Can OCD change how you see yourself?

Living with OCD can, sadly, change the way you see the world. OCD forces its own perspective on nearly everything—seeing danger where there is none, feeling guilt for things you never did, finding disaster in any imperfection. I know from a wealth of experience, both suffering from OCD myself and treating it in others, that nothing is off limits for OCD and its distorted perceptions. Not even your identity itself. 

I’m not being dramatic when I say that people’s self-concept can become radically skewed by OCD. People may make countless negative, illogical inferences about their true identities—all a well-crafted illusion that OCD paints. 

“Who am I?”

Identity may even be at the core of a person’s OCD symptoms. Many people fear that they can never know their true self—at least not enough. The slightest uncertainty about their own behavior, personality, sexuality, memory, or values can end up feeling like a crisis of identity.

Here’s the thing: no one can be absolutely sure about who they are. At our core, we’re imperfect, and we change—and this means that we can never be 100% sure of our identities. So when someone who isn’t afflicted with OCD—or someone who has learned to manage OCD through treatment—has an intrusive thought that doesn’t align with their identity or values, it doesn’t cast doubt on their entire identity. They are able to say “No, these are my values—and I’m sticking to them.”

People with OCD, on the other hand, often want to know why the thoughts were there in the first place. They can spend endless amounts of time researching, ruminating, and trying to reassure themselves that they are not what they think. People with this disorder struggle with thought-action fusion, or the idea that if you think something, it is just as bad as having done it. They often report feeling that just having an intrusive thought makes them a bad person. 

The hardest part is that OCD often attacks the things a person values the most. Examples can be seen in many people who feel uncertain of their sexual orientation, whether they are in the right relationship, or if they could harm someone they love. What if I am capable of harming someone? What if I lose control and go “crazy?” How can I be sure I am not a serial killer or a rapist? When people see these thoughts as significant or meaningful, they feel that their very identity is in doubt. Otherwise, why would they occur?

Believe it or not, everyone has intrusive thoughts. And it’s actually quite common for them to oppose a person’s real values or intentions. They might randomly think “I could stab myself with this knife,” or “What if I drove straight off this bridge?” People without OCD, however, are better able to recognize the truth, as strange as it is: These thoughts mean nothing. That’s what makes them intrusive!

In fact, if we were to draw any information from these thoughts whatsoever, it would be that they often point out exactly what isn’t in line with our values or identity. If we experience a thought about harm as intrusive and unexpected, that’s probably a sign that it’s completely out of alignment with our actual identity.

Possibility doesn’t equal probability

It may seem paradoxical, but the answer to these endless doubts and obsessions about one’s identity is to accept that maybe these things are true, and maybe they aren’t. We hear this time and time again in the OCD communities. It is important that a person with OCD accept that they will never be able to give 100% certainty to OCD. 

The solution? We stop trying to give it anything. I do not know for sure that I will not acquire a rare disease and die, and until that happens I will live my life, I can confidently say that this hasn’t happened yet, the chances of it are small, and at the end of the day, I don’t know if it will or won’t ever take place. And I can live with that.

Often OCD sufferers will say that they can respond like this with most of the things their brain throws their way, but there may be just one area or theme where that response is just unacceptable to them, where it feels impossible to accept any amount of uncertainty. Certain themes may be more taboo by nature. These topics do carry with them extreme feelings, often shameful emotions, and negative stigma—even when they’re completely out of line with one’s actual values.

Take, for example, the theme of pedophilia OCD (POCD). People with this theme will often say that they would take any other fear over this one. They will say that they could sit with uncertainty about any other topic. The truth is that OCD knows this! That is precisely why intrusive thoughts surrounding this theme feel so unbearable, and why they tend to get worse and worse over time. This is something that harasses and torments the sufferer because it goes against the core of who they are. 

When someone is sitting with maybe this could happen and maybe it couldn’t, it is important to recognize that just because something is possible doesn’t mean it is probable. In other words, is it possible that you wake up and do something that goes against your morals? Yes—it’s possible for anyone to do so! However, it’s highly unlikely, and you have no reason to worry about the mere possibility. 

To put this in greater perspective, could I wake up tomorrow and run a half marathon tomorrow, even though I have absolutely no training and am in pretty rough physical shape to do this? Sure, I bet it’s possible. I could choose to run my heart out, or I may collapse in the process, but I could attempt it. But I can be quite confident that this won’t happen.

This is the sort of uncertainty that OCD doesn’t like. There’s absolutely no reason to worry about the idea that you might find yourself running a half marathon tomorrow unless you intend to do so. When a thought of something far more distressing pops into your head, it can feel like the uncertainty is too horrible to tolerate, but it’s really no different from our half marathon example.

The solution with OCD is to sit with the possibility, and let the anxiety pass on its own. Your brain is responding to a false alarm, but it feels very real at the moment. When you don’t engage in compulsions to neutralize these fears, you teach your brain that you are not really in any danger and you never were. You learn to recognize the false alarms. Sometimes, the thoughts can even go away completely when you learn to stop responding to them. 

ERP can help

Exposure and response prevention (ERP) therapy uses these exact principles. It’s the gold standard in OCD treatment, and it helps you to understand that you are so much more than just a person with OCD. You experience symptoms of OCD and you are still you, the same person with the same intrinsic values as you had before OCD visited your life. OCD doesn’t have to define how you feel about yourself. 

ERP teaches the person with OCD that thoughts, feelings, and urges do not have to have meaning. They can just be background noise. There is no real danger. You can learn that although it may be uncomfortable, you can actually tolerate the distress that the thoughts cause. Eventually, the feelings of anxiety do pass. When you don’t give in and do a ritual or a compulsion your brain actually relearns that there was no danger in the first place, and you can feel secure in your identity, even when it doesn’t feel perfect. But it takes consistent practice. Retraining your brain takes time, commitment, and perseverance.  

If you’re struggling with OCD and want to take the power away from your intrusive thoughts, NOCD can help. Our licensed therapists deeply understand OCD and are specialty-trained in treating OCD with ERP. We work side-by-side with the OCD experts and researchers who designed some of the world’s top OCD treatment programs—and that means the best care for our members. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment.