The following is an essay written by a 16-year-old girl who engaged in evidence-based exposure and response prevention treatment for anxiety and Obsessive-Compulsive Disorder with Staff Social Worker, Courtney Muller, LICSW. She has since graduated from treatment and wrote this essay independently to destigmatize mental health for teens and spread the word about effective mental health care. She has graciously agreed to allow us to share her essay with our community, in the hopes of helping others who are experiencing similar challenges.
When I was 14, I started having scary thoughts about knives. They were usually violent, unsettling, or just random. I didn’t know why these were happening, but right before my 15th birthday, it started to become a big issue. I started imagining knives everywhere—attacking myself, other people, and inanimate objects—and even though I couldn’t see them, I felt that I was going crazy. Soon, they were consuming most of my day. I felt extremely anxious to go to school and do my activities, and it became harder for me to concentrate in my classes. I’ve always had anxiety, so I was familiar with the term “intrusive thoughts," which are ideas and images that are uninvited and unwanted, but I still felt so embarrassed that I was having these thoughts and didn’t tell anyone.
Common misconceptions about violent intrusive thoughts are that the sufferer is also violent. In reality, intrusive thoughts fixate on ideas that bother people the most, and people experiencing violent thoughts are often gentle and dislike aggression. Rationally, this normalized unwanted thoughts for me, but my stress level was too high to fully grasp it. Although I kept silent about the inner turmoil I was experiencing, my family noticed how agitated I was. My parents brought me to a psychiatrist to be interviewed, and I learned that I have Generalized Anxiety Disorder, which shares similarities with OCD. I discussed my aggressive thoughts with the psychiatrist, who was non-judgmental and acknowledged that I was a very safe person. After that, I felt compelled to tell my family about my disturbing thoughts, and as soon as I told them, they were incredibly supportive of me.
My parents found an amazing therapist for me who knew exactly how to deal with intrusive thoughts. I learned to look at my thoughts objectively, not engaging with them but just observing. Because I have a tendency for intrusive thoughts, other themes popped up: death when my classmate passed away, the fear of losing control, and a stressful incident at my orchestra. Before therapy, I’d often go online to find reassurance for my obsessions. But with her help, I was able to resist the reassurance and instead do exposures and desensitize myself to the fear. An exposure is when you feel the fear associated with a thought and don’t try to fight it, which makes the thought less likely to return. Reassurance works the opposite way because it shows your body that the thoughts have merit.
One exposure that I did often for my violent intrusive thoughts was holding a knife for six minutes. In the beginning, it was scary for me, but after a while, I realized that I was a perfectly safe person who wouldn’t act on those thoughts. With the support and love from my family, friends, and therapist, I became even more confident and learned how to radically accept myself and my thoughts. My mom encouraged me to do exposures with knives, even asking me to place a butterknife flat on her hand for an exposure so that I could become more desensitized. I cultivated self-compassion and realized that my thoughts didn’t define me.
Although I still occasionally have intrusive thoughts, they usually don’t bother me at all. It’s crucial for people with GAD and OCD to have access to the right forms of therapy. For someone with intrusive thoughts, traditional talk therapy as opposed to exposure therapy might even be harmful. Misinformation about intrusive thoughts can be very damaging for someone with GAD or OCD. There are probably a lot more people who struggle with intrusive thoughts but feel too embarrassed to share them. Therefore, it’s extremely important to break the stigma and misconceptions around intrusive thoughts and support people with GAD or OCD by trying to understand how these thoughts operate and not placing judgment on them.