Obsessive Compulsive Disorder (OCD) often presents as distressing thoughts, images, memories, or urges. Those with OCD will often report fear of their own thoughts as they begin to consider what such thoughts might mean about them, as they note fears about being a bad, harmful, or violent person. Such concerns will cause people to begin avoiding aspects of their lives that bring up such thoughts, due to evoking another common fear of OCD: losing control. In an effort to gain insight while the concerns are present, it can be helpful to borrow from some of the research on personality disorders, which differentiate thoughts on a meta-cognitive level (thinking about thoughts) between ego-syntonic and ego-dystonic.
We should first consider the brain and how it tends to work. The brain is essentially just a thought-making machine. It receives stimulus from the outside world, mostly via our senses, and it spits out thoughts as a reaction. In this way, to suggest that thoughts are “ours” as if we have some ownership of them might not be completely correct. Consider, for example, a radio that picks up AM and FM transmissions. Depending on which station you are tuned into, the radio will play a different song, but this does not mean the radio owns the songs that it is playing. Instead, the broadcasts are just a result of which station the radio is tuned into.
In much the same way, we can note that the thoughts our brains spit out is more determinate to the stimulus or “station” we are “tuned into.” If the brain is tuned to distressing or worrisome content, it is more likely to play thoughts that reinforce and encourage that distress. Where this gets tricky is when we begin to notice that thoughts can be both the song and the station—in other words it is not just the stimulus in the physical world that effects our thoughts but noticing and focusing on our thoughts can trigger even more thoughts! For OCD brains, this can feel like a never-ending cycle.
From here, we can assert that thoughts do not necessarily have to have ownership—they are simply signals or reactions. Now we can assert that we are allowed to agree and disagree with our own thoughts. If we agree with the thought and feel it jives with our values, beliefs, intentions, and sense of self then we would categorize that thought as ego-syntonic.
When we experience a thought that goes against these conceptions and sensibilities, we would categorize it as ego-dystonic. This can be helpful, and dare I say reassuring, when experiencing OCD because it can allow the person having the thoughts to notice the distance between themselves and the thought and decide whether that is a thought they agree with or not. Often OCD can convince us that our thoughts are important or have deeper meaning about the self.
For example, it is common with people suffering from harm or taboo thoughts to consider, “These thoughts must mean I am a bad person!” or something similar. However, when we notice the discomfort and distress these thoughts bring up, it can be a pretty clear sign that these thoughts do not align with our values or sense of self.
There are some limitations that should be considered here. Afte rall, any binary understanding of thoughts or thinking will be limited in its helpfulness as such things tend to exist on a spectrum. While, yes, our brain can come up with some obvious examples of completely dystonic thoughts, this doesn’t mean they will always feel particularly distressing. Many people report thoughts as landing somewhere in the middle. While some categorization of thoughts can allow us to gain insight, becoming dependent on such examinations for reassurance or as a sign that we should or should not worry is ultimately going to push us to re-engage with the OCD cycle and feel more suffering.
By seeking regular reassurance from categorizing our thoughts as ego-dystonic or ego-syntonic, we are essentially attempting to seek reassurance from our own distress or discomfort…and, no surprise, this doesn’t work very well and can turn into an over examination of the thoughts and feelings and new concerns such as “Oh no, I am not distressed enough!” which can begin to add fuel to the obsessive concern.
In conclusion, it is important to have a good education on thoughts: what they are (not much and barely “ours”), what they aren’t (most thoughts are not very meaningful), and that some thoughts fall in line with our values and beliefs and some don’t. But in the end qualifying, categorizing, and linking thoughts to particular feelings repeatedly can get us back into a rumination-based reassurance loop. Education about thoughts and why they can be so distressing is an important and necessary part of any OCD therapy. Noting thoughts as ego-dystonic can be validating and insightful because of course these thoughts are stressing you out—they are counter to your beliefs and values!
This doesn’t mean, however, that you should engage in testing every thought for its distress levels in an attempt to gain certainty about your diagnosis, your personality, or your values like some type of Thought-Terminator (a bit ironic as doing this will guarantee that the thoughts you are trying to get rid of will be back). Instead, remember your brain is like a radio, and while it can be frustrating that we do not always have control of the station, you can just let the thoughts play and decide for yourself which thoughts are meaningful to you or not.
