All of the following is from Daring to Challenge OCD: Overcome Your Fear of Treatment and Take Control of Your Life Using Exposure and Response Prevention by Joan Davidson, Ph.D. and is reprinted here with permission.
Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted (American Psychiatric Association 2013). They aren’t intentional. They include thoughts like What if I contaminate my family because I stepped on something dirty? What if I accidentally hit a pedestrian while driving to work? What if something bad happens to someone I love because I didn’t repeat lucky numbers in my head? What if I lose control and stab my husband? When you have OCD, you wish that thoughts like these would stop popping into your head. Obsessive thoughts intrude frequently and with great intensity. It feels impossible to stop them. They cause substantial anxiety or distress.
The content of obsessions isn’t different from the types of thoughts most people might have. People who don’t have OCD experience disturbing thoughts, but they can usually dismiss them and let them go. But when you have OCD, certain thoughts have a way of sticking. Some thoughts or images feel like they stick and seem especially important. They keep returning and are often very intense.
Mary: “If you have OCD, I don’t have to tell you how awful it is to have something that you can’t get out of your mind. If you don’t have OCD, imagine having to watch something disturbing on television over and over again, unable to turn it off. You don’t want this to keep popping up in your mind!”
Many types of thoughts can “stick like Velcro” and cause great distress for people with OCD. This is why OCD can seem so confusing. While one person has obsessions about germs and contamination, another has obsessions about being capable of harming loved ones. The content of obsessions usually falls into general categories, and you may have obsessions from more than one category. You can also have obsessions that don’t neatly fit into categories. In addition, the content of obsessions can shift over time. You may struggle with one type of obsession and later discover that you also struggle with another type.
Contamination obsessions usually focus on germs, diseases, bodily fluids, and potential health hazards such as toxic cleaning supplies or pest-control products. If you have this type of OCD, you experience excessively high levels of anxiety or disgust when exposed to triggers of contamination obsessions.
Emotional contamination is an OCD subtype involving fear of contact with certain people or places because they feel dangerous or contaminated due to negative associations. For example, the clothes you wore when seeing something unclean, indistinguishable, or unpleasant can feel contaminated by association. If you have an unwanted sexual thought while walking in front of a certain store, the store may then feel contaminated.
Responsibility for Harm or Mistakes This type of obsession involves thoughts about being responsible for something bad happening to others, either because of not doing enough to prevent it or due to making mistakes that cause it. Common responsibility obsessions include What if I left the stove on and my house burns down? What if I left the door unlocked and intruders harm my family? What if the bump I felt while driving to work was a pedestrian I hit with my car? Again, these kinds of thoughts aren’t unusual; many people have them. But if you struggle with this type of OCD, your doubts stick and make you highly anxious.
Symmetry, Order, or Completeness Some obsessions focus on excessive desires for symmetry, orderliness, or feelings of completion. For example, you may feel that if you touch something with one hand, you must also touch it with your other hand. You may feel the need to complete a task or read every word of an article before you leave it…If you have this type of OCD, you wish it didn’t feel intolerable when actions aren’t done “just so” or items don’t line up “just right.” If symmetry, order, or completeness can’t be achieved, you might fear dire consequences. Alternatively, you may not fear specific consequences and instead have vague feelings of discomfort that seem almost impossible to bear.
Aggressive, Sexual, Morality and Religious Thoughts Sometimes violent or sexual images pop into people’s heads. Impulses to do something harmful or inappropriate may cross anyone’s mind. If we’re honest, we all have disturbing thoughts. But if you suffer from this type of OCD, these disturbing thoughts, urges, and images can be terrifying. The distress they provoke feels unbearable, and the uncertainty and doubt they trigger feel intolerable. You may feel tormented by wondering what having these thoughts mean about you. You may conclude that you must be a horrible person because you have horrible thoughts. You desperately want these disturbing thoughts and images to go away because they go against the grain of who you are and what you value.
Gina: “What ifs flooded my mind: What if I just picked up that knife and stabbed my mom? What if I drowned my sister? It was like a broken record playing in my head…I tried to reassure myself that I wasn’t capable of committing horrendous acts, but doubts intruded. I couldn’t understand why those thoughts were so persistent. They disturbed me deeply. Being around a knife, water, or anything that could potentially cause harm to someone paralyzed me with fear.”
Obsessions can also include doubts about sexual orientation. These aren’t intentional thoughts directed at exploring and figuring out your sexual identity, and they cause great anguish because of unrelenting doubt and inability to know anything with complete certainty.
Scrupulosity refers to obsessions that involve thoughts about offending God or questions about morality. Blasphemous thoughts are especially disturbing to people with strong religious convictions. Unwanted thoughts about committing a sin can trigger agonizing distress. Yet you can’t control the thoughts or images that enter your mind. And with OCD, thoughts and images tend to stick in spite of desperate efforts not to have them. You don’t need to be religious to have obsessions about morality.
Relationships Doubts about romantic relationships are not unusual, but obsessions involve a preoccupation with them and often interfere with relationships themselves.