Understanding OCD “What If” Thoughts

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Understanding OCD thoughts

Obsessive Compulsive Disorder (OCD) affects millions of people worldwide, presenting a wide range of distressing symptoms. One of the most common manifestations of OCD is the presence of “what if” thoughts.

OCD is a mental health condition characterised by intrusive, unwanted, and repetitive thoughts, images, or urges (obsessions) that lead to repetitive behaviours or mental acts (compulsions) that help to temporarily reduce the anxiety associated with the obsessions.

It’s estimated that around 12 in every 1,000 people in the UK are affected by OCD: almost 750,000 people1.

One of the most common types of intrusive thoughts are known as “what if” thoughts. These often involve catastrophic or irrational scenarios, creating a perpetual cycle of anxiety and fear. These thoughts can revolve around various aspects of life, such as personal safety, relationships, health, or moral values.

What sets them apart is the obsessive nature of these thoughts, leading individuals to constantly question and doubt themselves, seeking reassurance or engaging in compulsive behaviours to alleviate anxiety. It’s crucial to recognise that these thoughts are a product of OCD and not a reflection of reality.

In a recent series by the biotech company Biohaven, people living with OCD were asked about their “what if” thoughts2.

In one testimonial video, Ethan, who has lived with OCD since childhood, describes his “tormenting what if” questions. His OCD-induced anxiety revolves around health and food. He says he worries about “is food bad or did it go bad. Issues and concerns around getting food poisoning.”

When describing the way he copes with these “what if” thoughts, Ethan says: “the important thing to know is those ‘what if’ thoughts don’t have the power over me that they once did.”

In another testimonial video, Katie describes some of her biggest “what ifs” as: “Am I a bad person? Am I an immoral person? What if everybody secretly hates me? What if I’m secretly a sociopath? […] What if I’m harmful in some way to my clients now that I’m working in faith and mental health? What if I wasn’t worthy of getting a divorce from a past toxic marriage?”

These “what if” thoughts in OCD as described in these patient videos, tend to follow a vicious cycle. It starts with an intrusive thought that triggers intense anxiety. In response, individuals engage in compulsive behaviours, such as mental rituals, seeking reassurance, or avoiding certain situations or triggers. While these behaviours may temporarily relieve the anxiety; they reinforce the underlying anxiety and perpetuate the cycle. Understanding this cycle is essential for effectively breaking free from the grip of OCD and managing “what if” thoughts.

One way to cope with these harmful thoughts is to use acceptance and mindfulness-based approaches, acknowledging the presence of intrusive thoughts without judging or engaging with them. The mental health charity Mind recommends mindfulness techniques as self-care for OCD, they describe these techniques as “noticing what’s happening in the present moment, without judgement”3.

Furthermore, mindfulness techniques, such as meditation and grounding exercises, can help individuals stay present and focused, reducing the impact of intrusive thoughts.

People living with OCD who are experiencing “what if” thoughts may also find relief in seeking professional help from a qualified medical professional in the form of cognitive-behavioural therapy (CBT). In some cases, medication may also be prescribed to alleviate symptoms and support therapy.

MAC Clinical Research are committed to improving the quality of life for people living with OCD through clinical trials and are currently investigating a medication that is thought to target a different signalling pathway in the brain to current OCD treatments, which may help to control obsessive or compulsive behaviours. With your participation, you may be able to contribute to scientific research which may lead to a new medicine to help people living with OCD.

The trial is taking place at MAC clinics in Lancashire, Greater Manchester, Merseyside, South Staffordshire, South Yorkshire, Teesside, and West Yorkshire.

To be eligible, you must:

  • Be aged between 18 and 65 years old.
  • Have had OCD, or OCD symptoms for at least 1 year.
  • Feel that your current OCD medication is not fully working.

Eligible participants will receive up to £490 for their time and commitment to the study, along with reasonable travel costs. If the treatment works you may be allowed to continue taking it (open label extension) for up to 48 weeks.

For more information on how you can get involved, visit our OCD Research page.

1 NHS Inform – Obsessive compulsive disorder (OCD)

2 Biohaven YouTube – OCD Playlist

3 Mind – Mindfulness

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