Trigger warning. This blog talks specifically about upsetting intrusive thoughts. Please read at your own discretion.
One of the most beautiful places I have every been is Horseshoe Bend. I grew up in Arizona but somehow never knew this place existed, probably because of the lack of social media posts that exists in the 80s and 90s when I grew up. I had seen the images online and wondered if the images were just oversaturated or if it was truly as beautiful as it seemed. Around the time I was 30 I finally made my way to it on a trip with some friends to Zion national park. It was about quick hike from the parking lot to the scenic overlook which was crowded with tourists from all different places.
I was surprised at how you could just walk up to the edge. There was no railing anywhere and it seemed like it would be easy for someone to slip. But I was thankful for the lack of a barrier. We're always so worried about comfort and safety and a stupid metal rail would just take away from the raw wildness of what the Colorado River had carved out for us to gaze upon. As I perseverated on this further, I heard a voice in between my ears. "What if you jumped?"
It sounded like a dare and a warning all at the same time. I wasn't sure if it was coming from my own wants or desires or some evil force trying to trick me. I also wondered if I actually did want to harm myself? Was I suicidal? Why was this thought here? Has anyone ever jumped here? I know people jump off of cliffs and so does it come impulsively or from a planned attempt?
My mind continued to move and suddenly I wanted to be as low to the ground as possible. I crouched down as to not draw too much attention to myself, though I would probably rather be lying down. My palms began to sweat and I felt a sense of tunnel vision taking over. I wondered if I was safe to be standing there and then began to see why there actually should be a rail.
This, my friends, is an example of an intrusive thought. I wanted to begin with a descriptive story to conjure up some mental images in your head that would describe the type of unwanted thoughts that most of us have had at some point. If you haven't had the "what if you jump" though before, there has probably been something along those lines. Having intrusive thoughts is a normal experience that many people have in their everyday life. It is not necessarily indicative of mental illness, though when the intrusive become obsessive thoughts, it might begin to border on the criteria of a diagnosis.
For the sake of this blog we will be focusing on Obsessive-Compulsive Disorder and OCD thoughts, though you might relate to some of them without having OCD. I want to encourage you to not jump to any conclusions based off of reading this if you should have this diagnosis or not. In my time engaging others in OCD treatment, I have learned that there are many forms of OCD and it is one of the more misunderstood diagnoses. When most people think of OCD they think or ordering, arranging, checking door knobs, or washing hands. It's true that these are some common subtypes of OCD, but harm OCD is one of the most common forms that shows up. It carries a great deal of fear and shame with it and people can be very afraid to talk about it for fear of what others might think. We become afraid that if we vocalize those thoughts, somebody might think we actually want to do them. Or saying them out loud makes it "feel more real." But like a plant grows in the sun, intrusive thoughts grow in the dark, and the more we try and ignore them the more root they will take.
Harm OCD
Harm is an OCD subtype that can be one of the more difficult types for somebody to experience. OCD always gets us at what is near and dear to out hearts and there is not an easy subtype of OCD, but I've observed this being one that can have some huge impacts on a person's life.
Harm OCD generally begins with intrusive thoughts about harming somebody else or harming one's self. Take for instance standing in the kitchen while chopping vegetables and the thought coming into your mind "what if you stab one of your family members?" Again, this thought is not indicative of actually wanting to engage in that behavior, and the reason that these unwanted obsessions become so disturbing is usually because of how repulsed the person is by the idea. At this point, the person might engage in compulsive behaviors such as asking family members to go into a different room while they are making dinner, or potentially avoiding knives all together.
Some more examples of intrusive thoughts that show up in this category are thoughts of "what if I kill myself?" I see these types of intrusive thoughts come up as cooccurring with different types of OCD. Since OCD takes such a toll on our lives, people might have the fleeting thought of "all this pain will go away when you die." When the thought gives a bit of relief to the pain of OCD, the person usually begins to panic that they might be considering suicide. It is also important do distinguish between if the person is actually experiencing suicidal ideation, or rather dealing with unwanted intrusive thoughts.
Religious OCD
Religious OCD can look like a number of different experiences. I tend to see this OCD experience come up more in the Judeo-Christian religions, but it absolutely is not exclusive to them. The OCD symptoms in this subtype might look like having intrusive cuss words come up when praying to God. They also might have an intrusive thought about "worshipping the devil" or "denying God" in some way. People generally engage in mental compulsions as a way of neutralizing these thoughts, such as praying to God or asking for forgiveness.
