OCD, overthinking and social anxiety
Read aloud: Listen to the narrated version of the blog post.
What is interesting about OCD, overthinking and social anxiety is not simply that they often occur together. They can share the same underlying mechanism: an attempt to achieve certainty through thought, analysis and control.
Up to 40 per cent of people with OCD may also have social anxiety or difficulties resembling social anxiety.Ruscio et al. (2010) found lifetime social phobia in 43.5% of people with lifetime OCD in the National Comorbidity Survey Replication. Other clinical estimates report lower figures, such as 18% for social anxiety disorder or social phobia. The figures therefore depend on the population, the method and whether diagnosed social anxiety or broader difficulties resembling social anxiety are being measured. The figure of 40% given here reflects how often, in my clinical experience as an OCD specialist, social anxiety or similar difficulties occur alongside OCD in practice. At the clinic, we often see OCD, overthinking and social anxiety becoming intertwined. They are not necessarily three separate problems, but three manifestations that may be rooted in the same pattern: doubt, self-criticism, shame and attempts to achieve a sense of certainty.
These are the mechanisms we often work with in treatment, which is why we frequently see improvements across all three areas. Working with overthinking and social anxiety in this way can also lead to improvements in OCD.
Social anxiety is not a lack of social skills
It is common to think that social anxiety only affects people who lack social skills. That is simply not true. Someone may be socially adept while still expending a disproportionate amount of energy on social interaction.
With social anxiety, social situations can feel like performances. Social anxiety can therefore also be described as performance anxiety in social settings. Some people are introverted, while others appear highly sociable but expend considerable effort monitoring themselves.
Overthinking can take many forms
Overthinking should be understood in a broad sense. It can concern social situations, decisions, responsibility, mistakes, relationships and anything else we later go over again and again. When overthinking becomes persistent and pronounced, it is also known as rumination.
When we overthink, we are often concerned about what other people think and how they see us. We may also develop a disproportionate sense of responsibility for other people’s feelings and wellbeing. This thinking is often marked by negative judgements, catastrophic thoughts and thinking through every possible consequence.
Decisions about what to buy, what to study, where to live and much else can become extremely difficult. This often happens because we reflect deeply and bring many variables into the decision-making process, making the whole process very complicated.
It becomes difficult to weigh the different variables against one another. Choosing between equally good options can become almost impossible. Which criteria should matter, and how can we avoid regretting our choice?
The shared mechanisms are key
The shared mechanisms are key to working with a wide range of difficulties. When we learn new ways of responding to unhelpful thoughts, we are investing in a life that is far less burdened by them.
That investment can pay off in several areas of life.