Living With Intrusive Thoughts29 April 2016
Content warning: references to sexual assault, suicide and self harm.
Have you ever had a thought that didn’t seem quite right? Am I attracted to my sibling? Do I want to jump in front of this oncoming train? Do I want to swerve my car onto the wrong side of the road? Do I actually think Donald Trump is a suitable presidential candidate? Perhaps you’ve had an unwanted image of committing some form of violent, sexual or obscene act.
If you have, you are completely normal.
Psychologist Stanley Rachman and his colleagues found that in a group of healthy college students nearly all of them admitted to experiencing an intrusive thought ranging from “imagining or wishing harm upon someone close to oneself” to “impulses to say something rude, inappropriate, nasty, or violent to someone”.
For most people these intrusive thoughts are usually fleeting and are not attributed much meaning or attention. However, certain individuals, like me, find them incredibly difficult to ignore. This is because we have a particular form of obsessive-compulsive disorder, but not as you might know it, and it’s known as ‘Purely Obsessional OCD’ or ‘Pure O’. Basically, our brains are wired a bit differently.
Pure O is the much lesser known manifestation of the more classic OCD, such as ‘Contamination OCD’, which features obsessions and compulsions. Obsessions are unwanted intrusive thoughts such as If I touch that dirty metro seat I may get a disease and die. Compulsions are behaviours that provide short term relief of the distress caused by intrusive thoughts such as immediately washing your hands repeatedly until you feel clean again.
Pure O features less overt compulsions – most take place within the mind, such as simply trying to suppress the intrusive thought or image. Another includes trying to replace the distressing image with a more positive one. For example, trying to substitute the image of you stabbing someone with cuddling them. Another common compulsion includes scanning your body to see if you were aroused by the unwanted sexual or violent image.
As a result of this disorder lacking overt behavioural symptoms it can be incredibly private and entails relentless internal suffering. In fact, the World Health Organisation considers OCD to be in the top 10 most debilitating mental or physical disorders. The very nature of the intrusive OCD thoughts depends on what the individual fears most; OCD does not play nice.
There are some general themes which OCD thoughts have been organised into. However, any OCD specialist will tell you that the nature of the thought is essentially irrelevant because it is simply a manifestation of the person’s innermost fears.
Some examples include ‘Blasphemous OCD’. Associated intrusive thoughts have been documented to range from the incessant thought that the individual hates God, to unwanted images of them having sex with a religious figure such as Mother Mary or Jesus.
‘Harm OCD’ involves intrusive thoughts of committing horrific violent acts towards yourself or others. For new mothers this commonly includes images of murdering their newborn baby.
‘Paedophile OCD’, the fear of being a paedophile, is particularly detrimental to parents, who as a result avoid touching or being alone with their child for fear of snapping and molesting them.
‘Sexual Orientation OCD’ is another extremely common theme that’s characterised by a fear of not knowing whether you are gay or straight. The fear is not necessarily being gay or straight, it’s the uncertainty of not knowing.
OCD is all about uncertainty. How can I know for sure that I’m gay or straight? How can I know for sure that I won’t snap and murder or molest my child? These thoughts send Pure O sufferers into a destructive spiral of searching for evidence that they are categorically untrue. But no amount of evidence is ever enough and the thoughts or images always come back more aggressively.
My experience with this ‘doubting disorder’ began in grade two with Contamination OCD. I truly thought that if I touched anything that seemed to be germ-ridden, I would get sick and die unless I immediately scrubbed myself clean. It got to the point where my hands were cracked and bleeding and much of my day was spent trying to keep myself sterile. My parents picked up on my unusual behaviour and took me to a psychologist where I was cured of these pesky obsessions and compulsions.
In high school there was a period where I could not get the thought that I might be gay out of my head and my mind became a cinema of unwanted gay pornography. Eventually, I circumvented my OCD thoughts by accepting the uncertainty that I may never really know whether I was completely gay or straight. Although at that time I did not realise that my experience was actually a manifestation of OCD.
