I’ve wanted to write something about mental OCD for a long time now, because it's really not talked about much in our society and it can be really torturous for the person experiencing the mental OCD. The treatment is also really different than regular therapeutic treatment, so it's vitally important someone goes to a specialist, or the problem can get worse. As therapists, we can easily fall into a trap of reinforcing the OCD, which I’ll go into later on. At the end of this post I’ll provide some helpful resources for mental OCD in particular.
Ok, so think of Obsessive Compulsive Disorder as a branch on the tree of Anxiety. There are two types of OCD, mental and physical. Most people are familiar with physical OCD - when a thought comes in (the "obsession") and the action ("compulsion") is physical. So a classic example is the obsession being, "germs are everywhere," and the compulsion is, "I have to wash my hands."
The obsession/thought is SUPER powerful with OCD. It's called an "intrusive thought". So take someone with a non-anxious brain. That person might come home from the park and think, "my hands are germy." It's a natural and healthy response to wash them as the solution. The OCD mind says, "my hands are germy," and washes them, but then the thought intrudes again. Maybe my hands are still germy. Am I sure I got all the germs off? Can I really be sure? So the compulsion to wash them over and over begins.
Mental OCD is much trickier, and the thoughts can be so difficult that very few people ever even tell their therapists about them. Mental OCD is nuanced; there are some thoughts that exist in distinct categories (health, sexual, religious) but some that are more random than that. The main root of mental OCD is that the person is terrified they are capable of something bad or harmful to others, or something that would make them repulsive to others. As with all anxiety, the fear is rooted in loss. What horrible thing about me would cause me to lose relationship/connection to others? The great OCD therapist Jill Garman shared this quote in a training: “Our fears are like dragons, guarding our most precious treasures," - Ranier Maria Rilke.
The OCD specialist Martin Sief would say, your mind has a ton of weird thoughts. Someone with OCD will have an odd thought, and then the mind wakes up and says - Wait a minute, what? You just thought about swearing in church? What is wrong with you? Oh my God, what if you did that? Wait, you had the thought, maybe that means you WILL do that. Maybe you're a bad person. Maybe you can't control yourself and how bad you are.
Or you’ll see a friend’s picture of their naked kid on instagram and you might feel a little uncomfortable. Your thought might just be – "huh, unusual". But then the OCD dragon wakes up and says, wait, why are you thinking of a kid being naked? Are you turned on? Are you attracted to that? What’s wrong with you for thinking that way? Are you messed up?
Some common intrusive thoughts are:
Maybe I’m attracted to people of my own sex, and I’m gay
Maybe I’m attracted to children and a pedophile
Maybe I could give someone I care about herpes or another disease
Maybe I would hurt my partner, like stab or poison them
Maybe I would hurt my child
Maybe I would say a racial slur or something similarly awful to someone or in a house of worship
With mental OCD, the thought is usually so repellent to the person, they wouldn’t tell anyone about it. Can you imagine telling someone you’re scared you could be a pedophile? Or that you would hurt your child? And an untrained professional, who doesn’t know about this, could do some serious harm here.
The compulsion part of mental OCD is unique. Unlike washing hands, or checking to see if the door is locked multiple times, they “check” with their thoughts. So someone might “check” about the thought they are gay by thinking about people of their own sex, and thinking, wait, am I turned on by that? Am I having any physical change about that? Could I be gay?
Or someone might check against past behaviors, “I’ve never hurt someone before, right? I’ve never stabbed anyone before, so why do I fear doing that right now?”
These reassurances provide only temporary relief, just like washing hands only provides temporary relief. This is where therapists can really go wrong.The therapist, coming from a good place, hears something they don’t think is true and reassures. “Suzy, I’ve known you for 3 years, you are not going to put your baby in the oven.” Suzy feels some temporary relief. “My therapist, an expert and someone who knows me, is reassuring me!” But that relief will only be temporary.
As you’re reading this, you might be thinking that someone fearing that they’re gay could mean they actually are gay. I have counseled both people who are trying to figure out their sexuality and fear family/societal rejection, and people who fear they are gay from their OCD. They are distinctly different. I can write more about this distinction later, or feel free to contact me if you want more information!
What breaks my heart about OCD is that it seems to manifest the most in such careful, conscientious people. Jill Garman described typical features of someone who suffers from OCD as:
Agreeable and well-meaning
Struggles to tolerate uncertainty
I want to emphasize the “struggles to tolerate uncertainty” because I think it’s particularly important. My favorite analogy for OCD comes from the old Jim Carrey movie, Dumb and Dumber (see video). The idea that there’s a chance that someone could harm someone, give someone a disease, have a disease themselves, even if it’s 1 out of a million, will cause enormous distress. So a lot of the therapy is accepting uncertainty, as painful as that is.
For people who want resources for OCD, and mental OCD in particular, these are the best resources I’ve found:
www.drmartinseif.com- he has a fantastic newsletter
Find a therapist who is specialized in OCD: https://iocdf.org