and Managing Intrusive Thoughts: A Guide for Patients

Obsessive thinking

Hello Dr.
Ding, I have been experiencing some symptoms of obsessive thinking for a while now, with fluctuations in severity.
I have consulted you before, and I appreciate your serious advice.
I apologize for the length of this message, and I thank you for your patience in reading it.
Although I have had concerns about obsessive thoughts in the past, they usually do not last too long.
I was previously very worried about contracting HIV, and I felt much better for a while, but recently, those thoughts have suddenly resurfaced and have been difficult to shake off.

There are three main issues that trouble me.
The first is that I once had tea with a male dormitory staff member at night.
Although I returned to my room, took a shower, and went to bed without noticing anything unusual, I worry that since the staff member has a spare key to the dorm rooms, he could have drugged me and done something while I was asleep without my knowledge.

The second issue occurred when I visited a female friend's house.
After drinking alcohol, I felt nauseous and fell asleep.
I woke up about two to three hours later, and my body felt fine, but since this friend has a more neutral demeanor and we are not very close, I worry that she might have drugged me or something might have happened while I was unaware.

The third concern arose during a dental visit when the dentist accidentally pricked his hand with a tool and had to bandage it before continuing my treatment.
I am unsure if this process could lead to infection due to blood or the tools used.
When I discuss these issues with my friends, they mostly think I am overthinking and say they wouldn’t worry about such things.
They believe that if something were wrong, they would know, and they think that my experience of falling asleep after drinking was just that—falling asleep.
I have also researched and found that transmission of HIV between women is quite rare, and that dental visits do not pose a risk for HIV transmission.
Sometimes I wonder why they do not worry at all.
Is it because my concerns are unreasonable and exaggerated? I question whether they are too carefree or if I am overly anxious about things that are unlikely to happen.
Although sometimes a voice in my head tells me that these worries are nearly impossible, I still find myself anxious, wondering if I might be the exception who contracts a disease unexpectedly.
I sometimes feel that my excessive worry has clouded my judgment.
How can I determine whether these thoughts are just my obsessive thinking or if they are legitimate concerns?
Some friends have suggested that if I am truly worried, I should get tested; seeing a negative result would bring me peace of mind.
However, my obsessive thinking makes me fear that I might contract something during the testing process.
I also wonder if this is merely a temporary solution, as I might continue to worry if something else happens in the future.
Recently, I considered trying to forget these thoughts as one would after a breakup, by engaging in other activities.
However, those thoughts often return, and I know I have not completely forgotten them.
In the past, I could fully forget certain thoughts, and while they might resurface occasionally, the fear of HIV feels different; it feels like a life-altering condition.
I have read some of your previous responses regarding obsessive thinking, and you mentioned that one of the most effective methods is to redirect attention.
I would like to ask, if I truly try to redirect my attention, would it require dozens or even hundreds of attempts in a day? Would that really help? I envy others who do not have worries like mine, but I seem to be overly concerned about the possibility of getting sick.
I hope you can provide me with some advice.
Thank you.

Niming, 20~29 year old female. Ask Date: 2016/10/26

Dr. Ding Shuyan reply Psychiatry

Hello, when we face problems in the real world, confronting and addressing them bravely is usually a better strategy.
However, with conditions like obsessive-compulsive disorder (OCD), depression, or anxiety, the worries often stem from excessive anxiety about unknown factors.
In such cases, our usual courageous approach to facing problems can actually lead us into a dilemma.
It’s paradoxical, but the fact is that the more we worry about it, the more energy we give to obsessive thoughts, making them stronger and more persistent in our minds, which makes it harder to ignore their presence.

