Magical Thinking: Its Importance in OCD

Magical thinking is also important to OCD because it’s not always its own subset but, rather, a symptom of other subsets. Someone who suffers from Contamination OCD, for example, may believe that they have COVID-19 merely because the thought popped into their head. Someone who suffers from Harm OCD may believe that their father will be killed in a plane crash if they say an unlucky number out loud. Someone who suffers from Relationship OCD may believe that their spouse is having an affair because they pictured him with another woman.

Magical thinking, whether its own subtype or a symptom, is a major component of OCD. And it’s among the most misunderstood as well.

OCD, The Ins and Outs of the Disorder

Obsessions present as intrusive thoughts or ideas that are egodystonic (meaning they go against the sufferer’s values), terrifying, and anxiety-provoking. Compulsions present as the rituals sufferers engage in to prevent their obsessions from coming, or being, true.

Compulsions act as a temporary reprieve from anxiety but, since OCD is never satisfied, the truce is short-lived and the angst always reappears. This causes the sufferer to engage in more (and more and more) compulsions, cementing the OCD cycle.

Over time, compulsions make OCD worse (if OCD is a monster, compulsions are its food). They lock in the intrusive thoughts, giving them validity and enhancing OCD’s power. The only way to truly stop OCD is to stop the compulsions (a concept that is much easier said than done).

Intrusive Thoughts in the General Public

While intrusive thoughts define OCD, they’re present in other mental illnesses as well as the general public. It’s believed that virtually everyone experiences intrusive thoughts from time to time. However, there are two distinctions that make intrusive thoughts different in OCD sufferers.

To begin, and most importantly, the OCD sufferer takes these thoughts seriously and, while they might not 100% believe them, they believe them enough. OCD feeds on this doubt and asks the sufferer, “What if the thoughts are true?” People without OCD, on the other hand, cast these thoughts aside, label them as nonsense, and ignore them entirely.

Second of all, intrusive thoughts are more frequent (and more terrifying) in people with OCD. This is because sufferers give the thoughts power and, if you give OCD an inch, it takes a mile (and another mile and another). In other words, the more attention OCD gets, the more it demands.

All of this works to feed the OCD cycle.

The Specifics of Magical Thinking OCD

Sufferers with these kind of thoughts may give meaning to numbers they perceive as unlucky, sounds, or colors. They may have additional fears that certain words will cause tragedy (such as the word “crash” causing an airplane to plummet from the sky) or that performing (or failing to perform) certain actions will lead to disaster. The latter may involve superstitions, as many people believe that specific actions (like walking underneath a ladder or breaking a mirror) will result in bad luck. But OCD is like superstitions on steroids. It’s not limited to folklore, either.

While the Magical Thinking OCD sufferer may be afraid of crossing the path of a black cat or they may make sure to avoid opening umbrellas indoors, they will also fear things that go well beyond stereotypical superstitions. For example, they may fear that wearing red will cause a loved one to die or that eating Cheerios instead of Lucky Charms will cause them to fail their midterms. They believe these things for no reason other than their OCD tells them to.

Common Magical Thinking Obsessions

Magical Thinking OCD is pretty much limitless in the obsessions it invites (limited only by the imagination). But there are telltale obsessions among the most common, including:

• The sufferer believes that harm will come to themselves or others unless they avoid particular words, sounds, phrases, numbers, or colors
• The sufferer believes that harm will come to themselves or others unless they say, make, or wear particular words, sounds, phrases, numbers, or colors
• The sufferer believes that harm will come to themselves or others unless they do things a specific way (often, these “things” are not important to everyday life – their OCD tells them they must load a dishwasher a certain way or read a book a certain way)
• The sufferer believes that harm will come to themselves of others unless they neutralize “bad thoughts” with “good thoughts” (for instance, if a sufferer says the word “death” they might have to neutralize it by saying the word “life”, by clapping, by snapping, by praying, or by engaging in some other type of compulsive behavior)

Common Magical Thinking Compulsions

Like with all types of OCD, compulsions in Magical Thinking OCD are designed to prevent something bad from happening (or assure that it hasn’t already happened). Among the most common compulsions for this subtype and/or symptom include:

