There is no fundamental difference between OCD focused on washing and OCD focused on checking. It’s all OCD, and your goal is to stop the compulsions that feed the Obsessive Compulsive Cycle.
As for OCD being “a primary indicator to Huntington’s or Lewy Body or other degen brain disease”, this is almost certainly just another obsession. While some people with these diseases may have OCD, the great majority of people with OCD do not have these diseases. In fact, we have treated thousands of people over the past 18 years with OCD, and have never seen a single case where a client with OCD had any of these diseases.
Thank you very much for the amazing article and replies. please help me overcome this awful ocd intrusive thought.
It’s over sleeping. It tells me that I will not sleep.If I sleep, I keep thinking about the next night & If don’t get enough sleep, I worry about feeling tired the next day and the consequences of lack of sleep. My doctor prescribed me fluvoxamine but didn’t mention therapy at all. I want to face my fear but I don’t know how . This OCD is ruining my marriage. I count my hours of sleep & if my husband falls asleep , I feel anxious !! I benefited from ERP when I had door checking ocd .Do you think i will benefit from ERP on this thought ? if yes, How ?
Your anxiety related to sleep and insomnia is actually a common, but under-recognized, variant of OCD. The good news is that the treatment for this form of OCD is the same as other forms of OCD, and you have already had positive experience with it. Using ERP, you should be able to get a handle on this.
I have had purely obsessive OCD for many years–they symptoms have gotten better and worse periodically but more or less remain. I don’t have rituals, but the thoughts are intrusive and persistent 24/7. Specifically, my thoughts are existential in nature. The worst thought I have is that no one else exists and I am the only one in the universe. This obsession plays over and over repeatedly throughout the day.
How can someone do exposure and response prevention therapy in this situation? Can you give me an example of what I can do?
Imaginal Exposure for existential obsessions is the same as for any other type of obsession. Write a story in which your feared thought is true – another words, a story in which it turns out that no one else exists and you are utterly alone in the universe.
This thought is only scary because you have determined that the thought is meaningful and important. It is just a thought that your brain conjured out of thin air, and it has no special meaning or importance.
Great article and replies. I have had ocd since I was eight years old. I am now in my early fifties and was diagnosed two years ago.Having only recently read about ERP, for me, it is certainly a differant way of looking at the problems I have had.I do have a question about imaginal exposure. My current obsession, relates to Hocd with rocd . When writing a paragraph, despite my underlying belief in my innocence should I write “I fear this is possible ” or do I actually say “I actually did this” thanks in advance ,Gary.
A general rule of thumb is to make the story as uncomfortable as you can handle. I suspect that writing “I did (fill in the blank)” is more uncomfortable for most people with OCD than “I fear it is possible I will (fill in the blank)”.
Thanks for such good article on ocd.sir i am sufering for ocd form last 10 years and my ocd is that,that there are some stupied thought that come to my mind every time i.e why i am doing this thing ,why i am looking tv ,why i am doing execrise.so this type of thoughts rained my life so plz help me what i can do to get raid of this ocd?
You can’t “get rid of OCD”. But you can learn to more effectively respond to these unwanted thoughts so that they no longer upset you. I encourage you to seek treatment with a therapist who specializes in treating OCD with Exposure and Response Prevention (ERP).
Can ERP help you eliminate your fears for good? I have learned to manage my condition, but i find that during big or stressful events my anxiety tends to flare up and the same OCD fears pop up again. And they don’t seem to go away despite the fact that I use my skills.
If you aim for eliminating your fears “for good”, you are setting yourself up for failure. Fear is a normal part of the human experience, and NOBODY lives without fear. Not one single person on the planet lives a life devoid of fear. The goal is to become better at managing fears and anxieties.
That said, it is quite common for OCD to spike at times of stress. Your job is to use the tools you have to manage the thoughts and feelings that are spiking.
But what about getting rid of specific fears of certain fears like of objects or situations? Or obsessions?
The goal is not to “get rid of” unwanted fears, but rather to become less reactive to them – i.e., to de-sensitize to them via habituation. This is what exposure therapy, including imaginal exposure, does. And yes, it can be used for specific fears related to objects or situations.
For my HOCD and ROCD, what are some good exposures to start off with since you have to keep them smaller at first? Would it be reading about denial or watching break up stories on youtube or anything like that?
As the article above points out:
“For imaginal exposure to be truly effective, it should be integrated into a cohesive treatment plan focusing on Cognitive Behavioral Therapy (CBT) that emphasizes Exposure and Response Prevention (ERP).”
I have never met you, and the only thing I know about you is the brief comment you have posted on this blog. Rather than providing you with guidance based on such minimal knowledge of your situation, I want to encourage you to seek treatment with a therapist who specializes in treating ocd with Cognitive Behavioral therapy (CBT).
Hello. I loved your article! I have a mixture between harm OCD and false memory OCD. I am afraid of doing horrible things without remembering having done them. That’s why the imaginary exposures exercises are very scary for me, as I am afraid that by imagining those horrible things I am also doing them. I have a strong magical thinking problem. What is your advice? Thanks so much!
