Understanding OCD, Intrusive Thoughts and Neurodivergence
28 July – written by Katrin Kemmerzehl – Blog
Have you ever found yourself replaying a conversation long after it ended? Wondering whether you said the wrong thing, forgot something important or made the right decision? Perhaps you have gone back to check that you locked the door, reread an email before sending it, or found yourself imagining all the different ways a situation could unfold.
Most of us have moments like these. We think things through, look back on what has happened and try to work out what might happen next. Sometimes that helps us make sense of things and move on. Other times, our thoughts can be much harder to put down.
We are all trying to make sense of ourselves, the people around us and the world we live in. We notice patterns, solve problems, learn from experience and look for meaning when life feels uncertain (Kahneman, 2011).
For some neurodivergent people, thinking deeply and noticing details can be a natural part of how they experience the world. A question might stay with you for longer. Something small that someone else barely notices might stand out straight away. You might want to understand something properly before you can move on, or find uncertainty particularly difficult to sit with. Research has also explored the relationship between autism and intolerance of uncertainty (Wigham et al., 2015).
There can be something valuable in this way of thinking. Curiosity, attention to detail, persistence and a desire to understand things deeply can all be strengths.
But sometimes the wish to understand or feel certain can become exhausting. A question that seemed small at first can start taking up more and more space. You might replay the same conversation, look for reassurance, check something again, or find yourself caught up in another “What if?”
And the difficult part is that thinking it through can feel as though it should bring relief. Yet somehow, the more you think about it, the harder it becomes to leave it alone.
Sitting with everyday uncertainty
None of us can know exactly what will happen. We can’t know what someone else is thinking, guarantee that we will never make a mistake, or be certain that nothing difficult will happen. Most of the time, we live with these little uncertainties without giving them much thought.
With OCD, uncertainty can be much harder to leave alone. A small doubt might keep coming back. A question can feel as though it needs an answer before you can move on. Even a passing thought can suddenly feel important, as though you need to work out what it means or make sure everything is okay (Freeston et al., 1994).
It makes sense that we might then look for ways to feel more certain. You might check something again, ask someone for reassurance, search online, replay a conversation in your mind, or try to convince yourself that everything is fine. For a little while, that can bring a sense of relief.
But the relief often doesn’t last. Another doubt appears, another question comes to mind, and before long you can find yourself back where you started. What began as an attempt to feel safe or certain can gradually become an exhausting cycle that takes up more and more space in everyday life (NICE, 2022).
When your thoughts don’t define you
One of the hardest parts of OCD can be having thoughts that feel completely out of keeping with who you are. You might be a kind person who has frightening thoughts about causing harm, a loving parent who is disturbed by an unwanted image, or someone who values honesty yet finds yourself repeatedly questioning whether you have done something wrong. Having a thought like this doesn’t mean you want it to happen, and it doesn’t make you a bad person (International OCD Foundation, 2023).
Intrusive thoughts are something most of us experience from time to time. What can make them so distressing with OCD is the feeling that you need to understand them, find an answer, or somehow make sure that everything is okay. The more important or frightening a thought feels, the harder it can be to leave it alone (Salkovskis, 1985; Rachman, 1997).
If you recognise yourself in this, you are far from alone. OCD can centre around many different parts of life, including relationships, health, morality, religion, sexuality, contamination, responsibility or fears about causing harm. The subject of the thought can be very personal, but the experience can leave you caught in a tiring search for certainty (International OCD Foundation, 2023; NICE, 2022).
Sometimes, beginning to understand that having a thought is not the same as wanting it, believing it, or acting on it can bring a little relief.
When OCD and Neurodivergence Can Feel Similar
A question that comes up quite often is, “How do I know whether this is part of my neurodivergence, or whether OCD is involved?” It can be difficult to tell, because some experiences can look very similar from the outside.
For example, routines can be comforting for an autistic or AuDHD person because they bring a sense of predictability and calm. You might genuinely prefer knowing what is going to happen, having things done in a particular way, or following a familiar routine. With OCD, there can be something different underneath. The routine may feel less like a preference and more like something you have to do because you are worried about what might happen if you don’t (National Autistic Society, 2024; NICE, 2022).
