The shape of OCD

Sometimes it can be difficult to know if our anxious feelings come from ourselves and are a real and genuine concern or if they belong to the condition of OCD. When we try to delve more deeply into this question, the answer can be elusive.

When we are triggered by OCD, we experience recurring and unsettling themes which compel us to engage with them. These can take many different forms. For example, we may feel concerned if we experience a horrible thought, image or feeling when we spend time with a child/young person. Sometimes we fear that this means we are attracted to children or that we would be judged by others to be a paedophile. It can also feel as though it's possible because we are experiencing horrible thoughts, images or feelings around children, that at some point we will lose control and harm a child.

Another example of an OCD theme is where we have recurring and difficult thoughts about our sexuality or gender. It can, of course, be the case that we are not sure who we are and that we question this for a while. This is completely normal. However, when our thinking around this topic becomes repetitive and annoying, and we feel compelled to seek answers to questions on an ongoing basis, the likelihood is that OCD has started to attack this area of our life.

This theme can sometimes cause people to worry that their concerns appear to others to be anti-LGBTQIA+ in nature. Often, people go to great lengths to clarify that this is not the case. They are simply questioning the feelings experienced within themselves, which seem at odds with who they truly feel they are.

In general, it's extremely common for OCD sufferers to worry excessively about being judged and found wanting by others. Another common concern in this community is wondering if we have offended people. It's not the case that we are judged any more than anyone else. If anything, we are probably far less likely to offend someone than the average person, because of our tendency to worry about causing offence!

Another example of an OCD theme is where people feel they can affect situations by thinking a certain thought or engaging with a specific action. For example, 'if I tap the table in three lots of four, I will prevent my family from having a car accident' or 'if I repeat the phrase 'I love you so much', nothing bad will ever happen to my child'. This is called magical thinking and forms another very common OCD theme. It isn't possible to affect situations in this way, but for an OCD sufferer in the moment this feeling is incredibly real.

Other OCD themes include contamination, organisation and symmetry, checking, harm, morality, religion, health-related obsessions, issues with sounds and bodily functions, but there are many more.

The urge that we feel to engage with these themes is almost impossible to ignore. We seek safety in the shape of rituals, designed to enable us to move away from the triggering situation and to feel better about it. Sometimes we find this safety, other times not. If we don't, we keep on trying by repeating the thought or action some more. The problem with this approach is that the more we engage with compulsions, the more triggers we create for the future. It's not the thoughts, images, feelings, sensations or urges in themselves which are the problem, but our engagement with them.

Our brain believes in these moments that we are facing real danger. When it compels us to find the right answer or to do the right action, it believes it's protecting us from this danger. When we engage with a compulsion, this confirms to our brain that we were indeed facing a threat and now we have saved ourselves from this situation. This prompts it to keep scanning for 'danger' signals in our daily life, meaning we continue to feel triggered. It's of course not the case that we face ongoing danger every day. It's therefore important to learn how to show our brain over time that we are safe.

We can do this by engaging with exposure and response prevention (ERP) exercises. This should be done in a graduated way, with the help of a therapist experienced in working with ERP. You should be given the chance to have your own input into this process and to choose the pace at which you move forward. This work will feel counter-intuitive in the sense that it encourages you to move towards your feared situations and to stay in them for a while, as opposed to avoiding them or protecting yourself from them.

When we stay in the situation without engaging with any safety behaviour, and wait for the anxiety to shoot up, peak and then reduce slightly in a natural way, nothing bad happens. We discover that we are safe. Over time, this method of working has the power to move mountains and create a much easier and more enjoyable life for us.

Always ensure that your therapist is qualified and registered with a professional organisation. For informal support and information, please contact the charity OCD Action.