Yes, you are correct – you have a strong magical thinking problem. To put it as indecorously as possible, your imagination cannot make bad things occur. Things outside of your mind occur with absolutely no input from your imagination.
Likewise, you are also over-valuing the power of your mind to forget. I assure you that if you started doing horrible things, you would not somehow forget that you did them. If anything, you would more likely obsess about how horrible a person you would be for doing those things.
Follow the instructions outlined above for doing imaginal exposures. Expose your self to the thought that you are causing horrible things to occur, without attempting to soften the blow. Do this as often as possible.
I have this fear that I will loose control and become addicted to drugs. I have never ever tried any form of Drugs. Is this considered Harm OCD and would imaginable Exposure help? Medication has helped but not 100%.
I don’t know if I would call this Harm OCD, but it certainly could be OCD. Keep in mind that people can develop OCD symptoms about just about anything. Also don’t get too caught up in the names of the various sub-types of OCD. Harm OCD is just a colloquial term for OCD that focuses on harm obsessions.
Imaginal exposure is not something that one should try out of the blue. I encourage you to seek treatment with a therapist who specializes in treating OCD with Cognitive Behavioral Therapy (CBT).
I am afraid of writing this kind of worst case scenario because I am afraid that if I am writing it, it is also happening (it is very difficult for me to make the difference between a very scary thought and reality), I also have magical thinking OCD. One more thing, can we write these scripts on our own, without a therapist guidance ? Thanks so much.
Thoughts are not the same as reality. They are just thoughts.
I do not encourage you to attempt to create imaginal exposure stories on your own. As the article above notes:
“For imaginal exposure to be truly effective, it should be integrated into a cohesive treatment plan focusing on Cognitive Behavioral Therapy (CBT) that emphasizes Exposure and Response Prevention (ERP).”
Hi. I loved your article. I will start CBT & ERP only in September (apparently it’s hard to find an OCD therapist these days). I would like to start Imaginary Exposure ON MY OWN until September when i will be guided by a therapist as I can’t afford to live in this nightmare until September. What would be the RISK of a bad performed exposure exercise? Thanks and all the best!
A few thoughts…
1) As the article above notes, Imaginal Exposure should only be done as part of a structured course of Exposure and Response Prevetion (ERP).
2) You appear to have no training or experience with ERP or Imaginal Exposure.
3) Based on #1 and #2, I think it would be unwise for you to attempt Imaginal Exposure on your own.
4) If you are uncomfortable waiting until September to start treatment, I encourage you to consider online therapy.
Thanks for your answer. But what could actually be the RISK of a bad performed exposure exercise? Thanks.
The risk is that you get freaked out by the story you write, and your OCD gets worse not better, and you then see therapy as being too scary to undertake.
The bottom line is that therapy is not just random techniques that one throws at OCD to see what sticks – it is a process that has a logical progression, and is best provided by someone who actually knows what they are doing.
Thank you for the article. I suffer from hypochondria and my therapist has prescribed some ERP homework for me. Do you think this would be an effective tool for me? Also I would imagine that this would make my anxiety and the accompanying symptoms worse in the short run but be beneficial in the long run? Also will this help with body vigelance?
Exposure and Response Prevention (ERP) is exactly the right approach to treating Health Anxiety.
I have to say I’m kind of confused by the comment:
“Some thoughts cannot be acted on for legal or ethical reasons. We cannot assign someone to kill someone or to molest a child. But we can assign them to write a story about those things.”
Why would you discuss ethically not assigning someone to kill someone or molest a child since this IS their WORST FEAR. Even if it wasn’t unethical to assign these things, why would you tell a client to go make their worst fears come true, meaning they become a murderer or pedophile. I honestly found that comment rather triggering and unnecessary. I think a better comment would be “We would assign a client an exposure script about killing someone or molesting a child in order for them to be LESS afraid of that thought and more confident that it won’t happen” Isn’t that the point.
You’re over-thinking this. The point we were making is that there are some situations in which imaginal exposure is of particular value, specifically because exposure to the actual thing would not be ethical or legal. In other words, we would never assign a client to molest a child or murder someone, but we can still assign imaginal exposure stories in which the client exposes themselves to their fear by writing a story about it.
Keep in mind that, when conducting exposure therapy (including imaginal exposure), the therapist generally does NOT assign exposures which are designed to “make their worst fears come true”. For example, we don’t assign people who are afraid of AIDS to go get AIDS, and we don’t assign people who are afraid of burning their house down to burn their house down. ERP most often focuses on assignments in which the client faces their irrational fears by doing rather mundane behaviors that they usually avoid due to their OCD – for example, touching doorknobs they normally avoid for fear of getting AIDS, or using a stove to cook, even though they are afraid of burning down the house.
Unfortunately, some people are afraid of ERP because they erroneously think they will be told they have to “make their worst fears come true”, but that is not the case. In fact, the great majority of exposures are simple everyday behaviors that those without OCD do without even thinking about it (i.e., using a door knob or stove). You are likely confused/triggered by the comment you noted in your post because you have OCD. People without OCD would find the comment about which you are concerned to be benign and unworthy of much time or energy.
