Obsessional Thoughts

In my practice, I have seen a number of people who come reporting highly intrusive and distressing thoughts sometimes categorized as "pure O". I want to take some time to address other ‘bad’ thoughts that people may have, yet feel they must keep to themselves due to feelings of shame and guilt. Usually these unwanted thoughts fall into three broader categories that encompass violent, sexual, or blasphemous themes. These may also come in the form of repetitive, recurrent images. As examples, some of these may involve thinking of or visualizing yourself pushing someone onto train tracks, wanting to have sex with a child or family member, using racist slurs, or shouting blasphemous words while in a place of worship. Some postpartum mothers report having distressing thoughts of smothering their baby. These recurrent and intrusive thoughts and images, if left to their own devices, can be appalling to the individual experiencing them and cause quite a bit of emotional turmoil if they are not properly addressed. Many who have these urges might feel they are alone in their suffering and could never mention this to anyone for fear of judgment, embarrassment or disgust at themselves.

If you experience any of these disturbing urges, a good question to ask is, how do I know I would never act on such thoughts? How do you know you are not that murderer or pedophile or racist (or anything else that you deem horrifying)? The truth is, no one can be one hundred percent certain that a situation would NEVER happen. In fact, the notion that there is even the slightest doubt involved is usually enough to torment someone who is suffering from these violent, blasphemous, or sexual thoughts. However, as the saying goes, the best predictor of future behavior is past behavior. If you have never had a previous history of acting on your most feared thought, it is unlikely that you will behave in such a manner in the future. More importantly, if you are plagued by a fear of acting on these thoughts, this is a good indicator that these unwanted thoughts are most likely a manifestation of OCD rather than a sign of impending criminal or immoral behavior.

You may wonder why people are afflicted with such thoughts. In the book, Imp of the Mind, author and psychologist Dr. Lee Baer discusses how there are evolutionary reasons and societal taboos that shaped the urges in our minds to do the worst thing imaginable. There are also neurobiological factors involved that may predispose an individual to these obsessions. There are also personality traits that may increase one’s sensitivity to “bad thoughts”.

People who are tormented by their “badness” may have tried suppressing their thoughts. However, research has shown that thought suppression does not work. It’s as if I asked you to STOP thinking about a polka-dotted zebra. Stop already! Most likely, you would have trouble keeping your mind off of this creature. However, if you allowed yourself to think of and acknowledge this polka-dotted wonder, inevitably your mind would soon wander to other things.

Dr. Baer aptly names these form of OCD a “silent epidemic”, as many people think they are the only ones who suffer from such horrifying thoughts. The gold standard treatment for obsessions of this sort is exposure and response prevention (ERP). This type of therapy has been demonstrated successful in bringing relief to those suffering from bad thoughts. Cognitive therapy has also been found to be useful in treating OCD in identifying cognitive distortions that play into obsessive thoughts. Perhaps just imagining telling someone about your bad thoughts today might be the first step in helping these thoughts go away.