OCD: When should you worry about intrusive thoughts?

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1:16Kimberley Wilson:Hello and welcome. I'm Kimberly Wilson, I'm a psychologist, and this is Complex. Complex is the podcast that makes sense of the information and misinformation that's out there about our states of mind, so that hopefully you can feel calmer and a bit more reassured about your own mental health. In this episode, I'm exploring OCD, obsessive compulsive disorder. Now, have you ever heard a friend say, or maybe you've said it yourself, Oh my god, I'm so OCD. When you've just reorganised your shelves or cleared your desk. I've certainly heard that phrase a lot of times, just casually dropped into a conversation.

2:03Kimberley Wilson:And while it's easy to say, and while I know what you mean, technically it's unlikely that you are. Obsessive compulsive disorder is a condition that research suggests around 1-4 % of the population struggle with at any point in their lifetimes. So what's the difference between lining up the pens on your desk in colour order and clinically recognised OCD?

2:36Kimberley Wilson:I've brought in the perfect guest to help shed light on this condition and in particular on intrusive thoughts, one of the key symptoms. We'll also be hearing a story from someone who is grappling with intrusive thoughts and my expert guest will help me to unpack the topic so hopefully we can create more awareness and self-awareness. So, let me be your guide through the thorny briars of misinformation to the sunny uplands of understanding.

3:09Kimberley Wilson:Okay, let's crack on. I've invited psychology researcher Dr Nina Higson-Sweeney to come and unpack this topic. Hello Nina. Hi Kimberly. Thank you so much for being here. Before we start can you just tell me a little bit about yourself and also about your work? I am as you said a psychology researcher. I am currently a postdoctoral researcher at the University of Oxford. Broadly I do research in child and adolescent mental health and next year I'll be focusing a lot more on OCD particularly among ethnic minority adolescents. Your work sounds absolutely fascinating but also you bring a little bit of your own lived experience to your work as well is that right?

3:50Yes I do yeah so one of the reasons I'm interested in OCD in children young people is because I was diagnosed with OCD when I was 10 years old I had symptoms since I was eight years old and it's something that I've lived with ever since. Thank you.

4:07Kimberley Wilson:I think this is going to be a really helpful, powerful episode. So let's get into the complexity. Now, I have a story here that we've been sent and Nina, I want to share it with you. And I'd like to know what you think about it, what you make of it. So I'm calling this person Damien just to protect their identity. Damien says, it all started when I first got engaged. I started questioning everything about my sexuality and whether I was attracted to other people. It sounds small but it drove me to the point of despair. I loved my partner. I was hitting myself to make the thoughts stop in the middle of the night.

4:48Kimberley Wilson:It was an obsession that I couldn't control. It all came to a head during our honeymoon. We got matching tattoos and I felt like I wanted to cheese grate my tattoo off. and this was when I knew I was experiencing something seriously wrong. I wanted to get married but my head was out of control. What is your response to that? It's very visceral isn't it? It is and I think from my own experience of OCD although I haven't gone through the same exact experience obviously OCD can be so intense, intrusive thoughts can be so intense in this context to the point where you do want to do extreme things to get rid of the anxiety to make sure nothing bad happens yeah it's this kind of sense of being persecuted by your own mind and I think especially when you don't know what's going on as well it can you know I don't like to say oh I'm feeling crazy or whatever but I think in that moment when you just don't know what's happening you do feel crazy completely out of control and I think this is one of the reasons we wanted to talk about this particular condition is kind of to make that point you know to talk about how overwhelming it is how distressing it is and that it's far far away from being conscientious or liking things in the right place it's a very very different thing yeah you know OCD, intrusive thoughts, can be all-consuming, really.

6:25Kimberley Wilson:And they are never positive thoughts, always harassing, aggressive, hostile. They're never anything that feels easy to live with. Yeah, they always evoke distress, or that's when it can really become a problem.

6:43Kimberley Wilson:So, first things first, I always like to start with a definition so that we're all on the same page. and particularly in the case of something like OCD which can often be very misunderstood but also does show up in lots of different forms. So Nina if you could distill it as a definition what do we mean by OCD? So OCD is a mental health disorder that is made up of obsessions and compulsions as it kind of says on the tin right so by obsessions we mean these unwanted intrusive they could be thoughts feelings sensations and then compulsions are these repeated ritualized acts that are done to neutralize or alleviate the anxiety caused by those obsessions what are the kind of trends in the types of thoughts people might be experiencing within OCD?