Thank you for the article. I have a question, though. Won’t writing a story and then repeating it work like the law of attraction (everything you think about and repeat will happen to you)? I am afraid that if I start doing these stories for my HOCD then I’ll really become gay and like it.
The law of attraction is ridiculous nonsense. Humans are not able to make things happen simply by thinking them. If that were the case, I would have willed Donald Trump out of office by now.
Hi Mr Corboy,thanks a lot for this article. I suffer a lot from OCD. Now my obsession is that I may have a wrong baby. What happened was that after giving birth to my daughter, I was told by the nurse to have a shower. During the shower , no one was with my daughter as my husband went home to grab something. After shower , i believe I went back to the wrong delivery room and got a wrong baby . After I got back to the delivery room, they got the baby all wrapped up ready to move to the postnatal ward . My daughter is already 4 years old. Only 2 months ago, I started to worry that I may have a wrong baby. Now I have so much anxiety and trying to remember and make sure that I did not go back to the wrong delivery room . The memory seems real. I even want to do a DNA test . I don’t know what to do . Do i just have to live with this doubt that I may have a wrong daughter ? How do you think I do ERP about this ? What should be the script ? I really appreciate your kindness and looking forward to your quick reply . Thank you ever so much .
As noted near the end of the above article, the proper way to do CBT/ERP is with the guidance of a therapist who has training and experience with CBT/ERP. I appreciate that you want to try this yourself, but you have not provided me with any evidence that you have any knowledge about how CBT/ERP is done. I encourage you to seek out treatment with a therapist who specializes in treating OCD with CBT/ERP, rather than trying to do this yourself.
My wife is bipolar and suffers from many OCDs. One of the worst is imagining that her father is watching her when she is trying to sleep. Her father abused her as a child by being a voyeur (e.g., watching her get dressed, shower, etc.), so it’s not some sexual act that she’s afraid of but the “looking” itself. Since she is bipolar not being able to sleep is particularly problematic. I have tried to reassure her that he is thousands of miles away and cannot see her. Do you think writing about her father watching her would help?
Because of your wife’s diagnosis of Bipolar Disorder, I believe the best course of action is for her to discuss her concerns with a therapist who specializes in treating Bipolar Disorder. Imaginal exposure would likely be a terrible idea for someone whose fears are rooted in Bipolar Disorder, and that seems a distinct possibility in your wife’s case.
Is it true in essence it’s actually the ocd that’s the problem not the thoughts as the ocd can seem to fix on anything? If so is there some universal way of just dealing with the ocd, rather than imaginal exposure to each dfferent thought.
The unwanted thoughts ARE the OCD. They are the “O” part of OCD (you know, the “obsessive” part of “Obsessive Compulsive Disorder”).
And yes, obsessions can focus on anything.
The “universal way” of dealing with OCD is Cognitive Behavioral Therapy (CBT), focusing on a specific type of CBT known as Exposure and Response Prevention (ERP).
How does one deal with ROCD thoughts when there are real issues in the relationship? Ex – my husband can shut down and not express himself often. A healthy relationship is one where two people can connect emotionally and communicate. We are going to therapy now for Attachment issues (I’m anxious in relationships and he is avoidant). I have been instructed to address when I start to feel anxious, but I know sometimes I’m right in my assessment of my husband being distant and sometimes my OCD is overreacting. My husband is going to therapy with me, but he’s frustrated by my anxiety and emotions (he says it pushes him away). I really try to be realistic in my assessment of his behavior and my reactions, but I just don’t know.
Treatment for ROCD is quite different from treatment for non-OCD marital issues. If you want help for ROCD, I strongly advise that you seek treatment with an OCD specialist.
I have always been an anxious person… with anxiety manifesting physically as racing heart and electricity sensations running through my body. I became fearful of the physical sensations and was trying to get treatment for the same. I also was under stress caring for twin infants. At the same time, my closest friend was sexually misbehaving with me… and while I said no a bunch of times, I feel like I gave in to his touch a couple of times. I don’t know why this didn’t come to the foreground – I suspect I brushed it under the carper because of our intertwined lives – same age kids, parents knowing each other, caring for twins, etc…. but when it happened the the 5th time or so, it hit me and I called him out and told him that I didn’t like it. He apologized and said that he was “sorry for taking advantage of me”. I even told my husband about it and now we are disconnected from my friend’s family. It’s been more than 3 years since I told my husband. He seems perfectly fine but I have been beating myself and guilting and shaming myself for having cheated on him and feel worthless. I keep going back to what happened and why it happened although I have no answers.
Nothing you write here really sounds like OCD. It sounds like you feel legitimately upset that your friend pushed for sexual contact, and that on at least some occasions, you “gave in” to his pushing and agreed to sexual contact. Then you felt regret and guilt, told him you didn’t like his pushing for sexual contact, and told your husband about this matter. This is clearly causing you distress, and I encourage you to discuss the matter with a therapist.
