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?