by Debra Kissen

Dr. Debra Kissen is the Clinical Director of the Light on Anxiety Treatment Center of Chicago.

Dr. Kissen specializes in CBT based treatment to children, adolescents and adults with a focus on anxiety and stress-related disorders, including OCD, PTSD, panic disorder, agoraphobia, social anxiety disorder, generalized anxiety disorder, specific phobias, separation anxiety disorder, compulsive skin picking, trichotillomania and other Body Focused Repetitive Behaviors (BFRBs). Dr. Debra Kissen applies the principles of evidence-based treatments while at the same time treating the whole person, with deep respect for the human spirit and the challenges we all face on our journey through life.

clinicalfellows.jpgDr. Kissen is a Clinical Fellow at the Anxiety Depression Association of America (ADAA) and is a Co-Chair of ADAA's Public Education Committee.  

Step 1: See Through OCD’s Scare Tactics

OCD is the fear network of the brain sending a signal that something is wrong and needs to be done about it IMMEDIATELY. OCD only reports on feared consequences that are important to a person. For example, if somebody does not fear spilling water on the floor, OCD will not send the intrusive thought, “Oh no you spilled water. You must clean it up IMMEDIATELY”. On the other hand if someone does care about the safety of her family, OCD might say, “Oh no you left the stove on. You must go back and check IMMEDIATELY or the most important people in your life will die and it will be all your fault.” Similarly, if you care deeply about your family's well-being or your students safety, OCD may inject itself into your awareness with the thought “Oh no. What if I lose control and harm my children or students.”

My clients always ask me what it means about them that they could have such “horrible thoughts”. What I tell them is that somewhere within an obsession is the flip side of a core value. If OCD taunts you with images and thoughts about offending god, then religion must be important to you. If OCD reviews all the ways your family could be hurt, then your family is clearly one of your top priorities.

There is checklist of common intrusive thoughts that I find helpful to share with my patients. There are numerous thoughts on this list regarding losing control and acting out violently or sexually. Several research studies found that when this list is shown to a non-clinical sample of people, approximately 90 percent of those surveyed will agree to having experienced some of the intrusive thoughts.

When the non-clinical sample is asked how bothered they are by experiencing these intrusive thoughts, they are most often only mildly bothered by them. In contrast, when this same list is shown to individuals diagnosed with OCD, a similar percentage of the sample will agree to having experienced these intrusive thoughts but the big difference is how much distress these thoughts evoke for the OCD sample. For those meeting criteria for OCD, there will be a much higher level of emotional distress when these same intrusive thoughts surface.

What keeps OCD alive and well is not the experience of intrusive thoughts but actually one’s reaction to them. The more one dislikes experiencing intrusive thoughts and then tries to repress or fight with these thoughts, the greater the frequency of intrusive thoughts one will experience. The very act of trying to “not have” a bothersome thought guarantees its resurfacing. The only way to know if you are having or not having a thought is to think “Am I think about X” or “I better not think about X” which of course causes one to think about X.

So back to the question of why do those meeting criteria for OCD have such disturbing thoughts? Because they are human and to be human means one will experience freaky, odd thoughts. The human mind is constantly spinning around trying to find interesting problems to solve, in order to keep us alive. We don’t have the speed of the jaguar or the strength of a bear but we do have an all too powerful mind that is very good at planning for future challenges but also for tying itself into a knot. Freedom from OCD is not about stopping the mind from offering up strange and occasionally disturbing thoughts but learning how to recognize spam vs. urgent mail.

I must give a disclaimer here that OCD loves taking anything that is reassuring and turning it into a compulsion. So, if you are reading this blog for the hundredth time and desperately trying to figure out if this sounds like you and if your “awful thoughts” are OCD or if in fact you are an awful person, then STOP reading this blog. As I am sure your experience has shown you obtaining short-term anxiety relief through a compulsion comes at a cost in the form of greater overall anxiety. Instead, strive for long-term freedom from OCD by teaching your mind to not take itself so seriously.

Step 2: Exposure and Response Prevention (ERP)

There is no way past OCD except through it. As described in step one, the more one avoids an intrusive thought, the more one will experience the feared, bothersome, super annoying thought. Therefore, we need to flip the equation on its head and practice bringing on the thought while disengaging from any compulsions that have been utilized to obtain short-term anxiety relief. Common compulsions engaged in, when struggling with intrusive thought OCD are reassurance seeking, information seeking/googling to determine if there is something wrong with self, mental reviewing and avoidance. The best way to organize exposure tasks is by creating an exposure hierarchy that outlines baby steps that you can take to slowly but surely prove to OCD who is in charge (hint…YOU).

