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How Do Obsessive Compulsive People Think?

Fear of your thoughts and sensations.

Key points

  • People with obsessive-compulsive disorder have intrusive thoughts (or images) that bother them, leading to a cycle of behaviors.
  • The cycle of obsessive-compulsive disorder begins with a trigger, which eventually lead to negative thoughts, compulsive actions, and avoidance.
  • Obsessive-compulsive behaviors stem from a need to be in control.

In a previous post, "Those Damn Unwanted Thoughts," I indicated how your anxiety often is a result of your fear of your thoughts and sensations. Let's say that you are obsessive and you have the recurring thought, "Maybe I have cancer." But you don't. You've seen the doctor, she tells you that you are fine, you go home and begin thinking again, "Maybe she's wrong. Maybe I have cancer." Then you think, "The fact that I'm thinking that must mean that there is something to worry about. I need to know for sure. I need to do something." So you Google every possible cancer and expect to see your face appear on the screen.

People with obsessive-compulsive disorder have intrusive thoughts (or images) that bother them. These can be thoughts about making mistakes, harming someone, contamination, disease, religious preoccupation, fears of impulses or desires, or just about anything that you might consider dangerous, disgusting, or dirty. Examples of obsessions are, "I made a mistake at work and it will blow up on me," "I touched the chair and it's contaminated," "I had a violent fantasy and now I will lose control," "I left the gas on (the doors unlocked, the cat in the washing machine)" or "I did something that God will punish me for." Once you have the intrusive thought you begin looking for more examples of these thoughts. "Oh God! I just had that thought again." You now are watching yourself, totally self-conscious, fearing every possible thought or intrusion that does not reflect a pure and good mind. Your theory of your mind is that you should only have certain thoughts. Everything else is bad or dangerous.

So what do you do when you have these unwanted intrusive thoughts? Do you shout at yourself, "Stop!" Do you try to get reassurance from someone, "Does this look like cancer to you?" Perhaps you pray for peace, or you have a drink, or you binge eat. Or maybe you ruminate, thinking over and over, "Why am I having these damn thoughts? Am I going crazy?"

How to Understand Your OCD

The diagram below (which, I admit, is a little obsessive itself) is from my book, Anxiety Free: Unravel Your Fears Before They Unravel You. It lays out a detailed schematic on the nature of OCD. Let's take a look at each step:

1. Triggers. These are the events or stimuli that set you off. It could be touching something (contamination), leaving the house (something is unlocked, the gas is on), driving at night (I ran over something), thinking of sex (God will punish me, I will lose control).

2. Odd thoughts or images. You have some thoughts or sensations that you don't like. "Why am I having those bizarre, sick, disgusting, unwanted thoughts?"

3. Negative evaluation of thoughts. You think there is something wrong with your thinking-as if you should only have pure and good thoughts and feelings. You have a lot of "shoulds" about the way you should think and feel. You think that now that you have the thought, you have a responsibility to get reassurance, get control or get rid of it. Having the thought is equivalent to being sent on a mission. You have become the thought police.

4. Self-monitoring. You watch yourself like a hawk-looking for those thoughts. Of course, simply because you have to think about what you are looking for ("I am looking for that disgusting and dangerous thought"), you always have to find it. It's like holding up a mirror to yourself and saying, "I am looking for a mirror. OH MY GOD! THERE IT IS!"

5. Demand for certainty. You think you should know for sure whether you will act out, lose control, or are contaminated. Nothing short of perfection and certainty will suffice.

6. Thought-action fusion. You equate having a thought with committing an action. "If I think I will get violent, I will." Or, a thought is the same thing as reality. "If I think I have cancer, then I must be a dead man." Thoughts, actions and reality are all one. All in your mind.

7. Thought-suppression. Your first line of "defense" is to try to stop having these thoughts. You tell yourself, "Don't think that." It works, for three minutes. But your failure to permanently suppress these thoughts leads you to believe

8. "I've lost control." You now equate control in your life to eliminating unwanted thoughts. Now you feel more out of control as you desperately try to control your thoughts more and more. It's like slapping the water and drowning.

9. Compulsions. You now perform some neutralizing ritual. Perhaps you wash your hands excessively, pray, repeat "No," walk a certain way, wash a certain way, arrange things, go back and check, check again. You find yourself frenetically doing these things until you have a

10. Felt sense of completion. You say, "I can stop now because I feel I have done enough. This felt sense of completion now becomes your new rule book for rituals. "I need to do them until I feel I did enough." You are hooked on your rituals.

11. Avoidance of triggers. You remind yourself, I wouldn't have any of these thoughts if I simply avoided the triggers. So you avoid touching things, avoid public restrooms, avoid shaking hands, avoid movies with Satan, avoid people that make you have feelings that are bad and disgusting feelings. Avoid, avoid and avoid. You are running away from the world.

This is how you think. All in the name of being responsible, conscientious—all in the name of avoiding losing control, going crazy, or becoming irresponsible. All because you need to be in control. And it doesn't work. Take a look at the schematic and let us know where you see yourself. In a later post, we will discuss what you can do.

But the first step is understanding how your OCD makes "sense" to you.

The American Institute for Cognitive Therapy
Source: The American Institute for Cognitive Therapy

From Anxiety Free: Unravel Your Fears Before They Unravel You by Robert L. Leahy, Ph.D.