OCD Causes Common Cognitive Distortions in OCD By Owen Kelly, PhD Owen Kelly, PhD Owen Kelly, PhD, is a clinical psychologist, professor, and author in Ontario, ON, who specializes in anxiety and mood disorders. Learn about our editorial process Updated on November 13, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print Scott Kleinman / The Image Bank / Getty Images Table of Contents View All Table of Contents Over-Importance of Thoughts Overestimation of Danger Inflation of Responsibility Overestimation of Consequences Need for Certainty Emotional Discomfort Intolerance Although obsessive-compulsive disorder (OCD) is a complex illness with many causes and risk factors, understanding the psychological factors that cause OCD symptoms and keep them going is essential to getting the most out of treatment. It is now clear that OCD is characterized by a number of errors in thinking called cognitive distortions, which can potentially lead to obsessions and compulsions. Cognitive distortions are ways of thinking that negatively skew the way in which we see the world, ourselves and others. First identified by the seminal cognitive-behavioral therapist Aaron Beck, cognitive distortions are prevalent in many forms of mental illness, including mood and anxiety disorders. Cognitive therapists have identified a number of cognitive distortions that seem to be particularly prevalent among people with OCD. Identifying and challenging these distortions is a central component of psychological therapies for OCD. Over-Importance of Thoughts Through a process called thought-action fusion, people with OCD are often prone to equating their thoughts with actions. For example, if you have OCD you might believe that having the unwanted thought of harming a loved one is morally equivalent to actually harming them. You might also believe that such a thought means that deep down inside you really want to harm your loved one. Although thoughts themselves are actually harmless, for some people with OCD, the apparent meaning and consequences of such thoughts cause them to be labeled as dangerous and immediately pushed away. Unfortunately, suppression of such thoughts only causes them to come back even worse than before. Cognitive-behavioral therapy (CBT) challenges the importance of thoughts through various exposure-based exercises. The Best Online Therapy Programs We've tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain. Overestimation of Danger People who have OCD often overestimate the potential for danger and the consequences of making an error or not doing something perfectly. For example, if you have OCD you might believe that the likelihood of being fired is extremely high and that if you make any mistake at work, even a small one, you could be let go. This kind of thinking can help fuel compulsions by causing excessive checking or other types of repetitive behavior to ward off the feared danger. Of course, it is possible that the fears may be justified, but in the vast majority of cases, this overestimation of danger is unfounded. Inflation of Responsibility If you have OCD, it is common to overestimate your responsibility for an event and to discount, ignore, or underestimate other plausible influences. For instance, someone with OCD may think that if one leaves for work at the wrong time it will set in motion events that will lead to a plane crash. To prevent this from happening, the person with OCD may engage in compulsions to undo or neutralize this negative outcome, such as repeating a phrase over and over again or leaving and returning to the house numerous times. Of course, it is almost impossible to imagine how leaving for work at the wrong time would cause a plane to crash, nor is it logical that a compulsion such as repeating a phrase over and over again would prevent such an outcome. People’s actual level of responsibility for events can be tested in therapy using exposure exercises. Overestimation of Consequences People with OCD often believe that if they encounter danger, they will be overwhelmed and will not be able to cope with the situation or will go crazy. They may also believe that encountering danger invariably heralds a catastrophic outcome such as losing everything and ending up on the street. For example, someone with OCD might fear being rejected in a romantic relationship because rejection would automatically mean one would become depressed and end up homeless. This irrational belief discounts the very real possibility that the person with OCD might be able to cope with the situation completely fine, that family members would be there to offer support, and that the relationship ending could be an opportunity for a fresh start. Need for Certainty If you have OCD, it is very common to have an unrealistic need for certainty, even in situations where certainty is not possible. This need for certainty can lead to seeking excessive reassurance from family members, therapists, and many others, to avoid feeling anxiety. Excessive reassurance seeking is a form of avoidance, which only serves to reinforce anxious thoughts. As well, it can cause loved ones to withdraw their support as they grow overwhelmed trying to provide reassurance. Emotional Discomfort Intolerance People with OCD often believe that they will embarrass themselves or go crazy if they experience intense negative emotions. It is thought that compulsions and excessive reassurance seeking from others often develop as a means of avoiding having to experience negative emotions. 7 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Beck AT. Cognitive Therapy: Nature and Relation to Behavior Therapy - Republished Article. Behav Ther. 2016;47(6):776–784. doi:10.1016/j.beth.2016.11.003 Lee SW, Cha H, Chung Y, et al. The neural correlates of thought-action fusion in healthy adults: A functional magnetic resonance imaging study. Depress Anxiety. 2019;36(8):732–743. doi:10.1002/da.22933 Jónsson H, Hougaard E, Bennedsen BE. Dysfunctional beliefs in group and individual cognitive behavioral therapy for obsessive compulsive disorder. J Anxiety Disord. 2011;25(4):483–489. doi:10.1016/j.janxdis.2010.12.001 Mitchell R, Hanna D, Dyer KFW. Modelling OCD: a test of the inflated responsibility model [published online ahead of print, 2019 Oct 31]. Behav Cogn Psychother. 2019;1–14. doi:10.1017/S1352465819000675 Thorpe SJ, Barnett J, Friend K, Nottingham K. The mediating roles of disgust sensitivity and danger expectancy in relation to hand washing behaviour. Behav Cogn Psychother. 2011;39(2):175–190. doi:10.1017/S1352465810000676 Rector NA, Katz DE, Quilty LC, Laposa JM, Collimore K, Kay T. Reassurance seeking in the anxiety disorders and OCD: Construct validation, clinical correlates and CBT treatment response. J Anxiety Disord. 2019;67:102109. doi:10.1016/j.janxdis.2019.102109 Hellberg SN, Buchholz JL, Twohig MP, Abramowitz JS. Not just thinking, but believing: Obsessive beliefs and domains of cognitive fusion in the prediction of OCD symptom dimensions. Clin Psychol Psychother. 2020;27(1):69–78. doi:10.1002/cpp.2409 Additional Reading American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM–5). Fifth edition. Arlington, Va.: American Psychiatric Association; 2013. Szechtman H, Harvey BH, Woody EZ, Hoffman KL. The Psychopharmacology of Obsessive-Compulsive Disorder: A Preclinical Roadmap. Pharmacol Rev. 2020;72(1):80–151. doi:10.1124/pr.119.017772 Woody EZ, Hoffman KL, Szechtman H. Obsessive compulsive disorder (OCD): Current treatments and a framework for neurotherapeutic research. Adv Pharmacol. 2019;86:237–271. doi:10.1016/bs.apha.2019.04.003 By Owen Kelly, PhD Owen Kelly, PhD, is a clinical psychologist, professor, and author in Ontario, ON, who specializes in anxiety and mood disorders. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? 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