In this episode:
Venessa: One of the most misunderstood parts of OCD is intrusive thoughts, especially when they feel disturbing or out of character. Jay, can you describe the kind of intrusive thoughts you experienced?
Jay: I've had many, to be fair. But one that I use as an example is harm OCD. Many times when I've been driving, I'll hear a noise, maybe a stone's hit my car, or I've gone over a pothole or whatever. And in my head, my brain says, "You just killed someone," straight away. My compulsion is to check in the mirrors to make sure I've not. In that moment, my brain is being irrational, so someone without OCD could rationalise that and go, "Yeah, I know I've not ran someone over. It's broad daylight, I can't see anyone." But with my brain, it's like I can't trust what I am seeing. A dreaded fear of guilt comes over me then. The next compulsion could be to turn around and go back and check to make sure no one's on the road. Other ones are like contamination, is a big one for me, so getting ill myself, but also making someone else ill.
So say when I make my breakfast, everything that I touch will get rewashed, like the knives, the forks, the plates, the cups. Even though I've washed them, say the night before, I don't trust that they're clean. And it's always, what if you don't wash your hands now and then you get really sick, and then you can't go to the footy on Saturday, or you can't do your training and it's going to mess your routine up. Or it could be, what if I touch this and then someone gets sick, and then they die because of me? You think you're responsible for so many bad things happening in the world when it's not the case.
There could be a 0.0001% chance of something happening, but to me, that could be like, that is going to happen now because I've thought it, and I can't get it out of my head. One was when I used to getting changed, getting ready for the day. When I put my top on, I'd have to keep taking it off because it didn't feel right, because I had an intrusive thought in my head that was unwanted, that was a bad thought. So I'd have to take it off and then redo it again, because if it didn't, it means I'm a bad person.
Venessa: Thank you for sharing that. Sorry, go on, Peter.
Peter: I was going to say, I think something that Jay was talking about there is really important with people with OCD, and it's that trusting yourself thing. We often say that people with OCD have what we would call mistrust of the self and senses, which is where people will say, "How can I be sure about this? How would I know? Would I be the kind of person..." Using Jay's example it's like, would I know whether I ran somebody over with my car? How would I know? I don't think I did, but do I trust myself that I didn't do that? And then people will engage in the compulsive behaviour of going back and checking and getting reassurance because they don't just trust that they would know this.
And this mistrusting yourself comes up an awful lot, which is what leads to people doing the compulsive behaviour because that's how they get their trust back. They get the trust back because they trust the compulsive behaviour they did because they don't trust themselves.
Venessa: So Peter, staying with you then, where do intrusive thoughts come from? What are the differences when something becomes obsessional, and do we all get them?
Peter: Everybody experiences intrusive thoughts. People would commonly refer to these as spontaneous thoughts, so thoughts that just come from seemingly nowhere. You might be walking down the street and see somebody wearing a nice outfit and go, "Oh, I wonder where they bought that from." It just came into your head. We call them intrusive when people find them upsetting, distressing, and unpleasant.
So you might have an intrusive thought that is about harming somebody. You might have an intrusive thought about doing something bad. You might have an intrusive thought about something bad happening to you or to somebody else. A common example is if you're driving down the road and somebody cuts you off, you might go, "Oh, I hope they just crash their car." And you might go, "Oh, that's not a nice thing to think. That's not the kind of person I want to be. I don't want to harm people. I don't want to be that kind of person." And so that, we would call an intrusive thought. You experience the thought, and you find it upsetting.
It becomes obsession when you start asking yourself questions like, "Why did I have that thought? Where did that thought come from? What does having that thought say about me as a person? Is that coming from some deep, secret part of me that I don't know about yet?" And that's what leads people into that cycle of going round and round and thinking, thinking, thinking, that they try to escape from by doing the compulsive behaviour.
So yes, everybody has intrusive thoughts, but not everybody worries about them and obsesses about them and asks themself why and where and what for with their thoughts.
Venessa: Thank you. Thank you. So Jay, how did these thoughts make you feel about yourself at the time? Not specifically the ones Peter described, but the intrusive thoughts that you had.
Jay: Just that I'm a bad person. Why am I thinking these things? Yeah, it's like I try to neutralise that thought, but that makes it worse. That makes it stronger. It's just not a really nice feeling. It's so distressing, and it's hard to switch off from it. Like if I have an intrusive thought, I could be thinking about that for hours or days.
People with OCD are probably the safest people you can be around because we're that scared of upsetting someone or hurting someone that we do everything in our power to make sure that everyone's okay. So, we are probably one of the safest people, which we have mentioned before, didn't we?
