OCD symptoms, such as acting on an unwanted impulse, can best be addressed through exposure and response prevention (ERP). Useful exposures will involve embracing your own vulnerability by intentionally entering uncomfortable situations that trigger your OCD fears.
Question: I’m a teenager and keep having OCD symptoms related to impulse control. I often worry that I’ll lose control and scream or blurt out obscenities. I am especially triggered in quiet public places like classrooms, churches, and movie theaters. I have never actually acted on my impulses and cursed in public, but I still feel very anxious whenever these thoughts occur. Do you have any tips for me?
These types of symptoms are very similar to other OCD symptoms in which people worry about losing control and acting on unwanted impulses. Most typically, these types of thoughts attach to situations that are considered morally or socially taboo. Related OCD symptoms include fears about losing control and:
- Harming a loved one (most often fear of harming a child, spouse, or parent).
- Killing a loved one (i.e., stabbing, shooting, suffocating, or poisoning).
- Killing or harming the self (i.e., suicide obsessions, fear of jumping from high places).
- Engaging in inappropriate sexual behavior (e.g., the urge to expose one’s genitals in public, undress in public, or touch another person’s genitals).
- Engaging in socially inappropriate behavior (e.g., cursing/using profanity/dirty words, insulting others, making negative comments, calling people names).
- Engaging in criminal behavior (e.g., theft/stealing, arson, vandalism, rape).
- Confessing non-committed criminal activity (e.g., talking about terrorism while at the airport/during security screenings, confessing crimes to police officers, mentioning guns/weapons while undergoing security screenings at courthouses or schools).
For individuals with OCD, these thoughts and urges are distressing and are often a source of guilt and shame. Many individuals with OCD report that these urges are unwanted, but others get confused because they worry that the reason the thoughts keep occurring is because they secretly want to act on them.
This is not the case. This phenomenon simply reflects the doubt and uncertainty that is characteristic of OCD.
In your situation, I would recommend finding a CBT therapist to help you address your OCD in the right way. Check out the providers at www.ocfoundation.org. Treatment can be confusing, and you want to make sure that you’re selecting strategies that are going to move you in the right direction.
Once you’ve found a specialist in OCD treatment, you might consider the following four strategies for addressing your obsessions and compulsions:
OCD Treatment Tips for Unwanted Impulses/Urges
1. Practice non-avoidance of your OCD symptom triggers. The key is to embrace vulnerability and to intentionally put yourself in situations that trigger your OCD fears. Enter these situations as often as possible and refrain from engaging in any compulsive behaviors (e.g., physical rituals, mental rituals, reassurance-seeking behaviors). You might consider volunteering more often in class, sitting in the most “vulnerable” place in the movie theater, or spending additional time in quiet places (e.g., churches, libraries, museums, etc.).
2. Eliminate subtle OCD-related avoidance behaviors. Do you keep your hands over your mouth, clench your jaw, hold your body tightly, sit in the back of the classroom, or try to distract yourself in order to avoid acting on your impulses? Eliminate these behaviors, as they reinforce your fear. The idea is that you want to stand on the precipice of your fear without using subtle avoidance as a safety net. With sufficient practice, you’ll begin to modify the neurobiological pathways associated with OCD. Because exposure and response prevention (ERP) alters OCD-related neural circuitry, it provides a way of doing “brain surgery” without a scalpel.
3. Work with your therapist to practice imaginal exposures to your feared consequences. Imagine what would happen if you actually screamed or blurted out obscenities. You might do this in the context of writing a short story or script about your feared consequence and then reviewing it as often as it takes to habituate. The goal of this activity is not to make yourself feel bad but to become less afraid of the consequence…and recognize that you could actually handle it. Don’t allow your OCD to trick you into thinking that it would be “too difficult” or “too embarrassing” if you acted on the impulse. Although you might be embarrassed, you could handle it; the moment would pass, and life would go on…
4. Work with your therapist to practice in vivo exposures. You might consider exposures based on your feared consequence. If you are worried about being able to deal with potential embarrassment, you might consider in vivo exposures that tap into that fear. You might practice purposefully making a loud noise in a quiet place. Some people also practice actually screaming or saying bad words in public. If this feels very difficult, perhaps your therapist could model the behavior for you.
If you go the route of intentionally swearing, make sure you clear it with your parents first and are aware of any local laws/rules that might apply to the situation. I wouldn’t want your exposure to earn you a detention (unless, of course, getting in trouble is your feared consequence…in which case you might want to purposefully earn a detention).