• Repeating words, sounds, phrases, or numbers that the sufferer believes are good
• Wearing or looking at colors that the sufferer believes are good
• Performing minor tasks (such as zipping a jacket or organizing a spice rack) over and over again until it feels right
• Performing tasks at certain times of the day as a matter of routine (because the OCD sufferer fears that if they don’t act at the perfect time then something bad will happen)
• Engaging in common superstitions, such as throwing spilled salt over the shoulder or knocking on wood
• Reorganizing or cleaning things a certain way (this is where Magical Thinking OCD and Contamination OCD might merge)
• Counting to numbers the sufferer believes are lucky or doing things in lucky numbered sequences (such as brushing one side of your teeth exactly 21 times)
• Avoiding numbers the sufferer believes are unlucky and making sure not to do things in an unlucky numbered sequence (those with OCD may run 14 laps around the track instead of 13 because 13 feels unlucky)
• Touching things a certain number of times
• Touching things a certain way (such as tapping a particular pattern)

Some OCD sufferers dislike odd numbers, believing they can cause something bad to happen. However, this is not a hard and fast rule and, often, people with OCD deem numbers “lucky” or “unlucky” for other reasons than their potential pairing (or for no sensical reason at all).

What Causes Magical Thinking OCD?

The OCD brain is a brain that is abnormal both in structure and in function. In particular, vital parts of the communication process are compromised between the front areas of the brain (including the orbitofrontal cortex and the anterior cingulate cortex) and the deeper parts (including the striatum and thalamus). This is perhaps why people with OCD have differing levels of neurotransmitters: Miscommunication results in too little serotonin and, maybe, too much glutamate.

Genetics play a large role as they tend to do, a hypothesis that, though only recently proven, was long suspected among doctors and scientists. OCD tends to run in families (this is not limited to families with OCD but also those with other types of anxiety and autism).

In general, 25% of people with OCD have an immediate family member who has it as well. In twins, this link is more profound: If one fraternal twin has OCD, the other has it 50% of the time but, if one identical twin has OCD, the other has it 90% of the time. This points to guilty DNA since identical twins share the same code.

Even with the above, most people who have a genetic disposition to OCD don’t develop it. Likewise, having no genetic disposition does not render one immune.

Behavioral conditioning is crucial to the mental illness as behavior is what turns OCD into a full-fledged disorder. Because OCD is reliant on compulsions (i.e., behavioral conditioning), in can’t survive without the sufferer engaging in their rituals.

Dysfunctional Beliefs in OCD

OCD sufferers possess several dysfunctional beliefs that keep their disorder at the forefront. Per the Obsessive-Compulsive Cognitions Working Group, there are six types of beliefs that help explain why the condition persists as much as it does. These include:

• Possessing an overinflated sense of responsibility: OCD sufferers suffer from hyper-responsibility, believing it’s their duty to prevent bad things from happening in a way that is well outside of realistic.

In Magical Thinking OCD, this belief may manifest as the sufferer believing they have to eat exactly eight peas for dinner or else a train will crash later that night.

• Engaging in thought-action fusion: This is another way to describe magical thinking and it’s present in the different subtypes of OCD. It’s simply the idea that thinking a bad thought will cause something bad to happen. It equates thoughts with actions (e.g., OCD insists that thinking of stabbing your child is the same thing as doing it).

In Magical Thinking OCD, this belief dominates as the sufferer is constantly met with the idea that their thought or ideas can alter real life in a tragic way.

• Trying to control thoughts: Because the intrusive thoughts present in OCD are so terrifying and anxiety-provoking, the sufferer understandably wants them gone. As a result, they attempt to control their thoughts, unwittingly making them stronger in the process. They also make them more frequent as there is no way to not think of something without actually thinking about it.

In Magical Thinking OCD, this belief may manifest as the sufferer attempting to cancel out “bad” thoughts with “good” ones. For instance, if they have a thought about a loved one drowning, they may force themselves to picture their loved one wearing a life jacket.

• Overestimating the threat: OCD sufferers, in addition to an inflated sense of responsibility, tend to overinflate threats as well. For example, while leaving a coffee pot on all day may cause the pot to burn, the OCD sufferer fears something much more tragic, such as a five-alarm fire that kills their cats and dogs.

