The OCD cycle and recovery using Exposure Response Prevention (ERP)

We get pulled into anxiety disorders when we catastrophically misinterpret our primitive ‘freeze, fight or flee’ stress response reaction. This stress response reaction has two very powerful aspects; it wants to both physically mobilise us and emotionally motivate us to escape the physical threat it erroneously thinks we are facing because we have been behaving (thinking and/or acting) so apprehensively.  

OCD sufferers are in the highest echelon of anxiety sensitivity and so are even more vulnerable to catastrophically misinterpreting higher levels of anxiety than the average anxiety sensitive who constitutes up to 20% of the population. The catastrophic misinterpretation takes place when the sufferer assumes that what they experience from anxiety means that the intrusive thoughts/obsessions they are engaging in are important/true. As a result, the sufferer will engage in apprehensive rituals and/or compulsions to help relieve their anxiety, although this ultimately results in the reinforcement of their anxiety and the creation and reinforcement of their OCD cycle. The more powerful this OCD cycle becomes, the more powerful the experience of anxiety becomes, pulling the sufferer into an anxiety distortion where the sense of risk is blown completely out of proportion and there is an ever-escalating loss of rational perspective.     

Once a catastrophic misinterpretation has taken place, an irrational belief system is formed that results in irrational feelings which trick the sufferer more and more into believing that their OCD fears are true.   

Trauma (usually childhood) also compounds this catastrophic misinterpretation.

Here are some examples:

Harm OCD
The emotional experience of anxiety: A dark sinister dread feeling, like something bad is about to happen.
The physical experience of anxiety: Tingling in the hands.
Intrusive thoughts: “What if I lose control of my hands and harm somebody?!”
Compounding childhood trauma: Being physically and psychologically abused by caregivers and thereby falsely believing that ‘I must somehow be bad’.
Catastrophic misinterpretation/irrational belief system: I’m a danger and should be locked up!
Irrational feelings from the irrational belief system: Shame and guilt.

Transgender OCD
IMORTANT NOTE: Transgender OCD is a sub-category of OCD and characterized by persistent, intrusive thoughts, distress and doubts about gender identity. This has nothing to do with actual gender dysphoria, the diagnosis associated with being transgender. In actual gender dysphoria someone has a natural drive and need to transition because their body and brain don’t feel right in the gender package they received at birth.
The emotional experience of anxiety: Feeling like something is off and not right.
The physical experience of anxiety: Not feeling in body (depersonalisation).
Intrusive thoughts: “What if not feeling right in my body means I want to be another gender?!”
Compounding childhood trauma: Neglect resulting in a loss of sense of self.
Catastrophic misinterpretation/irrational belief system: I want to be another gender and I’m in denial!
Irrational feelings from the irrational belief system: Fear that my life is about to completely change.

Relationship OCD
The emotional experience of anxiety: Whooshes of doom. 
The physical experience of anxiety: Stomach drop, feeling sick.
Intrusive thoughts: “What if this relationship isn’t right!”, “What if I don’t really love them!”
Compounding childhood trauma: Emotional abuse and neglect resulting in a core belief ‘I’m not good enough and will be abandoned’ fuelling an intense fear of being vulnerable in a relationship.
Catastrophic misinterpretation/irrational belief system: I must leave this relationship!
Irrational feelings from the irrational belief system: Resigned feelings of sadness.

Paedophilia OCD
The emotional experience of anxiety: Whooshes of doom and a feeling like evil is looming.
The physical experience of anxiety: Hot and flustered with heart flutters. Groinal response (e.g. pulsing, twitching, vibrating, erection, increased lubrication, even orgasm).  
IMPORTANT NOTE: Groinal responses in OCD don’t indicate true arousal or sexual desire. They occur because the sufferer is anxious about the idea of a sexual attraction and hyper fixated on the groin area as a result which results in sensations in that area. Then more the sufferer notices the groinal responses, the more they occur. Excellent information here: Groinal Responses in OCD: What They Are and Why They Happen - Impulse (impulsetherapy.com)
Intrusive thoughts: “OMG what if I’m attracted to this child!”, “What if I’m going to harm them!!”.
Compounding childhood trauma: Extreme exposure to all things bad from physical, emotional and sexual abuse ready to hook onto in times of high anxiety. The trauma resulting in a core belief ‘Nobody loves me, I don’t fit in, and I will be abandoned’ fuelling an extreme fear of being singled out and abandoned.  
Catastrophic misinterpretation/irrational belief system: I’m a paedophile and should avoid all children!
Irrational feelings from the irrational belief system: Terror, shame, guilt, my world is over.

This is just a small handful of OCD themes people can experience. In fact, there’s no limit to the number of OCD themes we can experience because we can create an OCD cycle in whichever way we feel compelled by fear and anxiety.

Recovery from OCD requires breaking the OCD cycle of apprehensive obsessions, rituals and/or compulsions that pull us into an anxiety distortion where risk is blown completely out of proportion, and we lose all rational perspective. We do this through Exposure Response Prevention (ERP). This requires Exposing ourselves to situations/people/places/things that trigger the disturbing emotional and physical experience from anxiety and changing our Response – i.e. we work on not engaging in the obsessions and we systematically drop the rituals and/or compulsions. By breaking the OCD cycle over time, risk starts to feel more and more proportionate, and we regain more and more rational perspective.

​Exposure requires facing extreme fears, so it definitely isn’t easy but the rewards for this short-term pain are freedom from debilitating anxiety and OCD. 
​© Amanda Morgan