7:45Kimberley Wilson:Intrusive thoughts can take many different forms and you know it will differ from person to person so you might have intrusive thoughts about harm, harm coming to loved ones, you can have intrusive thoughts about religion, it could also be in the case of Damien you know about sexuality and attraction so questioning one's sexual attraction you know thinking are you homosexual or are you heterosexual it could also um even be as extreme as worrying are you a pedophile for example it can also be about gender identity um and you know a really a really common one that we know a lot in the media is intrusive thoughts about contamination and worries of getting ill or spreading sickness or anything like that there are so many other other ones and so we can really see from those that really clear summary how distressing it would be to feel plagued and persecuted by these kinds of thoughts and ideas and particularly where we feel that they conflict with who we understand ourselves to be who we care about that you can feel like you don't even know who you are you don't know what's happening in your own mind yeah and I think that's part of why when intrusive thoughts become quite distressing and part of that is because it isn't how we view ourselves and that can add to the anxiety caused yeah you feel like an alien to yourself yeah yeah and that's it's such an important point because and this comes up in lots of different mental health conditions that kind of fusion with your thoughts the idea that the thoughts that come out of my mind must be saying something true about me my deep unconscious beliefs my desires rather than sometimes your brain does does unusual things and it doesn't necessarily mean something fundamental about who you are yeah but when you start paying attention to it as you've just said that can be really frightening.

10:00Kimberley Wilson:Now, it's important to note here that almost all of us experience unwanted intrusive thoughts, the kind of thoughts that are basically gate crashes of the mind. And research suggests it's around 80 % of us, maybe even more, who experience these thoughts at different times. They pop into our minds. We don't know where they've come from. It might be that you're sitting in a meeting that's particularly boring and you wonder what it would be like to stand up and shout or start singing. But I guess the difference is that when we have these kinds of thoughts, we can look at them, think, oh, that was odd.

10:39Kimberley Wilson:That was a bit weird. I didn't want that. But then put them aside and carry on. There's a sense of kind of feeling reassured that it doesn't necessarily mean anything but that's quite different with the OCD related intrusive thoughts isn't it where they don't just pass through they don't move on they take up residence yeah another example could be um you're driving your car and you might have an intrusive thought of what if I crashed and I think that's a bit old I won't crash you know and you brush it off and you continue on driving whereas when it starts to not be so typical and potentially indicative of OCD is when you really start to focus on that and really question it and think well what if I did what are the repercussions of that you know really not being able to let it go becoming really preoccupied with it and then it results in compulsions so that's one of the key elements is in OCD and those compulsions might not be visible they might be mental it could be counting so not saying it out loud but just counting something until you reach the right number yes exactly or it could be this rumination just going over and over again and what might the visible compulsions look like so for example it might be having some kind of ritual with your car keys it could be you know every time you're going to drive you're checking the tire pressure again and again making sure that it's right and it's safe to drive even if you know in the back of your mind you know you check them earlier yes the reassurance doesn't quite work yeah yeah and so at this point they start maybe not just having these compulsions but then also avoiding driving and trying to find other ways to get around it and it starts to impair their ability to live their lives um and to to be engaged with their family or their work in a normal way.

12:39Exactly, yeah.

12:40Kimberley Wilson:And so we've said intrusive thoughts, everybody gets them at some point. The difference with OCD intrusive thoughts is how persistent they are, how distressing they are. And, you know, we can spend a long time, hours a day kind of experiencing them, trying to push them away, trying to deal with them. And then they lead to these compulsive behaviors, which might be physical behaviors or psychological behaviors that are designed to try to reduce the anxiety, reduce the distress caused by these persistent thoughts. Yeah, exactly. And I think the persistence and the distress that causes is really key and does take a considerable portion out of your day.

13:20It affects your functioning. That's when we start to see that it's an issue.

13:25Kimberley Wilson:And I think it's also worth saying here, I know we've said that intrusive thoughts are universal to a degree, but it's also worth making another distinction, which is that intrusive thoughts aren't exclusive to OCD. They also emerge in other mental health conditions as well, things like PTSD and depression. Okay, so I think we've got a sense of what it looks like, how it presents. Let's have a think about where OCD begins. So research suggests that it starts as early as six years old, which feels incredible to think that little children are struggling in this way. but we know that the common age of onset is usually around puberty and early adolescence so somewhere around 14 and 15.

