A concern that people often raise in therapy sounds something like this: I’m sure other people with OCD are suffering, but these thoughts are the worst thoughts I can imagine. I’d rather have any thoughts but these. Why do I have these kinds of thoughts? Only someone with something seriously wrong with them would think this.
The frequency with which this concern comes up in therapy is notable, especially since it occurs with people who have different types of thoughts. The person who worries about harming their children cannot imagine a worse type of thought, someone suffering from sexual intrusive thoughts would do anything to stop them, the person that struggles with doubt about their morality and adherence to their religious principles finds that their OCD has eroded the very core of their life, the person who repeatedly questions their relationship finds it is ruining their most important and enriching connection…the examples abound.
Getting some clarity on this matter is a crucial step in understanding OCD and setting yourself on the path to recovery. If we’re honest, it’s also not a question you can answer fulsomely just by reading an article online. Answering this question properly involves a thorough understanding of you as a unique person, so the best thing you can do to better understand and address your experiences with OCD is to talk to a qualified therapist with lots of OCD experience.
With that disclaimer, we can think of the answer to this question as actually involving multiple “layers”, with the deeper layers getting more and more specific to you as a person. So as a primer for a potential conversation with a therapist, here are the layers we often go through when working with clients to explore the question of why they have the thoughts they have:
Layer 1: Intrusive Thoughts are Common
The first layer to this answer is that, at a baseline level, you experience your specific intrusive thoughts because everyone experiences your intrusive thoughts. One of the most isolating parts of OCD is that the people around us don’t talk about having intrusive thoughts, and some with less awareness of mental health experiences may react poorly when we talk to them about it.
But research has repeatedly verified that virtually all people experience all manner of intrusive thoughts. This is equally true for more commonly understood expressions of OCD, like contamination fears or those involving checking, ordering, or arranging, as well as less commonly discussed but highly prevalent concerns such as harm thoughts, sexual thoughts, taboo thoughts, relationship worries, existential fears, and so on. Time and again research has shown that everyone has these kinds of thoughts. The difference between someone who experiences OCD and someone who doesn’t is about how they react to the thoughts, not whether they have them in the first place.
So, the first and most important answer to your question is that although you may feel like a uniquely horrible or unwell person, the reality is that your thoughts are human thoughts. Rest assured that no matter what your mind can come up with, the rest of us have those thoughts too sometimes. If people close to you deny having such thoughts, it is likely that they are either ashamed to admit it, or they give those thoughts so little weight in their mind that they are barely aware that they are happening. But chances are they do have them sometimes too.
Layer 2: The Fear-Avoidance Flywheel
Most people aren’t very reassured by the first layer answer, and for understandable reasons. Many rightfully point out—yes, but I have these thoughts much more strongly, vividly, and frequently than others. I’m not struggling with every intrusive thought, I’m struggling with these thoughts. Fair enough!
So, why do you have these thoughts frequently and strongly? The second layer to answering this question involves a bit of background on the wonderful machine that is your brain.
Across history our super-sized brains have been our closest ally, and what they excel at most is anticipating and avoiding danger. If you only dealt with danger when it was actually literally in front of you, we would have all been gobbled up by tigers or bears or what have you many generations ago. So, instead, our brain sends us anxiety signals at the mere possibility of danger.
The most natural response to danger is to try and get away from it. When our brain sends us anxiety signals, and we respond in some way to reduce potential danger, our brain learns that it helped us. So, every time you wash your hands, check to see if you are feeling arousal, ask a friend for reassurance that you’re a good person, reason about the likelihood that you could be a risk to yourselves or others, check the stove, or any other action grounded in fear, it’s like saying to your brain “hey thank you for making me anxious, that helped keep me safe. Can you please send me more anxiety signals, and stronger ones too?” Of course you are trying to feel less anxious in the moment, but that teaches your brain that the anxiety is serving an important function in your survival.
So, the second layer of the answer to why you have the particular intrusive thoughts you have, is that they are the ones you reinforce by trying to avoid them. The more you can refrain from responding to these thoughts and sit with the resulting feelings of uncertainty and anxiety, the more your brain will learn that there isn’t much point in sending you these anxiety signals. Your brain knows that they take a lot of mental resources to send, so if you’re not going to use them, well that’s just bad resource management and it learns to send them less frequently and less strongly.
Layer 3: Your Values and Underlying Fears
Different OCD therapies have different perspectives on the underlying process that drives the particular content of your intrusive thoughts. In Cognitive Behavioural Therapy there is a focus on the concept of a “core fear”. A core fear is an underlying worst-case scenario that can be tied to the various different intrusive thoughts a person might experience. Common core fears include causing irreversible damage, suffering endlessly or intolerably, being a bad person, being completely alone, and death. Some experts like Dr. Michael Greenberg have suggested that these core fears are grounded in an aversion to experiencing certain emotions like shame, disconnection, helplessness, and worthlessness, and that the emotion we specifically fear can be grounded in past experience. For example, if someone grew up with highly critical parents, they might have the core fear of being a bad person, because if that were true that would make them feel permanently ashamed and unlovable. This core fear and avoidance of feeling ashamed might express itself as a variety of surface-level intrusive thoughts like harm thoughts, getting a contagious disease, or blurting out an inappropriate word.
In Inference-Based Cognitive Behaviour Therapy, there is an emphasis on a person’s “vulnerable self-theme”—an idea of the kind of person we fear becoming that is at odds with the reality of our intentions and behaviour. So, we might worry about being a reckless or negligent person when in reality I am a very measured and careful person.
Anecdotally, in our practices we have found that people’s values and personalities are often the exact opposite their intrusive thoughts. For example, people who worry about hurting others or acting inappropriately in some way tend to be some of the most compassionate, thoughtful, and caring individuals we have worked with. If you buy the rationale that anxiety is a generally useful signal that serves to protect us from danger, it makes intuitive sense that we would tend to worry about the things we care about the most.
Identifying your core fears or vulnerable self-theme is a highly individualized process and is best done in collaboration with a well-trained and experienced therapist.
Layer 4: Tolerating Uncertainty
If you find yourself somewhat dissatisfied with the above, and wishing you had a more satisfying or clear answer to the question of why you have the thoughts you do, then that is in keeping with a key feature of OCD—struggling with uncertainty. OCD craves 110% certainty, a level of clarity that is unfortunately impossible to attain.
As you reach the end of this article, rather than spending a lot of extra time trying to analyze your intrusive thoughts and find an insight that will banish them once and for all, we would encourage you to sit with the discomfort of not knowing exactly why they are there and spend your intentional mental energy on something that will move your life forward. If it is hard to think what that might be, ask yourself—if I wasn’t worrying about this, what would I be doing right now?
For additional information on this topic, please see the following resources:
https://drmichaeljgreenberg.com/the-core-fear/
https://icbt.online/what-is-icbt/
Belloch, A., Morillo, C., Lucero, M., Cabedo, E., & Carrió, C. (2004). Intrusive thoughts in non‐clinical subjects: The role of frequency and unpleasantness on appraisal ratings and control strategies. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice, 11(2), 100-110.