Step 3: Get Support

“Support” may sound superfluous but without it your Intrusive Thought OCD fighting plan will most likely be a bust. It is near impossible to do this work alone. It is not that you are not smart enough or determined enough or brave enough to beat OCD. The reason you need external support is because there is nothing more powerful in taking the wind out of OCD’s sails than voicing intrusive thoughts out loud, to a compassionate, informed coach. The same intrusive thoughts that feel so real, all powerful and self-defining when swirling around in your head will disintegrate when said out loud. When your intrusive thoughts are released into the world and your supportive coach looks back at you, and still sees the YOU they believe in and hears your intrusive thought as “blah blah blah” and possibly laughable, your brain will be one step closer to understanding that these thoughts are spam mail and nothing more.

In terms of finding a supportive OCD coach, you can contact a therapist that is well trained in CBT for OCD but if this is price prohibitive or if there is not access in your local community to OCD experts, there are other options. You can purchase a CBT for OCD workbook and go chapter by chapter through it with any licensed therapist in your community. You can schedule an appointment with one of ADAA’s OCD specialists who offer tele-mental health services. And it is perfectly acceptable to purchase a CBT for OCD workbook and go through the material together with a friend or family member.

So you now know the three basic steps necessary to kick intrusive thought OCD to the curb. And remember, we are all so much more than our thoughts. Our lives are defined by the actions that we choose to take, not by the electrical storm of thoughts that flicker through our minds.

Free Webinar!

Dr. Kissen and Dr. Ashley D. Kendall, PhD presented a live webinar on this topic on March 12, 2018 at 1:00 pm ET. 

This webinar will share tips and tools to:

  1. Identify if you may be dealing with harm OCD
  2. Make sense of why harm OCD picks such painful themes and content 
  3. Take the power away from harm OCD 
  4. Re-engage in your life now that you are giving less of your attention and energy to harm OCD

Watch here. 

Additional Resources:

Thank you! I feel like you were talking to me personally. I've had OCD for ~10 years and although I'm "coping" (meds & therapist). You express the mental baggage very well and put a light on it that I found very relieving.

My 13 year old OCD/Extreme Anxiety disorder Son suffers from above after a certain sicko had tried to abduct him.Ever since the trauma of why? and images has led him to scream over thoughts 24/7.His medication is compounded by possibly allergic reaction or Simutaneous Anaphalaxic attacks.So much so when he never reaches a level to get CBT.So six mths later no further on.!This webseminar seems to be perfect in understanding for Us but to Our Boy who needs it most when is he ready ,Please help.

I am doing my doctorate on trauma and ocd and the use of a trauma-based technique called Somatic Experiencing. It is my clinical experience that when trauma is strongly linked to ocd, one needs more than CBT and ERP. In fact, CBT and ERP can be re-traumatizing in some cases. SE or a carefully implemented body-based trauma approach assists with re-stabilizing the fight or flight response in the body, assists with teaching regulation and establishing a sense of safety through the central nervous system. I think this is critical for trauma-based ocd. Peter Levine is the founder of SE.

That's quite interesting. I suffer from Pure O and have relapsed after a decade of being relatively symptom free.
It's now attacking my family with mental imagery of the worst things happening to them either by my hand or someone else's. It's directly linked to abuse I suffered in childhood. ERP was extremely graphic and haunting and long term only made me worse. I'm struggling to cope - please tell me more about Somatic Experiencing and where I can follow up to get help.

I'm sorry that I have no information about Somatic Experiencing ... but I wanted to send empathy and encouragement in regards to what you are going through.

I also suffer from Pure O but have been symptom free since 2010. Like a freight train, the thoughts reentered my brain in 2017. I also have the very graphic images of harming people or myself. We only know individually what we are going through and we each suffer in our own way....but I feel that it is so much harder to cope this second round because I thought I had it "beat".

I describe my current struggle to cope to the people closest to me... "that if I were to be diagnosed with cancer in 2010, I similarly would have been strong and determined to beat it. I would do everything I could to win..... and I did. To have it reemerge 7 years later is devastating. To muster up the will to fight seems so much harder..and then to know that even after I fight it, that it may return later again in my life... is beyond discouraging (I don't even know what the right word is to explain the bottomless pit feeling).

The way I "got out" the first time was using CBT & medication. It feels cheesy at first.. but by documenting or writing out my feelings each day after my CBT sessions... I was able to see the verrrry slow progress until I was finally out. (I measure my success by the time span in between my scary thoughts). I hope that you are able to get more information on Somatic Experiencing. I know that my paragraph was not very helpful but I just wanted you to know that there are some similar struggles out there and that you aren't entirely alone in your journey to relief. The sooner we reach out for help like this... the sooner we will get better I believe.

