- OCD with obsessive, intrusive thoughts is a lesser known subtype of Obsessive-Compulsive Disorder.
- The behavioral compulsions associated with purely-obsessional intrusive thoughts OCD are not apparent; they are all in the mind.
- It can be difficult for non-sufferers to understand and support those who experience obsessive intrusive thoughts OCD.
Many people think they know what Obsessive-Compulsive Disorder (OCD) looks like. They’re mostly wrong, and often misinformed by cruel jokes or inaccurate portrayals. Most have a very superficial, and not entirely kind, picture of stereotypical OCD symptoms: hand-washing, light-checking, and the tics and nitpicking often associated with OCD. This is not to suggest that all non-sufferers are entirely uneducated or unsympathetic; only that an observer’s perspective of OCD is necessarily incomplete. Such a perspective omits the lived experience of the sufferer, the inner reality of the disorder, the obsessive intrusive thoughts that lie beneath the surface.
The Reality of Intrusive Thoughts
That inner reality of obsessive intrusive thoughts can be horrifying. There’s a cliché about icebergs and their tips—but a better analogy might be the maw of a carnivorous plant, with its spoiled-wine stench and needlepoint thorns. The plant is unpleasant to see, smell, and touch. But such discomfort is not comparable to the experience of the insect caught inside: suffocating, thrashing blindly, digested alive in an oubliette of gastric acid. OCD as seen from the outside is a curiosity, a mild irritant at most. But the experience inside is humiliating, exhausting, and agonizing. No form of OCD illustrates this dichotomy better than the obsessive struggle with intrusive thoughts.
In his book, The Imp of the Mind, psychologist Lee Baer explains how obsessive intrusive thoughts plague OCD sufferers with recurring images of, “whatever it is you consider to be the most inappropriate or awful thing you could do.” The human mind is nothing if not productive, and not all of the thoughts it conjures are pleasant ones.
Baer describes several cases of the types of thoughts that torment OCD sufferers, but seen from the outside, his examples may lack the necessary impact to explain the suffering. Some obsessive thoughts may strike the reader as innocuous, even comical: “When he was an adolescent—although he was heterosexual—the worst thing [he] could think of was being gay, which could cause relentless teasing… he would find himself scanning his body to try to feel certain that he wasn’t sexually aroused.” Other intrusive thoughts, the shocking or offensive ones, may seem to reveal disturbing secrets about the sufferer’s unconscious beliefs: “[He] was now a liberal college student… So now, if he saw an African-American walking toward him on the street, the urge would come to shout [racial epithets].” Some intrusive thoughts sound totally irrational: “Just a glance at the wagging tail was enough to start the bad thoughts—he felt compelled to stare at the dog’s anus and his thoughts would start,” and, “[S]he thinks about how easy it would be to throw her defenseless Jessie against a wall and smash her skull.” If a confidant told you they were experiencing such thoughts, with or without the context of an OCD diagnosis, you’d be extremely concerned.
An Exercise in Understanding
Even Baer’s most horrific case studies fail to convey how devastating obsessive intrusive thoughts can get and how shockingly explicit and agonizingly persistent they can become. If you’re a non-sufferer hoping to better understand the experience of an OCD sufferer in your life, please consider the following exercise.
First, take a moment to name and visualize each of the following:
Your closest friend…A beloved pet…A religious icon of personal significance…A figure of authority, such as a teacher or employer…A vulnerable, elderly relative...A committed romantic partner...A child who trusts and depends on you…Or anyone who simply happens to be present, right now, in the room with you. Someone you can look in the eye.
Next, make a note of which figure triggered the strongest emotional response. Now, still picturing that image and face and name as vividly as possible, incorporate some of the following content:
Violent injury...Verbal or physical abuse…Public humiliation…Religious blasphemy…Human waste or other bodily products…Transgression of sexual taboo (incest, pedophilia, bestiality)…Graphic mutilation of the face, eyes, or genitals…How an object in the room, perhaps one you are holding in your hands, could be utilized as an instrument for violence, torture, or sexual assault…A prolonged and agonizing death.
Finally, imagine that you, yourself, are the perpetrator of that transgression. Imagine you, yourself, committing the most upsetting imaginable action against a victim you care about deeply. Imagine that you are committing this act and that you are somehow powerless to stop yourself, even though you are horrified by your action.
This is the moment when the sufferer is well and truly ensnared by the insidious logic of the intrusive thoughts of OCD. You may notice that the more you try to ignore or dismiss a thought, the sharper it becomes, the longer it persists. You can’t ask anyone for help, because they would think you’re going insane, and you aren’t entirely sure that this isn’t the case. Why is the sufferer unable to ignore or control the disturbing thoughts? They’re just thoughts, after all. But the OCD pleads the brain for further investigation, because these uncontrollable and impossible-to-ignore intrusive thoughts seem to hint at something terrible.
The Invisible Compulsions of Intrusive Thoughts
For those who experience purely obsessional intrusive thoughts as a part of OCD, the compulsive behaviors that follow are invisible and continuous. There is no counting, no hand-washing; those afflicted with intrusive thoughts OCD will instead lose months and years hiding behind a nervous smile, attempting to scrub clean the contaminated brain. The compulsions are a frenzied internal dialogue, panicked and desperate arguments, endless pointless reassurance, the impotent application of reason and logic to sterilize dark places within the self. "I would never do that, I would never do that," again and again, without end.
There is a cruel paradox that any thought you attempt to suppress will instead recur with greater frequency and power. The old joke is to ask someone not to think about a white bear, and then watch them twitch in frustration as they find they can’t stop themselves doing so.
At the beginning of the obsessive cycle, the sufferer may experience brief periods of relief or distraction. But the longer the thoughts recur, the heavier the sufferer’s burden becomes. Intrusive thoughts that once troubled you a few times a week may now start up before you get out of bed in the morning. They will ruin once-pleasurable or diverting activities. And if you have wrestled with nearly-continuous intrusive thoughts for years, the duration of that obsession itself starts to feel like definitive proof of dangerous mental instability. Eventually, intrusive thoughts are more than disturbing and horrifying—the impossibility of overcoming them invites total despair.
The Impact of Intrusive Thoughts OCD
This is the lived experience of intrusive thoughts OCD. It finds purchase in the unthinkable. It has no concept of propriety or restraint. It will never spare you from a thought that’s just too personal, too uniquely and intimately disturbing because it is pathologically drawn to exactly these things. It does not relent in heightened circumstances, in school or work or church, during exams or funerals or sex—because such circumstances only make you more vulnerable to its disruptive powers. It will inundate you, incessantly, remorselessly, with what are quite literally the most repulsive things that you are capable of imagining. It is no exaggeration to say that intrusive thoughts OCD ruins lives.
In explaining intrusive thoughts OCD, it’s often difficult to effectively communicate the sheer crushing weight of their psychological burden. I hope this column will help non-sufferers empathize with and support loved ones who struggle with this easily misunderstood, and yet frequently devastating, mental illness.
Lee Baer, PhD. The Imp of the Mind. New York, Plume Publishing (Penguin Books), 2001. pp. xiii,5-11.