Something similar can happen with thinking. Many neurodivergent people enjoy going deeply into a subject, following an idea or trying to understand something properly. You might replay a conversation because you are curious about what happened or still have something you want to understand.
With OCD, the thinking can feel very different. You may find yourself going over the same conversation again and again, wondering whether you said something wrong, whether someone is upset with you, or whether you can ever be completely certain that everything is okay. You might know that you are unlikely to find a definite answer, but still feel pulled back into the thought (Salkovskis, 1985).
People with ADHD and AuDHD can also describe getting stuck on unfinished thoughts, replaying conversations or finding it difficult to move their attention elsewhere. The important part is often how it feels. Is the thinking interesting or absorbing, or does it leave you anxious and unable to let it go? Is a routine something that helps you feel settled, or does it feel as though you have no choice but to follow it?
Of course, things are rarely completely clear-cut. Neurodivergence and OCD can exist alongside each other, and sometimes it takes time to understand what is happening. Rather than trying to find the perfect label for every experience, it can be more helpful to become curious about what you notice in yourself, what seems to help, and what leaves you feeling stuck.
You might find yourself asking:
What am I feeling when this happens?
Does this bring me comfort or genuine interest?
Or do I feel anxious, uncertain and unable to leave it alone?
There may not always be a simple answer. Understanding yourself can be a gradual process, and approaching these experiences with a little more curiosity and compassion can be a helpful place to begin (Neff, 2003).
Taking the first steps
Living with OCD can be exhausting, especially when thoughts take up a lot of your time and attention. There may not be a quick or simple way through it, but things can change gradually, and small shifts can sometimes make everyday life feel a little lighter.
For some people, part of this is finding a different way of relating to difficult thoughts. You might begin to notice a thought without feeling that you have to work it out, check it or do something about it straight away. Over time, there can be more space for uncertainty, and more room to bring your attention back to the people, activities and parts of life that matter to you. This is not always easy, but even small changes can begin to create more freedom in everyday life (International OCD Foundation, 2023).
If OCD is having a significant impact on your life, support is available. Some people benefit from specialist OCD treatment, while counselling can also provide a supportive space to talk about what you are experiencing and how this is affecting your life (NICE, 2022). You do not have to make sense of it all on your own.
How counselling can help
Counselling can offer a space to talk about thoughts that feel difficult, frightening or hard to let go of. You might find yourself questioning what a thought means, going over it again and again, or worrying about something that other people might not understand. Having somewhere to talk about these experiences without judgement can help you feel less alone and begin to make sense of what is happening.
Living with OCD can be exhausting, especially when you have spent a long time keeping your thoughts to yourself or worrying about what they might say about youIf you are autistic, have ADHD or are AuDHD, we can also explore how this might fit into the bigger picture of your life and experiences.
Counselling can be a gentle place to talk things through, understand yourself a little more clearly and find ways of moving forward that feel more manageable. If something here feels familiar, you are very welcome to get in touch.
References
- Abramovitch, A., Dar, R., Mittelman, A., & Schweiger, A. (2021). Don’t judge a book by its cover: ADHD-like symptoms in obsessive-compulsive disorder. Psychiatry Research, 302, 114025.
- Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17(6), 791–802.
- International OCD Foundation. (2023). What are intrusive thoughts?
- Kahneman, D. (2011). Thinking, fast and slow. Penguin Books.
- National Autistic Society. (2024). Obsessive compulsive disorder (OCD) and autism.
- National Institute for Health and Care Excellence. (2022). Obsessive-compulsive disorder and body dysmorphic disorder: Treatment (Clinical Guideline CG31).
- Neff, K. D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85–101.
- Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35(9), 793–802.
- Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23(5), 571–583.
- Wigham, S., Rodgers, J., South, M., McConachie, H., & Freeston, M. H. (2015). The interplay between intolerance of uncertainty, anxiety, repetitive behaviours and restricted interests in autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(4), 943–952.
Katrin Kemmerzehl
I’m a qualified counsellor based in Newcastle upon Tyne.
Please get in touch if you’d like to arrange a consultation.