OCD Can Be Sneaky — Sometimes it Manifests as Sticky Thoughts

A problem more common than is realized

When most of us think of obsessive-compulsive disorder (OCD), we imagine repetitive handwashing, checking rituals, obsessive cleaning, or the need to repeat other useless behaviors over and over. This is the only form of OCD that used to be recognized, and it’s shown up repeatedly in popular culture, films, and television shows.

In the past, OCD was considered rare.

We’ve learned a lot about OCD in the past decade, and like other common brain glitches, it exists on a continuum from mild to severe. What I call subtle OCD is when the compulsions happen primarily in the thinking processes without actual behavioral components.

This form of OCD is every bit as distressing as the kind that involves behavioral rituals.

In this more subtle form of OCD, the disturbing thoughts repeat in an out-of-control manner and cause constant anxiety, despite repeated attempts to stop them. The thoughts are often involving themes of guilt, “I am a terrible person,” ruminations about mistakes we have made in the past, “Why did I date that person ten years ago,” or actions we are afraid we might take that are completely out of character “What if I accidentally abuse my child?”

People who have been raised in punitive forms of organized religion may become focused on their imagined sins, engage in compulsive prayer, and near-constant worry about going to hell.

While everyone may have random odd thoughts, most people can let the thoughts go and redirect their thinking. In OCD, the thoughts are persistent, unmanageable, and cause intense distress. I call these “sticky thoughts.”

People with sticky thoughts often have difficulty making decisions and constantly doubt their job performance or romantic relationships. They may worry about food contamination, dietary purity, and exaggerated health concerns. Others may call them “control freaks” due to a preoccupation with moral issues. It’s a common factor in chronic insomnia. It’s particularly disturbing when sticky thoughts manifest as a fear of impulsively doing something horrible that is entirely out of character.

One of the most insidious aspects of OCD is that people usually feel embarrassed about their sticky thoughts and don’t share their struggles with anyone. Often, if they disclose their struggle to others, they are met with advice that’s not helpful.

“Just stop thinking that way” isn’t useful advice. Of course, the person with sticky thoughts would love to be able to make it stop — that’s the problem. They can’t.

Sticky thoughts are usually anxiety-driven and get worse when we’re under stress. Depression often accompanies the condition. Financial problems, a move or job change, or even a new relationship can intensify the symptoms. It’s common for people with this problem to have chronic insomnia because they can’t stop the looping thoughts long enough to relax and fall asleep.

It’s common for people to attempt to self-medicate with alcohol, making anxiety worse and intensifying the symptoms.

This is the time when many people come to therapy, and fortunately, with a combination of psychotropic medication and specialized psychotherapy for OCD, symptoms typically improve dramatically. The change in thinking patterns may happen remarkably quickly.

The first step in getting better is understanding that when sticky thoughts are exceptionally troubling, and we cannot make them stop, it’s likely mild OCD. The next step is to find a therapist who specializes in helping people with this problem. It is an area of specialty that not all therapists are practiced in treating, so it’s important to ask up front if the therapist has significant training and experience in treating all the various forms of OCD.

There’s no need to be ashamed of sticky thoughts. It’s not something that anyone would choose. We can start by recognizing it for what it is and accept our symptoms non-judgmentally. Then we reach out to an expert for help.