An Introduction - Why I wanted to write about urges and OCD
I’ve been wanting to write about this topic for ages – it’s an area that doesn’t get covered anywhere near enough but I’ve been a bit worried about it. Understandably, it’s a massive topic and one I absolutely want to get right. There’s no way I was going to write it without being under the watchful eye of an OCD professional who I trust completely. Enter the Amazing Kelley Frank. Kelley is the Director of The Center for OCD, an outpatient private practice in Southern California. and co-host of the Purely OCD podcast. She is wonderful and, hugely importantly for this blog, understands the role of bodily sensations in OCD at a professional level – waaaaay beyond my own understanding.
For this post, I talk about my own experiences of dealing with bodily sensations in OCD and Kelley helps to explain them from a professional viewpoint. Thank you so much Kelley for helping with this – I’m so lucky to have had your help and time.
Okay so to start off, it’s common, especially in the UK, to hear people talk about ‘urges’ or ‘impulses’ when talking about OCD obsessions. That feeling like you are going to do something awful. In this case, the word ‘urge’ or ‘impulse’ can have multiple meanings, and at its worse can also give OCD more power, so here’s Kelley to explain how the bodily sensations we feel differ from actual urges.
A true urge is a desire to actually act on something, for example, someone who lives with impulse control disorder and quickly acts on urges that have undesirable outcomes.
Though they are fully aware of the consequences of their action, they are aligned with the urge because it is a desire they want to actually act on.
Someone with OCD is not having an urge, they are fearing an urge because they are having a physical experience paired with an intrusive thought/image - which is best defined as a feeling obsession or intrusive feeling. Those with OCD become so overwhelmed with the fear they might act, they describe this feeling as an "urge," and that it "feels real.
My experiences with OCD intrusive thoughts that I worried were urges.
Like most people, I’d experienced unusual thoughts and bodily sensations in my life. They only really bothered me when I was already struggling with my mental health. I remember once being on a plane with Pete - we’re a tall couple and were put in the emergency seats for the extra leg room - that’s right, the ones next to that big red emergency button. I was in the midst of dealing with a horrendous panic disorder at the time and was so convinced I would press it, I had to swap seats with Pete. Even after I’d moved away, I still felt petrified for the rest of the journey. Like most people, I’ve had that weird feeling about jumping from somewhere up high or swerving my car into oncoming traffic. Lots of people can identify with these experiences. They rarely come up in every day conversation though – funny that!
Father Dougal in Father Ted gets it!
When I had my son in 2012, I developed perinatal OCD. It was the first time I had experienced intrusive harm-based obsessions where I feared I’d actually cause deliberate harm. They were mainly word-based thoughts and tended to sound like ‘What if I lose my mind and hurt him on purpose?’, ‘What if I drop him on the stairs?’.
Thanks to therapy, I could just about recognise that these types of intrusive thoughts meant nothing. I’d learned to recognise that I wasn’t my thoughts and that the brain often has weird random thoughts. I’d learnt that leading Perinatal OCD researcher - the wonderful Fiona Challacombe - had produced research that suggested over 95% of new mums experienced intrusive thoughts about their child, many of which were concerned with deliberate harm. I knew that as a new mum it made sense that I was focused on keeping my child safe and one huge way of doing that was by assessing risk – and yes, that assessment also included assessing me as a potential risk!
When my son was a couple of weeks old, I had an intrusive thought about deliberately hurting him (again this is common among new mothers – just rarely spoken about) and alongside it I experienced a rush of bodily sensations that felt like an urge. I felt, for the briefest of moments, like I was actually going to push the pram I was pushing – with my son in it – under a train as it was pulling into the station. It felt very, very real.
This absolutely terrified me, it seemed to give validity to my thoughts and showed a real intention to harm. That moment was the start of a very rocky road for me. I used avoidance as a compulsion and avoided going anywhere near my little boy ‘just in case’. I couldn’t feed him, I couldn’t change him, I couldn’t snuggle him to sleep. My husband had to take leave from work. I started to wonder what on earth I could do to guarantee my sons safety when it was me who (I thought) was the risk. I considered leaving my family and also suicide.
This is the reason why, as soon as I hear someone use the term OCD incorrectly, I want to force them into a three-hour presentation on the realities of OCD. Thankfully, our awesome film Waving, should go a long way towards doing that next year. That, and the brilliant work of our advocates and professionals such as Kelley, who work all the hours trying educate people on the realities of OCD.
Not once, during this whole horrendous time did I recognise these feelings as OCD. And just in case you’re in that position now, here’s Kelley with a little more information.
