Episode 19: Mental Health Obsessions

Episode 19

Mental Health Obsessions

In this episode of Purely OCD, Lauren and Kelley go over mental health obsessions. They chat about obsessions and compulsions. They also talk Exposure and Response Prevention (ERP) – the go-to therapy for OCD. The two discuss issues that arise in this form of OCD and answer questions.

ALSO – This Episode of Purely OCD was sponsored by NOCD.

Mental Health Obsessions are such jerks.

Lauren: Of course you want to get better. Then stupid OCD comes and snakes in and is like “Ha ha.” 

Kelley: (Punching her fist) Stupid OCD! Was that too aggressive?

Lauren: No, it was just the right amount of aggressive for OCD… Of course your brain’s like “What if you don’t get better and what if you can’t get better and what if you’re just going to be sick forever and what if you’re going to get sick with other mental illness?

Kelley: Yeah, are you sure that it’s even OCD and that it’s not that you’re Bipolar and that you’re not feeling mania.

Lauren: Or maybe you’re psychotic. Maybe, maybe.

Common obsessions in Mental Health OCD include:

  • What if I’m depressed?
  • It’s possible that I really want to harm myself.
  • What if I contract a mental illness by hearing about it?
  • I could have Borderline Personality Disorder?

Side note: Anxiety related to personality disorders can be complicated by stigma against them and the narrative that personality disorders are intractable.

Common compulsions in the realm of Mental Health OCD include:

  • Emotional checking – what do I feel now?
    • Do I feel happy or is this mania
    • Do I feel a sense of unreality? Am I psychotic?
  • Checking to see if people in public are looking at you as though you’re talking to myself when you’re with a friend (because they might be a hallucination)
  • Asking if people saw or heard things
  • Checking symptoms on google
  • Rumination

Some exposure work that people with Mental Health OCD include:

  • Watch TED talks where people talk about their lived experience with mental illness. E.g.:
  • Setting reminders of triggering words
  • Putting up post-its of triggering words
    • E.g. Different diagnoses (e.g. psychosis)
  • Psychotic simulation
  • Imaginal exposures
  • Watching triggering movies (e.g. Shutter Island)
  • Listening to sad music (when your anxiety revolved around depression.
  • Watch sad movies
  • Setting reminders to have breakdowns

When it comes to navigating obsessions related to depression (which often occur alongside obsessions about self-harm), we want to accept that we might feel sad without spending lots of time in analysis trying to figure out what it means. Side note: accepting sadness is not the same as wallowing in sadness. Oftentimes it involves acknowledging sadness and then bringing it along with you as you live your life.

Here are some questions from the Q&A.

Question: I obsess about whether my meds have stopped working. How can I work on this?

First off – we can’t give direct advice. That said, this fear does arise in the context of OCD. Consult with your therapist and your psychiatrist about whether you’re behaving compulsively in relation to obsessive thoughts about the efficacy of medication.

Some things that Lauren and Kelley have seen occur for people with these types of obsessions include the tendency to

  • ruminate about changing meds
  • ask for reassurance about the meds working

Hypothetically, someone with these types of obsessions would aim to accept uncertainty

Oh – quick detour as Lauren goes on a tirade:

There’s this general fear, and we’ve talked about these terms, like breakdown or losing it… these larger terms that we use in the culture… and I think they do us all a great disservice because… we have this general idea of ‘mental breakdown’  but I remember growing up thinking that that was a specific thing. Like that a breakdown looked a certain way, or you could have a ‘nervous breakdown.’ 

I do think it’s really important to acknowledge that there’s no feeling that ends you. You can feel them all… 

Lauren Rosen, LMFT

People with obsessions about mental health might find that they are triggered by an absence of feelings.

Also, when intrusive thoughts present as commands, this can be triggering for people with anxiety about psychosis given that they might worry “What if that was a voice?”

Question: How can you sit with uncertainty that you may have a mental health problem now?

Consider if there’s a fear that something bad will happen as a result of a mental health problem that is happening now that one’s not aware from. It’s still about the future. 

Generally, the fear that something unknown is wrong now is related to the idea that there will be some negative repercussions of that thing in the future. So there’s the uncertainty about whether or not something’s wrong now and the uncertainty about what could happen if the initial uncertainty goes unresolved.

Side note: In general, compulsions are unlikely to do anything to help you figure out whether you have a mental illness. They are also unlikely to help you to navigate a mental illness if it turns out you have one. 

Question: Is it common for therapists to miss this subtype or assume it’s general anxiety?

Many OCD subtypes are missed or misdiagnosed.  

The thing about OCD and Generalized anxiety is that they are very similar and function in the same way. Generalized Anxiety usually involves more typical worry. That said, Relationship OCD and Existential OCD hit on topics that are quite common for people to worry over. On the whole, OCD fears are a little more far-fetched.

On a separate note, sometimes people with this subtype might be misdiagnosed with depression or some other mental illness. If someone with anxiety about becoming depressed endorses symptoms because they are hyperfocused on their experience, a therapist might be led to believe that the issue is actually depression.


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Disclaimer: This information is meant to be general information not unique to any individual. Before following any guidance or advice found on this site or in the Purely OCD Podcast a visitor or listener should always consult with their own licensed healthcare practitioner. The Purely OCD Podcast and Website are not therapy or intended as a replacement for therapy. They are for educational purposes only.

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