I am suffering with OCD for ten years and this is my eleventh year. I tried meds( which doesn't help me much). So whenever I get these thoughts I usually try to distract myself by watching my favourite tv shows or playing the guitar. Sometimes doing something interesting helps a lot. You should keep a nice conversation with him and try to keep him close don't leave him alone. Invite his friends to spend time with him. This might keep him busy and distracted.
If he does something like studying or school homework ask him to do it in the same room where his parents are. Keep him away from violent games, pictures. Try not to discomfort him. He might get nightmares too so make a comfort zone for him so he could share about it. I get lots of troubling thoughts when I share about it with my parents I feel better. I wish that your son get better and keep smiling.
P.S. I m telling this because I have been through worst. And there was no one to help me and I don't want anyone else to go through this.

It is amazing to me and so relieving to know that my specific intrusive thoughts are centered around what is actually really important to me. It's so true. Thank you.

I just want to say thank you so much for creating this article. I've suffered from OCD and intrusive thoughts for about 4 years now and it has been treacherous!! Due to the nature of the thoughts, there was no way I felt comfortable to share my experience with those around me and walked around with this deep dark "secret" feeling that I was a terrible person. I've done everything from binge eating to abusing alcohol and other substances to help alleviate the agony. Its such a relief to know that I am not a monster and that there is actually a name for this.

This was very helpful and enlightening to the kind of intrusive thoughts I am having. I have an appointment with a professional and will bring up this! I don't feel so scared anymore.

"Our lives are defined by the actions that we choose to take, not by the electrical storm of thoughts that flicker through our minds."

Thank you so much for this. Coming from a professional, it's even more powerful Thank you. I'm going to take your suggestion to buy a book to start a self-therapy since I don't have money for a therapist.

As I am lying in my bed, it is 23:35,can't sleep because I have way too many thoughts in my head. But this description and advice about ocd brought some peace.

When I read about intrusive thoughts it sounds like me but I don't have any typical OCD symptoms. I don't need to obsessivly do anything... i dont have compulsions ir anything I just have awful thoughts constantly. I do have tourettes syndrom which is commonly paired with OCD. I know that I am a good person who has always wanted to help people but sometimes the thoughts take over. Could this still be OCD?!

Hi, I have that same problem, but I believe that it's OCD because I've always had intrusive thoughts with no compulsions and as I am getting older, my life is getting very complicated (stressed life due to University and bullies) and some compulsions are now kicking in.

I believe the thoughts alone are a symptom. The thoughts their self are obsessive and compulsive. I'm just now finding out intrusive thoughts even being a thing. I am 31 and have been tortured by my thoughts just about my whole life. Good luck!

What you’re experiencing could totally be OCD - there are types of OCD that don’t include compulsive behaviors (rituals) as symptoms. What you’re describing sounds very much like intrusive thoughts OCD, and if you’re concerned or just want to get some more information, you should talk to a mental health professional such a psychiatrist or a therapist, or even just your general physician to get some help. :)

There is a segment of OCD sufferers with Pure Obsession. This typically has very little to no compulsive behavior(s).

Thank you so much for writing such an informative and well-written article. The discomfort that intrusive thoughts cause for those with anxiety disorders is a serious issue. As someone diagnosed with OCD, having read this article made me realize that I am not alone or wierd. Thanks again!!!!!!!☺☺☺☺

I can't even tell you how much this post made me realize I am not alone and definitely NOT the only one fighting with these thoughts. I've always been scared to tell anybody about all those terrible insecurities and intrusive thoughts I've experienced so far. THANK YOU SO MUCH!

Thank you all for sharing. I, too, find hope in these words. I am a mother, a nurse, a Christian, and a wife. I love people, and the very heart of me lives to love, care for, and help others. I have been suffering with this alone for a little over 10 years now. I have taken medication the whole time, but it wasn’t until recently that I have sought help from a psychiatrist. I am beginning the healing process. I must say, this is a scary battle to fight at times. Hang in there, we aren’t alone. There is hope and beauty to come.

I unfortunately can't take meds...I have tried more types and kinds of meds...Either I get sick, sleep all the time, worse, or nothing...The sick part is bad for me...I am extremely sensitive to meds...Bile pucking, migraines, nausea and diahrea...So I can't do that...But I wish I knew of a book since counseling I can't afford...