One specific way I have seen this take root is through "the unforgivable sin." This comes from a verse in the Gospel of Matthew about blaspheming the Holy Spirit, and how doing so is unforgivable. OCD will tell the person that they have blasphemed the Holy Spirit in some way and the feared consequence is generally about eternal damnation. These thoughts can be difficult to work with as mental health professionals do not want to get involved in the theology of their clients. However, in my time researching this verse and understanding more of the etymology, I do not think that the verse means what OCD twists it into meaning.
Sexual Intrusive Thoughts
Sexual intrusive thoughts have the ability to cause some of the most emotional distress. This is because sexual thoughts do not generally intrude in a way that is not taboo to some regard. People will describe having involuntary thoughts about having sexual encounters with somebody in their family. Their mind will tell them that because this thought came up to some degree, it must mean that they want to engage in this sexual act and that makes them disgusting in some way. Additionally, I've seen a number of people suffering from POCD (pedophilia obsessive compulsive disorder). This is obviously one of the hardest obsessions for one to talk about. These thoughts can come up in the form of words or even intrusive violent images. As most people find these thoughts disgusting, people will describe hating the thoughts so much and praying for them to get out of their head. Again, it is noteworthy that this should be distinguished from somebody who is actually experiencing pedophilic urges, but this is generally pretty easy to distinguish if you are a trained OCD therapist.
Sexual orientation OCD happens when someone has intrusive thoughts that they might not be aligned to the sexual orientation that they always believed themselves to be. I generally see this show up with people fearing that they might be homosexual when they have always identified as heterosexual. Most of the people I have worked with who have experienced this theme cite that they do not have a problem with homosexuality in anyway and believe it to be a perfectly fine life style. I do at times see this cross over with religious OCD, if homosexuality is outside of the values of their religious view. The core fear in these instances is less about if they are able to trust who they are attracted to, and more about experiencing disconnection from God or others because of a sexual orientation. People working through this might go through mental rituals to reassure themselves that they are actually straight.
Relationship OCD
In this subtype of OCD, the person is generally fearful that their relationship is going to fall apart in some way. It tends to latch onto the possibility that their partner will leave or betray them in some way or that they are going to leave or betray their partner in some way. Intrusive thoughts in this situation show up by wondering if you are with the right person, or fear that you might actually be sexually attracted to a coworker. These thoughts cause significant distress and compulsive or avoidant behaviors are generally present here. When it comes to "being with the right person" the distressing thoughts will sound something like "are you really in love with them? or "if you knew you were with the right person you wouldn't have thought your friend is cute." People will look for mental rituals to engage in that brings on some temporary relief from the feelings of anxiety, but the anxiety generally returns with the same level of intensity that it was at before.
Treatment
The good news is that intrusive thoughts are very treatable. The recommended treatment is a combination of psychopharmacological intervention and exposure and response prevention, otherwise called ERP therapy. ERP is a form of cognitive behavioral therapy that is based on exposing oneself to their obsessive thoughts and/or feared stimuli without engaging in any behaviors or mental compulsions that would otherwise decrease the feelings of discomfort. There has been a lot of research on selective serotonin reuptake inhibitors and their positive effect as part of a treatment plan. As always, you should consult with your psychiatrist of healthcare provider about pursuing any medication intervention.
Peer led support groups for OCD tend to not be very effective for their tendency to turn into reassurance giving groups. This is generally what people with OCD are not needing. Almost everybody I've ever met with OCD is one of the sweetest people I've ever met, and so it makes sense that they want to rescue others from the discomfort of their thoughts. They tell their peers "you wouldn't ever hurt anybody, you're so gentle!" But this defeats the response prevention therapy portion of ERP. This is why all of our OCD groups are therapist led. Connecting with peers who have OCD can be very helpful as people with OCD tend to feel quite alone in their experience. It is just important that the people spending time together have awareness of what is giving reassurance and what is not.
Resources
We hope you are leaving this blog with a bit of new information for your OCD journey, whether it is for you or a loved one. OCD is a diagnosis that isn't a quick thing to arrive at, or work through and we hope we have been a small support to you. We have more resources for you available not only in our blog, but also our online membership. Thrive+ features a library of psychoeducation classes for you to learn more about yourself and enhance your healing journey. If you are looking for in person treatment for OCD we have both an Intensive Outpatient Program specific to OCD, and a weekly ERP Group. If you have questions about our service options, don't hesitate to reach out!
