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OCD

How to Stop Compulsively Confessing OCD Intrusive Thoughts

Exposure response prevention therapy can help interrupt the ritual.

Key points

  • Intrusive thoughts are among OCD’s most agonizing symptoms.
  • OCD sufferers may compulsively confess intrusive thoughts to receive reassurance and reduce anxiety.
  • Practicing exposure response prevention therapy can help interrupt the cycle of confession.
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Source: alexgreen/pexels

Intrusive thoughts are some of the most personal and agonizing symptoms of obsessive-compulsive disorder. Thanks to OCD, just one single unpleasant thought or image—violent, sexual, obscene, blasphemous—can trigger weeks and months of tortured, cyclical self-interrogation. What does it say about me that I had such a horrible thought? Do I subconsciously want to act it out? Even if I don’t want to act it out, how can I be sure I won’t lose control and do it anyway?

Usually, intrusive thoughts are kept secret. But sometimes, hoping that external reassurance will neutralize their fears, an OCD sufferer may be compelled to confess their thoughts to others. As obsessive thoughts grow worse over time, these rituals of confession may increase in frequency and desperation, burdening both the sufferer and their chosen confessor.

Determine if the Intrusive Thoughts Are a Symptom of OCD

A sufferer afflicted with this particular permutation of OCD must ask themselves three important questions:

  • First, would a therapist or other expert on OCD consider my thoughts dangerous, or would they diagnose them as symptoms of my anxiety disorder?
  • Second, can I live with the unlikely possibility—infinitesimal, but always nonzero—that these thoughts might not be OCD but something actually dangerous?
  • And third, how can I stop myself from compulsively confessing these thoughts going forward?

It’s usually a relatively simple matter to confirm that disturbing thoughts are the product of OCD by consulting an expert on the disorder. In The Imp of the Mind, Lee Baer explains the rare cases when disturbing thoughts are potentially dangerous, and should be directly addressed with psychiatric treatment:

If you do not feel upset by the thoughts but instead find them pleasurable…

If you have ever acted on violent or sexual thoughts or urges in the past—either while sober or under the influence of alcohol or drugs…

If you hear voices, think people are against you, or see things that others do not see…

If you feel uncontrollable anger and find it hard to resist urges to act on your aggressive impulses…

If you're reading this column, and you've been diagnosed with OCD, Baer’s warning criteria probably do not apply. "Probably." Baer laments that “[d]iscussing certainty with my patients is a precarious balancing act. On the one hand, most are obsessed with the effort to reach absolute certainty that they can never act on their thoughts—and are tormented by the existence of even the slightest doubt. This is always a losing battle, since we cannot be one hundred percent certain of anything…”

“Probably” is a curse for anyone afflicted with OCD, the "doubting disorder," because “probably” gives you plenty of room for second-guessing and cyclical, obsessive self-analysis. So—I'm pretty sure that I am indeed legitimately disturbed by my thoughts, and that I don't find them pleasurable. But am I really sure I feel that way? Really? How can I know for sure? And what if my false certainty stops me from recognizing when I pose a legitimate danger to myself or others? I better check in, with my parent or priest or therapist, just to be safe.

How to Interrupt the Ritual of OCD Confessions

Interrupting the ritual of OCD confessions is a two-stage process.

First, yes, you should discuss your intrusive thoughts with your treatment provider to confirm they are a product of OCD. But typically this is only necessary once, as part of the initial diagnosis. I've learned that you do not always want to return to your therapist to ask if your thoughts are still harmless. Because if you keep coming back every week with an updated litany of new disturbing thoughts, double-checking that every new permutation is still just OCD, then congratulations: You may have successfully turned therapy into an OCD ritual.

Sadly, because OCD is so insidious and internal, even trained OCD professionals can miss that they're subtly reinforcing a patient's symptoms. If you suspect that's the case, bring it up with your treatment provider—together, you can work out how your conversations might be aggravating the anxiety disorder, and avoid such accidental reassurance going forward.

And that's the second stage of overcoming OCD confessions: You need to stop seeking reassurance, and that means you need to stop confessing. This means practicing exposure response prevention therapy (ERP) under the guidance of a trained therapist to learn to resist the ritual and to process the anxiety. While ERP is never easy, in this case the treatment should at least be fairly straightforward.

The "exposure" part requires that you confront and accept the—once again, infinitesimal, but still nonzero—possibility that, yes, your intrusive thoughts may be dangerous and should be confessed to others.

Then the "response prevention" part comes in. Even though you're upset by your thoughts and you know that confessing them to someone else might provide relief, you prevent yourself from making that confession. Here, you identify the people in your life you usually confess to and instruct them not to listen to your confessions or provide reassurance. Just ask them not to respond. If they’re up for it, you could even explain to them how your OCD works and why confessing is a symptom, then ask them to remind you of that instead of reassuring you.

Confession is a uniquely pernicious OCD ritual, but thankfully, once it's identified it's relatively straightforward to address. Informing the people around you to whom you typically confess, and asking them not to indulge your confessions, is already a significant step to addressing the problem. They may very well experience some relief knowing they won't be asked to interpret your confusing and upsetting thoughts.

If you can stop yourself from relying on others to provide you with a sense of wellbeing, you'll soon find that you can obtain it on your own.

You may also be interested in my columns, Confessing Intrusive Thoughts and The Obsessive Struggle with Intrusive Thoughts in OCD

To find a therapist, please visit the Psychology Today Therapy Directory.

Copyright Fletcher Wortmann, 2022

References

Lee Baer. The Imp of the Mind: Exploring the Silent Epidemic of Obsessive Bad Thoughts. Penguin Plume, NY, 2002. Pg. 43-44, 53.

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