I am beyond greatful to have come across this particular website. You can’t rely on everything you run across on the internet. This right here is my breakthrough!!!! I always had intrusive thoughts. Every single day without a fail since I could remember. Particularly about things that I love the most, including with religion. I’m 22 years old, and this is best way to find out what I been battling my whole Life. God has given me the key to my peace. I’m in a new state of mind. “ And remember, we are all so much more than our thoughts. Our lives are defined by the actions that we choose to take, not by the electrical storm of thoughts that flicker through our minds”.
Thank you, Debra Kissen!
God bless you all!!! Your not alone we are al equal!

Really I need help...thoughts are bursting in my head...I don't know from where a question arised that from where word came...they are real or not...and now the condition is that I'm being reality I don't wanna think even in my mind ....every word is irritating me....plz help...

When I went into a sudden fear of leaving a candle burning at my house and wanted to go home to check on it, I was told not to come back to my boyfriend's house after I left. We live 5 minutes from each other. This seems very punitive and unhelpful sending me into more anxiety.
His approach is not to be an enabler such as you might find with an alcoholic. Is this best practice?

For what it's worth, I have discovered that worry and stress due to worry comes in waves, like an attacking army in the brain but it does eventually diminish, I guess like a tsunami... the thing to do is restrict what damage they can do when they are attacking.. the brain does seem to have a mechanism for defeating worry in itself, if you let it work for you...or in other words the negative thoughts might still be there but they don't produce the physical symptoms of stress and worry and eventually can even be forgotten.... So take the example of something extremely embarrassing, like a faux pas... of which I have a whole series dating back decades... initially the thoughts induce stress/ embarrassment and depression, then they fade and they may come back for a second wave, or a third, just when you think you are over it, and the same stress returns, but eventually, they die away, seemingly unconnected with the symptoms, completely neutralised.... so by laughing at yourself or with others, it starts to remove the connection between the thought and all the flight of fight reactions of the body.... I had the handwashing thing, and the checking front door thing and all the related things like -surely the iron is on right now at home and about to burn down my flat- I defeated the handwashing thing by rationalising that my folks didn't have to wash their hands all the time, so why should I have any special privileges than them in life.... I defeated the checking door thing partly by saying WTF, but practically by saying "Check Out" on locking the door and giving it a thumb... both things that I can recall later more than the actual act of locking... but also by having a laugh about it with colleagues , to remove the connection between the thought and any stress the thought might create...." We are all human, all together. It is great to be human... to be perfect and germ free or perfect and never making a mistake is not to be human at all!

My thoughts are so overwhelming and crippling at times. I feel the need to overevluate just about everything in my life. The bigger issue it is in my life, the more thoughts I get. I feel like I need to get the best out of everything. Its not a feeling like someone is going to die or I will kill somebody? That's why it seems different than others. Does anyone else have thoughts like this? Has anyone found a way to deal with these?

I’d struggled with ocd and anxiety type behaviour my whole life. I turned into a clean freak at about age 10. Nobody could touch me without showering, I’d scrub the house down daily and washed my hands until they bled etc.
I’ve convinced myself I had everything from cancer, to rabies, to brain eating bacteria and more.
But I’ve never been actually diagnosed. Lately, about the past week after watching a bunch of “To Catch a Predator” episodes, I’ve gained this fear of “what if I’m attracted to children” ... I’m 15 years old.
My half brother had been raped by his brother a while back, and I think it affected me way more than it should have. I wasn’t even there but I remember my hard dropping when my mother told me.
I have 0 attraction to children and deep down I know I’m not this creep my brain is convincing me I am, I’m just so afraid of these people and the way they think. I’m afraid if I think about it too much it will become normalcy to me.

I know that feeling really well. There have been so many devastating, sad killings and rapings that it becomes a target of my OCD. It feels really real while I'm in it, but when I go out of these phases, I can feel more neutral about the thoughts. Getting help like was recommended in the article is super helpful; I was always afraid if I went to the doctor that it would be validating my fears somehow. Though that fear still comes up for me some times, when you push through it, it feels wonderful to get help.

I had my first Harm OCD thought in over a year and a half just a couple days ago. I had a vivid thought that I stabbed my mother who is my world. Even at 33 i'm still a mama's boy. After I stabbed her in my head that is I immediately stabbed myself. I stinks because I thought I had it beat. All my harm thought's originally were against my ex fiance who was at one point my hole world. She walked out last year so I decided to go off my Zoloft. Most of the SSRI medication have sexual side affects. It contributed but not the reason we ended. The will to be physical with her was just not there. I have been off it for 5 months and the OCD has come roaring back. I hate that it attacks the one's I love but I can not beat it alone. I know sex sounds trivial when it comes to mental health but I want a wife and a family someday. I know they have medicine to fix that issue and they prescribed it to me but my insurance does not cover it. It's hundreds of dollars out of pocket that I can not afford. I feel like i'm left with 2 choices living in fear or being alone forever. Neither is living and i'm so lost any advice could help as i'm not okay :(

Don't lose hope. I understand and struggle with the same dilemma. I believe it is possible to be in a healthy relationship and to live in a mostly fear-free existence. I'm still navigating what this looks like myself but I am optimistic. We all have challenges specific to our own lives but we have to push through and see what these challenges have to offer and teach us. I know some of my challenges with OCD have made me a more empathetic, open, and resilient person. I wish you well.

