Dr. Hanscom's Blog Dr. Hanscom explains (so we can understand) the brain science behind OCD

[edit: I added the bolded emphasis below]
[also note that he does not mention OCD in so many words/letters - but RUTs and OCD are the same brain process]

RUTs – Can’t Take Your Hand Off the Stove? Turn Down the Heat
Sunday Feb 9, 2025 newsletter
David Hanscom, MD

Holding your hand over a hot burner triggers an immediate threat response (anxiety) and prompts action to address that threat. This sequence is part of the protective pain response known as the nociceptive pain system. Numerous danger cues activate this response. As your nervous system memorizes dangerous situations, this system guides you to avoid threats. The goal of the nociceptive system is to reduce pain, and it quickly becomes an automatic reaction. How often must you get close to a hot stove before learning to avoid it?

Some of the most intense pain arises from obstructed internal organs. Kidney stones, gallbladder stones, blocked coronary arteries, and bowel obstructions are among the worst pains imaginable. These pains indicate that you have exceeded the structural limits of your tissue or organ system.

Unpleasant, threatening thoughts (Repetitive Unpleasant Thoughts – RUTs) send danger signals through your nervous system and are processed similarly to physical stimuli. However, we have limited options for coping with them. Strategies include using substances to make it more bearable, suppressing thoughts, feelings, and emotions, or developing mental rigidity as a protective barrier. Our responses and mechanisms may be effective for a time, but the relentless onslaught wears you down.

You really are trapped

Your goal in addressing physical pain is to distance yourself from the source of discomfort. You wouldn’t keep your hand over a hot burner. It makes no sense to undergo counseling suggesting that the heat isn’t so bad, to prescribe medications to dull the pain, to promote self-medication with alcohol or opioids, to advise you to toughen up and stop complaining, or to immerse yourself in addictions or obsessive activities as a distraction from the pain. Positive thinking is another method of suppressing pain, but it isn’t effective. None of these strategies make any sense if your hand is still close to a hot burner. Yet this is often how we manage mental pain. It’s absurd.

We have little to no conscious control over RUTs. There is no escape. Threat physiology drives RUTs, and RUTs stimulate physiology. In this state, neurotransmitters shift from calming acetylcholine to excitatory glutamate. Your brain contains inflammatory cells called microglia, which lead to inflammation. The speed of nerve conduction doubles.

In summary, your nervous system is hyper-reactive and takes less stress to trigger unpleasant danger signals. This is a bidirectional problem. So, what can you do?

Turn down the heat!
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