Is it OCD or an Intrusive Thought?
What is OCD?
If you’ve ever wondered if you are living with obsessive-compulsive disorder, you are not alone.
Almost all of us use the term “OCD” colloquially in conversation and yet few people understand the difference between having an intrusive thought or a strong penchant for cleanliness and living with a diagnosable condition like OCD.
Obsessive-compulsive disorder is a condition that can manifest differently depending on how symptoms present and are experienced by an individual. For someone to meet criteria for diagnosis, they must experience either obsessions or compulsions or both. Furthermore the obsessions and/or compulsions must be significantly time-consuming and as is the criteria for any psychiatric diagnosis, must cause clinically significant distress and/or impairment in crucial areas of functioning (think work, school, relationships). If a person does not experience impairment in any functional areas, subjective distress (i.e. feeling anxious, depressed, or fearful as a result of symptoms) must be present.
Some people who have OCD only suffer from obsessive thoughts, images, or impulses and don’t experience compulsions. Other people experience both. Compulsions are behaviors associated with OCD that feel out of one’s control and are repetitive and ritual-like in nature. Sometimes compulsions can manifest as mental acts. For example, a compulsion can include something like hand-washing, but also encapsulates behaviors like counting, repeating words, or checking to see if an appliance is working. Often compulsions are related to obsessions. For example, an impulse may be to imagine a specific scenario (even if the person does not want to do so) and a related compulsion may be to imagine that scenario a certain number of times while simultaneously repeating specific words.
Sometimes obsessions or impulses are sexual in nature and for many people, include sexual taboos or images that cause significant distress, ranging from imagining a family member engaging in a sexual act to imagining harming children or animals. These thoughts foster intense shame for the very reason that they are unwanted, and yet many people assume these thoughts reveal a buried desire or conflict, which only further entrenches feelings of shame and alienation. While it is natural to wonder if our thoughts are clues to some unconscious desire, more often than not intrusive thoughts have nothing to do with our actual desires or intentions. OCD is an ego-dystonic disorder which means that symptoms are often at odds with desires, goals, and wishes. Subsequently, the emotional toll that comes with OCD is often deeply distressing and exhausting. Thankfully, there are many evidence based treatments for OCD that are extremely successful and that I will outline later.
What differentiates an intrusive thought from OCD?
Have you ever had an impulse to jump in front of a subway before your morning commute? Most of us have experienced some version of that thought or impulse, however fleeting. For an individual living with OCD, the thought or impulse does not simply go away when the subway arrives. The thoughts or impulses remain, and the desire to push them away increases just as intensely. So what characterizes an intrusive thought? As I mentioned in the subway example, most people have experienced some form of an intrusive thought. Intrusive thoughts tend to increase when anxiety and/or depression is present. Anxiety in particular is often accompanied with intrusive thoughts or images, like imagining a perceived faux pas. Thoughts can range from self-flagellating like “my friends hate me” or they can also have a taboo or distressing nature—like violent images. What differentiates these thoughts from obsessions however is that they eventually subside. For individuals who do not meet criteria for OCD, intrusive thoughts can manifest due to stress. If you notice experiencing more anxiety and intrusive thoughts than usual, or even for the first time, reflect on any major life stressors that may be impacting you. Stressors like burnout, fighting with a partner, caretaking for a family member, financial hardship, an upcoming exam, or even anticipating a significant shift in your life (like going to college for example) are all stressors that can trigger unwanted thoughts or impulses.
How to Cope and Find Relief
If you are experiencing any of the symptoms outlined above, it may be time to contact a therapist for an evaluation and/or treatment. Psychological treatment of OCD is often accompanied with psychiatric treatment, though many people find relief in therapy alone. Cognitive-behavioral therapy (CBT) and exposure/response prevention therapy (ERP) have consistently been found to successfully treat OCD. Both of these specialties are commonly by practiced by therapists with experience in treating OCD. In the meantime, the following strategies may be helpful in relieving the distress associated with intrusive thoughts and symptoms related to intrusive thoughts. Keep in mind that any technique or treatment is always more likely to be successful with the guidance of a professional.
Exposure
A professor of mine who worked as a psychologist once shared an example of a patient he treated who was plagued by recurring intrusive images of stabbing his wife. In the first session, after hearing about what was happening, my professor opened a drawer in his desk and took out a letter opener. He walked around his desk and placed it in the client’s hand and reminded him his wife was in the waiting room, and he could easily go do the deed at that very moment. In that moment the client realized that in fact not only did he not want to hurt his wife, but that he would never be able to do so. The intrusive thoughts immediately began reducing in frequency and intensity and after a short time in treatment, he reported that they were gone. Try to confront the impulse and image head-on. Ask yourself: what would really happen if I found myself in the situation I am imagining?
2. Practice acceptance
Many techniques for OCD, and anxiety disorders in general, initially appear counter-intuitive. That is because the goal is to create new associations for your brain and challenge the anxious thoughts themselves. One of the most helpful techniques to try when in the midst of experiencing an intrusive thought is to practice acceptance. Instead of pushing away the distressing thought or feelings of anxiety, welcome them in. If the thought or image is replaying in your mind—let it. This is most helpful when sitting down, or in a quiet environment where you aren’t distracted. Allow the thoughts to enter and begin to practice breathing as you let them. Often this helps alleviate anxiety which in turn allows you to better focus on something else.
3. Focus on something that demands your attention.
Watching television or looking at social media is something many people try to do to alleviate obsessions but often find that these distractions are not helpful. That is because they tend to not require very much focus at all. Something that demands your full attention like exercise for example, is much more likely to successfully distract you from a recurring thought. Cooking, playing a sport, riding a bike, singing a song that you know all of the lyrics to, solving a math problem, cleaning, re-arranging a room, and using an adult coloring book are all activities that require focus and attention.
4. Check in with what you are actually feeling
There are some clinical theorists who believe that obsessive-compulsive disorder manifests when underlying feelings of anger and rage are not expressed. At the very least, when experiencing OCD symptoms or intrusive thoughts, most people feel anxious and stressed. Try to first acknowledge what it is that you’re feeling by allowing for any underlying emotions to enter your consciousness. It may be helpful to check in with bodily sensations to identify what is coming up for you; from there, notice what feelings arise. Instead of pushing them away, allow yourself to sit with and fully recognize what emotions are present.
5. Remember that you aren’t alone
Intrusive thoughts are incredibly common. In addition to seeking professional help, consider a support group. You can find online and in person support groups for individuals with OCD at https://iocdf.org/ocd-finding-help/supportgroups/ and https://peaceofmind.com/resources/support-groups/.