I have many types of ocd. I have fear of being murdered. I have got this thought after my husband telling a story of a girl got shot inside her home. This thought doesn’t go away and it won’t. It makes me feel anxious. I don’t know why I have it!! My husband should have it because he watches the news everyday.
Please help me in this tough time I’m going through. Thanks
There is no way for me to provide you with significant help on a blog. I encourage you to seek treatment with a therapist who specializes in treating OCD with Cognitive Behavioral Therapy (CBT).
Great article. If I’d read this even two years ago I’d have recoiled in terror. However my OCD has become much more intrusive and I’ve since that time become ready to engage in this now.
One question I wanted to ask and I’d like clarity on: One of my major themes is religious OCD. However it’s not limited to my own salvation. My thoughts are for ANYONE who goes to hell. I find this traumatising. The bible presents hell as a certainty for some (although I my views on this have changed – the fear is ancient in me and still holds onto previously held beliefs).
My understanding is that OCD recovery is about getting used to uncertainty. However in effect this is not necessarily an issue of uncertainty but more of certain terrible suffering for some (as presented by the bible). Is it possible to treat this issue in the same manner as other intrusive thoughts, or is the uncertainty element a prerequisite for dealing with intrusive thoughts?
Is there hope or recovery when the thought is presented as a certainty?
A few thoughts…
1) Other people’s eternal salvation or damnation is not your responsibility. Let others take care of themselves.
2) You may think that the bible provides absolute certainty and objectively true answers about salvation, but there are millions of people on this planet who would disagree with you on that notion.
3) You would be better off accepting uncertainty, including uncertainty about the bible’s allegedly absolute truth.
Hello, thank you for this article. I am trying to set up a therapy appointment, but they take weeks to get back to me, so anything like this I’ve been able to find has helped a lot. I believe I am experiencing relationship OCD, obsessing about not being in love with my girlfriend or about wanting to cheat on her etc. The thing is, it’s just very hard to tell sometimes if I actually have OCD or if I really just have fallen out of love with my girlfriend… I think the levels of anxiety and stress these thoughts cause me, and how little sense and out of nowhere they seem to be, is a good indication that it’s OCD, but it just becomes very difficult sometimes to tell myself that. Anyways I tried this exposure therapy technique tonight, have read through my story about 8 times or so, and am already starting to feel reduced anxiety from it, which gives me hope! I’m going to try to keep up on reading it and doing other things I’ve been learning about through all this, and I just hope I can keep moving towards that light at the end of the tunnel!
Thanks for commenting. I’m glad to hear that you have had a positive response to your imaginal exposure story.
That said, keep two things in mind:
1) Don’t get too attached to the sense of relief. The real goal is to become less reactive to the thoughts. Some people become overly focused on relief, rather than on acceptance of the unpleasant, but harmless thoughts that constitute OCD.
2) Don’t get fooled into thinking that your OCD has gone quietly into the night. Think of exposure as being like exercise – you need to repeatedly do the work in order to see consistent results. But like I said in #1, don’t get too attached to these results.
I just wanted to thank you for helping all these people in the comments section. I am not brave enough to write stories about my worst fears, things that I can imagine that moment that are most hurtful to me. These things change and I can imagine lots of different stuff that would disgust me or scare me. It would be too difficult of an exposure for me and I can’t just keep on writing stories of any imaginable thought that I think I can ruminate on. I only started typing to thank you for helping these people but I guess I couldn’t resist sharing my thoughts
Thanks you for your kind words. I’m always happy to hear that someone responds favorably to our efforts at helping.
That being said, I hope you will reconsider your notion that exposure would be “too difficult”. Many people have the idea that ERP is some sort of torture, but in the hands of a qualified, compassionate therapist, ERP is quite manageable, and is done at the client’s pace. Challenge your fears and you will see results.
I’m trying to tackle my obsessions with ERP but I’m confused about how to do it since I have real event ocd. One of my big obsessions is that I’ve let my husband down & cheated on him (emotionally) over 6 years ago because I flirted and fantasied about someone we know. Although I know I didn’t actually do anything physical I feel I have betrayed him by enjoying someone else’s attention & fantasising/daydreaming about this person. Many people would think this is nothing but me & my husband have really high morals on being loyal and I know it is something he would not have done. I have spent a lot of time trying to explain why I acted this way & convincing myself I have not cheated. Im always confessing and apologising to my husband & ask him for reassurance. I know we all make mistakes & look back in things we do when we are younger & wonder why we did that. And either way my husband say he has forgiven me (although he says there’s nothing to forgive) & we just want to move on. But I just can’t let it go I feel so guilty all the time & keep Checking the past to see how bad it is. What imaginary exposure script would you do for this since there is a real mistake behind…
As the article above points out:
“For imaginal exposure to be truly effective, it should be integrated into a cohesive treatment plan focusing on Cognitive Behavioral Therapy (CBT) that emphasizes Exposure and Response Prevention (ERP).”
Your best approach is to stop trying to do something for which you have no training, and to instead find a therapist who specializes in treating OCD using Cognitive Behavioral Therapy (CBT) that emphasizes Exposure and Response Prevention (ERP).
