Doubt and irrational thought processes in OCD

Doubt is often involved in the mechanisms of OCD, and for the person affected by OCD, doubt-related thoughts can be a major challenge when working with OCD. Doubt is not problematic in itself. The problem arises when irrational doubt is given unhelpful meaning.

Doubt and irrational thought processes

Doubt is something all people know, and it can arise in many different situations. Doubt affects the considerations and choices we make in life, the way we understand the world, and what we experience as right and wrong. Doubt is often associated with something negative because of the uncertainty and scepticism it can bring, but doubt can also be necessary and helpful. Doubt can make us think twice about important things in life, it can start curious or creative processes, and rationally based doubt can be necessary for development. Doubt is therefore not problematic in itself. The problem arises when irrational doubt is given unhelpful meaning.

This article sheds light on some of the different types of doubt that can be experienced in OCD, and gives insight into the mechanisms involved in these thought processes.

Rational versus irrational doubt

How do you distinguish between rational doubt and irrational doubt? Rational doubt is based on reason and logic. This means that when you think rationally, you are able to consider and explore a thought from different angles based on reason before drawing conclusions. Irrational doubt, by contrast, is driven by feelings, which means that conclusions are quickly drawn on an illogical and emotionally driven basis. In irrational thinking, a form of thought-feeling fusion arises, where thoughts and feelings merge and are no longer distinguished from each other. In this state, even the most illogical and insignificant thought can seem important and relevant, because feelings are listened to instead of reason. Here we also need to look at the thought process itself. Sometimes you may experience that the doubt you have seems rational enough, but that the process itself is irrational. When a thought process is irrational, it is again connected with thought-feeling fusion, where emotional impact gives the thought process great importance. This can result in spending enormous amounts of time thinking something through, while feelings and anxiety make it overshadow everything else.

An example of this is decision-making processes where doubt and thoughts may be rational, but the process itself becomes very extensive and uncomfortable because anxiety is allowed to take up space. Here, the thought process itself can function as a compulsion, because the person experiences an urge to think the matter through with every possible perspective in mind, while anxiety is also connected with it. This is also one reason why decision-making processes can be very difficult in an OCD state.

Below is a simple illustration of what a doubt-thought process can look like.

Ordinary doubt

One of the recurring challenges in OCD is that many insignificant thoughts are given value. This also applies to doubt thoughts, which can therefore come to take up a great deal of space and shape everyday life. We all know the doubt that can arise when we find ourselves out the door on the way to work or school: “did we remember to lock the door and turn off the stove?” For most people, these thoughts will be easy to let go of, and any urge to go back and check will be easy to resist. In OCD, these thoughts are given greater meaning because thought-feeling fusion occurs. The thoughts are therefore often associated with emotional discomfort and possibly anxiety. The thought-feeling fusion gives the thought meaning by giving it an emotional impact, so the thought is experienced as very important, as illustrated in Figure 1. This means that the thought is given a lot of room to grow larger, which often creates a strong urge to check several times in order to make the doubt and discomfort disappear. In this way, many compulsions can be triggered by irrational doubt thoughts, where quick illogical conclusions become the basis for the action in question. The compulsion can therefore be seen as a form of unhelpful problem-solving strategy, and the action itself can have a confirming and reinforcing effect on the irrational thought process and the conclusions that were drawn.

An example of this is when someone has OCD thoughts about bacteria, contamination and illness, and becomes afraid that they may have dangerous bacteria on their hands after touching a door handle. The feeling of fear is allowed to take over, and the thoughts are given great meaning. A quick conclusion is drawn that they will definitely become ill if they do not hurry to wash their hands, perhaps even several times. Once they have washed their hands, they feel relief and may think, “phew, it was good that I took the thought seriously and acted on it, so I will not get ill.” Next time, they may avoid the door handle, or at least wash their fingers again afterwards just to be safe.

That is how the confirmation works: the next times, the person is also more likely to give the thought and the doubt meaning, even though it is irrational, and perhaps move more quickly into action.

The “what if” thought

In treatment for OCD, it is fundamental that you learn to identify your OCD thoughts and not see them as current threats. If you are able to do this, the thoughts are stripped of their meaning and you can learn to let them go. This is easier said than done. One element that can make this process difficult is doubt about whether the OCD thoughts really are OCD, or whether there might still be something true about them. This built-in doubt in OCD is therefore a driving force that maintains and confirms OCD. Added to this are the so-called “what if” thoughts, which are based precisely on doubt and which, for some people, are the hardest thoughts to handle.

An example is a person affected by OCD who struggles with thoughts about harming others. Through treatment, the person has become aware that these thoughts are caused by OCD, and that there is therefore nothing true about them. The person affected by OCD is working on shutting down the OCD thoughts, but is troubled by doubt thoughts that say: “what if it is not OCD after all? And what if you are actually a danger to the people around you?”

The challenge with these thoughts is that even when a person begins to recognise the mechanisms of OCD, the “what if” thoughts can create a new doubt if the thoughts are given meaning. Here again, the same thought-feeling fusion is at play, where the feeling of, for example, fear becomes steering and excludes rational thinking. This can create a starting point for the “what if” thoughts, so that they become catastrophic thoughts. It also happens that some people experience the consequences OCD talks about as too serious for them to dare to let go of the doubt about whether it is OCD. They therefore continue to listen to the doubt and assign it value, because when they are in the grip of feelings, they do not dare to do anything else. Added to this is a feeling of responsibility, guilt and shame about the thoughts, which can also be a heavy burden for the person affected by OCD.

Doubt as a starting point for catastrophic thoughts

Doubt can be connected to catastrophic thoughts, as mentioned in the section above about “what if” thoughts. However, it is not only “what if” thoughts that can create a starting point for catastrophic thoughts. In general, OCD’s doubt thoughts can develop into potential catastrophic thoughts because doubt thoughts revolve around not knowing, uncertainty and risk factors.

An example of this is a doubt thought about whether you remembered to turn off the hob on your stove. If this thought is given meaning, it can develop into potential catastrophic thoughts such as: “Now there will definitely be a fire in the flat, which will spread to the rest of the building and all my neighbours. I will be responsible for many people dying and for people’s homes being destroyed.”

The consequences that OCD and its doubt can put forward in a person’s thoughts are often characterised by an unrealistically high risk assessment. The high risk assessment can seem very realistic in the moment because of thought-feeling fusion, which leads to irrational thinking and also reinforces the thoughts and gives them more meaning. It can be difficult to break out of this pattern, because it is rarely possible to see clearly what is happening in the moment. An important part of working with OCD is becoming aware of these thought processes and patterns, so that you become better at recognising when they appear.

It is difficult to distinguish between rational and irrational doubt, and sometimes you instead need to look at the process in order to identify the thought pattern you are moving in. Thoughts and feelings are, fortunately, something you can work with, and the first step is to become aware of which mechanisms and patterns are at play.