Externalisation in OCD

“The problem is the problem, not the person.” On the one hand, this may seem obvious; on the other, it can be a difficult idea to come to terms with. This article therefore explains why it matters to distinguish between the person and the problem, and why it can be problematic to see the problem as an inherent part of the person.

When the problem is treated as part of the person

In modern society, we tend to treat every thought as part of who we are. This way of thinking makes it easy to forget that the thoughts entering our minds do not define us. What matters more is how we choose to respond – or not respond – to them.

In OCD, negative thoughts can become particularly prominent. The same can happen during periods of strain, stress, anxiety or depression. This alone can be deeply distressing. If a person also begins to identify with the thoughts that arise, the experience can become almost unbearable. In OCD, this process is often particularly intense because the thoughts can feel like signs of who a person is or what they might do. Qualities such as empathy, morality and responsibility can become so prominent that the person constantly monitors themselves and the situations they are in. This is especially true when thoughts centre on other people’s wellbeing and on how they might perceive the person. The constant monitoring demands a great deal of energy.

For example, the thoughts might be:

“Did they think it was strange or greedy of me to take that piece of cake?”

“It may be slightly bigger than the others. Perhaps it could have been cut in half.”

“Maybe I should put it back – but wouldn’t that look odd?”

You can find yourself arguing with the thoughts. This can begin to feel uncontrollable, and the negative thoughts can become dominant and leave you uncertain. The thoughts become distressing. You end up caught in a stream of thought that can feel unstoppable, which can lead you to spend a great deal of time and energy trying to control it.

Thoughts and self-image

The stream of thoughts can create a sense of being at war with yourself when the thoughts conflict with your morality, values and self-image. Thoughts can appear in a split second. They may, for example, concern paedophilia, self-harm or a fear of harming others. They become distressing because we cannot identify with them. This can lead to increased focus on the thoughts. There is nothing abnormal about a thought arising. Thoughts are fleeting and arise in a steady stream that we cannot always control.

The thoughts themselves, and the discrepancy between them and our self-image, can activate our anxiety system. This can create intense discomfort. We therefore try to move away from the discomfort by attempting to control either the thoughts or the situation. Sometimes there is no thought at all, only a physical sensation of discomfort. This can lead a person to avoid situations in which the discomfort arises.

The paradox is that the more we try to control our thoughts and monitor them, the more power the thoughts gain. At the same time, the discomfort that accompanies them grows. It is therefore important to work on leaving the thoughts alone and accepting that they do not have to be part of who we are. They do not define you. Thoughts are not actions, and in themselves they do not harm anyone. This does not mean dismissing every thought. The point is that we can relate to our thoughts in a fundamentally different way. When we encounter a thought that creates doubt and discomfort, it is important not to dwell on it. Dwelling on the thought can intensify the feelings already present.

How do you let go?

Externalisation is a process in which a person begins to see the problem as something that affects them, but not something that defines who they are. Externalisation helps a person begin to let go of negative thoughts. It does so by treating the thoughts as a temporary influence rather than as part of the self.

As a practical step, some people find it helpful to give OCD a name or form. In practice, externalisation involves actively choosing to see what affects us negatively as an external agent. This does not remove responsibility for our own actions. It means not treating unwanted thoughts as evidence of who we are.

Giving the agent a name or form that conveys its effect can help. It might be a dark cloud that obscures our thoughts, or a backpack full of stones that we carry around. The form itself is less important than what makes sense to the individual. Nor does the problem need a name. What matters is having a sense that it is not part of oneself.

The difference can be difficult to describe in abstract terms. It may therefore help to see how externalisation feels from the inside. One client described it this way:

During my OCD treatment, one tool in particular proved helpful. When you have OCD, the boundary between yourself and OCD can become very blurred. That made it difficult to understand what was me and what was OCD.

This was reinforced by the fact that I had lived with OCD for so long that it felt like a natural part of me. When my therapist began referring to OCD as something external and suggested that I give it a form or a name, it suddenly became easier to separate myself from it.

It has helped me gradually let go of OCD and work with the grief and frustration that can also come with living without the sense of security OCD used to provide.

I can only recommend that others with similar difficulties try working in this way.

The client’s previous therapists had described OCD as a permanent part of them. This led to a deep internalisation of the thoughts and feelings OCD created. When the client began to externalise, they could start to see the problem as something separate from themselves.

Once we see the problem as something separate from ourselves, it also becomes easier to notice when it is affecting us. This creates more distance from the situation. The problem is still there, but it no longer has to define who we are. In this way, a person can begin to live with greater distance from the problem, allowing it to take up less space in everyday life.