Your therapist can also be helpful in this regard. When I’m working with students in my psychological practice in Palm Beach County, South Florida (Palm Beach Gardens/Jupiter/West Palm Beach/Boca Raton) providing OCD treatment, I often coordinate with school personnel (teachers, guidance counselors) to implement in vivo exposures that might otherwise be difficult to orchestrate. Usually, schools are pretty receptive to this if they understand the underlying rationale.
If done properly, in vivo exposures are likely to be the most useful tools in your arsenal. However, if implemented haphazardly, they are likely to backfire.
Wishing you the best of luck with this!
Questions? Comments? Do you experience the fear of blurting out curse words in public?
Hi Steven, its a good section on unwanted impulses but with regards to point 3. above I understand certain things you could think of the consequences of shouting out load or saying something inappropriate and the consequences apart from embarrassment aren’t that bad but how can you not worry about the consequence of certain urges/things in the above list, harming a loved one etc, where the consequences would be extremely bad.
thanks
Actually, this very issue was discussed in a scripting workshop recently given by Jon Grayson and Jon Hershfield at this year’s IOCDF conference. It’s also something that is currently being discussed on a professional listserv for psychologists and therapists. FYI, not everyone may share the same opinion on this.
Grayson’s point seems to be that it IS important to expose yourself to the imagery/content of even the most unwanted thoughts and to identify how you would actually cope in that situation. If I committed murder, what would happen in the first second…in the next ten seconds…in the next five minutes…all the way out to longer time intervals?
Many people stop scripting at the point of committing the unwanted act or shortly thereafter when they’re in the throes of despair. However, this can be just another form of avoidance. Life doesn’t stop even when terrible things happen. Despair and grief change and eventually, you have to pick yourself up and somehow learn to cope.
I tend to use both types of scripts in treatment — the ones that end with catastrophe, as well as the ones that take it out further and include attempts to cope.
Hi Steven I think this is a topic that really needs looking into.
With regards to Grayson’s point I don’t think I can agree or would like a more in depth answer, So in a situation when near someone and you have a trigger/thought of murder or physical contact or attacking or sexual just any type of inappropriate thought about the person you near adult or worse even a child, your saying in the moment when you are unable to ignore the thought which from therapies point of view you shouldn’t ignore anyway. At this point Grayson and yourself recommend not to ignore the thoughts/urges but to think of the stages of acting out the thought and not to be concerned of the consequences of this. As a sufferer I don’t see how this could be beneficial as during the moment when your hit with the urge/thought to expose yourself more to the thought and don’t be concerned about the consequences this would/could have a negative effect in my opinion cause more confusion. Also if your in with a therapist and exposing yourself to the thoughts/urges with the therapist sitting with you is a totally different situation than if you have the thought/urge about someone your near in public, alone with, in a busy place, or even while interacting with someone etc, the anxiety that accompanies the thought in these situations is totally different than when in with a therapist.
I can totally see how this could work with ocd around germ ocd and some other categories but with regards to pocd/harm ocd I’m not sure.
Steven all of the other points in the topic
are really good but with regards to this I just cant get my heads around it.
Thanks
Hello . I find this post today . I suffer with panic disorder .
When i m having a panic attaks i have alot of thoughts and those thoughts make me fell very anxious .When im having a panic attack i start felling like im loosing control and i have the sensation of saying those thoughts , and i probably didint .Because i dont remember saying those things .Sometimes i touch mouth because i cant feel any muscle of my face . I feell so dizzy because of the panic and for seconds its like i can t ear or see anything clearly . In these moments my mind its like a roller coaster , its so much noise and i have to wait to calm down.
3 years ago i went to psicologist and she help me to control my anxiety and the panic attaks . She advise me to ignore the thoughts and to stop covering my mouth . I only feel like this when im alone in public or if i go to job interview .Sometimes when i dont pay atention to the thoughts they go away. Today i thing i feel much better that years ago but i still have the same problem .Before having panic disorder i didnt have any problem with thoughts or things like that. Im wondering if i develop something . Do you think is OCD ? Do you thonk this is normal to happen ? I think is not very normal … Please give me an answer i already research and i dont find anyone with the same problem .
Point 3 makes no sense if you’re fear is molesting or murder. In those cases you just accept the anxiety not the possibility. You never have to accept the content of an OCD thought, just that you have them.
See my comment above. Also…
Bad things can happen – this is a reality. However, possibility is not probability. As we know, OCD causes distortions in estimation of threat and makes normal intrusive thoughts feel more personal, more possible, and more distressing.