Most recently and most debilitating, I experienced the far too common obsession of Pure O suffers: the fear of being a paedophile. I mean, what’s worse than a paedophile? They’re considered the lowest of the low, monsters worse than serial murderers or even Hitler.
The thought first floated into my unsuspecting mind in early 2014 following a criminology lecture. Fittingly, we were discussing the widespread social construction that paedophilia is considered the most monstrous crime. It wasn’t really until a few weeks later when I was sick and was stressed with multiple assignments that the thought dug its uninvited, sharp jaws into my anxiety-ridden mind, refusing to let go.
For the next year and half this thought plagued me. Admittedly, I did have periods of respite when I was more relaxed but, at its worst, the thought pervaded my mind every second of every day for weeks on end. It was unforgiving. It was terrifying.
I finally decided to see a psychologist who diagnosed me with Generalised Anxiety Disorder, perhaps because I did not reveal the full extent of my experience. Therapy wasn’t helping and I soon began compulsively telling myself I would rather commit suicide than become the thing my mind was trying to convince me of. My OCD thoughts changed to self-harm. Kill yourself. Just do it. I was subjected to graphic images of my wrists and throat being cut so often that I had a constant niggling sensation there. Soon the images included other people being slashed, beaten or abused in some way, myself often as the perpetrator.
At this point I had not told anyone about what I was experiencing. I was so ashamed that I didn’t even reveal the full extent of my truly distressing Harm OCD thoughts to my psychologist. I was petrified and trapped within my own mind. I had lost all sense of my identity and self-worth and was completely drained of energy from trying to block out the disturbing graphic images. How the hell was I supposed to tell anyone about the thoughts I was having? Surely I would sound like I was going insane. I thought I WAS going insane.
OCD is all about uncertainty. How can I know for sure that I’m gay or straight? How can I know for sure that I won’t snap and murder or molest my child?
Then, in the summer holidays just passed, I Googled “intrusive thoughts”. The first link I clicked on was a news article detailing the experience of a woman, Rose Bretécher, who, as a teenager, experienced the fear of being a paedophile and then grappled with Sexual Orientation OCD. I felt an overwhelming sense of relief to read something that paralleled my experience. I immediately purchased and read her novel, Pure.
I also read The Imp of the Mind: Exploring the Silent Epidemic of Obsessive Bad Thoughts by Dr Lee Baer, a leading psychologist in the field of intrusive thoughts. He explains that the fact that Pure O sufferers find their intrusive thoughts distressing and have never acted on them is fairly sure evidence that they never will. The book also lists various treatments from medication to exposure and response prevention therapy.
Lastly, I read The Mindfulness Workbook for OCD: A Guide to Overcoming Obsessions and Compulsions Using Mindfulness and Cognitive Behavioural Therapy by Jon Hershfield and Tom Corboy. These authors reassure you that your thoughts are just that, thoughts. They are not reality and they can’t make you do anything you don’t want to.
If you’re experiencing intrusive thoughts that you find distressing and seem out of your control I would recommend reading these resources. I would also recommend seeing an OCD specialist because receiving ineffectual treatment from a general clinical psychologist or GP may potentially increase the severity of your OCD thoughts.
It is estimated that at least half of two per cent of the general population who have OCD experience intrusive thoughts. This means that of the 40,000+ students currently enrolled in the University of Melbourne, about 500 are going through a similar experience to mine.
Thankfully, I am no longer plagued by intrusive thoughts. Of course, one of some nature may enter my mind on occasion, as they do for everyone, but I let the thought float by without asking why it is there and what it may mean. Everyone, and particularly those with OCD, needs to know that you cannot control your thoughts, all you can do is control how you respond to them. This very fact may just release you, as it did for me.
Anxiety Recovery Centre Helpline: 1300 269 438
Lifeline: 13 11 14
Suicide Line: 1300 651 251