The Four Types of OCD - Part 4a - Intrusive Thought OCD
I hope you all had a good week and are making progress managing your anxiety challenges. Most of my recent posts have focused on OCD, but if you have some other form of anxiety, fear not because I plan to address other flavors of anxiety in the very near future. If there is anything specifically you’d like me to address please let me know.
Intrusive Thought OCD (“Pure O” OCD)
Help My Thoughts are Driving Me Crazy!
We now come to what is a lesser known type of OCD and though all forms of OCD are painful, I believe this is one of the most painful types. Most people are aware of at least the first two types - Contamination and Checking, may have heard a bit about Just Right OCD, but have probably not heard of Intrusive Thought OCD or, if they have heard of it, they call it “Pure O” OCD. Pure O OCD refers to OCD where it used to be thought there weren’t any compulsions and thus the name, Pure O (Pure Obsessional) OCD.
We now know that there are, indeed, compulsions in Pure O OCD, but since they are usually mental compulsions and thus can’t be seen, people used to mistakenly think there were no compulsions - but there are. I prefer the term “Intrusive Thought’ OCD since it seems more accurate to me and recognizes that there are compulsions in this form of OCD as well. In the same way when someone with contamination OCD will wash their hands (do a compulsion) after touching a doorknob to reduce the threat they believe is posed by the “contaminated” door knob, the person with Intrusive Thought OCD will perform a mental compulsion to reduce the danger they think the thought represents. The “danger” is that they fear they will act on the thought. The two main theme in this type of OCD are thoughts of having sex with with an inappropriate partner or physically harming a loved one or someone who is probably unable to defend themselves.
I have had clients whose intrusive thoughts range from fearing they will reach out and touch a work colleague inappropriately all the way up to parents who fear they could actually molest/harm their own or someone else’s child. In over 35 years of practice I have never had a client actually act on their intrusive thoughts (and I realize that statement could be reassurance - which we’ll cover in great detail in a future post), but the clients I have seen truly fear they could act on their thoughts. My clients are the type of people I would be comfortable babysitting my children.
I Don’t Want to Have These Thoughts
A frequent initial response to having these types of thoughts is to try to not have them...which sure makes some sense, but unfortunately it is one of the worst things you can do. In a future post I will elaborate on this, but in short “What you resist, will persist!” The more you try to not think a thought, the more you think it. Just try to not think about something and see what happens. I know...very frustrating, but that's how it works!! Another response then is to try to figure out what the thought means about you as a person:
“Why am I having thoughts like that?”
“Do I deep down really want to hurt my child?”
“Am I actually sexually attracted to my baby?”
“What is wrong with me that I’m having thoughts like this?”
“What if I snap and actually act on these thoughts?”
“Some parents have had that happen. How can I be sure that won’t happen to me?”
“What if this isn’t OCD and I really am a pedophile/serial killer?”
“How can I be sure?”
What Type of Person Am I?
We can separate the questions into three categories. The first category might be questions about what type of person has such awful thoughts, such as questions 1) and 4) above. The short answer is “everyone”. While that might seem surprising, there are some good research studies that have demonstrated this to be true. If we can accept that most people actually have the same types of thoughts that we have, it may make the thought seem less threatening. Maybe you aren’t so odd/dangerous after all.
Why Did I Really Do That?
A second category might be questioning if the thoughts really do reflect some deep, dark, hidden part of ourselves that could actually be true...such as questions 2) and 3). This can often lead to questioning our “real” motives for doing something. “I had my niece sit on my lap last night for a few minutes...I wonder why I did that? Did it feel good? Why did it feel good?” and etc. People who would never actually hurt or molest anyone can start to question what kind of human being they really are and question their motives for doing what they do.
How Can I Be Sure?
Questions 5), 6), 7) and 8) all reflect another very common/universal theme in OCD that I’ve already alluded to - doubt and uncertainty. It’s always important when working with OCD to remember that uncertainty/doubt is at the core of the disorder so when someone is plagued with questions like the ones just listed, they are desperate for an answer, but are unable to get an answer that is acceptable. They are unable to ever feel sure.I believe this is at the heart of virtually all types of OCD. “Did I lock the door?”; “Did the last person who exited the bathroom wash their hands?”; and in the current version of OCD “How can I be sure this is OCD and that I won’t act on these thoughts?” The best way to confront the doubt, in fact the only answer that will help in the long run, is to accept the uncertainty and move on as if the thoughts aren’t important. Of course, this is so much easier said than done, but it is something that must be worked toward over time.This is a crucial aspect of treating all forms of OCD, but especially important with Intrusive Thought OCD. If you attempt to resolve the doubt, engage in some form of compulsion, you are feeding the OCD and it will, most likely get worse. And you will have spent probably hours upon hours in a vain attempt to “feel” certain and never get there.
Next Week
I have much more to say about Intrusive Thought OCD, but in the interests of keeping this post from getting too long I’ll stop there for now and continue this topic next week. One of the main questions for my next post is how to address the fact that some people do actually molest/hurt children/ or loved ones and how do we separate those people from the OCD clients I have discussed above.
Some Suggested Resources
There are some recent books that do a great job of covering the above topics and I thought I’d mention several here as additional resources you might consult to further understand and manage, not only Intrusive Thought OCD, but any type of OCD.
For Intrusive Thought OCD:
The Imp of the Mind by Lee Baer, PhD.
Overcoming Unwanted Intrusive Thoughts by Sally Winston, PsyD and Martin Seif, PhD.
Overcoming Harm OCD by Jon Hershfield, MFT.
For managing uncertainty:
Needing to Know For Sure by Martin Seif, PhD and Sally Winston, PsyD.
For all types of OCD:
The Mindfulness Workbook for OCD by Jon Hershfield, MFT and Tom Corboy, MFT.
Everyday Mindfulness for OCD by Jon Hershfield, MFT and Shala Nicely, LPC.
Getting Over OCD (second edition) by Jonathan Abramowitz, PhD.
These posts are intended to provide education about OCD only and are not intended as a substitute for treatment by a qualified professional. If you find yourself plagued by any form of OCD, I strongly recommend you seek the help of a qualified professional. If you are having trouble finding a therapist with whom you can work, I wrote a short ebook on how to find a therapist to treat your anxiety disorder, which you might find helpful.
Some of the above links are affiliate links and so if you click on any of the links and make a purchase from Amazon, I may receive a small portion of the price you pay. You will not be charged anything extra from Amazon.
Have a good week,
DrBob