Cognitive therapists have identified a number of cognitive distortions that seem to be particularly prevalent among people with OCD. Identifying and challenging these distortions is a central component of psychological therapies for OCD.
Over-Importance of Thoughts
Through a process called thought-action fusion, people with OCD are often prone to equating their thoughts with actions. For example, if you have OCD you might believe that having the unwanted thought of harming a loved one is morally equivalent to actually harming them. You might also believe that such a thought means that deep down inside you really want to harm your loved one. Although thoughts themselves are actually harmless, for some people with OCD, the apparent meaning and consequences of such thoughts cause them to be labeled as dangerous and immediately pushed away. Unfortunately, suppression of such thoughts only causes them to come back even worse than before.
Overestimation of Danger
People who have OCD often overestimate the potential for danger and the consequences of making an error or not doing something perfectly. For example, if you have OCD you might believe that the likelihood of being fired is extremely high and that if you make any mistake at work, even a small one, you could be let go. This kind of thinking can help fuel compulsions by causing excessive checking or other types of repetitive behavior to ward off the feared danger. Of course, it is possible that the fears may be justified, but in the vast majority of cases, this overestimation of danger is unfounded.
Inflation of Responsibility
If you have OCD, it is common to overestimate your responsibility for an event and to discount, ignore, or underestimate other plausible influences. For instance, someone with OCD may think that if one leaves for work at the wrong time it will set in motion events that will lead to a plane crash. To prevent this from happening, the person with OCD may engage in compulsions to undo or neutralize this negative outcome, such as repeating a phrase over and over again or leaving and returning to the house numerous times. Of course, it is almost impossible to imagine how leaving for work at the wrong time would cause a plane to crash, nor is it logical that a compulsion such as repeating a phrase over and over again would prevent such an outcome.
Overestimation of Consequences
People with OCD often believe that if they encounter danger, they will be overwhelmed and will not be able to cope with the situation or will go crazy. They may also believe that encountering danger invariably heralds a catastrophic outcome such as losing everything and ending up on the street. For example, someone with OCD might fear being rejected in a romantic relationship because rejection would automatically mean one would become depressed and end up homeless. This irrational belief discounts the very real possibility that the person with OCD might be able to cope with the situation completely fine, that family members would be there to offer support, and that the relationship ending could be an opportunity for a fresh start.
Need for Certainty
If you have OCD, it is very common to have an unrealistic need for certainty, even in situations where certainty is not possible. This need for certainty can lead to seeking excessive reassurance from family members, therapists, and many others, to avoid feeling anxiety. Excessive reassurance seeking is a form of avoidance, which only serves to reinforce anxious thoughts. As well, it can cause loved ones to withdraw their support as they grow overwhelmed trying to provide reassurance.
Emotional Discomfort Intolerance
People with OCD often believe that they will embarrass themselves or go crazy if they experience intense negative emotions. It is thought that compulsions and excessive reassurance seeking from others often develop as a means of avoiding having to experience negative emotions.