Dear Doctor Kissen:

I love your outlook and approach to intrusive thoughts, the positive attitude and approach is what most people with OCD need to combat their condition.
I printed out your article and showed it to my son who suffered from intrusive thoughts when stressed out and it made a huge difference.
I live in suburb of DC,( Fairfax, VA) do you know of any provider who has the same outlook as you.


Thank you Dr Kissen for this insight. I have been debilitated by many forms of OCD for over two decades. I 'm in my 50's and suffer and struggle with very bizarre strong images and bad thoughts. Mostly I have contamination OCD. For up to four years I have been on Clonazepam which greatly helps slow down my brain so I can think a little bit because OCD speeds my brain up like a fast-moving freight train. I pray for scientists to do more research and unlock the mysteries of this disabling disorder. God bless you.

One thing that helped me with OCD is taking 80 mg of Prozac. It wiped out my intrusive thoughts to almost nothing. I also learn to look at thoughts as just thoughts. It's how you react to them that causes the OCD. IT is a tough battle. Last year a went thru hell and back with OCD. I saw therapist, take meds, CBT and ERP. It worked, OCD waxes and wanes. IT is back again now, but since I have already been thru it. ITs easier for mr to contain. PLUS I have ADHD and that helps forget the intrusive thoughts sometimes. But what worked best for me is meds, meditation and facing the fears. I would but my self in a situation for it would cause me anxiety without doing in ruminations. And overtime it helped.

Thank you for this article. I have battled with these intrusive thoughts for years in silence and shame because they are so unlike me. I wouldn't do these things but I thought I was the only one suffering them. I only stumbled upon your article because a Scottish comedian, Fern Brady mentioned it as part of her routine. It was the first time I'd ever heard anyone talk about something I'd hidden for years and so I googled it. Now that I know that I'm not bad, twisted or immoral I think at least I have something to work on. I could very well be OCD and there are childhood traumas aplenty in my history.
Thank you.

I have a son In law that has a bad case of ocd. Anxiety whatever. He needs help really bad. He came apart this last week. So now he’s hospitalized. He hasn’t touched his kids in over a year. When they come running he gets out of the way. Plus lots more. Always needs reassuring. What’s the best thing to do with bad thoughts. Pls help

Thanks for you advice! Everyday I have outburts of unwanted thoughts, I count numbers in my head before I do somethings, I do these stupid rituals over and oven again until Im confortable to stop and this takes so much time out my day. It drives people away from me as well. But your advice couraged me to say f## it to all my fears, ocd, and intrusive thoughts.

Thank you again Dr. Debra Kissen

I keep this scary image of me strangling my cat and at one point I had a panic attack and actually did squeeze her neck which I quickly stopped and broke into sobs because I was so scared I was suddenly a danger to my cat. I suffered attacks for days and now I do feel better but now I will occasdionally look at my cat and feel a mixture of guilt and anxiety that isntantly makes the image of me strangling my cat appear in my head. I have had this cat for a while and I dont know why this has happened to me all of a sudden. Should I see someone? I love my cat and I dont wanna hear that I am a danger to her and end up giving her up.

I don't have those kind of thoughts often heard about related to OCD (hurting someone, sexual thoughts, etc.) but I thin that i DO have infinitely repeating thoughts about certain topics that won't go away. For example, I am separated from my wife and two kids and I CONSTANTLY ruminate about I did a horrible thing about leaving 7 years ago and that I SHOULD be with them RIGHT NOW b/c somehow they are suffering. The guilt. I left for a very good reason back then I think and they are actually dong just fine without Mom and Dad screaming at each other. Or, alternatively, I obsess about work-related things. Like, "I know they don't' like me at work. They think I'm a jerk and need to leave." etc etc. The next thing I will do is self-examine myself to try to find out why they hate me. It's hard.

Are you familiar with PANDAS ? Child before first grade had strep throat , scarlet fever and urinary track infection for which they were hospitalized. Cried every day in first grade , As adult always has a fear of abandonment and uncontrollable thoughts . Any advice ????