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The “Thinking Mistakes” of Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder,

If you’re someone who can’t let an uneven picture hang without leveling it, you may be teased about “being OCD.”

If you’re abundantly cautious about germs and contamination, people may call you OCD. Are you? It depends. 

Many of us have quirks of habit that may seem obsessive or controlling to others. We may enjoy getting involved in details and “micromanaging” situations. While these traits may at times be annoying to other people, they wouldn’t be a sign of obsessive-compulsive disorder unless they are driven by intense anxiety and interfere with our ability to function well in our lives. 

If you clean a lot because you enjoy it and love basking in a clean space, you probably don’t have OCD. If the thought of dirt–even dirt you can’t see–makes you so anxious that you clean as a way to calm the anxiety, you might have OCD. In that case, all of your cleaning wouldn’t actually help the anxiety very much. In fact, the more you clean, the more the anxiety builds, having the exact opposite effect you intended. 

It’s easy to get stuck on the behaviors of OCD because repetitive hand-washing or cupboard straightening are visible. But sometimes people with OCD don’t manifest those easy-to-spot symptoms. Their OCD is more thought-based. For example, someone with OCD might have repetitive, intrusive thoughts about what is a “right” thing to do or a “right” way to be. They may appear to behave fairly normally, but everything they do is driven by a nagging fear that they’re doing it wrong or should be doing something else entirely.  

Another way this might play out: someone may have constant, unwanted thoughts about hurting other people. They don’t really want to hurt anyone and never would, but they live with the conviction that they are a terrible, evil person for having such thoughts. To “make up for” their thoughts, they might be overly submissive to others, trying to do all the good they can to compensate for how bad they think they are. 

It can be very difficult, with OCD, to trust your own mind and emotions. What thoughts are coming from the mental illness, and what thoughts are “legitimate”? To help untangle these questions, medication and talk therapy are often used in conjunction. 

Treatment for OCD

Medications that have been effective for OCD are primarily SRIs (serotonin reuptake inhibitors) and SSRIs (selective serotonin reuptake inhibitors), types of antidepressant medication. Typically, higher doses of these antidepressants are required for OCD than for depression, but they help to decrease the persistence of repetitive thoughts and the accompanying anxiety. 

Cognitive-behavioral therapy is a standard psychotherapy used for OCD. A cognitive-behavioral therapist can help clients learn to detach from their stream of intrusive thoughts and recognize them as inaccurate. With practice, clients gain a sense of power over these thoughts and choose not to react to them. 

What Causes OCD & When Does it Begin?

OCD is believed to have both genetic and environmental triggers. Abnormalities in certain areas of the brain may also be at play, although research is ongoing. Some studies have associated childhood trauma with the development of OCD. 

OCD can begin as early as childhood or as late as adulthood, but is typically diagnosed between the ages of 7 and 12. However, unless an adult in a child or teen’s life is educated on the symptoms of OCD and can intervene, many children and teens do not understand that their high anxiety levels are not normal. In addition to fear of dirt/germs, a need for order/symmetry, and intrusive sexual or aggressive thoughts, the most common obsessions in children include

  • Religious obsessions
  • Preoccupation with body wastes
  • Lucky and unlucky numbers
  • Fear of illness or harm coming to oneself or relatives
  • Intrusive sounds or words

These obsessions can manifest compulsions such as: 

  • Grooming, repeating, and checking rituals
  • Rituals to undo contact with a “contaminated” person or object
  • Rituals to prevent harming self or others
  • Hoarding and collecting things of no apparent value
  • Cleaning rituals 

OCD as “Thinking Mistakes”

The obsessions of OCD can be so distressing because the thoughts are often aggressive, sexual, or otherwise “bad” in nature. The person with OCD comes to believe they are a bad person because of their unwanted thoughts. According to the Perelman School of Medicine at the University of Pennsylvania, some experts suggest that those with OCD make specific “mistakes” in their thinking They believe that:  

  • Thinking about an action is the same as doing it, or wanting to do it
  • People should control their thoughts
  • Not trying to prevent harm is the same as causing harm
  • Harm can always be blamed on a specific person, regardless of the circumstances

If you or a loved one is suffering from painful and worrying thoughts and trying to counteract those thoughts with compulsive behaviors, consider reaching out to Eagle View Behavioral Health. Our experts can talk with you about your experience and provide the diagnosis and treatment that can help you start the path to healing. We work with adolescents and adults on an inpatient and outpatient basis. Contact our facility in Bettendorf, IA, to learn more.  

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