I also have a situation similar to Louise, and I believe I am suffering from real event OCD. I recently went though a divorce where my ex repeatedly accused me of being an unfit mother, manipulative, and mentally ill. My own mother had bipolar disorder and one of my greatest fears is that I am just like her. I have been through talk therapy which I believe I just used as a checking and repeated confession tool. All therapists I have ever seen have said that I am not bipolar like my mother, and that my worrying about it obsessively to try and make sure it’s not true is not what an unfit mother would do. But I still spend hours each day going over and over the events and what happened to examine the evidence again and again. If he accused me of it, couldn’t it be true? Do I have pure O OCD or am I like my mother? I am afraid that my daughter needs to be protected from me, that I might accidentally damage her psychologically like I was damaged by my mother. Do I need OCD treatment or am I just a bad person?
You do an admirable job of acknowledging that you have used your past talk therapists to get reassurance that you are not dangerous. Then you proceed to ask if you are dangerous. I fail to see how that is any different from what you say you have used other therapists for in the past. Also, there is no way for me to provide you with anything resembling a diagnosis without conducting an assessment of you.
All that being said, I encourage you to seek an assessment with a therapist who specializes in treating OCD with Cognitive Behavioral Therapy (CBT) with an emphasis on a specific CBT technique called Exposure and Response Prevention (ERP).
Thanks for the reply. I realized that I had effectively just asked for reassurance in my comment shortly after I hit send. I feel trapped in a cycle. Thank you for the link, this sounds exactly like what I keep going through. It sounds like it would be a good idea for me to contact a OCD/CBT therapist so I can get some help.
Hey Dr. Corboy,
I’ve been struggling with an intrusive thought about vomiting for about a month now. Every time I eat I become hyper-aware of my bodily sensations. I also tend to experience anxiety symptoms when having these thoughts, etc. My anxiety symptoms are usually nausea, GI issues, etc. Do you think ERP would help me?
The symptoms you describe are consistent with Emetophobia, which responds quite well to ERP.
I have a question about OCD in general.
Experts say that everyone has irrational thoughts but we OCD victims respond to the thoughts . my question is why do we respond to the thoughts? Are we different from normal people?? I mean why did we take them seriously in the first place??
Hope you get what I mean.
If you guys accept insurance, I really wanna get help.
Trying to figure out why someone with OCD responds to their thoughts is a waste of time. The best answer is this: you respond because you have OCD. It is your OCD that makes you respond, while those without OCD ignore the ridiculous thoughts that arise in their minds.
So I live in Texas, No one believes me when I say I may have OCD. I am afraid to commit suicide.
It’s in my head 24/7 always have to reassure myself I don’t feelike dying. I have lost my job due to this. I cannot concetrate. I feelhopeless. I always seek reassurance I wont do such a thing. I dont know where to go for this. The moment I wake up I say in my head I love my life I don’t want to die. I hate to be asked do you want to die. My head is full of doubts. I need help asap. I been at this for 8 months. I use to have other obsessions. But this one has hold me back tremendously. Help please. I’m new to this. I have not gotten a diag.
Obsessions of self-harm and/or suicide are fairly common in OCD, and are generally considered to be a variant of Harm OCD.
I strongly encourage you to seek out face-to-face therapy with an OCD specialist in Texas. You can find good OCD therapists in Texas on the website of the International OCD Foundation. They are the largest OCD organization in the world, and they maintain a searchable database of therapists who specialize in the treatment of OCD.
My wife has had OCD for a year now. She has an obsession that once she sees/use a mobile phone or a laptop connected to the internet, her mind keeps telling her that she sent a bad message about herself or to that person or that she might have disgraced herself by message to that person. I wonder what kind of OCD she is suffering from. Is that pure-ocd?
I have a feeling this kind of therapy real imaginal exposure might strongly help her overcome this image she had every time she is exposed to a mobile-phone or laptop.
So any advice for her in particular? She is also extremely reluctant to do ERP.
This all sounds like OCD. Don’t focus on what “type” of OCD this is. The words that people use to describe their “types” of OCD are just slang terms, and focusing on what “type” of OCD a person has is a waste of time.
As for my suggestion, the answer is simple. Your wife should seek Cognitive Behavioral Therapy (CBT) focused on a specific type of CBT called Exposure and Response Prevention (ERP).
I have been to a psychiatrist who advised ERP as well. I have encouraged her to do it but after each time we finish the ERP session with an actual mobile phone, she has these thoughts again. So what i did was i printed screenshots of my mobile and we started doing ERP only using these. But once again, after we finish the session, when we go to sleep at night. She tells me that her mind tries to convince her in the morning that she woke me up at night to send a message to disgrace her. Its like her OCD now convinces her she now knows the exact location of any social app on my mobile through the ERP we did and that because of this, my wife now even thinks that it really happened.
I can’t seem to break this vicious cycle through ERP. So have you got any other recommendations? Should we keep trying do ERP even though while she has these obsessions?
Thank you. I really apprecaite your reply.
It sounds like you are conducting ERP with your wife. If this is the case, I strongly encourage you not to continue. Simply put, you do not have the training to conduct ERP.