In Magical Thinking OCD, sufferers overestimate a non-existent threat because they give power to things that are powerless (thoughts, words, unlucky numbers, etc.).

• Trying to be perfect: Perfectionism is not exclusive to OCD; in the general population, about a third of people identify as perfectionists. But it does appear in OCD frequently and sufferers tend to hold themselves to ideals despite offering compassion for the imperfections of others.

In Magical Thinking OCD, this belief may manifest as the sufferer believing they must draw a picture perfectly or play the piano without committing any errors or their brother will get a deadly disease.

• Hating uncertainty: OCD sufferers strongly dislike uncertainty and struggle to tolerate it. In fact, it is uncertainty that is truly the crux of the disorder. OCD sufferers often recognize that their behavior is irrational but they’re not 100% certain and OCD requires proof beyond a shadow of a doubt.

In Magical Thinking OCD, uncertainty is especially tricky because the sufferer will argue that thoughts, numbers, colors, or sounds could cause the universe to do bad things. While they recognize the impossibility in their obsessions, the imp in their mind whispers “What if?” When it comes to OCD, logic is never proof enough.

What Doesn’t Cause Magical Thinking OCD?

Magical thinking doesn’t involve frivolous things. Case in point: The sufferer doesn’t fear that thinking about winning the lottery will cause them to win it (though this kind of thinking may be present in manifestation techniques that are outside of OCD).

Those with OCD, even when the thoughts urge the sufferer to perform a compulsion so that something positive happens, also don’t take credit for fortunate outcomes. This is because OCD focuses on fear, not fantasy.

For example, if an OCD sufferer’s mother is undergoing heart surgery, they might perform several rituals to assure that nothing goes wrong. But, when their mother comes out of surgery free of complications, they won’t turn to the doctors and say, “Look what I did!” If their mother dies and they don’t perform their compulsions, however, they will believe it’s their fault. OCD is a Debbie Downer, focused on the negative.

Magical Thinking OCD isn’t a reflection of actual risk, either. For example, someone who fears that driving sixty-miles through their neighborhood could cause them to hit a child is not experiencing an OCD thought. Instead, their fear is legitimate because speeding down a residential road does invite disaster. Thus, it’s a sense rooted in reality, not imagination.

In contrast, the Magical Thinking OCD sufferer experiences thoughts that tell them they’ll hit a child if they don’t turn off a certain song playing on the radio or if they fail to tap the steering wheel exactly 16 times. The sense is rooted in imagination; reality plays no role at all.

As for OCD in general, there are several things that don’t cause it, although they were implicated in the past. Non-guilty parties include:

• Over-domineering toilet training
• Parenting
• Upbringing
• Latent anger or sexual frustration
• Stress (though not a cause, stress tends to make underlying OCD worse and might trigger its initial onset)

Misconceptions About Magical Thinking OCD

OCD is nowhere near as common as society tends to believes, either (people who suggest they’re “so OCD” generally don’t have OCD and simply like things done a certain way).

When it comes to magical thinking, more misconceptions exist because it’s human nature to hope that our thoughts can dictate outcomes. For instance, some believe in positive thinking, vision boards, and manifesting. Many are superstitious too, at least to some degree.

However, there are a couple important differences between magical thinking in the general public and magical thinking in OCD. To start, the general public tends to limit their magical thinking to beneficial things; they focus on fantasy, not fear. For instance, they encourage positive thinking or putting positive energy out into the universe in hopes that something wonderful will happen. And they engage in this thinking willingly.

While there are some people who can be quite superstitious, it’s not in a way that dictates their life. For example, baseball players are notorious for their superstitions, with some consistently using the same bat, eating the same breakfast on game day, and, if the rumors are true, refusing to change their underwear when on a winning streak. But, outside of America’s favorite pastime, their superstitions don’t tend to persist.

What’s more, the power of the thoughts, whether they involve positivity or superstition, is nowhere near as potent in the general population as it is in people with OCD. They’re not as frequent or intrusive either. A non-OCD person may spend a few minutes each morning thinking good thoughts in hopes that they’ll have a good day or avoid walking under a ladder if they happen to see one while jogging down a city street. Someone with OCD, on the other hand, is constantly bombarded by magical thinking fears – they’re uninvited, unwanted, and terrifying.