OCD is fundamentally related to an intolerance of uncertainty. Recovery is based on learning to coexist with this uncertainty and resisting efforts to artificially eliminate it (i.e., through rituals).
Hi you def spk a lot of sense I know it’s all in my head cause if im busy then I don’t think bout it, I had anxiety years ago got over it, and after aving my baby three mths ago it’s back ;( except it’s stupid thoughts bout wat if I get the thoughts of taking my own life because my dad did this year and wat if I get thoughts of harming my baby its all wat if ;( wat if im goin mad, after reading ur info I feel a lot better in knowing im not going mad, it is a actual condition, so that alone has stopped me constanly panicking, im Also on beta blockers and citalorpram from today so hopefully with ur info and tabs I can beat this, thank u
Hi,
I have a problem similar to the teenager. My situation is a bit different though. I’m yelling in my mind the obscenities that I sometimes think I’m saying them outloud. Sometimes I feel I’m actually saying them because people laugh at me. How can I fix this problem?
It would depend on the specifics of the situation. When you say people are laughing at you, is it that you’re noticing that they’re laughing — and you then assume they’re laughing at you because of your thoughts?
Sometimes when people feel anxious, they can misinterpret other people’s behavior in line with their own thoughts.
Hei steven.could you please explain what impulse and urges means/can be like in harm ocd/kill ocd cause i didnt Quite understand?i am norwegian an am diagnosed with ocd from my terapist (what i can doubt).we dont have litterature about it here.its like i want to kill expeccialy my doughter.its like a strong want.often some say its unwanted thought.she is ten now.
See some of the discussion on my post about OCD & pets. I think many people struggle with this concept.
Hei steven.i wrote an answer under pers. Maybe you could answer there.i dont understand.can impulse feels like a want?
Hi I wanted to say that I have been experiencing this problem I live in an apartment complex with a patio where I sit and smoke cigarettes and a long hallway with lots of people’s doors it is very unnerving I have a diagnosis of schizoaffective disorder but I still experience this problem. It happens when I’m driving and the windows are down and when I’m by myself around strangers or anywhere where others could be listening I’m basically scared that I’m yelling out racial slurs controversial statements and words that could prevent me from ever making a new friend words that could hurt me my husband assures me that I’m not doing this but sometimes I hear voices of people talking about the things I’m saying or at least I think i do
I know the world doesn’t revolve around me lol but still this makes me very scared and uncomfortable being around anywhere or meeting new friends and I’m starting to worry that I am a terrible person and if I was saying these things I know why people would want to stay away from me this is uncontrollable and I hope to God I’m not saying these things out loud
I’m a sufferer of OCD and I did not understand why I was having racial slurs spew in my mind repetitively about all races including mine. It puts me in a lot of distress. I’ve developed this years ago, a new habit forming after a new one. I’m a compulsive picker and seem to deal with thoughts that progress when I am isolated. I’d really like to get out but I have social anxiety. I do find your article a bit of a relief because I was always wondering about my thinking. I knew it wasn’t me even though I grew up back in an era where there was segregation in my neighborhood.
Please help!
my adult daughter (27)has been diagnosed with complex PTSD, also anxiety and depression. She come back to live w/me while recovers, since she also has POTS (postural orthostatic tachycardia)
She swears at me badly when she gets upset/scared or anxious,she is afraid of being alone, today she called my phone while I was close by, I was in another call and didn’t realize,she was so upset, she said mean things and I am tired and confuse with all this, she then sent me your link. Could this behavior be OCD? what can I do to protect my mind from this damaging hatred?
I am suffering from ocd and cannot stop controlling screaming due to these highly disturbing, depressing sexual obsessions. As a result, we need to leave our rent house. What to do? help!
It sounds like your OCD is really impacting your quality of life. I would strongly recommend seeking treatment with an OCD expert who can help you get a better handle on your symptoms. Treatment isn’t always easy or fun, but it can really help!
Hi, Thank you for taking the time to enlighten the silent sufferer. I consider myself strong most of the time but I have been raped and abducted early on in life. I lived under the scope of fear since I could remember. A Doctor told me that I suffer from PTSD but I am not so sure. I read one of your articles and began following you on Twitter right away because it is the first time I have read something that makes sense. on the other hand, acting out fits of screaming or revisiting the compulsive side to these horrific thoughts is equally terrifying. Does medication help people who suffer who OCD? I am missing out on the best years of my life, missing out on family, church, and all things good because of this fear.