OCD Awareness: Coping with Intrusive Thoughts
By: Allyson Inez Ford, MA, LPCC
Intrusive Thoughts: The Thread Between Both Eating Disorders and OCD
Intrusive thoughts are an experience that both Eating Disorder and OCD sufferers have. The content of the thoughts show up differently, but those sticky, nagging, relentless and unwanted thoughts that drive much of the behavior in both conditions makes it so hard to learn to trust your “authentic self” when your brain is screaming something else. At first, most people with Eating Disorders don’t identify their intrusive thoughts as intrusive, they might feel ego-dystonic (that is, the thoughts do feel like their authentic self, they don’t feel unwanted, except in the case of binge eating where there is more social stigma). As time goes on with an Eating Disorder, the more intrusive the thoughts feel. This is because over time (most) Eating Disorders take us away from living out our real values. They take up so much brain space it’s hard to be present with loved ones or engaged in our passions. This is where they become more intrusive. I often see this when folks decide they want to recover and reclaim their life from their ED- but feel stuck in the thoughts. With OCD, intrusive thoughts are a core part of the condition. They are not usually centered around food in OCD, and can be about literally anything. They tend to attack things you really care about, which is why they feel distressing and awful. More on that below! The reason why I want to talk about both Eating Disorders and OCD is because they have around a 40% overlap rate, however OCD often gets missed in Eating Disorders treatment due to a lack of awareness amongst ED providers. Personally, this was my experience in Eating Disorder treatment, and I could have saved years of suffering had I know what OCD actually was.
What is OCD?
So, you might be wondering, what even is OCD? Isn’t it just a love for handwashing and organizing? This is a common misconception- fueled by a Hollywood version of OCD that fails to showcase the root of the issue. Sure, sometimes OCD causes sufferers to have compulsions that make them seem like a “clean freak”- but they don’t enjoy this. They feel compelled to do these compulsions in fear that if they don’t, something horrible will happen and it’ll be all their fault. OCD starts with an intrusive thought, which is an unwanted, repetitive thought that triggers anxiety and disgust. Instead of being able to laugh away the thought, the person with OCD gets hooked into it, believing they need to figure it out or do something to make it go away. That is where compulsions come in. Compulsions are any behavior that is aimed at reducing the distress the intrusions bring. Compulsions can be physical, or they can be entirely mental (rumination, replaying memories, counting, etc). They can also be reassurance based (googling symptoms anyone?!). Finally, compulsions can also look like avoiding places and things that trigger the thoughts. While a person might get temporary relief from performing the compulsions, this only reinforced the obsessive-compulsive cycle. The intrusive thoughts get louder and more distressing over time, the longer you continue using compulsions. This cycle makes the person feel trapped, shameful, bad, depressed and often times, severely anxious. As someone who has OCD, I can tell you it becomes almost impossible to focus on anything else. When you think of Eating Disorders, you can see the commonality. Thoughts about losing weight and hating your body fuel restrictive or compensatory behaviors, which provides short term relief but only keeps the Eating Disorder going. Let’s explore what we can actually do with these thoughts, to not perpetuate the cycle.
Coping with Intrusive Thoughts
Knowing how to cope with intrusive thoughts is one of the first steps we go over in OCD recovery. And honestly, I wish we paid more attention to this in Eating Disorder recovery. Before we get into how to respond, let’s dive into intrusive thoughts a little bit more. I mentioned earlier how intrusive thoughts attack what we care about most. Here’s what they can sound like:
- “What if I hit that pedestrian with my car while I was driving to the store and didn’t notice it?” (Known as hit and run OCD)
- “What if I blurt out racial slurs to that person and everyone learns just how disgusting and horrible I am inside?” (Known as morality OCD or social justice OCD)
- “What if I am attracted to my sibling?” (Known as taboo sexual obsessions)
- “What if I want to throw my baby off the balcony? Or what if she stops breathing in her sleep and I miss it?” (Postpartum OCD)
- “What if I accidentally touched a surface that has the HIV virus on it, and I spread it to my family?” (Contamination OCD)
- “What if I am with the wrong partner, and I am eternally unhappy?” (Relationship OCD)
- “What if that ringing in my ear never goes away, and I am eternally uncomfortable because I can’t pay attention to anything else?” (Somatic OCD)
Hopefully by now, you get the picture. There are many themes of OCD intrusive thoughts, and they range from sounding totally strange, unlikely to monstrous and taboo. This is why people with OCD do not share their thoughts often. It can even be scary to tell a therapist, in fear they might report you or have you hospitalized. Most people with OCD know the thoughts sound bizarre and opposite to who they are, but they feel real. Logic does not typically work with OCD. There are different schools of thought as to why these thoughts pop up and become intrusive for a person. Some think it is purely biological, an overactive fear center of the brain. Others think it points to a feared possible self vulnerability in our unconscious. This does not mean the thoughts are true! Rather, it means you are scared of these thoughts being true, likely because of something you witnessed or experienced. It is my opinion that both can be true. Just like Eating Disorders, there are biological and environmental components to why we suffer.