Additionally, your wife needs to be on board with doing ERP, and doing it with someone who specializes in conducting ERP. Of course she continues to have OCD thoughts. If these thoughts were easily removed, nobody would have OCD.
Your wife needs to understand that the word “exposure” means that her role in treatment will be to purposely expose herself to her unwanted thoughts and to accept the discomfort they produce. It is only through repeated exposures, without her compulsively responding to the anxiety produced by those exposures, that she will get a better handle on her OCD.
Thank you so much Tom. I think this is the first time that i am finally getting the whole concept of ERP. Knowing all this now will motivate me to help my wife to fight against OCD and of course to seek professional help from a CBT specialist.
Hi Tom-I have pure O Ocd that focuses on a fear of schizophrenia.
It tends to cycle around and around. I’ll have grandiose or paranoid thoughts, that I will sometimes struggle to turn off. I have high anxiety over them, especially as they keep finding new ways to outwit me. For example, I’ll have a thought that I’m a goddess, *which obviously I know is false) but then my brain will go on and on how I believe I’m a goddess. Sometimes I have trouble turning the thoughts off, which just adds to the fear that I will one day believe them, and lose my mind. MY OCD adapts pretty quickly, so a new thing it likes to do is, when I’m having these thoughts and thinking they’re “stupid.” or “boring” my brain will tell me those are the intrusive thoughts, not the thoughts I’m already having. Flooding does not seem to work, as my brain just twists itself into more and more of a pretzel, until I’m exhausted and I’m in tears. And sometimes, when I’ve been doing the thoughts for a bit, I feel like I can’t get myself out of them-almost like I’m in a trance state. Do you have any advice for me, on what might be helpful? Thanks!
The problem is not the thoughts, but rather the attempt to turn them off. These are just thoughts. The more seriously you take them, and the more effort you make to control them, the worse your OCD will be.
My advice is two-fold.
1) Accept the presence of the thoughts without investing any energy in controlling or eliminating them. Just let them exist as interesting fictions that your brain has conjured.
2) Find a therapist who specializes in treating OCD.
Hi Mr. Corboy,
Your article is immensely helpful. I’m currently trying to do ERP. For those of us with HOCD or POCD, I wanted to know if you’d recommend not only scripting, but actually acting out your worst fear—of course, without anyone around. Or, would this just make us more likely to commit our worst fear?
Your comment illustrates why it is important that you not try ERP on your own.
No, you should NOT act out your worst fear. For someone with HOCD, that could mean acting in a manner that is counter to their actual sexual orientation. And for someone with POCD, acting on their worst fear could mean molesting a child. So I reiterate, no, you should NOT act on your worst fear.
Now imagine someone with Harm OCD who has a fear of committing murder. Should they kill someone? Of course not!
Please find a therapist who specializes in treating OCD rather than coming up with exposures such as the one you suggest.
Hello Mr. Cowboy,
I wanted to ask you that I have been suffering from ocd for a few years now and my obsessions have changed
currently I am obsessed about my breathing now and I notice that when I try to control it, I’ll start to breathe fast which causes me to be in a state of panic. So now I have a fear of hyperventilation, I freak out when that happen and I sometime prevent myself from breathing fast because im scared I will not get my breathing back to normal. what do you suggest I can do for that. If I do an exposure what would it be like for my fear. I am currently not seeing a therapist because I have little one to take care of.
You ask for my suggestion, so here it is…
Get into treatment with a therapist who specializes in Cognitive Behavioral Therapy (CBT)!
Having a child to raise is not a reason to avoid treatment – it is a reason to get into treatment.
Hi Mr. Corboy,
My thoughts are centered around the idea that my family are secretly doing horrible things, or did horrible things to me in the past. I know these thoughts are irrational, but it makes it tough for me to talk to my family.
I was wondering if you’ve ever heard of OCD centered around fear of other people being horrible, not fear that YOU are secretly horrible?
Do you have any advice as to what could help me?
Thank you for all the good work you’ve done. 🙂
Yes, we have treated people with irrational thoughts about what they fear other people may have done or what they may do in the future. OCD obsessions can focus on just about anything, and there is nothing special or unique about this type of thought.
You ask for my advice, so here it is: get into treatment with a therapist who specializes in treating OCD.
This is an excellent article. I have had OCD since I was a teenager (over 20 years now) however I have never had any ‘themes’ that can be visible to others. I have had health worries, POCD, HOCD and now I have another one which I am working on since I became a father. I wish there was more awareness about non visible OCD as the traditional cleaning etc don’t apply to many.
I agree exposure is difficult to get a grip of for non visible OCD. I have done many articles and loop tapes. I also find just closing my eyes and bringing on all my biggest worries fully visualising them in all there glory. Normally As the anxiety starts to plateau it becomes more difficult to maintain concentration so I switch to articles or tapes. As you have rightly said I have also found I have to tweek my articles because new concerns /doubts still under the same ‘theme’ can become the hot worry of the day.
Again great article and I have saved it to my reading list to keep reminding me of what I should be doing
Thanks for commenting. It’s great to hear that this article resonated for you.
