Written by Johanna Younce, MA

Obsessive-Compulsive Disorder (OCD) is a really difficult thing to have and experience for yourself, but it is also difficult to care for someone who experiences it. When someone has a diagnosis of any kind, psychological or physical in nature, it is always better to have support from loved ones. If you are reading this because someone you love has OCD, I want to start by thanking you for caring so much. The first step is to do more of what you are doing right now: Seek out information. One excellent source for information on OCD is the International OCD Foundation website (start with https://iocdf.org/about-ocd/). This will help to get a basic sense of what the disorder actually is. This is important because OCD is often misrepresented in media and popular culture, so what many people think they know about OCD may not be completely accurate. As you learn more, it is important to remember that OCD is a complex problem and it looks different for everyone. Some people with OCD have symptoms that most people are aware of, such as fear of germs and washing rituals, but others experience completely different types of obsessions and compulsions. In fact, some people perform compulsive rituals entirely in their minds (for example, repeating phrases over and over in their head). Look for reputable sources to find information, but also ask your loved one about what OCD looks like for them.

Depending on your relationship with your loved one, you may want to help them find a therapist if they don’t already have one, or if their current therapist is not experienced in treating OCD. When looking for a therapist, look for a specialization in OCD or anxiety disorders, and ask whether the therapist is trained in exposure and response prevention (ERP), the gold standard treatment for OCD. For a list of providers at OakHeart that specialize in treating OCD and utilize ERP, visit our OCD specialty page. ERP for OCD is very well-researched and effective. For more information on finding a therapist, see the past blog post "How to Find the Right Therapist for You" by Dr. Katherine Harris. 

This next piece can be harder to do. When a loved one experiences great anxiety, our impulse is often to help them get rid of the anxiety by helping them avoid or escape their triggers (feared object or situation). This is super helpful when someone’s anxiety is caused by a truly dangerous thing - when our loved ones are actually in danger, we want to help them and ourselves get to safety. However, when the anxiety is unhealthy and disproportionate to the actual danger involved, we find that these escape and avoidance behaviors actually worsen the problem. When loved ones help the client avoid, we call this “accommodation.” When I work with the families of individuals with OCD, we talk a lot about identifying accommodating behaviors and stopping them. This is often very hard to do, because this makes your loved one more anxious in the short-term, but it is essential to their recovery. It’s similar to when a person struggling with alcoholism begs for alcohol - it’s going to make them feel better in the short-term, but it feeds their problem. We wouldn’t want to give alcohol to an alcoholic, so we also don’t want to give accommodations to our loved ones with OCD.

One of the most common accommodations is reassurance seeking. People with OCD will sometimes seek reassurance from others regarding their fears. If the fear is that they are secretly an evil person, they might ask a parent or partner if they did something wrong or if they are a good person. If they have fears that the house will burn down if the oven isn’t turned off, they may ask someone if they did indeed turn the oven off. It is difficult to do at first, but we as loved ones must learn to stop giving reassurance. If the loved one is in treatment, you can remind them of their treatment goals and tell them (gently) that you will not answer their question. Sometimes I will have the client write down the loved one’s typical response to their reassurance seeking, and the loved one can simply remind them to look at what they wrote the next time that client asks for their reassurance. It feels difficult, and it may go against everything you have been doing for this person for a long time, but finding a way to stop accommodations and communicate your love and support in more fruitful ways will be the best you can do to help your loved one with OCD.

Finally, take care of yourself. Those of us in the helping professions put great emphasis on self-care because we cannot support others well unless we are taken care of. Take care of your body, mind, and spiritual self. Look for support from others. 

I believe in you.

If you feel you would benefit from talking with a clinician who specializes in OCD call OakHeart at 630-570-0050 or email us at [email protected].

