Jo struggles with relationship-intrusive thoughts (ROCD) seen in obsessive-compulsive disorder (OCD). As a result, she engages in evidence-based treatment exposure and response prevention (ERP). But resisting the rituals in ERP isn’t enough for her, or so it seems. For example, she systematically faces her fears (exposure) and resists the compulsions (response prevention), but she struggles to make progress.
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What makes it difficult is that, on the one hand, she has an aversion to the thoughts, and on the other hand, she feels as though she has a strange desire for them. Jo is also bothered by automatic groinal responses and worries how the initial sensation increases to stronger arousal. Consequently, she worries she could act on the thoughts, even though objectively, she knows she won’t.
The Fault Lies In The Brain
The idea of liking your thoughts in OCD isn’t unusual, but for Jo, it’s as if thinking she wants the thoughts prevents her from reaching her recovery goals. For instance, it makes her believe her OCD diagnosis is something else. As a result, she looks for reassurance repeatedly. But, of course, it’s not her fault she seeks reassurance, but her brain’s cortex. Since it’s the thinking part of the brain, it assesses situations. Then, it comes up with solutions to help with erroneous beliefs, but unfortunately, it doesn’t always suggest the right ones, as in Jo’s case.
So now picture Jo with her peers at university. Her cortex assesses she fears her problem is not ROCD when a guy grabs her attention, and she thinks he’s cute. That being so, her initial defence reaction to sudden groinal response is to seek reassurance. And so she calls her friend to ask, if deep down, she does not love her partner, Eric. Instead, she thinks she has a hidden problem with wanting to cheat on him.
But no matter how often her friend tells her ROCD is the theme of her obsessive thoughts, not about her, she still worries. It’s because Jo’s cortex continues to try to find the solution about desiring the thoughts. It thus erroneously communicates with the brain’s amygdala that something is amiss. In that case, her amygdala keeps producing a defence reaction (fight, flight, freeze) as though she must repeatedly seek reassurance to protect her relationship with Eric (the solution).
The Biology Of OCD
To help Jo, her therapist explains the biology of OCD. She tells her to think of an obsession as a mixture of intrusive thoughts and interpretations processed wrongly by the cortex and amygdala. The amygdala reacts to erroneous input from the subconscious while the cortex continues to find a solution, such as encouraging reassurance or checking online. Consequently, this biological interaction becomes repetitive through ritualising. Moreover, Jo’s therapist explains that analysing whether she has another problem, not OCD, is a compulsion that feeds it as well as reassurance-seeking and checking.
In addition to understanding the biology of OCD, it can further show how cognitive therapy and ERP can correct the disorder. More about this later.
I now want to explain erroneous desire amidst aversion in OCD. First, away from OCD, the brain’s nucleus accumbens can experience desire, producing the feel-good factor dopamine. But more to the point, it can also experience aversion, giving the impression that you can like and dislike something together. It might be certain foods, drinks, sensations, or something else. Second, a septum separates this part of the brain and is only a fraction of an inch thick. The divide shows how the nucleus accumbens creates the effect of liking something on one side and disliking it on the other side. It explains mixed feelings of being half-and-half about something, such as being in the middle about a specific person or thing where you can take it or leave it. So when referring to OCD, it shows it’s possible the nucleus accumbens influences like, dislike and mixed feelings about intrusive thoughts, causing distress and confusion.
But despite Jo’s new understanding of the nucleus accumbens, she is still bothered by increased arousal, making her believe even more that she does not have OCD. And this brings on terrible feelings of guilt. Nonetheless, there is another explanation. For example, it brings the problem to several hormones produced by the brain’s hypothalamus, which lies at the centre of the limbic system where the other brain regions mentioned are also nearby. It coordinates physiological processes, such as thirst, hunger and sleep, among other functions, and includes emotional states.
One of the hormones produced by the hypothalamus is oxytocin. An example of the things it does is to trigger feelings of affection for babies, children, certain people and animals. It also influences sexual and social behaviour. It is close to and interacts with the thalamus, the brain area responsible for receiving and sending messages to the cortex and amygdala and other regions of the brain. In addition, dopamine stimulates arousal. And oxytocin, the hormone that drives sexual behaviour, fires up.
But oxytocin is triggered not only when sexual arousal occurs but also when we feel stressed and anxious. So, with the latter, when it produces “love” feelings for a certain person, the feelings are physiological symptoms of anxiety, not genuine love. In other words, when it involves OCD, it explains the confusion of experiencing increased arousal coupled with a fear of the unwanted stimulation and thinking it is not OCD but something else, as in Jo’s case.
This is a crucial moment for Jo. She realises she does not need to give in to the urge to seek reassurance, check and analyse whether she has OCD or not. Instead, she is relieved to identify that arousal pertains to anxiety and stress symptoms, not sexual feelings. Any groinal response before that is an automatic nervous twitch. On that basis, it clarifies that arousal in OCD is nonsexual, meaning there cannot be any agreement between an individual and the sensation.
Correcting The Brain Parts
Jo can stop and think objectively when her cortex and amygdala create their obsessional scenarios in this case. She can decide not to agree with the suggestions from her cortex and, instead, encourage it to come up with more rational ideas. And she can calm her amygdala by not responding to its false alarms.
In short, she identifies a disorder that cannot validate its amygdala-based warnings and incorrect cortex-based suggestions. This also includes the release of dopamine and oxytocin that do not create natural desire and drive to satisfy arousal in OCD, but rather, a faulty communication affecting that stimulation due to stress and anxiety. In short, it helps her see why coping with uncertainty can help her brain re-evaluate and correct its thinking.
One way to correct thinking errors is with cognitive therapy. It helps Jo better prepare for ERP and improve its effectiveness. It also helps ground her in the here and now. So, in place of the thinking error, ‘What if groinal responses means deep down, I’m a a cheat and do not love my partner’, Jo thinks the following instead.
‘I could be a cheat, but it’s unlikely. It’s also possible I like the thoughts, but a better guess is that it’s false desire and somatic arousal brought on by anxiety and stress. That being so, I will cope with the feeling of worry about the uncertainty of my thoughts and feelings. More specifically, I do not need to check further through reassurance and other rituals.’
In short, a better understanding of how false desire, groinal response and thinking errors work in OCD improves the ERP process towards remission for Jo.
Coming Soon: Revised Edition of Desire-Intrusive Thoughts: What to do When Sexual, Religious, And Harm Obsessions Carry Unwanted Arousal.
Available on Amazon Soon!