14:10Yeah I think it can happen later in life or be identified later in life as well.

14:18Kimberley Wilson:That's a really good point that people might have gone years and years and maybe decades masking, covering up, excusing, finding ways to kind of distract from the real distress that they're in. Yeah, exactly. But I think it can also, you know, have an onset later in life. We just often see it much more in adolescence. And when you think about that age and everything, young people have going on. Everything that's happening. Yeah. And do we think that there are specific things that happen to us that increase the risk of developing OCD? Is it just constitutional? or is it just the way our brains are wired?

14:56Kimberley Wilson:Well, it's complex. Some research says there's a genetic element. If you have a parent who has OCD, that might increase your risk for developing it. There's a lot of research around early life events, stressful life events. Such as things like divorce or... Yeah, things like divorce or bullying or bereavement. So there's a lot of different biological or environmental or social elements that could lead to OCD. It sounds like stress, kind of acute stressful events or experiences is really the key factor. Yeah, I think so. And I think definitely from my own lived experience, I began to exhibit symptoms when I was around eight years old.

15:49and I was going through a really stressful period in my life. Looking back, I've always felt, you know, I was in such an uncontrollable period of my life. OCD gave me control over something.

16:03Kimberley Wilson:Yeah, and at the age of eight, you are literally as a child powerless in order to maybe try to change the environment or influence whatever might have been happening. And so these internal means of trying to gain control become the only thing that's really available to you. Yeah. And it's such a weird thing thinking about it because I was so out of control with it. But it's this idea of if I can do something, I can prevent something happening. I can protect people. Okay, thank you. One of the things I really like to do is to put things, our topic, on a scale. And the reason for doing that is really so that the listener, if anybody is experiencing something that feels familiar, has a sense of where they might sit.

16:52Kimberley Wilson:So can we put it on a scale from mild to more severe? Yeah, I think in a way you can put it on this kind of continuum, you know, during my own lived experience. When my OCD was very bad, so when I was a child, but also during my teens, I'd get the bus home from school, I'd be walking home and I'd tell myself I'd have these intrusive thoughts while walking home. if I don't walk the whole way home thinking good thoughts something bad is going to happen to my family and that will cause me a lot of distress I would be really worried and I'd be convinced that was true and so what I'd end up doing is restarting my walk so I'd walk all the way back to the bus stop and I would start walking all the way home again until I could get into my house without having an intrusive thought and so it's when you've got those compulsions you know trying to neutralise this intrusive thought, it's when it's causing a lot of distress and it's when it's taking a lot of time out of your day.

17:55Kimberley Wilson:That's really moving because I can literally see you kind of in your school uniform kind of going back and trying so hard to suppress the thought and which we all know doesn't work. And to think you've got this burden of trying to keep your family safe but also seeing how lonely that is as an experience and confusing and scary yeah and I just remember that real fear of well if I if I don't start re-walking if I don't redo it then if something bad happens that's my fault but that is a very extreme version of it but but that's how these intrusive thoughts and OCD can really be on a continuum and that you can move between those spaces depending on what else is happening in your life right when you're feeling maybe particularly stressed or worried or anxious or something is happening you might be more vulnerable to those thoughts kind of coming back or being more intense yeah and I think you know that's the thing in my current everyday life I'd say I've never gotten over the OCD I've never stopped having OCD but I'm quite functional with it.

19:05I have mild intrusive thoughts. I have a lot of insight into it. I can recognize that those thoughts are illogical or won't come true. But, you know, when I do go through periods of stress, I do start to notice my intrusive thoughts are more distressing. I find them harder to dismiss. And sometimes they do resolve in compulsions. So yeah, I guess across my life I've been all across the continuum really thank you for showing that it's really beautiful

19:38Kimberley Wilson:that you're here as an example of someone who has been there at that severe end but is I'm not even going to say functioning like thriving and you can just live with it and live well with it and I think that's also fine for everyone listening who recognizes that they might have intrusive thoughts associated with OCD, then I do urge you to find expert help. You can also look on the BBC's Action Line page for specialist helplines. The details are in the show notes.

