Thought-Action Fusion

Thought-action fusion is the name given to the mistaken belief that a "bad thought" is equivalent to a "bad action".  Many OCD sufferers will find the concept of thought-action fusion familiar, but the form that it takes will be different from one OCD sufferer to another.  An important example of thought-action fusion is the belief that the thought of harming someone is as bad as actually harming someone (although the concept of thought-action fusion can involve things other than harm).  Thought-action fusion can be a source of torment in some OCD sufferers, as such involuntary thoughts can lead to a crushing sense of guilt and anxiety in the mind of the sufferer, or can lead to the sufferer performing compulsions in a vain attempt to 'cancel out' the bad thoughts.  It is known that if an individual fears a particular thought in some way (e.g. by the sense of guilt), then that person is likely to have more of such unwanted thoughts.  This means that the thought-action fusion concept is one means by which OCD can get out of control.

Most rational people would agree that thoughts are completely different from actions, and probably most OCD sufferers who experience thought-action fusion would agree with this on a logical level.  However, it is likely that the belief of thought-action fusion in an individual is based at a deep emotional level, rather than on a logical level.  This means that a bad thought can give such an immense sense of discomfort and fear that it gives the same feeling as though the bad thought were real.

I believe that thought-action fusion is at the centre of my own OCD.  My OCD worries focus on doubts about whether a thought of performing an impulsive harmful act towards someone in my vicinity means that I may have actually performed that act even though I have not wanted to.  To me these are very frightening and unsettling doubts as they make me think that I may have committed crimes that are abhorrent to me.  My mind can hook itself on to these doubts and as a result of just one thought on one day, I can worry for years that I may have committed an assault and that the police may be appear at my front door at any time to take me away for trial (an obvious example of catastrophizing!).  The guilt and anxiety leads me to compulsively mentally review the 'event' to try to find the answer of whether I had or hadn't acted, but all I remember is the thought that feels real.  This sets up a viscous cycle as the more I think about the event, the more it feels real.  The distress that this causes me is immense.

I have a conceptual model of this process that has helped me to describe my experiences to others.  The model involves the way that I feel that my memories are formed and maintained.  The following is not meant to be a literal description of what is happening inside my brain, but is meant to be a useful model.

Suppose we have two parallel memories in our brain, represented in this model by two magnetic tapes running past a tape head that forms memories, or signals on the tape (as in a tape recorder).  Suppose that one of the tapes is coloured red (representing memory of performing actions) and the other is coloured blue (representing memory of having thoughts), as in the figure below.

In a person who does not have my form of OCD, this memory works correctly.  If the person has an intrusive thought of doing something harmful, e.g. impulsively punching a child in the street, then this will be recorded on the blue tape, and nothing will be recorded on the red tape.  The person experiencing the intrusive thought may later review their memory and find nothing of concern on the red tape so that they are assured that they have not performed any act of harm.

In my case, the two recording heads are connected, as in the figure below, which results in this memory mechanism becoming faulty.  If I have the same intrusive thought as the healthy person above, it will be recorded not only on the blue tape, but also on the red tape.  When I review my memory, I find a signal of concern on both tapes, including the red tape, which wrongly tells me that something real happened, and hence the doubt, guilt and anxiety.  Even though I know that I have faulty wiring, I find it impossible to ignore what my own memory is telling me.