So since we can’t use compulsions in response to these thoughts, what exactly do we do? That is the million dollar question and you might find the response pretty anti-clamatic. The best thing to do is: nothing. You want to not engage with the thought. You want to notice it, but not give it much air time in your brain. It is in the resistance to the thought that it becomes more stuck. So we want to treat it like any other thought- have awareness that it is there, but not give it your continuous attention. We do this by retraining the brain. There are a variety of techniques we can use which I will outline below.
Acceptance and Commitment Therapy Skills for OCD
Acceptance and Commitment Therapy (ACT), has many useful interventions for OCD and specifically for OCD. An overarching goal of ACT for OCD is to defuse from the thoughts. To be able to mindfully notice the thoughts, without judgement or resistance. Just letting them exist. When we accept the presence of the thoughts and stop fighting them, they lose their power. Like leaves on a stream, we can practice noticing them pass by, along with all these other leaves. Another analogy that is helpful is the “bee on the shoulder” analogy, from therapist Alegra Kastens. Imagine the bee is your intrusive thought. It lands on your shoulder and won’t go away. If you fight it, it gets aggravated and might sting you. If you simply let it exist, it usually goes away on its own. It’s uncomfortable and you might not like it there, but you accept it and continue doing whatever you are doing. What we are doing here is refocusing your attention, also called attention refocusing training. We can notice many things in our environment, but we choose how much attention we give it and the behaviors we do around it. This is what we want to do with those pesky intrusive thoughts.
The other component I find really useful in ACT therapy is about reconnecting to your values, and aligning your behavior to them. Usually, when we are trapped in the OCD, we are forgoing engaging in the things in life we really value. We might be intentionally avoiding them. For instance in the postpartum OCD example above, the mother may start avoiding holding the baby, even though she deeply values her baby and her role as a mother. Well, ACT would say to practice leaning into the value even when it is uncomfortable. Over time, when we do this, our brain learns that we can tolerate discomfort, and by not engaging in the compulsion or responding to the thought like it is something true and important, your brain stops sending alarm bells every time you have the trigger. Essentially, you regain your true self power back, since leaning into the discomfort is in service of what is really important to you. OCD is no longer running the show. This might sound simplistic, but it is actually VERY hard. It’s hard to do the opposite of what your brain is yelling at you to do. It’s hard to trust you shouldn’t engage with the thought when it feels SO real and so distressing. It’s very hard to willingly be uncomfortable and full of anxiety. So please give yourself loads of compassion and know that this process takes time. It takes a lot of practice and patience to retrain the brain. Oftentimes, people need specialized support to do this- and more than ACT therapy. I recommend finding a therapist who specializes in OCD and utilizes ERP and/or Inference Based CBT- as well as ACT. Coping with the thoughts is one part of the journey, but learning skills to stop the compulsions is often needed too. Many OCD sufferers also benefit from medication support- I sure did! Please check out the International OCD Foundation for more information on different treatment options.
Seeking Proper Treatment
It is so crucial to seek proper treatment for both Eating Disorders and OCD. Please make sure you work with a specialist- ask about their training and credentials. Without a specialist, these experiences can worsen. The treatment for OCD can feel paradoxical, but it is also highly effective.
Lastly, please know you are not alone. Everyone actually gets intrusive thoughts, but with OCD and EDs, they become sticky and hard to untangle from. There is a way out though, and you do not have to suffer forever. I am proud of you for even considering reaching out for help- it truly is so brave!
