Trigger Warning: This article includes information about intrusive thoughts related to harm, pedophilia, and other potentially triggering topics. 

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Do you ever get a song stuck in your head that continues to loop over and over again? Imagine that you wake up in the morning, and instead of a song, you are bombarded with the most disturbing thoughts you could imagine having. The more you fight them, the stronger they become, and you wonder what these thoughts mean about you. You start to organize your life around making sure something awful doesn’t happen. This is a common experience for those with Obsessive Compulsive Disorder (OCD), and looks vastly different than the jokes often made about someone enjoying organizing or cleaning. Tragically, it often takes years or decades before a person with symptoms is diagnosed with OCD and receives proper treatment. As a clinician who has lived experience with OCD, I recognize that there are many misunderstandings about this mental health condition that often cause deep harm. In this article, I share a few important things to know about this mental health condition. 

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1. OCD is a serious mental health condition characterized by obsessions and compulsions that interfere with daily functioning. 

OCD is often used as an adjective to describe someone who’s organized or enjoys cleaning, but this is far from the truth. Obsessions are recurring, highly distressing intrusive thoughts, images, or urges that do not align with a person’s sense of self. Doubt is a common part of the human experience, but those with OCD experience obsessional doubt, in which doubt is experienced as overwhelming and urgent. The person often desires a feeling of complete certainty that is impossible to obtain. Compulsions are repetitive behaviors that a person performs to relieve their anxiety and prevent a feared outcome. While these behaviors help relieve anxiety in the short-term, they fuel the OCD cycle and make the obsessions stronger. This is because these actions teach the brain that intrusive thoughts are real fears that require action. While some forms of OCD include compulsions related to cleaning or organization, these behaviors are experienced as tormenting and necessary to prevent a feared outcome, rather than an enjoyable activity. 

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2. Intrusive thoughts don’t mean anything about a person’s actual desires, values, or identity. 

‍Intrusive thoughts are unwanted, repetitive thoughts that don’t align with a person’s values or reflect their beliefs about themselves. Research shows that the vast majority of individuals experience intrusive thoughts in their lifetime. None of us can control the automatic thoughts that pop in our brains. For example, many people have had the experience of standing by train tracks or a cliff and having the thought “What if I jumped off the cliff and died?” Most people will have this thought and think, that was a weird thought. You might even laugh it off. After a minute, we typically forget about the thought. We know it doesn’t mean we truly want to jump off a cliff. However, for those with OCD, these thoughts are more sticky and lead to strong emotions of anxiety, disgust, or guilt. Additionally, individuals often experience intense shame and guilt about their thoughts. However, intrusive thoughts don’t mean a person is any more likely to ‘act out’ on thoughts than the person without OCD. Some forms of OCD are especially stigmatized due to their content, even though the content doesn’t hold real meaning about the person. People with OCD might worry about discussing their thoughts with healthcare professionals or therapists due to perceived and real stigma related to certain thoughts. By educating ourselves and others about the many ways OCD can present, we can work to reduce the stigma and empower individuals to get the help they deserve. 

3. Obsessions can be about anything. 

While some individuals have obsessions related to germs or contamination, many people have other forms of OCD. OCD can be about any topic, though there are some common themes it tends to latch onto. Often, the relationships, identities or topics a person values most may be what their OCD latches onto. It’s common for a person to have multiple content areas their obsessions focus on, and it may change over time. It’s important to remember these thoughts are ego-dystonic and don’t represent a person’s actual desires. Some common themes are:

• Harm OCD: Intrusive thoughts about causing accidental or intentional harm to another person. Compulsions could include hiding knives or sharp items in one’s house, avoiding spending time with loved ones, and ruminating about the possibility of cauisng harm. 
• Religious/Moral Scrupulosity: Thoughts or feelings focused on religious or moral ideas. A person might obsessively worry about being a good person or following their religious faith perfectly. Compulsions can include reviewing past behaviors, praying excessively, or apologizing to others repetitively. 
• Pedophilia OCD: Intrusive thoughts about being a pedophile or inappropriately interacting with kids. Common compulsions with this type of OCD include avoiding children, ruminating about past behavior, and ‘checking’ feelings when around children. It’s important to note some individuals may experience bodily sensations such as the groinal response, which can increase fear but do not mean the person has any actual attraction to children. This is very common in individuals with this form of OCD and is commonly talked about by clinicians who focus on work with OCD.
• Sexual Orientation/ Gender Identity OCD: Intrusive thoughts about one’s sexual orientation or gender identity, that are obsessive in nature and don’t align with a person’s identity. A person of any sexual orientation or gender identity can have these obsessions. This could sound like, “What if I’m not actually gay and I’m lying to everyone?” or “How do I know for sure that I’m transgender?” Compulsions could include searching for reassurance on the internet and reviewing one’s feelings when around people of different gender identities. 
• Relationship- focused OCD: Relationship obsessions can focus on any relationship in a person’s life, but often centers on romantic relationships. This can show up as repetitive thoughts about a partner’s potential flaws, or recurring doubts about the ‘rightness’ of the relationship. The person with this type of OCD may want certainty regarding their relationships and may ruminate, ask for reassurance, or perform other compulsions to relieve the distress. 
• “Just- Right” OCD: Intrusive thoughts or feelings that something is ‘not right,’ or incomplete. Compulsions might include rearranging items or redoing tasks until they feel just right. 
• Contamination OCD: Obsessions focused on feelings of contamination, which may include intrusive thoughts about exposure to germs, blood, or bodily fluids. Compulsions may include washing hands repeatedly, avoiding touching others, and avoiding places that may have more germs. 

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4. Compulsions can be mental or physical. 

Some compulsions are observable, such as a person with contamination OCD who washes their hands many times in a day. However, many compulsions are mental and cannot be seen by anyone. Some mental compulsions include reviewing past events, counting, checking one’s feelings or bodily sensations, or praying excessively. 

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5. OCD is highly treatable. 

OCD is considered a chronic condition, but it is far from untreatable. Therapy has been shown to be highly effective for this condition. Specifically, exposure and response prevention (ERP) is considered the gold standard treatment for OCD. This form of treatment focuses on exposing a person to feared stimuli while discontinuing the use of compulsions. Other treatment options include therapy modalities such as Acceptance and Commitment Therapy (ACT), Inference-Based CBT (I-CBT), and Dialectical Behavioral Therapy (DBT.) Medication can also significantly reduce symptoms in some individuals. Although this condition can feel incredibly isolating, help is available. You are worthy of living a full, meaningful life despite what your brain feeds you. 

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Resources:

• The international OCD foundation (IOCDF) includes many resources for those with OCD and their loved ones, includinng a therapist directory to find a therapist who specializes in OCD. They also have a document outlining evidence-based treatment options. https://iocdf.org/
• The self-compassion workbook for OCD by Kimberly Quinnlan guides readers through utilizing compassion towards themselves in their journey with OCD. 
• The mindfulness book for OCD, written by OCD specialist Jon Herschfield, includes mindfulness and exposure techniques for those with the condition. 
• Some podcasts focused on OCD include the OCD Stories, All the Hard Things, and ‘Your Anxiety Toolkit.’ Additionally, the We Can Do Hard Things podcast did an episode about OCD with specialist Alegra Kastens, titled “The Truth of OCD.”
• Several instagram and social media creators provide psychoeducation about OCD and treatment. Some of my favorite social media accounts include @alegrakastens, @ocdexcellence, @ocdrebeltherapist, and @youranxietytoolkit. 
• The IOCDF has created a list of books, media, and resources related to OCD. Check this out for even more resources! https://iocdf.org/books/

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