Cognitive Distortions in OCD, PTSD, and Personality Disorders
Cognitive distortions for those with obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and personality disorders can look a bit different than other everyday thinking errors.
Anyone can catastrophize or overgeneralize things from time to time. However, these thinking errors can be core features of a mental health disorder that simultaneously maintains the other symptoms you feel.
Negative thought patterns in OCD, PTSD, and personality disorders usually follow predictable patterns unique to each condition. For instance, someone with OCD might catastrophize about contamination or personal responsibility, while a person with PTSD may overgeneralize about danger in safe situations. Further, those with personality disorders might engage in all-or-nothing thinking that destabilizes their relationships.
If you’re experiencing cognitive distortions related to a mental health condition, a mental health professional can offer valuable guidance and relief. This page can also help you understand the link between thinking patterns and certain conditions by exploring:
- Unique cognitive distortions for OCD, PTSD, and personality disorders
- How maladaptive thought patterns in mental health work to maintain symptoms
- How treatment for OCD, PTSD, and personality disorders can help to start the healing process from thinking errors
- Where to find professional support
- Answers to frequently asked questions about cognitive distortions
The Definition of Cognitive Distortions
Aaron Beck first identified cognitive distortions in the 1960s while studying depression, noticing his patients interpreted neutral situations negatively in recurring patterns that frequently discounted any positives. These patterns also operated without evidence and generalized the context.1
Thinking errors can often be a part of several mental health disorders and conditions, such as anxiety and depression. They tend to operate in a loop where the thoughts generate powerful emotions, in turn driving your behaviors that then produce results that appear to back up the original thoughts.
Common Cognitive Distortions in OCD
Ruminations and intrusive thoughts within OCD can interact with cognitive distortions to make compulsions feel absolutely necessary, which can be extremely difficult to cope with. The distortions can quickly transform an intrusive thought into what feels like an emergency, demanding immediate action.
Let’s look at this process in a little more detail.
Ties Between Thoughts and Actions
People with OCD often think that having a thought equals needing to act on it or make it more likely to happen. For example, someone with OCD may have an intrusive thought about harming a loved one, immediately concluding that they are then a dangerous person.3
This distortion can turn invasive and intrusive thoughts into pathological self-accusations, necessitating the completion of compulsions to neutralize and contain the imagined danger their thoughts created.
Inflated Responsibility
People diagnosed with obsessive-compulsive disorder often believe they have a responsibility and a duty to prevent harm to themselves or others. They may ask themselves if they remembered to lock the door, which quickly grows into worrying about how it’s all their fault if someone breaks in and harms their family.
Ordinary preparations and precautions typically feel inadequate, as the perceived stakes are so high. As a result, the person checks the locks repeatedly – becoming a compulsion – in order to prevent a possible disaster.
Struggling With Uncertainty
OCD demands certainty, which can be hard in a world in which it doesn’t always exist. The normal tolerance for ambiguity can be strained, prompting those with the disorder to perform compulsions (such as frequent hand-washing) to try to be sure that the contamination is gone.
Perfectionism
OCD perfectionism involves a belief that tasks at hand must be done in the exact right way or a disaster will happen. For example, rewriting emails dozens of times because imperfection feels dangerous.
This perfectionism can also cause people to rearrange objects repeatedly until they feel “just right”, convincing them that any imperfection carries moral or physical consequences.
Common Cognitive Disorders in PTSD
We explain how thinking errors in PTSD can manifest in the following sections.
Sensing Danger
Many people with a trauma background see danger everywhere. If you’ve been in a car accident, you might start avoiding car trips, roads, or anything to do with driving – which can also make day-to-day living difficult.
The thought pattern turns one situation that was dangerous into all similar situations being dangerous, applying trauma-influenced lessons too broadly.
Self-Blaming
Personalization can make you blame yourself for events that weren’t in your control. This distortion creates a false narrative in which you feel you might be able to prevent any future harm. However, this can turn into self-blame that feels more tolerable than accepting that trauma doesn’t always have a distinct cause and can happen at random.
All-or-Nothing Thinking
PTSD shrinks the middle ground, with many situations and places feeling either totally safe or completely dangerous.
Any hint of potential danger can trigger a fight-or-flight response, activating your body’s natural danger response system and preventing re-engagement with normal activities that usually carry minor and acceptable risks.
Fortune-Telling
Fortune-telling for those with trauma usually looks like convincing yourself that bad things will inevitably happen again. Feeling hopeless as a result can maintain negative and depressive symptoms, preventing you from taking positive steps toward recovery. After all, if you couldn’t change anything, then why would it be worth it to try?
Freezing Time
PTSD can also create distortions where past trauma feels very much present and ongoing. People can think they are still in danger for years after the events have ended. This can make it very difficult to recognize that circumstances have changed or even improved.
Further, the effect can also activate triggers for the same patterns that operated during the actual trauma, physically and emotionally, convincing the person that they’re indeed reliving their past experiences.
Common Cognitive Distortions in Personality Disorders
These patterns usually feel like natural parts of the person’s identity, rather than symptoms in need of treatment. Unlike a person experiencing depressive symptoms and recognizing they may need help, many with a personality disorder simply see symptoms as part of themselves. Therefore, they may see no issues.
Distorted self-perception within personality disorders can shape how you view yourself, others, and relationships, defining your sense of reality. We cover this in more detail below.
