OCD Core Fears: The Man Behind the Curtain

 

 – by Madison Di Silvio

The core fear is an important part in the treatment of Obsessive Compulsive Disorder.  Identifying the core fear is like revealing “the man behind the curtain” of OCD; we must pay attention to it in order to understand how it is controlling thoughts and compulsions.

What is a Core Fear?

The “core fear” in relation to OCD is the ultimate reason the sufferer does compulsions. OCD obsessions and compulsions can seem quite unclear and random to an outside observer and even the sufferer themselves at times. But looking at the core fear as the reason why this person feels compelled to engage in compulsions to prevent the obsession from happening makes these obsessions more clear. 

Some common examples of core fears include feeling:

• judged or ashamed
• abandoned or rejected
• contaminated 
• not good enough, worthless, or a disappointment
• powerless or manipulated
• like a “bad” person, or a person who has no morals
• uncertain or not in control

These core fears show up across all OCD subtypes. The issue is that individuals become so focused on the situation at hand, they are unaware that it is the core fear that is making the situation seem “dangerous”.

Let’s look at a few examples:

• Say you have Pedophilia OCD (POCD) or Post Partum OCD (PPOCD). You love children with everything you have so your OCD makes you think you are a danger to them so you avoid them. However, the core fear isn’t actually about causing physical or sexual harm, it’s about being an “evil” or not “morally sound” person.

• Say you have Health OCD or Mental health OCD. You love your life with everything you have so your OCD makes you think you are sick and going to lose your life due to a physical or mental illness. However, the core fear isn’t about developing the illness, but rather  about what that would mean for your life: uncertainty, being powerless, and being vulnerable. 

• Say you have Relationship OCD (ROCD). You love your partner with everything you have so your OCD makes you think you don’t love them/they don’t love you. However, the core fear is about something other than whether you love them or not. It’s about losing them, being inadequate, or being without connection. 

 

It’s like quicksand, they always say don’t move fast to try to get out; because the more you do the more you will sink. The function of moving quickly to get out of the quicksand is to save yourself. When you move too fast thinking you are trying to save yourself you end up doing the opposite and sinking. OCD is like quicksand; the more we try to escape our feared outcomes, the more trapped we become.

 

Why is it important to identify the Core Fear?

It’s important to identify core fears in treatment for a few reasons. First,  everyone’s core fears are different. Even if two people have the same OCD subtype, they may have different core fears. If that’s the case, then the treatment and exposures for each person would be also different.

Second, identifying the core fear by acknowledging the “man behind the curtain” provides context for people to understand their OCD.  Without this understanding, people with OCD will only fixate on how to prevent a feared outcome from occurring in a given situation. This may actually prevent them form actually according to their their values.

• In the POCD and PPOCD example, we see the person spending all their time avoiding the children they love so much just like they would if they actually were taken away from these children for being “evil” or “morally corrupt”.

• In the Health/Mental Health OCD example, we see the person tirelessly searching for signs of a physical or mental illness taking them away from the life they love and want so desperately not to change. Making them feel powerless and uncertain.

• In the ROCD example, we see the person doing compulsions that could ultimately lead to a drift in the relationship they are so worried they will lose. Making them feel less connected or inadequate. 

It’s important to understand that the life OCD is so strongly trying to persuade you from happening is actually leading you into that life. All of the above examples are people who are the opposite of these core fears. They are in control (a much as one can be). They are a kind and caring person. They are with love and connection. Yet, OCD had convinced them they are staying safe and preventing their worst fears from happening when instead it manipulated them into living that fear.

 

How do I identify my Core Fear?

In order to identify your core fear we first have to know what we value. Once we know this it’s easier to identify what we fear. Naturally, those with or without OCD want to protect what they value and care about most. Those with OCD are just a bit more protective of it. 

Examples of values include:

• being a good person, kind person, caring person
• having a purpose, being useful, having a community
• having control (which is something we don’t always have control over)
• being successful, feeling happy, being healthy
• independence, autonomy, inner peace

A therapist who specializes in OCD will support clients in identifying their values and how they relate to the overall theme of their intrusive thoughts. The two will then work together to create a detailed plan of exposures that will target their unique core fear.

 

Treatment

If you suspect you or someone you love is suffering from OCD know there are  effective treatments: 

• Exposure and Response Prevention (ERP): ERP is the gold standard treatment for OCD. It involves exposing yourself to your fears and not responding with compulsions. This idea ultimately teaches your brain that your fears are not as valid as originally thought. When we start to respond differently our brain learns to fear the stimuli less without doing anything to solve it. 

• Acceptance and Commitment Therapy (ACT): ACT is another form of treatment for OCD in which the sufferer learns to lean more into their values and uncover how those values don’t align with their feared subtype. ACT encourages the sufferer to engage in values-based behavior to get more in touch with who they are instead of who OCD says they are. 

• Inference-based Cognitive Behavioral Therapy (ICBT): ICBT is a newer approach to the US and is more of a cognitive approach to help the suffering slow down and understand the inferences they made to get them to do the compulsion. When the sufferer learns the reasoning behind why they continue to engage in compulsions it becomes easier to recognize their faulty reasoning ultimately limiting their need to do compulsive behavior. 

• Medication: SSRIs and other mental health medications prescribed by your psychiatrist or primary physician have been known to reduce the symptomology of both the physical and mental components of OCD. Research has shown when used in conjunction with therapy medication has had great effects. 

 

Seeking Mental Health Support

No matter how much OCD tries to convince you that you are alone in your thoughts this subtype like many others is more common than you’d think. It is important to seek therapy from a therapist who specializes in OCD. Consider scheduling an appointment with Chicago Counseling Center. Our therapists can provide guidance, support, and strategies tailored to your specific needs. Meet our team to learn more!