Sometimes the main problem in OCD is the presence of unpleasant thoughts, or intrusive thoughts, which just pop into your mind. The thoughts are usually horrible and repulsive. But the harder one tries to avoid having them, the worse the thoughts seem to get.
Some examples of intrusive thoughts
Derek had intrusive thoughts about stabbing people when he saw knives, and had at least one intrusive thought about his grandson.
Another example is Lucy, who had very troubling thoughts that she might harm her young children. When they were in the bath she had the thought, ‘I might drown them’, and had an image of herself holding them underwater. Lucy had to stop bathing her children, and even found it difficult to cuddle them sometimes in case she thought of harming them.
Why do we have these thoughts?
Psychologists studying this problem realised that when they asked people who weren’t troubled by obsessions whether they ever had strange thoughts that just came into their minds, almost everyone said yes. When psychologists looked at the kinds of thoughts that people reported, there were a number of common themes: these were, typically, ideas or images about sex, particularly inappropriate or unwelcome ones; and ideas or images of violence or harm, particularly of harm coming to oneself and other people, or of causing harm to other people. Although it’s strange, it seems that it’s simply in the nature of human thinking that we do think these things. The fact that we think them, however, really doesn’t mean that we want to do them.
As you’ve seen, it’s ‘normal’ for people to experience very similar thoughts to the ones that are common in obsessions. Why then do some people have these thoughts without developing obsessions, while others are so troubled by them?
Why do intrusive thoughts become obsessions?
The answer seems to lie in the attitude people have to their thoughts. For example, one mother might have an image of herself harming her children and think, ‘Oh yuk, fancy thinking such a weird thought, I certainly don’t want to do that!’ But another might think, ‘Oh my God, what a terrible thing to think – if I’m thinking that, it must mean that I want to do it. How can I think that? I must be a terrible, evil person.’ In the first case, the mother would have the thought, but wouldn’t worry too much about it, and wouldn’t have to do anything as a result. But in the second case, the mother would worry a great deal. She’d start to watch her thoughts, to make sure that she wasn’t thinking them. She’d struggle to dismiss the thoughts and get them out of her mind. She’d also start to avoid situations where she might have the thoughts, and where she fears she might harm the children. However, psychologists have realised that there is a very strange and unfortunate truth about thoughts: the more you try to stop having them, the worse and more frequent they get. So the more the second mother tries not to have the ‘bad’ thoughts, the more she has them.
You can demonstrate this effect to yourself with any kind of thought. For instance, for the next two minutes, try to make sure that you do not think about pink elephants…
How did it go? Did you think of pink elephants at all? It would be very unusual if you hadn’t! The effect of trying not to think something brings it into your mind, rather than keeping it out.
The unfortunate effect of this is that as the thoughts become more frequent you make more and more harsh judgements about yourself. The more, and the worse, the thoughts are, the more you feel this ‘proves’ you are bad, or are going to carry them out.
Another way of thinking about this is that the thoughts that become obsessions are usually associated with areas of life where you have very high standards, so that the presence of such a thought goes against everything you believe in about the world or yourself. For instance, blasphemous thoughts are much more common in very religious people, to whom such thoughts are repugnant.
You may also think you are going mad, and that these thoughts are the beginning of the decline into total madness and institutionalisation.
What can be done about intrusive thoughts?
The first step is for you to think very carefully about the explanation above, and to realise that it is normal to have extraordinary thoughts, and that they don’t mean that you are bad, mad, dangerous or anything else other than normal. In fact, you’re probably more troubled by the thoughts than other people would be because you have high standards for yourself and the world, not because there is something wrong with you.
The next step is to stop fighting the thoughts. When they come into your mind, instead of panicking and thinking, ‘Oh no, I mustn’t think that, I must stop’, try to keep calm. Remind yourself that it’s OK to have these thoughts, and just let them drift through your mind. If you feel able, you could even try something similar to the exposure technique described in Chapter 5. Set aside ten minutes or half an hour a day, and make yourself have the thoughts deliberately. Don’t try to avoid them or send them away. Even though it will make you very anxious and uncomfortable at first, you’ll find that you somehow get used to the thoughts, and that they’ll stop seeming so frightening.
Finally, if the intrusive thoughts have made you avoid things, start to work with the avoidance, by gradually making yourself do things you’ve stopped doing, or go to places you’ve stopped going.
You’ll find that as you tackle the thoughts in this way you’ll become less worried about them and they’ll start to occur much less often. You may still have them from time to time, because almost everyone does. But hopefully you can just let them drift through your mind without taking too much notice!
The above is an extract from An Introduction to Coping with Obsessive Compulsive Disorder, 2nd Edition by Lee Brosan (Robinson, 2018)