Perhaps most important are the compulsions: People without OCD don’t have them (or at least not in a way that is debilitating); people with OCD do. For example, a non-sufferer may feel a bit on edge if they cross the path of a black cat but, after a while, they’ll tend to forget about it and go on with their life. A sufferer, on the other hand, turns to rituals in order to relieve their anxiety.

The length of these rituals varies; some are short and some are long. Yet the pattern always persists – someone with OCD who counts to a lucky number after crossing paths with a black cat will feel relief only for a while. The anxiety always returns, forcing the sufferer to reengage in their rituals. Magical thinking, in the general population, does not come with this kind of doubt.

Magical thinking is problematic when it’s accompanied by a mental illness because, in these instances, the thinking cannot carry on as a benign thing and affects the sufferer greatly. OCD is not the sole mental illness where it may be present; it pops up in schizophrenia and general anxiety as well.

Treatment for Magical Thinking OCD

CBT with ERP: This is considered the gold standard of OCD treatment and many medical professionals argue that OCD can’t be treated without ERP. During this treatment, sufferers are instructed to expose themselves to their distressing thought and then refrain from performing their neutralizing ritual.

For example, in Magical Thinking OCD, the sufferer may be asked to think about a plane crashing and then instructed to avoid any kind of anxiety-reducing behavior (such as praying, counting, or cancelling out the bad thought by imagining a plane landing safely). In another example, the sufferer may be asked to tell themselves that their uncle will die unless they flip a light switch on and off 20 times. They’ll be instructed to refrain from touching the light switch and, instead, asked to sit with their discomfort.

While ERPs sound easy on paper, they are extremely hard in practice and cause all sorts of anxiety. But they do work! Someone who refrains from touching a light switch after picturing their uncle dying sees their uncle live and recognizes that their actions (or lack thereof) have no influence on reality.

Medication: The main purpose of medication is that it helps make ERPs easier to perform, reducing the anxiety enough that treatment is successful. Medication isn’t for everyone, with roughly 70% of people responding.

Even in the responsive, medication won’t eliminate intrusive thoughts altogether (at least not as a rule) but it does make the thoughts less potent and less realistic.

One of the biggest challenges with OCD meds is finding one that works. Some people have a faster-than or slower-than drug metabolism (determined by their genes) that may make the most common OCD drugs ineffective. Others have pre-existing conditions, leaving them especially prone to side effects.

The first medications most often tried include Serotonin Specific Reuptake Inhibitors (SSRIs), a class of antidepressants that increase serotonin (which runs low in OCD). Drugs that may be prescribed include:

• Prozac
• Lexapro
• Celexa
• Zoloft
• Luvox
• Paxil

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are prescribed as well. These are closely related to SSRIs but instead of just increasing serotonin, they increase norepinephrine as well.

Anafranil (or Clomipramine) is a tricyclic antidepressant that has skyrocketed in use over the past few years and it’s believed to be among the most effective medications. Clinicians who employ more extensive treatment, like brain stimulation, may not consider patients until they’ve tried Anafranil. The downside is that this medication can have some unwanted side effects, including hunger that results in weight gain.

Off-label meds are increasingly used too. These are drugs that the FDA has not explicitly approved for use in OCD (though they are approved for other conditions) but anecdotal reports as well as scientific research suggests that they’re effective in treating obsessions and compulsions.

Among the most common drugs in this category include:

• Tramadol
• Risperdal
• Haldol
• Seroquel
• Zyprexa
• Valium
• Abilify
• Xanax
• Buspar
• NAC
• Namenda
• Pristiq
• Ketamine

Anyone who is interested in medication to help treat their OCD benefits from knowing what kind of drug metabolizer they are, including:

• A Poor Metabolizer: People who are poor metabolizers break down medications very slowly, resulting in increased drug levels in their system. This can result in intolerable side effects.
• An Intermediate Metabolizer: People who are intermediate metabolizers break down medications at a slower-than-normal rate, though it’s not as slow as those who are poor metabolizers.
• An Extensive Metabolizer: People who are extensive metabolizers break down medications at the normal rate.
• An Ultra-Rapid Metabolizer: People who are ultra-rapid metabolizers break down drugs much faster than normal. This can render the drugs void because the body effectively chews them up before their effects kick in.

