Like any self-respecting French student, I have a two-hour break for lunch each day. It’s just enough time for me to walk the 25 minutes home, stopping off to buy my baguette on the way (unfortunately not wearing a beret or with a string of onions or garlic draped around my neck). Yesterday, as I was leaving the boulangerie I walked past the shelf full of pick and mix, including a huge box of chocolate bears. Suddenly, the thought struck me that I could steal one and that nobody would know. I quickly brushed it away and went on with my day, but it made me think about the universality of intrusive thoughts, something that is sometimes hard for someone with OCD to understand and accept.

In 1978, Stanley Rachman and Padmal de Silva interviewed 8 patients with OCD and 124 non-clinical subjects (people who didn’t have OCD) about the presence of intrusive thoughts and impulses that were deemed to be unacceptable by the respondents, as well as how frequent they were and how easy to dismiss. The results were fascinating –  to quote directly from the paper…

To conclude Study I, obsessions (thoughts andior impulses) are a very common experience. There are no sex or age-related differences in occurrence, and most thoughts and impulses are easily dismissed. There are individual variations in the threshold of acceptability of obsessional thoughts or impulses.

– Rachman & de Silva (1978)

They then looked at the content of these intrusive thoughts and urges – can you guess which of the following lists were intrusive thoughts reported by the 8 people with OCD and which were reported by the 40 individuals in the non-clinical group?

Were these impulses and thoughts from people with or without OCD?

Intrusive thoughts and urges –

Impulse to jump out of window
Impulse to attack and harm someone
Thought of ‘disgusting’ sexual acts with males (male subject)
Thought whether he has been poisoned by chemicals
Thought that his eyes will be/are harmed

What about these ones – OCD or not OCD?

Impulsive thoughts and urges –

Thought that she, her husband and baby (due) would be greatly harmed because of exposure to asbestos, with conviction that there are tiny asbestos dust particles in the house
Thought whether any harm has come to his wife
Impulse to shout at and abuse someone
Impuise to crash car, when driving
Impulse to attack and violently punish someone

The answer is that the first list comes from people with OCD and that the second list is entirely thoughts and urges reported by people from the non-clinical group. Don’t worry if you didn’t guess – Rachman and de Silva then presented the lists to a group of psychologists, and to quote from the paper –

It appears that the judges were not able to identify the clinical obsessions too well, but on the other hand they were moderately good at identifying non-clinical obsessions. From this we can conclude that clinical obsessions are not as readily discernible-even to experienced clinicians-as might be expected.

Rachman & de Silva (1978)

Back to the chocolate bears. I was able to brush this thought away, to see it as illogical and ego-dystonic (inconsistent with my beliefs and personality – in other words, I’d never steal. I’m far too much of a wimp) and therefore not concentrate on it, but this isn’t always the case. Had my OCD seized upon the thought, I could have interpreted it very differently, tangling myself into a web of doubt and worry over what it meant. How could I think such a thing? What does that mean? Does it make me a terrible person?

Take the classic CBT model of the vicious flower (see below), the trigger (the thought that I could steal the chocolate) would be misinterpreted as “I am a terrible person, probably a thief or a criminal”, which would cause emotional reactions (guilt, distress etc.), safety behaviours (trying to push the thought away) and neutralising actions (asking for reassurance that I wasn’t a terrible person, trying to rack my brain to see if I had previously done something similar etc.). I would probably try to avoid going into shops where I could steal, and soon my life would be revolving around this thought.

And yet this didn’t happen. Instead, I went home, had a very nice ham sandwich and went on with my day.

It’s a funny old thing, OCD, isn’t it?

TD&M Bellsie

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