All-or-Nothing Thinking (and Splitting)
All-or-nothing thinking isn’t unique to personality disorders, but it can be a feature of many. For example, those with borderline personality disorder often view others as either wholly good or totally bad, with no middle ground.
In narcissistic personality disorder, splitting can divide people into two camps: admirers and critics. Anyone not providing constant validation becomes devalued.
Paranoid personality disorder can often similarly feature splitting the world into groups of allies and enemies, with many people falling into the latter. No matter which disorder is being examined, all-or-nothing thinking can cause perceptions to shift dramatically based on scant or missing information.
Catastrophizing Social Situations
Avoidant personality disorder and dependent personality disorder can both cause people to make predictions around social situations, expecting humiliation, rejection, and isolation.
Avoidant personality disorder can frequently cause you to expect any awkwardness as a devastating failure, which differs from social anxiety. Instead, this distortion operates as a constant belief that a social exploration will be ruinous.
Dependent personality disorder, meanwhile, can make you believe you can’t survive without someone else making your decisions for you. Another example includes obsessive-compulsive personality disorder (which is separate from OCD), which may involve catastrophizing about mistakes or a loss of control.
Mind-Reading
Mind-reading can be a difficult cognitive distortion to experience, and it’s often a staple symptom and experience in personality disorders. Borderline personality disorder can cause people to turn to mind-reading to detect abandonment, whereas paranoid personality disorder can lead to interpreting malicious intent in nearly every interaction.
Always being on the lookout and interpreting others’ feelings and actions on their behalf can lead to major interpersonal difficulties. This can make mind-reading a primary driver and reinforcer of mental health challenges.
Distorted Self-Perception
Personality disorders can make it hard to see yourself, inflating or deflating your self-perception. Several personality disorders – along with other mental health conditions – can take a toll on your self-esteem, preventing you from recognizing and celebrating your true capabilities.
Rigidity and Rules
Several personality disorders also involve imposing stringent rules around how things “should” be done, as can PTSD and OCD. However, personality disorders typically revolve around believing there’s only one correct way to do things, be that isolated or as the center of attention.
Breaking Free From Distorted Thinking
The treatments for OCD, PTSD, and personality disorders can all look different, but they share a common goal: helping people recognize that their automatic thoughts don’t define them.
Cognitive-behavioral therapy approaches to these conditions are all applied differently, but each can help you better catch thinking errors as they happen and evaluate situations with more objectivity. Therefore, you can create more space between thoughts and actions.
Treatment doesn’t seek to eliminate difficult memories or eradicate traumatic memories. It looks to help you change the relationship you have toward your challenges and give you new tools for coping and healing.
Specialized approaches like trauma-focused therapy, CBT, dialectical-behavioral therapy, and group therapy holistically address the specific patterns that maintain each condition, giving you the support you need to start and maintain the recovery process.
OCD, PTSD, and Personality Disorder Treatment at Mission Connection
Mission Connection has the expertise and know-how you need to break free from cognitive distortions and thinking errors. Our IOP and PHP programs are flexible and can fit your life while delivering the support and treatment you need to take the next step forward.
Contact us today to learn how our programs can help you break free from maladaptive thought patterns and improve your mental health.
Frequently Asked Questions About Cognitive Distortions in OCD, PTSD, and Personality Disorders
If you have cognitive distortions relating to a mental health condition, it’s understandable to have some ongoing concerns. This is why we’ve provided the following answers to FAQs – to provide as much clarity as possible.
Why Don’t People With Personality Disorders Recognize Their Distorted Thinking?
People with personality disorders typically don’t recognize their thinking errors or the need for treatment, as these feel like natural parts of their identity. They’re how the person has always experienced their reality, unlike the symptoms of PTSD, for example.
However, treatment can greatly improve the quality of life for those diagnosed with personality disorders and struggling with thinking errors, increasing alternative perspectives and demonstrating new interpretations.
How Long Can it Take to Change Cognitive Distortions?
The answer to this question truly depends – some people notice improvements right away, whereas others may need extended participation in treatment to help their underlying or co-occurring conditions.
Progress isn’t the same for everyone, and setbacks can be a normal part of the process.
Are There Other Disorders That Feature Cognitive Distortions?
Absolutely. Depression, generalized anxiety, social anxiety, and more can all feature thinking errors. Your treatment should always be unique and designed with your goals and preferences in mind. Mission Connection is proud to partner with each of our clients to improve their lives and maintain their progress long-term.
References
- Beck, J. S., & Fleming, S. (2021). A brief history of Aaron T. Beck, MD, and cognitive behavior therapy. Clinical Psychology in Europe, 3(2), 1–7. https://doi.org/10.32872/cpe.6701
- Geller, J. (2022). What Is Obsessive-Compulsive Disorder? American Psychiatric Association. https://www.psychiatry.org/patients-families/obsessive-compulsive-disorder/what-is-obsessive-compulsive-disorder
- ADAA (n.d.) Understanding the Difference: Harm-Related Intrusive Thoughts and Wanting to Hurt Someone | Anxiety and Depression Association of America, ADAA. Adaa.org. https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/understanding-difference-harm-related-intrusive
- Van der Kolk, B. (2000). Posttraumatic stress disorder and the nature of trauma. Posttraumatic Stress Disorder, 2(1), 7–22. https://doi.org/10.31887/dcns.2000.2.1/bvdkolk
- MedlinePlus. (2019). Personality Disorders. Medlineplus.gov; National Library of Medicine. https://medlineplus.gov/personalitydisorders.html
