Understanding Intrusive Thoughts in OCD

Tuesday, May 21, 2024. This is for MH, who self-diagnosed. …Is it OCD or Monotropism?

Most people experience intrusive thoughts occasionally, but what distinguishes them in folks with OCD?

For those with OCD, intrusive thoughts are more persistent, frequent, and provoke a stronger urge to act, a study finds.

These thoughts also carry a significant fear that they might become a reality—for example, stepping off a cliff or harming someone with a knife.

The Intensity of OCD Intrusive Thoughts

Intrusive thoughts in OCD are much more serious than the everyday intrusive thoughts most people experience. While many might occasionally worry if the oven is off or the car is locked, these thoughts do not typically lead to severe distress or compulsive rituals.

For folks with OCD, however, their obsessions are highly distressing. Mr. Jean-Sébastien Audet, who has reviewed the evidence on what makes OCD intrusive thoughts so painful, explained:

"These thoughts provoke higher levels of guilt than in other anxiety-related disorders. They are also experienced as more unpleasant, unacceptable, and uncontrollable, and are associated with a higher degree of fear that the thought will become a reality."

How the study was conducted

The researchers reviewed 18 separate studies involving almost 2,000 people. They found that obsessive thoughts are painful because they clash with the sufferer’s self-perception. For example, a mother might have an obsessive thought about hurting her child while actually being an excellent caregiver. This internal conflict can be deeply distressing.

Mr. Audet continued:

"People with OCD think their actions could put them in danger—for example, their carelessness could cause them to be robbed or get sick. By contrast, depressed people don’t believe they are a danger to themselves but are consumed by feelings of worthlessness, and people with anxiety perceive themselves as victims of external danger."

Finding Relief: Treatment Approaches

Typical treatments for OCD include medication and 'exposure response prevention,' which involves exposing people to situations that might trigger their obsessions and then teaching them new responses. Another effective approach is 'inference-based therapy,' which targets the false conclusions people draw from their obsessive thoughts.

Mr. Audet explained:

"We think OCD is the result of a flawed narrative—a story that justifies the individual’s fears even though these fears have no basis in reality. Inference-based therapy helps the person see these false inferences and eventually stop their compulsive behavior because it no longer makes sense to them."

Final thoughts

OCD is not just about having intrusive thoughts.

It’s also about the intense guilt, fear, and distress these thoughts provoke, which is crucial. As a community of practice, let’s recognize the unique challenges faced by those with OCD so we can foster greater empathy and support for their journey toward healing.

Let’s also consider the severity of the experiences faced by folks with OCD so we can better appreciate the profound impact of this disorder and the importance of effective treatment.

Be well, Stay Kind, and Godspeed.

RESEARCH:

Audet, S., Bourguignon, L., & Aardema, F. (2023). What makes an obsession? A systematic-review and meta-analysis on the specific characteristics of intrusive cognitions in OCD in comparison with other clinical and non-clinical populations. Clinical Psychology & Psychotherapy, 30(6), 1446-1463. https://doi.org/10.1002/cpp.2887