Fear of Losing Control in OCD

If you have OCD, your symptoms may be affected by a fear of losing control

japanese woman portrait
Yagi Studio / 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 acts that are meant to reduce or neutralize anxiety and fears.  

Obsessions such as contamination concerns and those involving perfectionism are common obsessional themes of OCD that can manifest as cleaning, washing, checking, and arranging.

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

1. How Do I Know I’m Not Going to Hurt or Kill Myself?

If you find yourself asking this question, 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 yourself.

If you have OCD, you may fear losing control to the point where it results in your own demise. This does not mean you want to kill yourself. Rather your compulsions are likely carried out in a way that ensures you are safe. 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, and cabinets, or other objects that may be associated with suicide, or avoidance of being alone.

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

Many people with OCD fear that harm will come to their loved ones. If you are afraid you will harm someone close to your, 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.

If you have OCD, your fear of losing control may manifest in a way that appears 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 loved ones are safe. For example, you may find that you avoid 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. You may carry out these compulsions as a means of reassuring yourself that you won't hurt or kill your loved one, even if you lose control.

3. How Do I Know I Didn’t Unknowingly Harm Someone Else?

It is important to distinguish violent, antisocial behavior from unwanted, intrusive thoughts of uncertainty. If you have OCD, you might find uncertainty extremely distressing, thus increasing any obsessive thoughts you may experience. In these cases, compulsions are carried out as a way of trying to gain certainty. For example, compulsions may include seeking reassurances from others, checking behavior (locks, windows, schedules), and mental rituals that involve trying to seek clarification.

If you have any of these thoughts, it is important to speak with your doctor or therapist. Current evidence-based symptom treatments for OCD and the fear of losing control include cognitive behavioral therapy (Exposure and Response Prevention [ERP/ExRP]) and medication (selective serotonin reuptake inhibitors for OCD). If you have treatment-resistant OCD, your doctor may try a procedure like deep brain stimulation (DBS) or transcranial magnetic stimulation (TMS). 

Sources

  • 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