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Beliefs That Maintain OCD

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Hi Everyone,

I thought it would continue building upon the content of the last blog post regarding the cognitive aspects of anxiety and depression and list this week some beliefs that are thought to play a major role in OCD.

Some years ago a group called the Obsessive-Compulsive Cognitions Working Group (OCCWG)—an international group of very well known scholars who study cognitive models of OCD, met and came up with a list of what they believed to be some of the main beliefs within the various forms of OCD and now there is fairly widespread agreement that these beliefs play a major role in the development and maintenance of OCD. 

1.Inflated Sense of Personal Responsibility

People with OCD believe they are personally responsible for the content of their obsessions and also often believe they are responsible for preventing any possible negative outcomes that might arise from their obsessions (e.g. “If I imagine something bad happening, then I am responsible for making sure that it does not happen”). Errors of omission (not acting to prevent a negative outcome) are as bad as errors of commission (performing a bad act).

2. Overestimation of Threat/Danger

Many people with OCD have exaggerated beliefs about the probability and severity of aversive events (e.g. “If I do not take extra precautions, I am more likely than others to have or cause a serious disaster”). People with OCD avoid risks because they overestimate the danger of an event and then underestimate their ability to cope with the perceived threat.

Overestimation of Probability:  an exaggerated view of the probability that a bad event will occur. The situation is viewed as dangerous until proven safe or one is assumed to be guilty until proven innocent  (the average person usually sees the opposite - a situation is assumed to be safe unless proven to be dangerous and one is innocent until proven guilty).

Overestimation of Severity: sometimes the probability of danger/threat is seen as low, but the cost/awfulness (often responsibility, guilt, shame) as unacceptably high.

3. Perfectionism

Sufferers of OCD often report difficulty tolerating imperfections or mistakes and have the belief that they have to do, and are able to do, everything in a perfect way, whatever the cost (e.g. “To me, making a mistake is as bad as failing completely.”) One should be perfect at all times to be worthwhile to avoid disapproval. This reflects a belief that a “perfect” state actually exists.  Another aspect of this perfectionism belief is that things must feel “just right”. The idea is that a particular task of some sort must be continued until it feels “just right”, which is closely related to things feeling perfect.

4. Intolerance of Uncertainty

Many people with OCD believe that uncertainty and ambiguity are unacceptable and hold the belief that not only is it essential to do whatever is needed to make sure that negative things won’t happen, but that it is possible to do so.  Feeling uncertain as seen as dangerous and totally unacceptable and this belief often leads to doing compulsions in a futile effort to achieve a feeling state of “certainty” that the negative outcome one fears won’t happen.  Many people believe, as do I, that this issue around difficulty tolerating uncertainty is at the heart of most versions, if not all versions, of OCD.

5. Overestimation of the Importance of Thoughts

If intrusive thoughts come up, they must be important. And since thoughts may reflect the person’s true nature they worry that the content of their obsessions reflects their “real” self. (“If I have thoughts about harming others then I could be a serial killer!”...”If I’m not a serial killer then why do I have these thoughts?”) Individuals with OCD report the belief that the mere presence of unwanted thoughts makes such thoughts significant, threatening and dangerous. This belief often leads to constant and careful monitoring of one’s thoughts looking for the “dangerous” ones. 

6. The Importance of Controlling Thoughts

People with OCD often believe that having complete control over their thoughts and feelings is both necessary and possible (e.g., “If I don’t control my unwanted thoughts, something bad will happen.” - “If I can’t control  my thoughts then what else am I unable to control?...maybe I’ll act on my thoughts!!”).  Certain thoughts and feelings are unacceptable and having them could lead to some type of catastrophe. And since thoughts may reflect our true nature and are believed to have the power to actually influence outcomes, it is vital to control one’s thoughts.

Within this core belief is a phenomenon called “thought action fusion”. This idea has two different, but related aspects. Simply having a thought makes it more likely that the thought will come true  (“Thinking that the plane will crash makes it more likely that the plane will actually crash.”) and/or  having the thought is as bad as doing the behavior  (“Thinking of having an affair is as bad as having an affair.”). 

I hope you find this post useful and, as always, I welcome your feedback and let me know if you have any questions.

Stay safe,

Dr Bob