I often explain to my clients, once we become aware of the "fear of acting on something," we then over-attend to the part of our body associated with it (ie, hands, groin, physical sensation of anxiety). Think of the "urge" as being similar to the "groinal response," people often talk about in sexual obsessions. It takes one moment in time to notice the physical sensation of it, now add a strong fear of what it would mean if (fill in the blank), and the "feeling" (ie. urge) becomes so strong, people often describe it as feeling "real," and it just starts to pop up everywhere! The reality is, people who have a true "urge" actually align with the urge and don't spend every second of the day avoiding every aspect of it. They want to act on it and look forward to it!
For some, there might be a consequence they are aware of but actively disregard this and proceed to act on it anyways. Those who pick their skin (compulsive skin picking disorder), might be working on picking less but they have an urge that aligns with relief! They want to pick it!
In my clinical opinion, I think an OCD sufferer who names their fear of possibly acting on an intrusive thought or feeling, as an "urge," gives the OCD more power because it has validity to it. Similarly, to an intrusive thought or image as a "desire/ fantasy" - it's simply not true.
As Kelley mentioned above – the combination of the intrusive thought with the bodily sensations felt so real, and they really did start popping up everywhere for me. Whatever object I looked at, wherever I went, I experienced harm-based intrusive thoughts with bodily sensations which I misread as an urge towards wanting to hurt my son.
It took A LOT of therapy and eventually getting creative with Olivia to help me to understand that the bodily sensations accompanying my intrusive thoughts meant nothing. I had to do some seriously difficult exposures too. Most of them involved being somewhere high up or on a train platform with my son – I should say here I did them alongside a highly trained and qualified therapist – and eventually things began to look up.
Nowadays
This was eight years ago and now I can deliberately bring on all sorts of intrusive thoughts – I can even often deliberately bring on the bodily sensations too and they don’t bother me because I’ve habituated myself to them – I understand how they work and I know they mean nothing.
Treatment
Intrusive thoughts alongside bodily sensations are just obsessions. They can be treated with CBT, ERP and/or medication. Please make sure you get a professional to work through those with you. It’s totally normal if you feel worried about talking to a professional in the event that they misunderstand you – I’ve written another blog here that helps with this but for now, here are the main points.
1) Question your medical provider. What do they know about OCD? What do they know about the role of bodily sensations alongside intrusive thoughts in OCD?
2) Contact a charity like OCD Action, OCD UK, IOCDF and ask for an advocate to support you in asking for help.
3) Take in resources to support you talk to your medical provider. I wrote a piece for the British Journal of Midwifery about perinatal OCD. It’s aimed at midwives but would be suitable for anyone. Can you take in any others resources to help you? Can your charity recommend any?
4) In the UK, you very often speak to a GP as a first point of call. You do not need to tell them any specifics. Just say you are being impacted daily by OCD and need help. Wait until you are in front of an OCD specialist to speak specifics.
5) In the US and elsewhere, look for an OCD specialist – you can find them through the IOCDF.
Reminder - you do not need to disclose the exact nature of your symptoms if you are worried about it until you are in front of an OCD specialist.
For links to some other brilliant articles on this topic please see below.
Rounding Up
Okay so I’m going to end here with this quote by the wonderful Jon Hershfield:
"People with harm OCD often describe their intrusive thoughts as ‘urges’ because it’s difficult to find another word for the marriage of an intrusive thought and a sensation in the body that seems to indicated an imminent action. If you feel like your hand wants to move near a knife, you may interpret that as a scary urge to grab the knife and use it for harm. But this is actually better understood in OCD as a feeling obsession or intrusive feeling, not a genuine urge.” - Jon Hershfield
I hope you understand a lot more about the role of bodily sensations in Obsessive Compulsive Disorder, and know that you truly aren’t alone if you experience them. There are loads of resources out there to help you – there will come a time when they stop bothering you too. ♥
Please keep an eye out on my social media for a podcast between Kelley and myself coming very soon where we'll be discussing bodily sensations and OCD, along with loads of other OCD related chat.
Loads of love everyone,
Catherine and Kelley x x
Kelley Franke is psychotherapist who specializes in Mindfulness-Based Cognitive Behavioral Therapy, with a focus on Exposure & Response Prevention, in adults, adolescents, and children suffering from OCD, and other Obsessive-Compulsive Spectrum Disorders. Kelley is the Director of The Center for OCD, an outpatient private practice in Southern California. Kelley completed her Masters in Clinical Psychology from Pepperdine University. She received her training at The OCD Center of Los Angeles. Additionally, she received training in Dialectical Behavioral Therapy from Behavioral Tech Research through The Linehan Institute. Kelley is also the co-host of Purely OCD, a podcast on all things OCD. You can contact her here: kelley@centerforocd.com
Helpful further reading:
Further Reading
OCD can make us feel really bad about ourselves, read about how I started to build self love and compassion here.
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