Until the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), obsessive-compulsive disorder (OCD) was classified as an anxiety disorder. Many still consider anxiety to be the defining feature of the disorder, by which obsessions cause anxiety and compulsions alleviate those feelings associated with anxiety.
What is OCD? And how can it affect moods?
The defining feature of OCD is discomfort with uncertainty. Obsessions, or recurrent unwanted thoughts, images, or impulses, often trigger doubt or uncertainty, which is very uncomfortable and distressing to someone with OCD. Ritualistic compulsions, or behaviors that are intended to neutralize, prevent, or eradicate obsessions serve to get rid of doubt, which alleviates distress.
What happens to you when you are in distress and you cannot do anything to relieve it? Do you get angry and lash out at others? Do you get sad or hopeless and isolate? Maybe you feel so overwhelmed and break down and cry. Now imagine that this happens multiple times a day, every day. You would undoubtedly feel emotionally labile and helpless. That is the experience of someone with OCD.
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If any of the above sounds familiar, either because you have experienced it yourself or you have observed it in others, know that you are not alone. Drastic fluctuations in mood can often occur in individuals with OCD. This can be for various reasons. One reason is that the unwanted thoughts, images, or impulses can trigger intense emotions.
For example, having the thought that God does not exist might result in intense guilt. The image of sexual intercourse with a family member might trigger intense disgust and shame. It is common to develop feelings of inadequacy or low self-worth in individuals who experience these thoughts frequently enough. This subsequently contributes to depressed mood.
What are OCD Mood Swings and common symptoms to watch out for
OCD can impact mood when individuals are overwhelmed by their obsessions and/or compulsions. For example, someone may feel so overwhelmed by the frequency and intensity of their intrusive thoughts that they cry for long periods of time. Others may feel so hopeless about their ability to cope with their intrusive thoughts or resist compulsions that they stay in bed and avoid interaction with others. I have personally seen individuals experience intense anger and blame others when they are struggling with intrusive thoughts or strong urges to engage in compulsions. This can include family, friends, significant others, and treatment providers.
Mood swings may also result if an individual is deterred from engaging in compulsive behaviors.
One of the most common compulsions observed in people with OCD is to seek reassurance, either from someone else, from oneself, or from a source (i.e. the Internet). Intense feelings of anger are common when someone with OCD cannot get that reassurance.
If you had a nagging doubt that you did something offensive at a party and you asked your friend if they thought you did anything offensive, would you get upset with them if they would not tell you? This is a common example of when someone with OCD will experience intense anger.
How to manage OCD Mood Swings
One helpful strategy for managing intense emotions when one is struggling with OCD is to externalize the OCD. This is a strategy similar to cognitive de-fusion in Acceptance and Commitment Therapy (ACT). You may have a thought about harming your spouse, but cannot differentiate the discomfort associated with the thought from the fear of actually committing such an act. A common response to this obsession is to seek reassurance from your spouse, such as asking them if they think you would ever harm them or asking them if they think you are a good person.
Externalizing the OCD would involve you saying to yourself, “My OCD is telling me that I want to harm my spouse,” or “My OCD is telling me that I am a bad person because I thought about hurting my spouse.” If your spouse refuses to give you reassurance then externalizing the OCD would involve you saying to yourself, “My spouse is trying to help me and not help my OCD.” If you are the spouse in the situation, it helps to verbalize that you are not going to help the OCD and therefore will not give reassurance.
One must use caution with the practice of externalizing the OCD so that it does not become compulsive. It is critical that you do not tell yourself that the thought, image, or impulse is “just my OCD”. This is a compulsion and is attempting to neutralize the thought. The goal is to accept the thoughts and learn to view them as nonthreatening. That is ultimately going to help you overcome feelings of distress associated with your thoughts.
Next Steps: Seek help
It is important to note that OCD can coexist with other mental health conditions. Mood swings can be a symptom of a co-occurring mood disorder. If you struggle with OCD and experience frequent mood swings you may want to meet with a qualified mental health professional for an assessment to ensure you are getting the best treatment.
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