How To Know: Are You Living With OCD?

If the title of this article has captured your attention, I would imagine that you are feeling afraid:

Afraid of the thoughts that affix themselves to your identity, your values, your surroundings – beating pulses of panic and uncertainty that tether themselves to you.

Afraid of what might happen if you were to lose control - if you were ever unable to resist or comply with your thoughts, or the conditions they enforce. 

Afraid of yourself: Of what you might be capable of doing. Of what might happen if you were placed in certain environments or around certain people.

If the above descriptions resonate with your experience, then you may be living with Obsessive-Compulsive Disorder.

What is Obsessive-Compulsive Disorder (OCD)? 

OCD is a mental health disorder that affects 12 of every 1,000 people living in Britain today. Obsessive-Compulsive Disorder is characterised by experiencing cycles of unwanted, intrusive thoughts, images, or urges that trigger feelings of distress in sufferers.

To resolve these feelings, sufferers can engage in compulsions – behaviours that are practiced to reduce distress or eliminate obsessions. These behaviours may manifest physically or involve mental practices such as repetition, checking, and ruminating on the subject of one’s obsession.

Crucial to understanding this disorder is a knowledge of how obsessions develop and the motivations that fuel compulsive behaviour.

For a number of people with OCD, the following is true: Sufferers have an inflated sense of responsibility, a tendency to overestimate threat, and personal aggravators that feed their disorder. 

How do these characteristics exhibit in a person with OCD?

Having an inflated sense of responsibility means that an individual assigns the duty of preventing harm to themselves, rather than distributing that responsibility between themselves and others.

As the OCD sufferer is disposed to assume responsibility, this perceptual approach determines their response to fear-provoking thoughts. The individual with OCD believes it is their responsibility to diffuse the threat posed by fear-inducing thoughts, which fuels the development of compulsions.

This is because compulsions are developed to contain and minimise the threat posed by a sufferer’s thoughts – threat that the individual fears manifesting in the physical world if they fail to control it. 

This psychological characteristic is associated with another phenomenon in OCD known as ‘thought-action fusion’. Thought-action fusion is a meta-belief that equates thoughts to physical actions.

In OCD, thought-action fusion looks like believing a feared outcome may result from a thought associated with an obsessional theme.

For example, I may fear that I have the desire to harm a family member from having an involuntary thought of doing so, even if this thought causes me alarm and distress. This causes the OCD sufferer to attribute the same level of meaning and threat to their intrusive thoughts as they would to, for example, planning to intentionally harm a family member in their vicinity. 

OCD Characteristics and the Salkovskis Model

Thought-action fusion ties into the tendency for OCD sufferers to overestimate threat.

Clinical psychologist, Paul M. Salkovskis, attributes this characteristic to his ‘A-B-C’ model of cognitive therapy. Through his research into Obsessive Compulsive Disorder, Salkovskis formulated a model of thinking that he believes sufferers of the disorder unconsciously conform to.

The first component of Salkovskis’ model, stage ‘A’, involves experiencing an intrusive thought. The Cognitive Behavioural discipline stresses that cognitive events (thoughts) are random and spontaneous, meaning that the sufferer is indisposed to exercise control over this stage. 

The second component, stage ‘B’, is where Salkovskis believes the OCD sufferer’s interventions begin. For Salkovskis, stage ‘B’ is all about interpretation and attributing meaning.

Whilst those without OCD may experience intrusive thoughts and move on without questioning their meaning, the individual with OCD is compelled by their overdeveloped sense of responsibility to question the thought.

For example, a common intrusive thought people have is of pushing a member of the public into oncoming traffic. Whether we are waiting at the train station or loitering at the bus shelter, we have all wondered what would happen if we were to push the person hovering at the curb into the road.

According to Salkovskis, this experience would give an OCD sufferer the urge to contextualise their thought – to make their thought ‘fit’ into their understanding of who they are, what they value, and what they are capable of.

It is this process that leads the OCD sufferer to stage ‘C’ – consequences. During this cognitive stage, Salkovskis believes that the individual with OCD faces the implications of trying to make an intrusive thought, urge or image fit into their understanding of themselves.

What makes intrusive experiences so frightening for OCD sufferers is that they are ego-dystonic, meaning that they oppose their self-image and values. This means that intrusive experiences can alienate OCD sufferers from their sense of self and cause them to reconceptualise themselves as threats to others. 

Each of Salkovskis’ stages illustrates how the thought patterns that characterise OCD cause sufferers to sense a threat from experiences that, whilst strange and unpleasant to go through, do not represent the potential for harm to occur.

OCD and Personal Aggravators

The last defining characteristic of OCD I’ll be exploring is the personal aggravator:

A personal aggravator is a theme that triggers a fear-based response in a person.

Whilst we all have things that disturb, scare, and repulse us – people with OCD have an elevated response to phenomena of this nature. This is because OCD sufferers tend to view things of this nature as possibilities, rather than contingencies dependent on unlikely factors aligning.

For example, an individual with OCD may have an obsessional fear of cheating on their partner. This could mean that anything from media portraying cheating, conversations discussing extra-relational attraction to meeting a friend’s partner for the first time may aggravate the sufferer’s obsession.

This can plunge the sufferer into feelings of guilt, shame, and self-doubt – prompting them to perform compulsions for relief or avoid coming into contact with content, situations, and people that ‘aggravate’ this theme for them.

Early-Life Development and Personal Aggravators

According to Aaron Beck’s Developmental Theory, an OCD sufferer’s personal aggravators can have their roots in early-life experiences.

It is Beck’s view that what we experience during our formative years can create cognitive templates - through which, we continue to perceive the world as we grow.

An example of this could be a child that is consistently told they cannot be relied on to behave properly. The reinforcement of this message through the child’s formative years, from the perspective of Developmental Theory, can embed the belief that they are not a dependable or trustworthy person.

This core belief can then go on to influence the strategies the individual uses to mitigate threat as it arises in later life.

Such an individual may, for example, enter into a romantic relationship believing that they cannot be relied upon and may disappoint their partner’s expectations or abuse their partner’s boundaries.

If this individual develops OCD in conjunction with this core belief, it is Beck’s view that being placed in situations that appear threatening to the individual may activate these beliefs. This may then trigger compulsive responses that attempt to reduce the likelihood of outcomes associated with this undependable predisposition.

If you recognise any of the above cycles or thought patterns in your own thinking and behaviour, you may be living with Obsessive-Compulsive Disorder.

Whilst there is more to learn about OCD, such as the thematic subtypes that emerge between sufferers and the support and treatment that can be accessed, identifying your experience amongst the phenomena described indicates that you may be dealing with Obsessive-Compulsive Disorder.

Remember, the foundations of recovery are awareness and information. The illusion of control OCD perpetuates will keep you tethered to draining compulsions, whilst taking command of this disorder’s influence on your life will set you free:

Empower yourself to stop living under this disorder and begin living with it, today.

Never let fear decide your future.