We don’t need to be 100% certain of safety before taking action.
I often joke with my fellow OCD patients that if we really wanted to worry, we could find endless things to be concerned about.
Every aspect of life—food, clothing, housing, transportation—can potentially harbor risks, and the likelihood of encountering danger in daily activities is often greater than that of contracting HIV.
So why don’t we worry about being hit by a reckless scooter when we go out? Yet, we continue to live our lives.
If we could think this way, it wouldn’t be OCD.
Moreover, improving OCD isn’t about coming to a realization; it’s about feeling that we don’t need to constantly dwell on these thoughts, allowing our interests and attention to return to normal life! Redirecting our attention is not about avoidance; it’s about bringing our worries back to a reasonable level.
Our minds automatically generate numerous thoughts daily—some pleasant, some worrisome.
We are the masters of our thoughts; we can decide which thoughts to focus on and address, and which ones to set aside for now.
This involves some logical prioritization rather than being hijacked by obsessive thinking that demands immediate attention, which undermines our autonomy.
Redirecting attention means that when obsessive thoughts arise, we gently shift our focus from those thoughts to our sensory perceptions, such as our breathing, the scenery in front of us, or the walls and ceiling around us.
We can also move our bodies and feel the activity in our muscles and joints; this is a way to return to reality.
If obsessive thoughts occur a hundred times in a day, we can redirect our attention a hundred times.
This process is painless and doesn’t require physical exertion.
We just need to avoid falling into the temptation of focusing on obsessive thoughts again, and instead, casually redirect our attention to other aspects.
For those with OCD, seeing a doctor and taking medication is also a good approach.
A multifaceted strategy is beneficial and doesn’t need to be rejected.
Wishing you all the best.
Dr.
Ding Shuo-Yan

Reply Date: 2016/10/26

More Info

Understanding and managing intrusive thoughts, particularly those associated with obsessive-compulsive disorder (OCD), can be a challenging journey for many individuals. Your concerns about intrusive thoughts related to health, particularly the fear of contracting HIV, are not uncommon among those who experience OCD. It’s important to recognize that these thoughts, while distressing, are a symptom of the disorder and do not reflect reality.

Firstly, it’s crucial to understand that intrusive thoughts are unwanted and often distressing ideas that can pop into your mind without warning. They can be about various topics, including health fears, and can lead to significant anxiety. The key to managing these thoughts lies in recognizing them for what they are: symptoms of OCD rather than reflections of reality.
Your experiences of worrying about potential risks after social interactions, such as drinking with male dorm staff or spending time with a female friend, are examples of how OCD can manifest. The fear of being drugged or infected, despite the lack of evidence or logical reasoning, is a common theme in OCD. It’s essential to challenge these thoughts by asking yourself whether there is any factual basis for them. For instance, consider the likelihood of the scenarios you are worried about happening. Often, the reality is far less concerning than our minds lead us to believe.

You mentioned that your friends do not share your level of concern and that they perceive your worries as exaggerated. This difference in perspective can be frustrating, but it highlights the nature of OCD: it can distort your perception of risk and reality. It’s important to remember that just because others may not worry about the same things does not invalidate your feelings. However, it does suggest that your thoughts may be influenced by OCD rather than actual risk.

Regarding your question about whether these thoughts are a sign of genuine concern or simply OCD, it can be helpful to practice cognitive-behavioral techniques. One effective method is exposure and response prevention (ERP), a form of cognitive-behavioral therapy specifically designed for OCD. ERP involves gradually exposing yourself to the source of your anxiety (in this case, the intrusive thoughts about HIV) while refraining from engaging in compulsive behaviors (like seeking reassurance or avoiding situations). Over time, this can help reduce the power of these thoughts.

You also mentioned the idea of distraction as a coping mechanism. While distraction can be a useful short-term strategy, it is not a long-term solution. Instead, consider integrating mindfulness practices into your routine. Mindfulness involves observing your thoughts without judgment and recognizing them as just thoughts, not facts. This can help you create distance from the intrusive thoughts and reduce their emotional impact.

In terms of managing the frequency of these intrusive thoughts, it’s essential to understand that it’s normal for them to arise multiple times throughout the day. The goal is not to eliminate them entirely but to change your relationship with them. Instead of trying to suppress or fight against these thoughts, practice acknowledging them and letting them pass without giving them undue attention.

Lastly, if you find that your intrusive thoughts are significantly impacting your daily life, it may be beneficial to seek professional help. A mental health professional can provide you with tailored strategies and support to manage your OCD effectively. They can also help you explore the underlying issues contributing to your anxiety and develop a comprehensive treatment plan.

In conclusion, managing intrusive thoughts requires a combination of understanding the nature of OCD, challenging irrational fears, practicing mindfulness, and potentially seeking professional support. Remember, you are not alone in this struggle, and with the right tools and support, it is possible to regain control over your thoughts and reduce anxiety.

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