I know it’s not true but it feels true

OCD is difficult to understand if you haven’t experienced it. How can someone simultaneously feel that something is true, yet know that it’s not true? When I was younger my OCD took the form of thoughts that I could kill people by doing or not doing an unrelated action. For example, I felt that if I put my hand down in the wrong place, my mum would die. On some level I knew that was false, but it ‘felt’ true, and it terrified me so much that I did what OCD ‘told’ me to.

One of the reasons OCD is such a horrible illness is that generally we know that what we are doing has no connection to reality, but we do as OCD ‘asks’ anyway. This can lead to feelings of inadequacy – why can’t I stop this? The answer to this question is complex, but one part of it is difficulty tolerating uncertainty.

You can tell a person with OCD that there is a 99.9999% chance that their fear is unfounded, and all they will think about is the 0.0001% chance that their fear could be true. ‘What if?’ is a huge component of OCD – I was almost certain that I couldn’t kill my mum with my thoughts, but what if I was wrong? It would be intolerable to ‘know’ that I was responsible for such a terrible occurrence (this is inflated responsibility, a way of thinking that is common in OCD).

OCD targets the things people care about most

OCD is a deeply unpleasant condition; it targets the things a person cares about most deeply and turns them into a subject of intense fear. For example:

A single parent devoted to their child may have OCD thoughts that ‘say’ they want to sexually abuse their child. This person would never abuse their child, in fact it is the most abhorrent thing their brain can come up with. This makes it the perfect target for OCD.
A child who has lost a parent may have constant OCD thoughts that they will somehow kill their other parent, or be responsible for their death.
A person who is deeply religious may have OCD thoughts which involve blaspheming against their god.
A nurse whose primary goal is to care for his patients may be so afraid of passing on an infection that he washes his hands until they bleed.

The following is a more detailed example of the way that OCD focuses on the things that matter most to the person with OCD. It’s a personal example from when I was about 14. I was struggling a lot with life, and one of the only places I found a small amount of respite was in the music of my favourite band. The opportunity arose to go and see them live. My OCD ‘told’ me that if I went to the gig then the bassist’s 2 year old daughter would die. There was no logical connection – I was not going to be anywhere near his daughter and I didn’t think I’d be passing on any germs or harming her in any direct sense. I just ‘knew’, because my OCD ‘told’ me, that if I went to the gig she would die, and it would be my fault.

This is an example of magical thinking, which is a so-called ‘thought error’ that is common in OCD. I can still remember how terrified I felt. I desperately wanted to see the band, but the idea of being responsible for the death of a child was horrible. This is an example of excessive feelings of responsibility, or ‘inflated responsibility’ which is also common in OCD. In the end I did go to the gig, and the bassist’s daughter was fine.