Written by Johanna Younce, MA

When most people think about Obsessive-Compulsive Disorder (OCD), they think of the stereotypical symptoms: needing everything to be perfectly organized or “just right” and fear of contamination. While these are valid and common presentations of OCD, there are other types of symptoms that are less often discussed. One of these symptom types is the fear of unacceptable thoughts or repugnant obsessions, which feel incredibly scary and threatening to people with OCD. This type of OCD can cause an immense amount of shame and fear, and I believe we need to discuss it more openly to decrease the shame and give less power to these thoughts.

What does “unacceptable thoughts” mean? This type of OCD involves sexual, aggressive, and religious/moral obsessions. These obsessions involve very taboo thoughts that are hard to talk about, even with people who we are closest to. Many people with OCD have these unwanted, intrusive thoughts and think they are the only ones. However, research has shown that about 94% of people experience intrusive thoughts. That’s almost everyone! Almost every single person has intrusive thoughts from time to time. It is extremely common; People just don’t talk about it because it is so taboo and uncomfortable. 

So, wait, if so many people have intrusive thoughts, why do only some people have OCD? Thank you for asking; That is an excellent question. The difference is that people with OCD place an enormous amount of meaning on and responsibility for these thoughts. In other words, they interpret the thoughts differently. When most people experience unacceptable intrusive thoughts, they brush them off and recognize them as random and meaningless. People with OCD often think that having the thoughts must mean that they are terrible, awful people. But this simply isn’t true! The fact is, we cannot control what thoughts come into our heads, and sometimes the thoughts are taboo and uncomfortable, and that is ok. The same goes for dreams: Having a dream about something does not mean it is something you want to happen.

To further the cause of normalizing unacceptable intrusive thoughts, let me share some thoughts (in the form of either words or images) that I have had or have heard from others:

• An image of pushing someone down the stairs
• An image of driving one’s car off the road and into a lake
• “Do I love God enough?”
• An image of having sexual relations with one’s father or mother
• An image of having sexual relations with one’s sibling
• An image of having sexual relations with [fill in the blank with someone it would be inapproporiate to have sexual relations with]
• “If I swallow my saliva during Ramadan, am I not fasting?”
• An image of stabbing one’s eye into the corner of a desk
• An image of molesting a child
• “What if I’m secretly a pedophile?”
• An image of stabbing oneself, a loved one, or a stranger
• An image of a spider crawling into one’s vagina
• “What if I said that prayer incorrectly?”
• An image of Jesus Christ with an erection
• “What if I murder my spouse or partner?”
• Imagining the number “666”
• Images related to devil worship
• An image of throwing one’s baby out of the window
• An image of drowning one’s baby
• An image of or urge to throwing oneself into oncoming traffic
• The thought of swearing in church
• “Am I gay but haven’t realized it yet?”
• “Am I wrong about being gay and am actually heterosexual?”
• “What if I somehow accidentally poisoned my child?”
• “What if I somehow ran someone over with my car and didn’t notice?”
• Images of beastiality
• ...and much more.

Reading this list may have made you uncomfortable. You may have even found yourself judging either yourself or others for having these thoughts. The important thing here to remember is that these thoughts are intrusive, meaning they come into your mind without intending them, and they are unwanted, meaning they are not fantasies or desired outcomes. Just having these thoughts pop into your mind does not mean that you want them there and that you like to think about them. Fantasies are things that you enjoy thinking about (and every part of you enjoys it; there is not one part that feels anxious or thinks it is wrong). My random thought of myself driving off the highway this morning is meaningless and it does not worry me because I know that thoughts are just thoughts.

I hope this has helped you feel less alone in your more taboo thoughts or dreams. Almost everyone has them, and they are not meaningful. You are not alone, and you are not an evil person. 

Remember, thoughts are just thoughts.

To hear more about one individual’s experience with unacceptable obsessive thoughts, check out NPR’s Invisibilia Podcast’s Season 1, Episode 1: “The Secret History of Thoughts.” To learn more about intrusive thoughts and OCD, visit the International OCD Foundation website.

If you feel you would benefit from talking with a clinician who specializes in OCD call OakHeart at 630-570-0050 or email us at [email protected].