How can I tell what is OCD and what isn’t?

Sometimes people with OCD have trouble identifying which thoughts are OCD and which aren’t (see the bottom of this post for some tips on how to do this). I have had many years of therapy, and as a result I am relatively good at identifying when a thought comes from OCD. However, there are still times when I’m unsure. For this post I’ve divided OCD thoughts into ‘obvious’ ones and ‘subtle’ ones.

‘Obvious’ OCD

Obvious OCD thoughts are things like “my mum will die unless I touch the table 4 times”, “I knocked over the cyclist that I drove past”, “I can get cancer by breathing in when I look at the word ‘cancer'”.
You can usually spot the obvious OCD thoughts by imagining how someone else would react to the thought – they would know that it wasn’t true. The strange thing about these OCD thoughts is that even without asking anyone else, we know that others would see the thoughts for what they are – the output of a mental illness. (The reason why we still ‘obey’ them despite knowing this is discussed in other blog posts).

‘Subtle’ OCD

Subtle OCD thoughts are sometimes more extreme versions of everyday thoughts. For example “did I leave the cooker on?” People without OCD will wonder this from time to time, but they will usually forget about it quickly. In contrast, people with this form of OCD may check repeatedly that they turned the cooker off, and may worry about it constantly once they have left the house. In cases like this, if the thought interferes with your daily activities, and happens on a regular basis, it’s likely to be OCD.

OCD has been called the ‘doubting disease’ because it makes us doubt ourselves and the things that matter to us. For example, after a number of years of living with obvious OCD thoughts (e.g. “my mum will die if I touch the table”), I entered a period where I didn’t have many of these obvious OCD thoughts. What I did have, however, was constant doubts about my faith. It’s normal to have some doubts about faith and religion, but for me it was 2 years of doubts/fears which happened every hour of every day, irrespective of what I was doing at the time. It wasn’t immediately clear to me that this was another part of my OCD, because the content itself was something that many people think about at times, rather than a strange, obvious thought that doesn’t make sense to the average person. In this way it was an example of subtle OCD, it hid itself as something else (normal doubts).

OCD’s tactics

OCD is a crafty condition (though remember, you are always more intelligent than OCD is). Sometimes if you begin to resist it, it will try to recruit your emotions to make itself more powerful. For example, one of my OCD thoughts is that I will send loved ones to hell. I am usually relatively good at ignoring this thought, for reasons I’ll discuss in another post. However, this thought becomes much more powerful if I am feeling angry with someone. In this case, OCD will ‘tell’ me that not only can I send this person to hell [i.e. the basic OCD thought], but that I actually want to send them to hell because I’m angry. I have never wished for anyone to go to hell, never mind those that I love and care about. But OCD uses emotion to make me doubt that fact (there’s the ‘doubting disease’ again). This makes the thought more powerful – “what if I do ‘mean’ the OCD thought after all?” At this stage it becomes even more difficult to ignore, because it is recruiting additional feelings of inflated responsibility, guilt and fear.

Is it OCD? A few tips

The following list is intended to help people with OCD to work out whether the thought they are dealing with is a part of their OCD. It’s not designed to help people decide whether they have OCD or not. If you answer ‘yes’ to a few of these statements, it’s likely that OCD is driving the specific thought/fear. Note that you don’t need to answer ‘yes’ to all statements to label your thought as coming from OCD.

  • it focuses on something you care about in some way (e.g. loved ones, religion, work, things you enjoy doing)
  • it causes you distress
  • it interferes with your daily activities
  • it bothers you a lot of the time (not just occasionally)
  • it involves ‘magical thinking’ – the idea that thoughts or actions can cause real life events
  • it is the direct opposite of what you want to think
  • it involves symbolism, such as connecting unusual (typically frightening) meanings to left/right, colours or numbers e.g. yellow = cancer
  • it keeps coming back, even if you come up with a good ‘answer’ or reply to it
  • it gets stronger the more you think about it (even if the reason you are thinking about it is to contradict it); it gets weaker if you ignore it

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.