Fearless: Breaking Anxiety Down

Today I discuss six common thinking errors (or maladaptive beliefs) in obsessive-compulsive disorder. These are different from the ten cognitive thinking errors I have discussed previously. I divide these OCD-related thinking errors into three groups:

  1. Control of intrusive thoughts
  2. Exaggerated threat and responsibility
  3. Intolerance of uncertainty and perfectionism

To explain these patterns of maladaptive beliefs, I use the example of an individual who has checking compulsions regarding his family’s safety. He worries that strangers will break into his house and harm his wife and his little son. So he tries to reassure himself not only through walks around the house before leaving for work, but by calling home many times a day, calling the neighbors, checking the local news for reports of break-ins, etc.

Important uncontrollable intrusions

To explain these first two thinking errors, let us consider the individual in our example, who despite reassuring himself that everything is okay, is tormented by thoughts such as: Am I certain there was nothing suspicious around the house?

Why do these thoughts cause him such anguish? Because to many with obsessive-compulsive disorder, intrusive thoughts are important. It is as though such intrusive obsessions increase the likelihood of bad things happening. Therefore, people with obsessive-compulsive disorder try to suppress threatening worries.

However, it is very difficult to control one’s thoughts. To see for yourself, try this exercise: For five minutes, do not think of a purple kite, in the shape of a pig with wings. It is crucial that you don’t!

Set the timer for five minutes.

Okay, how did you do?

Compared to thoughts regarding a purple kite, obsessions are even more difficult to control because they are threatening. It is difficult to ignore thoughts like: What if I have AIDS and don’t know it? What if there was a rare virus on my hand when I put a band-aid on my daughter’s injury? What if I did not do my prayers right and go to Hell? Etc.

The more one tries to suppress such obsessions, the more powerful they seem to become.

Exaggerated threat and responsibility

To examine the next two thinking errors, let us return to the person in our example. He now obsesses about the possibility that this morning he failed to notice two strangers standing next to a tree, a block away. To him, such an error would be costly. Why?

Because those with obsessive-compulsive disorder overestimate both the likelihood and severity of something terrible happening. So two strangers a block away could not be tourists, photographers, people considering buying a house, someone’s guests…but criminals. And not thieves or swindlers, but unstoppable murderers who will break into this individual’s home and kill his powerless and defenseless wife and child.  This is a horrifying possibility. But a rare one.

Many things in life are possible but not probable. Just as it is possible that today, as you drive to work, you have an accident and become paralyzed from the neck down. Again, horrifying, but rare possibility.

Of course, it is rational to prevent harmful things from happening when their likelihood multiplies. For instance, it would not be a good idea to drive drunk, when the weather is terrible, or when your car’s brake is malfunctioning.

Let us talk about the other thinking error, that of responsibility. Our individual’s pseudo-prophetic vision of his family getting murdered is too powerful to ignore, so in a sense it becomes his responsibility to prevent their murder. Only he—not his wife, the neighbors, the police, etc—can anticipate or stop this tragedy. So he checks and checks and checks….

Uncertainty and “not just right” feelings

The last two thinking errors in obsessive-compulsive disorder are intolerance of uncertainty and “not just right” feelings. I start with the first.

Life is filled with uncertainties. Awful things could happen to anyone. Usually, we do not worry about such events because we can tolerate uncertainties.

But low probabilities are no source of comfort to one who can not tolerate uncertainty; for instance, for a person who needs to feel absolutely certain about the safety of his family, and for whom “good enough” is not good enough. Nothing short of perfect certainty will do.

Perhaps related to this is the maladaptive pattern of “not just right experiences.” People with obsessive-compulsive disorder have difficulty tolerating feelings of incompleteness and imperfection.

Being told that a negative event is unlikely provides no comfort when things do not feel right.

Case in point, the individual in our example needs to examine his surroundings until it feels right; until he feels a sense of balance, of things being just right. Only then can he stop obsessing.

Summary of thinking errors in OCD

People with obsessive-compulsive disorder

  1. Often consider intrusive thoughts to be important, and they try to control them.
  2. Exaggerate a threat’s likelihood and severity, and feel responsible for stopping the dreaded event from occurring.
  3. Have trouble tolerating uncertainty and “not just right” feelings.