Ego dystonic thoughts are thoughts that are not in line with who we are and/or what we believe. This is a common way that obsessions manifest in the context of Harm OCD (i.e. “what if I harm a loved one?,” “what if I offend the higher power in which I believe?”). People experiencing harm-related OCD often begin treatment with the unspoken belief that having a disturbing thought is as bad as engaging in a disturbing behavior. They have spent a lifetime trying to squash uncomfortable, egodystonic thoughts. Their extreme discomfort with egodystonic thoughts kicks off a vicious cycle of constantly trying to avoid having those thoughts, leading to an increase in the very thoughts they are working so hard to not have. In other words, the more we try to not have a thought, the more we will have that thought.
Effective treatment for Harm OCD entails assisting clients in making contact with their scary thoughts (exposure) over and over again until their brains grow bored with them. This process is similar to watching a scary movie until it loses its shock value and shifts from being frightening to absurd. At the same time, clients learn strategies and receive support to give up all thought-control behaviors (response prevention). This treatment approach is called exposure and response prevention (ERP) for OCD.
What we enjoy so much about working with clients seeking to overcome harm-related OCD is how rapid a recovery they can make — once they begin to see their disturbing thoughts from a new vantage point. The flip side of any egodystonic thought is a value. If you are ever unclear about what is important in your life, just see what material OCD chooses to terrify you about. OCD will never invade a territory that is irrelevant in your life. The goal of OCD is to alert you to potential danger and then have you engage in behavior to make things better immediately. OCD goes after what you care most about and what would be most devastating if things went wrong.
The teachers we work with, who enter the field because they love children, often have harm-related OCD thoughts around losing control and engaging in inappropriate behaviors with their students. For a new mother who is so deeply in love with her newborn, OCD may show up with thoughts around losing control and harming her precious little baby. A newlywed may have intrusive thoughts around losing control and engaging in sexually inappropriate behaviors with someone who is not a spouse. If the teachers did not care about their students, the mother did not care about her newborn, and the newlyweds did not care about their spouses, OCD would not waste its time with this material. So one thing you can remind yourself of — in the face of a harm-related OCD thought — is that there is some related core value in your life that OCD is ineffectively attempting to protect.
If you are struggling with these kinds of harm-related intrusive thoughts, we encourage you to seek out cognitive-behavioral therapy (CBT) for OCD and inquire if your mental health provider offers exposure and response prevention (ERP). Be wary, though: An untrained clinician may take these intrusive thoughts to be actual desires. You may want to print out this article when starting a discussion with a clinician about harm-related OCD.
And always remember that the net sum of your life is not what you think, but what you do. Live a life according to your values even if intrusive harm-related thoughts occasionally come along for the ride.
To learn more about CBT for Intrusive Thoughts, see below for free sample chapters from the Light On Anxiety book, Break Free From Intrusive Thoughts as well as recommended webinars on this topic.
Recorded March 12, 2018Featuring Debra Kissen, PhD, MHSA, and Ashley Kendall, PhDWebinar Description:Over the past few years, there has been increased awaren…
Recorded May 20, 2021ADAA Webinar Featuring Debra Kissen, PhD, MHSA and Paul Greene, PhDIntrusive thoughts can create intense anxiety and lead to rumination …
Recorded on November 5, 2020Featuring Debra Kissen, PhD, MHSA and Paul Greene, PhDIntrusive thoughts can create intense anxiety and lead to rumination for th…