Fear of Losing Control in OCD

Getty Images

Obsessive Compulsive Disorder (OCD) is a psychiatric disorder, which involves both obsessions (recurrent, persistent, intrusive thoughts, images, or urges that cause anxiety or distress) and compulsions (repetitive behaviors or mental acts that are aimed at neutralizing or reducing anxiety or distress or preventing the feared outcome.)  ​

Obsessions such as contamination concerns and those involving perfectionism are common themes, which are frequently identified as obsessional themes of OCD, as are common compulsions such as cleaning, washing, checking, and arranging.

However, some cases of OCD are misunderstood and therefore misdiagnosed and ineffectively treated such as those involving the fear of losing control.

OCD symptoms that are often misunderstood:

1.“How do I know I’m not going to hurt or kill myself?”

Scenario: The phone rings. It’s the guidance counselor from your daughter’s school. She informs you that your daughter is being taken to the local hospital to be evaluated for safety. She explains that your daughter had been upset and came to her with worries that she may kill herself. In disbelief, you rush to the hospital where your child has been admitted for 48 hours of observation and assessment. Your daughter is visibly shaken and distraught. You feel helpless and fearful. You return home and scramble to search the internet for information about suicidal ideation. She never seemed depressed. In fact, she seems terrified. What is happening?

How do you find help?

OCD Distinction: It is important to distinguish between actual suicidal ideation and thoughts of wanting to die versus unwanted, intrusive thoughts of fearing the loss of self-control that could potentially result in harming or killing oneself, which is a terrifying thought to individuals who struggle with this symptom of OCD.

Individuals with OCD who fear loss of control which may result in their own demise do not want to kill themselves, they are terrified of the mere thought of it. In fact, their compulsions are carried out to ensure that they are safe – just in case they might lose control and hurt themselves.Compulsions of this nature may include avoidance of knives or sharp objects, avoidance of songs, movies, or readings, which involve death or injury, avoidance of belts, ropes, medicine bottles/cabinets or other objects that may be associated with suicide, or avoidance of being alone. These compulsions are carried out to protect the individual from themselves.

2.  “How do I know I won’t deliberately harm someone else?”

Scenario: Your wife has just given birth to a baby, a long and happily awaited event for you both. However, in the six weeks since the child’s birth, your wife has been avoiding holding the child and caring for him. At her six-week check-up with the obstetrician, she tells the doctor she is afraid she may harm the baby.

You are asked to care for the child and your wife is sent to the local emergency department to assess for homicidal ideation and risk. Your wife is overwhelmed and distraught. You feel helpless and fearful of what is happening.

OCD Distinction: It is important to distinguish between actual homicidal ideation versus unwanted, intrusive thoughts of having the potential to lose control and kill a loved one, which is a terrifying thought to individuals who struggle with this symptom of OCD. Individuals with OCD who fear losing control in this way may appear neglectful or avoidant. Similar obsessions may involve assault, rape, incest, or other personal aggression or violation. Compulsions of this nature are carried out to ensure that their loved ones are safe – just in case they might lose control and harm them. For example, such compulsions may include avoidance of knives or sharp objects, avoidance of songs, movies, or readings, which involve murder, death, or injury, avoidance of touching or caring for a loved one who has been the subject of these unwanted thoughts, or avoidance of being alone with the loved one. These compulsions are carried out as a means of reassuring the individual that they are unlikely to be able to hurt or kill their loved one, even if they lost control.

2.  “How do I know I didn’t unknowingly harm someone else?”

Scenario: You read a story about a number of murders in the area and you think, “Could I have done that?” Of course, you don’t believe you would ever harm another person, but you think “What if I unknowingly sneak out of the house at night and commit such horrible crimes?” “Is that possible?” “What if I don’t even know what I’m doing, like sleepwalking or something?” You find it difficult to push these thoughts out of your mind. The fact that you keep thinking about it increases your anxiety and distress. You wonder if you are losing your mind and committing these heinous crimes.

OCD Distinction: It is important to distinguish violent, antisocial behavior from unwanted, intrusive thoughts of uncertainty. Individuals with OCD strive for certainty in a world in which there is much uncertainty. They find this extremely distressing which increases their uncertainty and obsessional thoughts. Their compulsions, in these cases, are carried out as a means of trying to gain certainty. For example, compulsions may include reassurance seeking from others, checking behavior (locks, windows, schedules), and mental rituals that involve trying to seek clarification, figure-it-out, or think-it-through. These compulsions are carried out as a means of reassuring the individual that they did not harm someone, although absolute certainty can never be gained or sustained.

Current evidence-based symptom treatments for OCD and the fear of losing control includes cognitive behavioral therapy (Exposure and Response Prevention [ERP/ExRP]) and medication (selective serotonin reuptake inhibitors for OCD).

For more information about OCD, visit the International OCD Foundation at www.iocdf.org.

Suggested Readings

Booth, B., Friedman, S., Curry, S., Ward, H., & Stewart, E.  Obsessions of Child Murder: Underrecognized Manifestations of Obsessive-Compulsive Disorder. J Am Acad Psychiatry Law 42:66–74, 2014

Himle M, Franklin, M. The more you do it, the easier it gets: Exposure and response prevention for OCD. Cognitive and Behavioral Practice. 2009;16:29-39. 

Hudak, R. & Wisner, K.  Diagnosis and Treatment of Postpartum Obsessions and Compulsions That Involve Infant Harm. Am J Psychiatry 169: 360-363, 2012.

Continue Reading