What you are describing as “non-visible OCD” is commonly called “Pure O”. You can read more about Pure O at https://ocdla.com/pure-o-101-6880.
Keep in mind that “Pure O” almost always includes plenty of compulsions that can and should be treated with Exposure and Response Prevention (ERP). Any therapist trained in treating OCD should be able to help you with crafting exposures that target your specific OCD symptoms.
Hi there, interesting article. So in short, i see like i have had OCD thoughts since a child. For example, i remember needing to check every window or door before going to sleep. Also washing my hands repetedly so it is really clean. I remember that during a period i even stopped eating a lot, for fear i become greedy. Some went away a litle. Now, growing up, i started a relationship around 23. Immediately anxiety kicks in. I start having thought of failure, the same as my parents had. Feel like i cant make it, or started having toughts of: do i really love her? Will i be able to make it. When maybe seeing another beautifull person i start thinking: why you find that person attractive, it must be because you dont love her. I even went so far by asking myself: do you find her attractive because she has small breasts? Sorry for writing this. I think it is a stupid thought and it doesnt represent me as a person. But they come. I just want to be able to get a grip on things and enjoy life. I forgot to write that i also have had thought regarding religious figures, one that i cannot even write about, i find it too disturbing. Hope that i can get a reply from you. Thanks for your work
Much of what you write about in your post sounds like a very common variant of OCD that is called Relationship OCD, or ROCD. I encourage you to read our article on ROCD at https://ocdla.com/rocd-relationship-ocd-myth-of-the-one-3665/.
It is also worth noting that many people with OCD have unwanted thoughts about religious figures (i.e., thoughts about sex with them or killing them).
All of these thoughts may be disturbing to you, but they are actually quite common in OCD.
Hi, I’m finally at the point where I can write the scripts, and I just recently did. But what I felt after writing it, and then after reading it was the anxiety subsiding rather than getting worse. It’s almost like writing and listening to a script was a huge fear of mine and now I’ve conquered that. I also feel so much relief when I read them because I can’t help but think how ludicrous they sound. (I have harm OCD.) Is there any advice you may have around this? Am I doing something wrong?
You ask for my advice, so here it is.
As the above article notes, imaginal exposure should not be untaken on one’s own – it should be done as one part of an overall structured OCD treatment protocol that is overseen by a seasoned therapist who specializes in treating OCD. I have no idea if your exposure story is appropriate. I encourage you to seek treatment with an OCD specialist.
Can you have HOCD then POCD the latter made me feel more scared and angry. Immediately when i had pocd thought yesterday i broke down crying and angry. I then proceeded to put a plastic bag over my face because after about 2 months of dealing with hocd i was stressed. I was crying saying why am i questioning if im a pedophile. When i know im not one. But people know that having this mental disorder know that knowing u aren’t hardly helps. Im so stressed i was disgusted at the thoughts i hate nonces. I was scared because i thought if i tell my family the thoughts they wouldn’t believe me I’ve never pedophile thoughts before. Just wanting to know what this is? Because i spend all day reassuring myself im not a pedophile i hate them being there. Thankyou if you do reply.
It is quite common for people with OCD to have more than one “theme”. It is especially common for people with sexually-oriented OCD themes to have other sexually-oriented OCD themes (i.e., HOCD together with POCD).
I can only assume that putting plastic the bag over your face was in some way an attempted suicide. I STRONGLY encourage you to see a therapist ASAP. And if you are feeling suicidal, please take yourself to a local emergency room IMMEDIATELY.
I was doing some ERP work with my therapist, I have some form of false memory ocd thinking I had sex with another man 12 years ago, despite me never having thought it before. I’ve had plenty of ocd themes, normally Centers around ROCD.
Anyways so currently I have a loop tape playing “what if I had sex with “””””
However I get zero anxiety from this, so we will be looking at scripts, I just don’t understand how I’m meant to create a narrative when I literally have no memory of it! I mean it’s paired with real even as I did kiss the guy and he did keep trying to get me to sleep with him but I said no. I’m lucky to have a husband who understands all this and supports me.
Do you think ocd will always remain on the same themes for a person? Like mines false memory/rocd, so I’ll never get like contamination ocd
Also another question, I’ve come a very long way in treatment but I have the flu at the moment and my ocd has hit me like a train. Do you think that flu/ocd can be links?
It is extremely common for people to see an increase in OCD symptoms when they are sick.
Other than that, I do not want to interfere with the work you are doing with your current OCD therapist. I encourage you to direct your questions to your therapist.
When reading this article I could feel my stomach churning at the idea, so I knew it was something I needed to do. I wrote a short story, and I read it out loud once. While doing so I was so absorbed in my emotions that I cried, and felt very distraught. I realize this is the goal with this exercise, and the more I do it the less anxiety I will experience with this thought. (Ideally, of course.) But how far should I push myself? How far is too far? How distressed should I allow myself to become before I can allow myself to take a break?
Thank you for your time.
