What are Intrusive Thoughts?
Recurrent, unwanted thoughts that occur without warning, are experienced as disturbing and distressing and crop up again and again
Links to OCD (Obsessive Compulsive Disorder)
Repetitive intrusive thoughts that cause anxiety and the need to carry out a behaviour to relieve them from the anxiety (American Psychiatric Association, 2013)
The behaviours turn into rituals – can consist of physical, behavioural actions or mental compulsions
When individuals cannot perform their rituals, they feel on the brink of complete psychological disintegration (Nolan, 2008)
Relentless strain on wellbeing, pervasive, causing social, cognitive and emotional difficulties
Covert OCD
Mental Compulsions
Transgressive (repugnant) thoughts – the most repulsive thing that one is capable of imagining, often involving children, sex, violence and/or religion
Obsessive Sexual Thoughts – intrusive, unwanted, forbidden, or perverse sexual thoughts
Images or impulses concerning sexual orientation (SO-OCD) or homosexuality (H-OCD) or children (paedophilia OCD (P-OCD)), family members, incest, rape, or sexual aggression, impregnating or violent
Scrupulosity – thoughts, worries, or concerns about moral judgment and behaviours (or “being good”)
Religiosity – offending God, blasphemy, committing sins
Losing Control – harming self or others through impulsive verbal acts, insulting someone, or saying something taboo or forbidden, or physical acts like stealing or violence
Mental Compulsions
Obsessive Thoughts – whatever is considered to be the most abhorrent/repugnant/censored thing one could do
Initially occur as sporadic intrusions – then individual binds to the thought(s) and they become inescapable
Rumination and re-running obsessive thoughts in a relentless and never-ending loop to reduce underlying distress, anxiety, self-doubt and uncertainty
Or replace unwanted thought(s) with alternative thoughts – self-reassurance, mantras
Seek certainty in their own minds rather than seek reassurance/checking with others
Need to find a reason to feel awful – not specific to the repugnant thought or act
Fear that these reveal disturbing secrets about unconscious beliefs – sexual violence, racist, sexual orientation
Scan mind and body ceaselessly for evidence to confirm the obsessive thoughts
Misinterpret somatic responses – sensations in the genital area are interpreted as sexual arousal rather than fear response
Apprehension leads to avoidance of being around content of the thoughts – children, people, knives…
Believe themselves to be the worst person on earth – 24 hours a day
So shameful that they can’t be revealed to anyone – suffer in silence
Unlikely to reveal these in therapy until there is trust in the therapeutic relationship
Seeking Proxies for Internal States (SPIS) Lazarov, Dar, Liberman & Oded, 2012
Many obsessive-compulsive symptoms result from impaired access to internal states such as emotions, sensations, and motivations
Drives individual to seek and use more easily discernible indices, or “proxies”, for internal states -more easy to grasp
Misconceived as objective
The rules and rituals of OCD act as a proxy for different internal states – such as the feeling of morality, cleanliness or security
The discomfort caused by intrusive thoughts is amplified since other internal states, (emotions and motivation) are not experienced clearly enough to balance the impact of these negative thoughts
The Role of Shame
Shame is the most dominant emotion in Covert-OCD (Veale et al, 2009)
Shame-based presentations most likely to have covert OCD
Self-blame, disgust, guilt – negative self constructs, self loathing
Shame = both a cause and consequence of the obsessive thought–‘no one can shame me more than I shame myself’
Obsessive thoughts are a defence/cover up of a core shame – too unbearable to feel (Oldaker, 2014)
Mental compulsion is protective strategy for shame – constant reminder, perpetuates shame
Internal shame – perceive themselves as faulty, not meeting their own moral standard
External shame – fear societal implications of their obsessive thoughts
Need to recognise the distinction between internal and external shame to gain a clearer understanding of the states of shame