Peter: They say the person who has intrusive doubts and worries about crashing the car is the person you want to be your chauffeur, because then there's no way that they're going to drive in any way unsafely or dangerous. They're going to drive so perfectly, so correctly, because they're so worried about it. They're so hyper-vigilant about it all the time.
Venessa: Thank you. So Jay, what stopped you from opening up about your intrusive thoughts?
Jay: Because when I was a kid, when I'd left school and I first started to learn about OCD, when you go to the doctors and then you get a referral to a therapist, obviously they say about the confidentiality, they can break it if they think you're a harm to society. So I'm thinking like, "Well, if I tell them these thoughts I'm thinking then I'm going somewhere," do you know what I mean? A mental hospital or wherever it is, that's what we say at the time.
And that thought of like, well, I can't really tell anyone about what I'm thinking because they're not going to understand. So that was just so scary for me to even want to open up to people.
Venessa: It sounds like, pardon the phrase, catch 22, Peter. So what would you say about that?
Peter: I think that's incredibly tough. The person with OCD worries genuinely that they are mad, bad or dangerous. And so the idea of going to tell somebody about it, people worry about all kinds of consequences. Will I lose my job? Will my kids be taken away from me? Will they phone the police and I'll end up in prison for thinking these things?
It's really hard for people to get through the door to go and tell somebody about these thoughts and about these worries because part of them is thinking, "Maybe I am this person. Maybe I am dangerous in some kind of way. Maybe I do need to be taken into a hospital, be put into a prison and be taken away from the people around me."
So if you were thinking that, if part of you is genuinely worried that you might be this bad person you don't want to be, it'd be very scary to go and speak to somebody to get help. The reassurance I would give is that mental health professionals understand OCD. We know how it looks and we can make sense of it. And from the outside we can clearly see that the person is not dangerous, that they're not a harm to themself or to somebody else.
And so, as Jay describes, we would want people to have the reassurance that we can tell the difference between people having OCD and people who are actually a harm to themself or to other people, and that they should feel confident coming forward and talking about it, and we can help give them that reassurance and insight.
Venessa: Yeah, definitely. So Jay, what helped you start to understand and cope with those thoughts?
Jay: Education. That helped me a lot, and having CBT therapy as well, that helped me to just understand. So learning about that and doing exposures. Although, when I've been to CBT, after I've been, a few months later, I get back in that routine of doing stuff.
Venessa: You mentioned CBT and exposures. Could you tell us a bit about that?
Jay: With my exposure, so for myself, washing myself, washing my hands, having a shower. If I'm in the shower, I could wash myself seven or eight times because I think, "Oh, I'm not clean," or, "I need to do it again because such and such is going to happen."
So my exposure therapy would be to reduce that to say, only do it six times, and then only do it four. Reduce your checking. If you're going to be checking something, say your door for an example, which is a more common one, only do the handle, say three times instead of five.
Venessa: How long was the whole process till you started to feel some difference?
Jay: It's just gradual, small little changes. Could take a few months before, say, I was talking about the washing myself in the shower. I think just doing small, tiny little steps really, for me, was the best way and not just jumping and saying, "I'm not going to do that no more."
Sometimes things fluctuate, and from day to day, so it depends how I'm feeling at the time. Just if I'm in a good mental state, I can do it better and sometimes I can't, and that's okay. I don't think you should put a pressure on yourself for it.
Venessa: So Peter, what's the difference between having an intrusive thought and acting on it?
Peter: Sure. This is what the people with OCD worry about. They'll worry, "Well, what makes me different from the kind of person who would hurt somebody? What makes me different from the kind of person who would hurt themself or do something bad?"
The technical phrase we use is that the person with OCD experiences the thoughts as ego dystonic, as in they find the thoughts upsetting. They don't fit with you as a person. You say, "That's not me. I don't like having those thoughts. This isn't like me."
The person who unfortunately would go out of their way to harm themself or to harm somebody else or to cause something dangerous to happen or to do something problematic, wouldn't find the thoughts upsetting or distressing. They wouldn't find them problematic. They would find them ego systonic. They would say, "This does fit with me in person. I want to hurt somebody. I want to cause harm. I'm okay with driving too fast. I'm okay with not doing this correctly, not doing this safely, not doing this okay."
Venessa: Thank you. And Jay, what helped you realise that your thoughts don't define who you are?
Jay: Education and realising that all the things that I've thought have never come true. So, I could worry about something that it's 0.00% chance going to happen, but it actually doesn't happen. So I feel like that helps me to realise that I can't be that much of a bad person.
Venessa: You definitely aren't.
Jay: Thank you.
