This is a question we get asked a lot at our OCD clinic: “How do I know if this thought is my OCD or if it is a ‘normal’ thought?” It usually happens when a person in treatment has certain familiar “regular” OCD thoughts, but then suddenly gets hit with a new, unfamiliar, unwanted intrusive thought that may or may not be OCD-related.
So even if you know that you have OCD, you may still wonder about that new thought that suddenly popped into your mind, “Is this my OCD acting up again, or is it just a regular, weird thought?”
Some examples of such thoughts include:
What if I spilled water on the floor and an elderly lady will slip on it and die?
What if I get rabies from the road kill?
What if I am that hit-and-run driver that injured a pedestrian earlier today?
What if I stab myself with this knife?
What if I accidentally offended God?
What if I broke the law without noticing?
What if my thoughts are causing harm to other people?
What if I unintentionally confess to a crime that I didn’t commit?
What if I accidentally cheated on my partner?
What if I sexually assaulted somebody at a party years ago, but can’t remember?
How can you know if it’s OCD, or if the thought is “normal”?
The thing is, the content of these thoughts is not specific to people with OCD. Our brain is constantly generating all kinds of creative thoughts (some more disturbing than others) and our mind chooses which thoughts to engage with. The subtle distinction between the "normal" and the "problematic" lies not in the content of the thought, but in what we decide to do about it.
Anybody can have a random, scary, nonsensical what-if thought such as, "What if I will harm my baby?" "What if I just caused a hit-and-run accident?" "What if I’ll drive my car into the oncoming traffic?"
Non-sufferers usually quickly dismiss these thoughts and continue with their day. If you have a negative thought and shrug it off without giving it much attention, you are unlikely to become obsessed with it.
In this case, your thought process usually goes, "Wow. That was one weird thought.”
But people with OCD tend to take these thoughts very seriously. Their thinking process goes like this, "Oh no! Why did I just have this thought? I must be a horrible person and a danger to others. I should try to prevent this disaster from happening. And I should double-check. And I need to understand what this thought really means."
You may find yourself engaging with the new thought by:
Trying very hard to get rid of it.
Trying to replace it with ‘positive’ thoughts or images.
Attempting to figure out the exact message/meaning of this thought.
Wondering what having such thoughts might mean about you as a person.
Asking others for reassurance hoping to hear that the thought is not harmful.
Attempting to neutralize the thought with a mental ritual
If you catch yourself doing any of the above, it likely means that the thought has become an “OCD-thought” and that it interferes with your life.
This over-engagement with the thought creates a never-ending loop of you trying to figure out or neutralize the thought and the thought coming back with vengeance. The more you attempt to either push away or to "understand" the thought, the "stickier" the thought becomes.
When the thought feels uncontrollable and "sticky" and the efforts to get rid of it don't bring a lasting relief, this may be a sign that your OCD got you on the hook again.
It is especially difficult to identify the problematic “sticky” thoughts when a person has primarily obsessional (“Pure-O”) OCD
Every type of OCD is characterized by obsessions (thoughts that make a person anxious, distressed, fearful, or disgusted) and compulsions (things that the person does to reduce these uncomfortable feelings).
The kind of OCD that primarily has mental obsessions is often called "Pure O," implying that the obsessions and compulsions are purely mental (not visible). Unfortunately, health professionals often miss the diagnosis of OCD in these cases because they can't observe the compulsions. This is tragic as the sufferers go undiagnosed and untreated for many years (sometimes they suffer silently for their entire life).
The good news is that the "Pure O" kind of OCD is just as treatable as the other OCD categories with the same ERP approach.
Where to start when addressing the new obsession?
The first step is to really understand how the viscous cycle of OCD develops. The more effort you put into getting rid of your thoughts, the more obsessed you are likely going to become. This includes following the popular (and uninformed) advice about trying to replace a negative thought with a positive one, to snap a rubber band on your wrist trying to stop the thought, or try to distract yourself from the thoughts by visualization, breathing, or relaxation. These tactics will force you to give these thoughts even more importance and hence, will gradually lead to more obsessing.
In fact, trying to get rid of the thoughts reinforces “the pathway of fear” in your brain. As this pathway strengthens, the mental rituals become almost automatic.
The goal of OCD treatment is to start creating and strengthening an alternative neural pathway – the pathway of “I can have an obsession and not succumb to OCD demands.” The more you use this new neural pathway in various situations, at various times of day, with different people, and in different moods, the more you develop and fortify it.
The following are some steps to start creating this new, healthy pathway:
6 strategies for nipping the sticky thoughts in the bud:
1. Start practicing seeing your thought just as it is – a thought. It is not a fact or a threat.
2. When you notice an unwanted obsessive thought, label it as such. Say to yourself: “I notice that I'm having a thought that [X is going to happen].” This is how you learn to become an observer of your thoughts instead of a willing participant in useless rumination, negotiation, and other attempts to neutralize the thought.
3. Allow the thought to come and go without trying to force it to go away.
4. Let go of the illusion that you can control your thoughts. You may be able to do it temporarily, but it takes too much of your energy and time to sustain it in the long run.
5. In spite of what many OCD self-help books will teach you, don’t aim to lower your anxiety. If the anxiety goes down, enjoy the good feeling. If it doesn’t – it means that you have an extra opportunity to practice building your new robust neural super-highway, so having high anxiety and, nevertheless, resisting the compulsion will benefit you even more.
6. Reward yourself for having an OCD thought, experiencing high anxiety, and still not doing the mental ritual. This is how you know that you are on the right track.
Bonus point: If you just had a thought that the number of strategies above (6) may bring bad luck or cause harm to you or others, deem this thought an OCD-thought and practice the strategies described here right away.
It is very important to seek treatment for OCD. The only evidence-based effective treatment for OCD is Exposure with Response Prevention (ERP), which is a very specific part of Cognitive Behavior Therapy (CBT). From our experience, when ERP is combined with Acceptance and Commitment Therapy (ACT), the treatment is even more effective. This disorder does not go away on its own and the earlier you start treatment, the better.
To summarize, it’s not the content of the thought that determines whether it’s an OCD thought. What gives you a clue is your appraisal of the thought, your level of engagement with it, and the extent to which you take the thought seriously.
Hence, if you are not sure, I suggest you assume that the thought is an OCD thought and treat it accordingly – with lack of attention and respect. Let the thought come and go, and re-focus on connecting to the present moment while practicing the strategies described above.
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Anna Prudovski is a Psychologist and the Clinical Director of Turning Point Psychological Services. She has a special interest in treating anxiety disorders and OCD, as well as working with parents.
Anna lives with her husband and children in Vaughan, Ontario. When she is not treating patients, supervising clinicians, teaching CBT, and attending professional workshops, Anna enjoys practicing yoga, going on hikes with her family, traveling, studying Ayurveda, and spending time with friends. Her favorite pastime is reading.