As the article notes:
“For imaginal exposure to be truly effective, it should be integrated into a cohesive treatment plan focusing on Cognitive Behavioral Therapy (CBT) that emphasizes Exposure and Response Prevention (ERP).”
Rather than encourage you to self-treat, I would like to suggest that you seek treatment with someone who actually knows what they are doing when it comes to treating OCD.
Amazing article, and thank you for your kind guidance throughout! As someone suffering with POCD, I am willing to try writing my own imaginal exposure stories. However, I am incredibly scared that by the time it simply becomes “a story I have read far too many times,” I will have been desensitized not only to my own intrusive thoughts (a good thing!), but to the notion of pedophilia itself. In other words, as I become more at ease with my POCD, I’m fearing that it will also make me less repulsed by pedophilia in general too. Is that a possible outcome?
Thanks again for your help!
As the article points out:
“…imaginal exposure is not in any way a silver bullet that provides a quick fix – it is just one piece of the puzzle required for effective treatment of OCD and anxiety. For imaginal exposure to be truly effective, it should be integrated into a cohesive treatment plan focusing on Cognitive Behavioral Therapy (CBT) that emphasizes Exposure and Response Prevention (ERP).”
You would be better served by seeking treatment with a therapist who knows what he/she is doing than trying to treat yourself.
I am so glad I came across this. I have not heard of this until one of my friends told me about it. My therapist has not really said anything about this so I want to do this work myself. My OCD is more about HOCD and ROCD. I do have one question, my brain always likes to think about what I don’t want it to think about so for example what if I am doing this exposure work and I start telling myself that I like it. How could I approach this? It feels as if my brain is always trying sabotage me. So it will bring automatic thoughts contrary to what I believe in so what if I tell myself this enough that I do start believing the thoughts.
You made a comment here that perfectly sums up OCD:
“My brain always likes to think about what I don’t want it to think about.”
If you have told your therapist about your unwanted thoughts, and your therapist has not mentioned OCD, then they almost certainly have no idea how to treat OCD. Any therapist who specializes in treating OCD would immediately recognize your unwanted thoughts to be a symptom of OCD, and would set about treating you with a specific type of Cognitive Behavioral Therapy (CBT) called Exposure and Response Prevention ( ERP). If your therapist is not utilizing this approach to your unwanted thoughts, it is further evidence that they have no idea what they are doing.
As for trying to treat your thoughts by your self, I strongly discourage this. Instead find a therapist who specializes in treating OCD with CBT/ERP.
Thank you so much for this article! My obsessions almost always center around sex, usually the fear of cheating on my husband and not remembering. Recently, I’ve became extremely anxious that when my husband’s sister (who is eight) showed me something in her room I touched her inappropriately. The part that I get stuck on with my false memories is being uncertain that they are false. Do you have any recommendations on how to do exposures/how to take the leap of faith that this is OCD? I’ve been in so much pain for this past month and so afraid that I violated her. I really want to get through this.
You ask for recommendations regarding exposures, so here goes…
Find a therapist who specializes in treating OCD. Simply put, unless you are a therapist who specializes in treating OCD with Cognitive Behavioral Therapy (CBT), there is not a chance that you are qualified to treat yourself for OCD.
ERP would work by you going to a therapist who specializes in treating OCD with ERP. Trying to do ERP on your own when you have no training or experience in using ERP would be a mistake.
Very interesting article. I´ve been in a clinic 4 years ago where I learned to do ERP. My problem is thinking bad words concernig my dear mother. So in the ERP I learned I just say mother and then bad words. I still do it, and over the 4 years it hasn´t stressed me, I got habituated. But after Christmas watchin a movie with her I suddenly got nervous and thought: “What happens if I say a bad word now?” So I escaped the situation, and afterwards I only thought about this still very nervous. Since that day I think more about bad words…and also whole phrases, previously it were only singular words. What do you recommend for my ERP: to include more bad words (like´16 in the clinic) and whole sentences?
You ask for my recommendation, so here goes.
1) Never avoid situations that bring on your unwanted thoughts. It sounds like you “escaped” the situation that triggered your recent episode, and that was the exact wrong thing to do.
2) Do what previously worked. In other words, say as many bad words about your mom as you can. Every day. Start now. Say “My mom is a (fill in the blank)”.
I am a 34 yo male with OCD since my 7th year, since the 12th about my sexual orientation. Out of fear that I am more attracted to men than women, I have never even had a kiss. On/off SSRIs for ages (on again). After 2 years of CBT/ERP, I got habituated to the anxiety of viewing semi-nude pictures of attractive men. I let the genital arousal come and go without judging, but it still makes me unbearably sad, the discomfort can last hours. I only fantasise about women, could never picture myself with a man, but the fact that the sight of a male body arouses me so reliably (even if due to anxiety), when I have not had such a reaction to women for years, screams dishonesty. I sometimes wish I were dead. How do I deal with this when dating women?
It sounds like CBT/ERP has helped you to address your OCD, but that you have not effectively addressed the feelings of sadness that you experience related to the unwanted thoughts. It sounds to me like you would be best served by returning to therapy to address those feelings. I encourage you to return to treatment with the same therapist who helped you before.