Emma is enjoying dinner with some coworkers after a very long work week. She always values their time together and has been looking forward to the groups’ never-ending laughs and warmth to ease her system. As the waiter sets down their plates, Emma reaches for her dinner knife. “What if you stabbed someone with that?” a familiar inner voice growls.
Emma’s hand freezes. She tries to breathe in and out, willing breath back into her suddenly too small lungs. “No, really, I know you want to hurt someone. Just think about how awful that would be.”
Emma tries to force her hand to wrap around the handle, suddenly aware of a couple friends’ eyes casually, but concernedly glancing at her outstretched arm. “No, I know I don’t want to do that” Emma silently tells that voice, “I love my friends. I would never.”
But even as she thinks this, dread pools in Emma’s stomach. She has learned from therapy that these thoughts are not what they seem - they are just random, intrusive thoughts that everyone has. The difference for Emma is that they break through her awareness because her brain and body have been taught they are scary and must be listened to. Her system is just trying to cope. In a room full of her friends who have no idea about these dark and hidden thoughts, rationalizing her way out of it seems futile. It feels like a small breeze on a fire that is about to take over everything.
She reaches for her fork in lieu of the knife, trying to stuff the thoughts as deep and far back as possible to just get through dinner. Her friends whose eyes had been on her half-committed hand give her small, reassuring smiles before turning back to the tables’ conversation. But as Emma goes home, turns off the lights, and falls into bed, the voice still whispers softly and violently, “You wanted to hurt them. If they knew, they would be terrified of you. You wanted to hurt them. If they knew, they would be terrified of you. You wanted to hurt them…”
This story is just one example of the ways people struggle with the symptoms of Obsessive Compulsive Disorder (OCD). OCD is not just the need to be tidy or clean, worrying about germs or needing to do something the same amount of times, every time. For many people with OCD, their bodies and brains feel like a war zone. Like they can never escape from the worst parts of them and are terrified of people finding out who they really are.
In reality, these thoughts and feelings are not defining characteristics of the individual - they are OCD. While the exact causes are unknown, we do know that OCD often arises as a way to find control in an otherwise turbulent and alarming environment. Genetics, biology, temperament, and childhood trauma are all risk factors that can increase chances of developing the disorder.
In this blog series we’ll explore the hows and whys of OCD, especially the lesser known ways, like Pure Obsessional OCD (although the existence of this sub-type has been up for debate). The series will also describe the most helpful therapeutic treatments for those who either have or may have the diagnosis.
Understanding OCD
As the name suggests, this disorder is defined by two main components:
Obsessions: Thoughts, images, or urges that are intrusive, unwanted, and cause alarm
Compulsions: Repetitive behaviors meant to cope with the anxiety from the obsessions
While every person experiences thoughts or feelings that may be uncomfortable and intrusive, a person with OCD will differ in that they:
Feel unable to control their obsessions and compulsions
Experience symptoms that are excessive, unreasonable, and often absurd
Spend at least one hour a day in the cycle or experience significant social or occupational impairment
Compulsions are meant to be the temporary salve on top of the obsessive wound. The behavior is often created and practiced in response to years and years of anxiety, so much so that some people will feel as if the behavior doesn’t even mean what it used to or has any effect, it’s just what they know to do. This image helps to explain how doing a compulsion continues the cycle of suffering.
In the above story, Emma’s obsession is the aggressive fear of hurting others. Her compulsion is reassuring herself that she would not hurt others and that she is a good friend, a good person. However, responding to this voice does nothing to ease its consequential distress. If anything, it affirms that it’s a thought worth listening to and therefore increases its disturbance the next time around.
Do I have OCD?
Here are also some ways to tell if you may have OCD:
Ruminating on the same thought over and over again
Only feeling relief from this worry when you perform a specific action (i.e. checking the doorknob to see if it's locked, saying a specific prayer, asking others for reassurance)
Noticing that you spend more time thinking and worrying about life rather than living in it
Knowing other people in your biological family who have been diagnosed with OCD or have the same symptomatology
If this resonates and you want support with OCD, please reach out to us to connect with Mac or another therpist specializing in Cognitive Behavior Therapy (CBT) and Exposure and Response Prevention (ERP) therapies to break the OCD cycle.
In the next parts of this series, we will discuss the ways to quell obsessional anxiety, as well as the other ways these symptoms arise. In the meantime, here are some resources to explore more about OCD.
Websites
Books
Educational
Brain Lock by Jeffrey M. Schwartz
“Pure O” OCD by Chad LeJeune
The Mindfulness Workbook for OCD by Tom Corboy and Jon Hershfield
Fiction/Non-Fiction
The Man Who Couldn’t Stop by David Adam
Obsessed by Allison Britz
Turtles All the Way Down by John Green