OCD is defined as: Obsessions are unwanted and repetitive thoughts, urges, or images that don’t go away. They cause a lot of anxiety. These obsessive thoughts can be uncomfortable. Obsessions aren’t thoughts that a person would normally focus on, and they are not about a person’s character. They are symptoms of an illness.
I wanted to shed light on mental images in OCD, a lot of times people who do know about OCD know about the intrusive thoughts or the compulsions. But what about the mental images? Many people who suffer with OCD are plagued by mental images that are often disturbing & distressing in nature. This makes the fears amplified to the point of the individual now picturing in detail their worst nightmares. Aaron Harvey describes it in an interview with Cosmopolitan.
“One of the things I have to deal with the most is harm OCD, and it’s really challenging. When I step into the shower and see the razor blade, it will automatically trigger [an image of] me, like, mutilating my genitalia. If I react to those images, they just get worse. It’s kind of like living in a nightmare. …I’ve struggled with sexual identity as a result of repeated, intrusive sexual thoughts about men, despite being straight. During sex, I may have dozens of intrusive thoughts spanning incest, violence, and other unwanted imagery that steals the beauty of the moment. I have graphic flashes of friends and strangers engaging in bizarre sexual acts” – Aaron Harvey (creator of instrusivethoughts.org)
The images are extremely debilitating, and getting to a point where you are okay with just allowing them to pop in and out is extremely painful and difficult. The images cause a lot of distress, so suffers gut reaction is to try their hardest to get rid of the thoughts. But as we know trying to push away and resist the thoughts fuels OCD and makes it worse.
ERP is a great tool against the images, exposing yourself to the images and not allowing yourself to engage in compulsions will allow the reaction subside. To really challenge yourself purposely try and think of the images and confront the discomfort.
Exposure Response Prevention, commonly referred to as ERP, is a therapy that encourages you to face your fears and let obsessive thoughts occur without ‘putting them right’ or ‘neutralising’ them with compulsions.
Exposure therapy starts with confronting items and situations that cause anxiety, but anxiety that you feel able to tolerate. After the first few times, you will find your anxiety does not climb as high and does not last as long. You will then move on to more difficult exposure exercises.
Being asked to face your fears is perhaps one of the bravest aspects of treatment, and is where the approach of the therapist is most valuable, helping a person understand the cognitive reasons behind an exercise and being there to help encourage and motivate them to face the challenges it involves. If the therapist actually participates in the exercises too, this helps build up trust and confidence in what they are asking the person with OCD to do.