Although OCD is complex illness with many causes and risk-factors, understanding the psychological factors that cause and maintain OCD symptoms is essential to getting the most out of treatment. It is now clear that OCD is characterized by a number of errors in thinking or so-called cognitive distortions that can potentially lead to obsessions and compulsions.
Common Cognitive Distortions in OCD
First identified by the seminal cognitive-behavioral therapist Aaron Beck, cognitive distortions are errors in thinking that are prevalent in many forms of mental illness including mood and anxiety disorders. As the name suggests, cognitive distortions are ways of thinking that negatively skew the way in which we see the world, ourselves and others.
Cognitive therapists have identified a number of cognitive distortions that seem to be particularly prevalent among people with OCD. Identifying and challenging these distortions is a central component of psychological therapies for OCD. These distortions include:
Over-importance of Thoughts: Through a process called thought-action fusion, people with OCD are often prone to equating their thoughts with actions. For example, if you have OCD you might believe that having the unwanted thought of harming a loved one is morally equivalent to actually harming them. You might also believe that such a thought means that deep-down inside you really want to harm your loved one. Although thoughts themselves are actually harmless, the apparent meaning and consequences of such thoughts causes them to be labeled as dangerous and immediately pushed away. Unfortunately, suppression of such thoughts only causes them to come back worse than before. Cognitive-behavior therapy challenges the importance of thoughts through various exposure-based exercises.
Overestimation of Danger: People who have OCD often overestimate the potential for danger and the consequences of making an error or not doing something perfectly. For example, if you have OCD you might believe that the likelihood of being fired is extremely high and that if you make any mistake at work - even a small one - you could be let go. This could help fuel compulsions by causing excessive checking or other types of repetitive behavior to ward off the feared danger. Of course, it is possible that the fears may be justified; however, in the vast majority of cases this overestimation of danger in unfounded.
Inflation of Responsibility: If you have OCD, it is common to overestimate your responsibility for an event and to discount, ignore or underestimate other plausible influences. For instance, someone with OCD may think that if they leave for work at the wrong time it will set in motion events that will lead to a plane crash. To prevent this from happening, they may engage in compulsions to undo or neutralize this negative outcome such as repeating a phrase over and over again or leaving and returning to the house numerous times. Of course, it is almost impossible to imagine how leaving for work at the wrong time would cause a plane to crash nor is it plausible that a compulsion such as repeating a phrase over and over again would prevent such an outcome. People’s actual level of responsibility for events can be tested in therapy using exposure exercises.
Overestimation of Consequences of Danger: People with OCD often believe that if they encounter danger that they will be overwhelmed and will not be able to cope with the situation or will go "crazy." They may also believe that encountering danger invariably heralds a catastrophic outcome such losing everything and ending up on the street. For example, someone with OCD might fear being rejected in a romantic relationship because it would automatically mean they would become depressed and would end up homeless. This discounts the very real possibility that they might be able to cope with the situation just fine, that family members would be there to support them and that the relationship ending could be an opportunity for a fresh start.
Need for Certainty: If you have OCD, it is very common to have an unrealistic need for certainty – even in situations where certainty is not possible. This need for certainty can lead to seeking excessive reassurance from family members, therapists etc. to avoid feeling anxiety. Excessive reassurance seeking is a form of avoidance, which only serves to reinforce anxious thoughts. As well, it can cause loved ones to withdraw their support as they grow overwhelmed providing reassurance to the person with OCD.
Intolerance of Emotional Discomfort: People with OCD often believe that they will embarrass themselves or go crazy if they experience intense negative emotions. It is thought that compulsions and excessive reassurance seeking from others often develops as a means of avoiding having to experience negative emotions.
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