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Do I really have OCD, or am I lying to myself?
A common source for anxiety and rumination in OCD is obsessing over whether or not the symptoms really are due to OCD, where this obsessive thinking style generates doubt and uncertainty, making the thoughts feel "true" and provoking even more anxiety, as well as reluctance to seek treatment due to fears of judgement. Read more about this common obsession in OCD below.
Symptoms
Individuals experiencing this obsession often experience intrusive thoughts, where their mind tells them they do not have OCD, and are lying to themselves. This generates anxiety due to the uncertainty it brings, along with the fear that maybe the rest of their intrusive thoughts are not OCD and who they really are.
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In an attempt to cope with this and disprove the thought, individuals with OCD fall into the trap of trying to argue with the thoughts in their mind, or other forms of mental compulsions, such as try to dismiss the thoughts, trying to suppress them, avoid them, or compulsively engage in reassurance seeking from others, therapists, or researching online to try and achieve a sense of certainty that they have OCD. However, compulsively trying to achieve this sense of certainty only makes the uncertainty grow, and the thoughts seem more and more credible and important, provoking even more anxiety and appearing more frequently.
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They may also develop a fear of going to see a psychologist, due to fearing they will be told they do not have OCD and their thoughts are true, or that they will be judged in some way. However, this is just another way the OCD tricks people into giving it attention, and is no different than any other kind of obsession. Where most obsessive themes can be traced back to anxiety around uncertainty, and the function of most compulsions is to try and achieve a sense of certainty, but only generating more uncertainty in the process.
OCD Treatment for Doubt & Rumination
Cognitive Behavioural Therapy: Helping individuals to recognise the mental compulsions fuelling this obsessive doubt, and learning to expose themselves to this thought and the anxiety it brings without engaging in any compulsions, helps to restore the sense of clarity that gets buried in doubt when someone is obsessively ruminating. Its a bit like when you repeat a word over and over again until it loses all meaning - when we ruminate obsessively over thoughts, we become increasingly uncertain until we feel like we don't know what we believe anymore. Where learning to let these thoughts be without trying to engage with them, reduces the anxiety attached to them and takes away the false sense of credibility these thoughts appear to have when we give them excessive attention or try to fight with them.
Mindfulness-Based Approaches: Mindfulness exercises (when applied in an OCD treatment congruent way) can help individuals observe their thoughts without judgment, reducing the urge to engage in mental compulsions.
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Cognitive Restructuring and Increasing Metacognitive Awareness: Identifying and challenging distorted thought patterns and beliefs associated with the need for mental rituals - rather than arguing with the content of thoughts (which fuels the OCD further), this cognitive restructuring is focussed on addressing beliefs about the need to engage in the compulsion, their perceived utility or function, or in shifting the perceived lack of self-efficacy in resisting the ruminative thinking patterns.