Underlying Themes of OCD

Given the varied content of obsessions, you may wonder why they all indicate the same disorder: OCD. Learning about the common themes underlying OCD will help you understand what lies at the heart of your problem and what different types of OCD have in common. Obsessions may have different and sometimes very personal and idiosyncratic content, but when you target the themes underlying them, you target the core problem.

Intolerance of Uncertainty

Most people don’t like having doubts or feeling uncertain, but when you have OCD, alleviating doubts and finding certainty can feel like a life-or-death matter.

Perfectionism or Wanting Things to Be “Just Right”

Being a perfectionist doesn’t necessarily mean that you suffer from OCD. Striving to do well and get things “right” can be motivating. However, people who don’t suffer from OCD can move on if things don’t look or feel perfect, whereas, with OCD, you may feel that if you don’t do things perfectly or in a certain way, dire consequences could occur and would be your fault. You may fear that you can’t handle the discomfort that you’ll feel if you don’t achieve that “just right” feeling. Uncertainty can prevent you from achieving a sense of perfection, and that can feel intolerable. The urge to make things “just right” can feel overwhelming.

Inflated sense of responsibility and overestimating the probability and severity of threat

Some obsessions involve overestimating your level of responsibility. You might feel a great degree of responsibility to safeguard others by avoiding oversights and never making mistakes. You may try to prevent possible catastrophic consequences by trying to do everything “just right.” You might feel overly responsible for protecting others from contamination or for preventing horrific outcomes due to fears that your thoughts mean you could be capable of committing unwanted aggressive, sexual, or blasphemous acts.

Interpreting thoughts as overly important and believing it’s important to control them

People with OCD tend to interpret intrusive thoughts as especially important. When you believe that certain thoughts must be important, these thoughts grab your attention. You may believe that having certain thoughts means you could act on them, or you may believe that having a thought is the moral equivalent of acting on it. You may fear that if you have a thought, it could occur. If you have an intrusive thought about stabbing the person next to you, you might interpret it as meaning you could be a murderer. You might conclude that you must be a bad person because you have bad thoughts.

Underestimation of Ability to Cope with Anxiety or Discomfort

You may think you can’t handle the level of anxiety or distress that your obsessions trigger. When uncertainty and feelings of threat or responsibility arise, it can feel intolerable. If something doesn’t seem just right, you may feel extremely uncomfortable. It may seem nearly impossible to cope with frightening obsessive thoughts. Obsessions can feel overwhelming, to say the least.

“Why Me?”

You may wonder why some people have more difficulty tolerating uncertainty and other underlying themes of OCD. You may ask, “Why me?” The answer isn’t known for sure, but genetic and biological vulnerabilities may play a role. Learning can also play a role, as people learn to associate negative emotions with certain triggers. For example, if one unclean public restroom triggers anxiety or disgust, then other public restrooms can become associated with anxiety or disgust. Then, behaviors can be reinforced. By avoiding public restrooms or washing excessively after using one, you might prevent or reduce anxiety in the short term. This is reinforcing, which means you’ll be more likely to engage in the same behaviors in the future. With time, strategies to reduce or avoid distress can generalize to other places, making you more likely to use avoidance or compulsions when you encounter other triggers that are similar.

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