Drugs are designed with extensive metabolizers in mind because the majority of the population belongs in this category (between 67% to 90% of people across the globe). Thus, being on either end of the spectrum can compromise medicinal response.

People with OCD (or anyone else) can find out what kind of metabolizer they are through a genetic test based on a sample of saliva. It requires a doctor’s referral but it’s typically covered by insurance. And it serves as a true timesaver.

ACT Therapy: Acceptance and Commitment Therapy (ACT) has recently climbed the treatment ranks. In ACT, the focus lies on accepting the intrusive thoughts and viewing them from a place of dissociation rather than reacting to them. Sometimes, ACT employs imagery to help the sufferer feel removed, such as picturing their intrusive thoughts on a billboard or movie screen.

ACT requires psychological flexibility, compassion for self, mindfulness, nonjudgment, and a willingness to face fears. Ideally, sufferers learn to view their thoughts as if they’re words in a book. In short, the thoughts are not a part of them but apart from them.

In Magical Thinking OCD, the sufferer may experience an intrusive thought that tells them that they’ll get pneumonia if they don’t wear a blue shirt that day. Rather than fighting back against the thought (and certainly instead of pulling on a blue shirt), the sufferer is instructed to state, “I’m having the thought that, if I don’t wear blue, I’ll get a pneumonia.” By labeling it as a thought, something that has no power, the sufferer is better able to detach from it and refrain from performing their rituals (both in ERP and ACT, this is the key).

Some clinicians focus on ACT as the main OCD treatment but most recommend that it’s coupled with ERP, hypothesizing that it might not be effective (or as effective) without it.

Lifestyle: It’s not recommended that people self-treat OCD and professional help is always warranted. Still, there are some things those with OCD can engage in to help keep their illness as controlled as possible.

Unsurprisingly, a healthy lifestyle helps control symptoms because it helps control stress (which, as previously noted, almost always makes OCD worse). It’s recommended that people who have OCD:

• Avoid diets high in fat, red meat, processed foods, or sugar and instead opt for diets rich in fruits, vegetables, nuts, lean protein, and whole grains
• Adopt an exercise routine
• Practice yoga, mindfulness, self-compassion, or meditation
• Limit caffeine, alcohol, and tobacco
• Join support groups and speak openly about their disorder
• Maintain social circles and engage in high-value activities
• Set up weekly appointments with a therapist who specializes in OCD

TMS: A new but not oft-used treatment for OCD is Transcranial Magnetic Stimulation (TMS). Most insurance companies don’t yet cover it for OCD (though they do for major depressive disorder) but clinicians employ it, nonetheless. It’s usually reserved for those who have failed more traditional routes of treatment.

TMS is a non-invasive procedure that eases OCD symptoms by using magnetic stimulation to regulate the deep areas of the brain linked to the disorder. The treatment is short, but intensive with daily appointments required for around 4-6 weeks. After treatment ends, maintenance appointments are recommended.

Finding an OCD Therapist

People with OCD seeking therapy should look for therapists who specialize in the disorder and who have the educational resume to back this up. Often, the best OCD therapists have completed intensive trainings or are accredited by an OCD organization.

One of the best places to start is the International OCD Foundation’s directory. This lists OCD providers by zip code so patients can find help nearby. Alternatively, more and more therapists offer teletherapy, making treatment easier to get than ever.

References:

https://iocdf.org/about-ocd/

https://www.livescience.com/44687-most-people-have-unwanted-thoughts.html

https://iocdf.org/about-ocd/what-causes-ocd/

https://pubmed.ncbi.nlm.nih.gov/9193129/

https://beyondocd.org/information-for-parents/helping-a-child-who-has-ocd/causes-of-ocd-in-children

https://www.sciencedaily.com/releases/2000/04/000426080211.htm

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4143776/

https://www.nature.com/articles/gim201680

https://www.health.harvard.edu/blog/transcranial-magnetic-stimulation-for-depression-2018022313335

https://iocdf.org/ocd-finding-help/find-help/