OCD and synesthesia: a curious couple

*This article reflects an evolving theory and hypothesis. Comments will be taken into account as revisions are made.

Synesthesia, or a mixing of the senses, is considered a neutral and sometimes positive condition that can even allow for greater creativity, memory and other capabilities.

Synesthesia is defined as “a neurological condition in which stimulation of one sensory or cognitive pathway (for example, hearing) leads to automatic, involuntary experiences in a second sensory or cognitive pathway (such as vision).” Psychology Today notes, “simply put, when one sense is activated, another unrelated sense is activated at the same time. This may, for instance, take the form of hearing music and simultaneously sensing the sound as swirls or patterns of color.”

There are less common types of the already uncommon neurological condition, including space-time synesthesia where individuals perceive time in spatial formations, like the months of a year in a track shape.

Questions of whether OCD can be considered a type of synesthesia for some have been posed by people with OCD themselves, and researchers have also explored links between clinical conditions and synesthesia. Forms of OCD like magical thinking and emotional contamination have striking similarity to the blending of senses described by synesthesia. This article does not argue that OCD = synesthesia. Rather, it suggests that some perceptions and cognitive processes involved in OCD, might be seen as a form of synesthesia or similar phenomenological process.

OCD has typically been seen as a singular disorder with multiple manifestations. Types or manifestations of OCD can be so disparate that individuals with OCD can have difficulty understanding one another’s “type.” However, it is possible that some neurological conditions such as synesthesia may underlie subtypes of OCD in different ways, or predispose individuals to develop certain forms of the disorder.

There are well established connections among OCD, tics, autism, ADHD, and related conditions or neurotypes. While autism and increasingly ADHD are considered neurodevelopmental conditions or neurodivergent neurotypes by advocates, OCD is still often considered a disorder. This is likely due to the fact that it can cause tremendous suffering and difficulty functioning in neurotypical society. Treatment methods also presuppose that OCD is perpetuated by the sufferer’s own actions alone and any neurological differences underlying OCD are seen as malleable through behavior. In short, OCD is generally seen as more able to be impacted through behavior and thus any observed neurological differences are not generally considered permanent characteristics.

“Thought-action fusion”, a core feature of OCD, describes the impression that thoughts are somehow equivalent to one’s actions, whether by thoughts leading to action in the real world (e.g., my sister will get hurt if I don’t tap the table until it feels “just right”), or a cognitive sense (“if I think of harming someone, then I essentially harmed someone”).

Is it possible that at least some individuals with OCD experience these thoughts through a synesthesia-like process that make them feel more “real?” Could this perhaps contribute to development of OCD?

If so, can thought action fusion itself be seen as a form of synesthesia in which one mental process or perception (thought) is linked to another (sense of action)?

One issue with this idea is that synesthesia is generally considered a neutral or even positive condition, while OCD is a mental health disorder which causes suffering and confers little if any benefit, despite popular stereotypes.

However, is it possible that certain types of perhaps yet undefined synesthesia or similar neurological traits can cause difficulty (i.e. it should not be necessary that synesthesia is only neutral or positive), or that when mixed with certain life experiences or other neurological conditions can maintain a disorder like OCD?

One might ask what benefit is there to considering some (or even most?) types of OCD as containing elements of synesthesia? For one, sufferers can realize that it is not their fault that they perceive things the way that they do. Many OCD sufferers feel “crazy,” knowing that their thoughts seem ridiculous or irrational, but that they feel so real that they cannot overcome them.

Considering certain types of OCD as synesthesia, or recognizing the role of synesthesia like processes, doesn’t mean that people with OCD shouldn’t pursue treatment to disentangle anxiety from any perceptual mixing. However, understanding the unique perceptual experiences of OCD suffers can go a long way in enhancing self-understanding and empathy from the broader population that all too often thinks of someone with OCD in terms of stereotypes such as being a “neat freak.”

Understanding neurodivergent traits and processes involved in OCD including but not limited to synesthesia may go a long way in enhancing self-compassion and compassion from others who may struggle to understand why it’s so hard for someone to do seemingly basic or simple tasks or why someone might engage in seemingly bizarre behaviors. Compassion flows more generously from understanding.

Does seeing OCD in this way change how we treat OCD? While OCD treatment is beyond the scope of this post, there may be some adjustments to treatment that emerge from such a perspective. However, even without changes to mainstream treatment, such understanding can help clinicians to better understand complex patients’ experiences, build empathy and help sufferers to better understand their own experiences.

If OCD sufferers can disentangle or dismantle thought-action fusion through treatment, then it could be argued that it is not a true synesthesia. For some people, OCD treatment may reduce or eliminate the mental processes such as TAF. However, if the definition of synesthesia suggests that it cannot be malleable in any case or that it is not “real” if there are other conditions at play, then maybe the definition of synesthesia needs to be updated to include such manifestations. Or it is possible that anxiety or similar conditions can create a “false synesthesia” in which one’s perception is altered by something other than a neurological condition. While this is certainly possible, in terms of understanding one’s individual experience, this difference may be unimportant.

While OCD sufferers are continually seen by the broader pubic through stereotypes such as perfectionistic, neat, overly fearful, odd, bizarre, quirky, neurotic, obsessively clean, and germophobic, understanding the processes that contribute to the disorder may help add to greater public understanding and help alleviate stigma that all too often accompanies mental health conditions like OCD. Whether or not OCD is considered to have components of synesthesia, such inquiry allows for greater curiosity about the complexities of OCD, particularly for complex forms.

Further consideration of neurodevelopmental traits of OCD suffers may allow better understanding of the specific, underlying needs and sensitivities of individuals with the condition and move toward more effective and compassionate approaches and treatment.

writer. be-er. looker for small truths. i live with ocd and write about it sometimes too.

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