Challenging Shame in Obsessive-Compulsive Disorder

Challenging Shame in Obsessive Compulsive Disorder

Written by Hillary Gorin, PhD, LCP

As a provider who works with many individuals with Obsessive Compulsive Disorder (OCD), I see the impact this disorder has on my clients, especially the profound shame it creates. For those of you who are reading this blog to better understand OCD, individuals with OCD have intrusive thoughts about taboo, inappropriate, bizarre, and/or distressing things followed by behaviors intended to neutralize the thoughts or prevent the fear from coming true. Throughout the day, many individuals with OCD are bombarded with disturbing images, distressing thoughts, and scary impulses that they fear they will act on; many of these individuals try to hide the fact that they are thinking such thoughts, believing their intrusions mean they are terrible people who want to do terrible things. However, what individuals with OCD do not often understand, is that everyone has intrusive and inappropriate thoughts throughout the day. Of course, we cannot read everyone’s mind for a reason. It would be overwhelming to hear everyone’s intrusive thoughts throughout the day and we would all feel some level of shame and embarrassment if all of our thoughts were displayed to the world. However, many of my clients describe that their extreme shame is related to a fear of being ‘found out’ that they too are having intrusive thoughts. They tell me they live in fear of being labeled a ‘monster,’ or of being a terrible person who will do terrible things due to their intrusive, unwanted thoughts. They even experience this in the therapy space, as many of my clients even fear sharing with me, their therapist, due to fear of judgment, hospitalization, or even imprisonment. 

While this blog is intended to serve as a reminder that no one with OCD chooses to have the intrusive thoughts that they do, I also hope to address the shame and fear of being a ‘monster’ that many of my clients live with. If individuals with OCD are monsters for having odd and taboo, intrusive thoughts, then we all are monsters because EVERYONE has intrusive thoughts. However, not everyone gets stuck in and judgmental about their intrusive thoughts the way someone with OCD does. Although the exact genetic or biological cause of OCD remains unknown, we do know that no one would choose to experience and get stuck thinking about scary, intrusive thoughts. In my years of experience treating OCD, never once did I have a patient inform me that they enjoy these thoughts or that they hope to act on them some day. In fact, everyone says the exact opposite. If a thought is intrusive, it is quite literally intruding into conscious awareness and is not a thought of desire or a thought that someone wishes to have or act on. Whatever an individual with OCD is thinking about is actually the exact opposite of what they want to do; often the intrusion represents the greatest fear an individual has or the thing they want to prevent at all costs. A thought someone wishes to act on will alternatively be welcomed by someone and it will not create distress; a non-intrusive thought is a thought that is intentionally created by someone and is aligned with their true desires, wishes, and values.  

Clearly then, if everyone has intrusive thoughts and intrusive thoughts are not chosen or desired thoughts, then there must be biological abnormalities in individuals with OCD that contribute to their distinct reaction to intrusive thoughts, as someone with OCD reacts to intrusive thoughts with extreme anxiety, whereas someone without OCD reacts with “huh, that was a strange thought” and moves on with their day. As discussed in previous blogs (see the Oakheart Blogs: OCD and “Unacceptable” Intrusive Thoughts - You are Not Alone - and The Role of Thought-Action Fusion in the Development and Maintenance of OCD), it has been identified that individuals with and without OCD have the same intrusive thoughts (Moulding et al., 2014). However, something in the brain of an individual with OCD is hypothesized to be different (Yang et al., 2024). As identified by Yang and colleagues (2024) in their meta analysis (a meta analysis examines the combined results of many studies), many research studies suggest neurobiological differences in individuals with OCD. Specifically, Yang and colleagues (2024) found that individuals with OCD exhibit abnormal functioning and structural differences in the bilateral medial prefrontal cortex/ anterior cingulate cortex (mPFC/ACC), insula, and inferior frontal gyrus (IFG). Therefore, overcoming OCD, a biological condition, is not a matter of will power. Instead, overcoming OCD requires structured, evidence-based treatment often in combination with medication management, in which the neurobiological abnormalities are considered and addressed. 

With this said, I believe it is important that we start discussing OCD as what is it: A medical condition, like any other medical condition. A medical condition is by definition “a disease, illness or injury; any physiologic, mental or psychological condition or disorder. A biological or psychological state which is within the range of normal human variation is not a medical condition” (Medical condition, n.d.). Should one feel shame due to having a medical condition? Most individuals would say no. Most people would not shame someone who has cancer or autoimmune disorders. Why? Because we cannot control our biological abnormalities or challenges. We cannot choose to stop having such differences. No one chooses to have intrusive thoughts about running over pedestrians or giving someone a deadly disease or causing harm to their loved ones. 

Alternatively, an individual with OCD desires nothing more than to stop having their intrusive thoughts, as they experience intrusive thoughts about their greatest fears in life. If someone is afraid of hurting others, they will have intrusive thoughts about harming others. Others are afraid of dying and leaving their loved ones behind so they have intrusive thoughts about deadly diseases. Others fear losing control over their environment and thus they have intrusive thoughts about order, symmetry, or contamination. Because OCD is a biological/ medical condition that reflects someone’s greatest fear in life and is a product of abnormal brain biology, as a provider, it is clear that individuals with OCD should not be ashamed of their intrusive thoughts or related compulsions. Instead, we should recognize that individuals with OCD simply have strong desires to engage in the world in a way that aligns with their values. They have a strong desire to keep others safe. They have a strong desire to stay healthy or to control their environment so that everything will be ok. 

So to anyone reading this who has OCD, it is time to let go of the shame of having this medical condition. It is time to find compassion for yourself and to attribute your intrusive thoughts and your reactions to them to the differences in your brain that cause you suffering. It is time to start believing that it is because of your moral integrity or value of safety and stability that these intrusive thoughts impact you.

If you would like help overcoming your reaction to your intrusive thoughts, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

References

Medical condition. (n.d.) Segen's Medical Dictionary. (2011). Retrieved April 24 2024 from https://medical-dictionary.thefreedictionary.com/medical+condition

Moulding, R., Coles, M. E., Abramowitz, J. S., Alcolado. G. M., et al. (2014). Part 2. They scare because we care: The relationship between obsessive intrusive thoughts and appraisals and control strategies across 15 cities. Journal of Obsessive-Compulsive and Related Disorders, 3(3), 280-291. https://doi.org/10.1016/j.jocrd.2014.02.006

Yang, Z., Xiao, S., Su, T., Gong, J., Qi, Z., Chen, G., Chen, P., Tang, G., Fu, S., Yan, H., Huang, L., & Wang, Y. (2024). A multimodal meta-analysis of regional functional and structural brain abnormalities in obsessive-compulsive disorder. European Archives of Psychiatry and Clinical Neuroscience, 274(1), 165-180. doi: 10.1007/s00406-023-01594-x