20:12Kimberley Wilson:And in terms of that support, Nina, what does appropriate support look like? Most commonly, OCD is treated with cognitive behavioural therapy, so CBT, with exposure response prevention so that's usually what you'll get potentially with or without medication SSRIs but the real importance of going to speak to a professional and getting referred to specialist support is that they will be able to work with you to figure out what's best for you I think there are things you can do personally to ease some of the distress, but I wouldn't say it's not a solution. But what I've learned over the years is doing things like recognizing that I'm having an intrusive thought helps ground me and remind me that it's not necessarily me.

21:11Yeah, a little bit of distance. Yes. you the self and the thought yeah yeah and I think visualizing OCD can be quite useful so when I was younger when I first started therapy my clinician got me to draw what I thought OCD looked like and you know two decades later I can still remember exactly what I drew because again And that really helped me get that distance. And as a child as well, that really helped me understand, okay, there's me and there's OCD. And they're two different things.

21:48Kimberley Wilson:I think that's really helpful because we often sometimes over-rely on words in therapy to try to encapsulate an experience and turn it into a concept that we can think about. And I really like the visualization idea. I think that get in under the thinking and get straight to the feeling. sometimes it's the little things that can make things a bit easier it can make it easier to have the headspace to dismiss the intrusive thoughts I think self-care generally you know for me my OCD spikes when I'm stressed when I'm not taking care of myself like eating well making sure I'm rested in particular is really important for me you know physical activity all those things So again, I'm not saying self-care is going to magically fix everything, but I do think...

22:36Kimberley Wilson:But if we can turn the dial down a little bit, and as you say, give yourself a little bit more resource, because this is what it's about, isn't it? It's about having the energy, the psychic resource to be able to say, oh, okay, I think this might be an intrusive thought, rather than being so overwhelmed and so exhausted that you don't have that kind of level of defence against the thought.

22:58Kimberley Wilson:Nina it's been so moving and actually quite profound to talk to you today there's a gentleness but a kind of quiet confidence in the way that you speak about it which is really beautiful and I think it comes from the humility of your own lived experience but also the kind of intellectual thoughtfulness and consideration that you bring to it and what I hope this episode does for anybody listening who feels like they're having a similar experience is to really help to shake off the shame and the embarrassment or the fear that these internal psychological experiences that they're having mean that they're a bad person or mean that they're going to do harm or mean that they won't be able to live a fulfilling life.

23:49That's part of why we need to talk about it more because it's not shameful at all and I know it's scary but I'd really encourage you to reach out for support if anything we've said today really resonates with you

24:03Kimberley Wilson:what I'm so grateful for about this podcast is the opportunity to speak to so many experts and that I get to learn along the way so thank you very much Nina and thank you to everyone listening I hope that's been helpful. As you can hear, I'm on a mission to clear up the mental health space. I want Complex to be your trusted place where you can learn to understand yourself more and take better care of yourself. And you are part of the show. Let me know what you want me to talk about. Just email complex at bbc.co.uk. If we use what you tell us, we'll make sure that we do so anonymously. Please also note that I can't answer you personally.

24:47Kimberley Wilson:If you have a concern about a medical or mental health issue, then please seek expert support. And if you want details or further information about some of the issues raised in this podcast, you can find them at bbc.co.uk forward slash action line. The link is in the show notes on BBC Sounds. Next week, we'll be looking at burnout and not a minute too soon because we are all exhausted. How does it affect our mental health and how can we recover? And I'd love you to subscribe to Complex on BBC Sounds and make sure that your push notifications are turned on so that you don't miss out on a single episode.

25:25Kimberley Wilson:And that's it. My thanks again to Dr Nina Higson-Sweeney and also to Damien whose story we share today. And thank you to the lovely team at Loftus Media who happen to mostly be in the room with me. Producer Kirsten Lass, Assistant Producer Katie Chandler-Clark, Researcher Grace Revel, Science Editor Rami Zabar, Technical Producer Ruben Huxtable, Digital Editor Richard Berry, Studio Engineer Matt Hewer, Sound Engineer Ruth Rainey, and at BBC Sounds, Assistant Commissioner Izzy Lee Poulton and Commissioning Editor Rhian Roberts. And that is it. I'm very much for listening. Take care and go gently.

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27:28Kimberley Wilson:Who's actually won the Iran war? I'm Tristan Redman. And I'm Asma Khaled. And together we host the Global Story podcast from the BBC. The US and Iran say they've struck a deal to end the war. But a key question is what's actually been achieved by nearly four months of fighting. And is the situation better, worse or the same for the region and Iran? For the full story, check out the Global Story on BBC.com or wherever you get your podcasts. Thank you.