It’s common for people with OCD to think in extremes, known as black-and-white thinking.

Obsessive-compulsive disorder (OCD) is a serious mental health condition that affects your thoughts (obsessions) and behaviors (compulsions).

The condition often involves cognitive distortions, which are inaccurate, unhelpful, and irrational beliefs that make us feel bad about ourselves. There are many types of cognitive distortion, and black-and-white thinking – also called all-or-nothing thinking — is common in OCD.

Rather than seeing that life comes in shades of gray, people who tend toward black-and-white thinking think in extremes. This is a rigid thinking pattern that doesn’t allow for the complexities of life.

Some examples include:

  • “I made a mistake. I always fail. I am a failure,” versus, “I sometimes make mistakes.”
  • “That person hurt me once, so they are an evil person,” versus, “That person does bad things sometimes.”
  • “It’s raining, so my day is totally ruined,” versus, “The rain is a shame, but there are still some good parts about the day.”

People who consistently fall into this type of thinking have trouble accepting uncertainty. They may use words like “never,” “always,” and “totally.”

While everybody falls into extreme thinking sometimes, mental health conditions like anxiety, depression, and OCD can mean it’s very difficult to move away from.

All-or-nothing thinking can have negative impacts on your life. For example, it could cause you to walk away from salvageable friendships after the first conflict, or you might quit a job as soon as you dislike something about it.

For people with OCD, extreme thinking can keep you locked in a self-perpetuating cycle of obsessions and compulsions.

OCD is also known as the doubting disorder. It can be hard for people with OCD to accept uncertainty.

For example, people who engage in compulsions do so to find a 100% guarantee that their intrusive thoughts (obsessions) are untrue. This may cause them to experience all-or-nothing thought patterns more often than most.

For example, someone with OCD could have the intrusive thought that they might have given their family an illness. They might then think “I risked getting my family sick, so I’m a terrible person,” versus, “Maybe I got my family sick, but I’m still a good person overall.”

Many OCD obsessions are in themselves examples of black-and-white thinking. For example:

  • “If I don’t do this ritual and my mother dies, then it will be my fault,” versus, “Whether or not I do this ritual, my mother could die. It won’t be all my fault.”
  • “If I go even a mile over the speed limit then I might kill someone and that will mean I’m an evil person,” versus, “Driving is inherently risky and one mistake doesn’t make a person evil.”

People with OCD may also have extreme thoughts about their treatment and recovery process. Examples include:

  • “There’s no way I’m ever going to get better — my case is too severe,” versus, “I might get better even if I feel like I won’t.”
  • “I’m always going to feel this way,” versus, “I don’t know how I’ll feel tomorrow.”
  • “I always do my therapy exercises but they never work for me,” versus, “Therapy hasn’t been as helpful as I’d hoped, but it does work around half of the time.”

Lastly, many people with OCD have co-occurring depression. In fact, depression is the most common comorbid disorder for people with OCD.

Depression could also lead to extreme thoughts for people with OCD, like:

  • “No one wants to hang out with me because of my OCD,” versus, “Some people have rejected me, but some people have wanted to get to know me.”
  • “OCD has ruined my life; I’m never going to be happy,” versus, “There are good things about my life that I’m grateful for too.”
  • “I missed a dose of my medication. I’m always messing up. I’m a disaster,” versus, “I missed a dose of my medication, and I’ll start up again today. I’m allowed to make mistakes.”

There are several effective treatment methods for OCD. According to the American Psychiatric Association, the most effective and recommended treatments are:

ERP works well for people with OCD. It challenges people to intentionally activate obsessions, then resist the urge to engage in a compulsion, in a safe, supportive environment.

Medication can also be very helpful for OCD. Selective serotonin reuptake inhibitors (SSRIs) are usually the recommended medication.

OCD is a mental health condition that makes it difficult for people to accept uncertainty. This can involve a type of cognitive distortion called black-and-white thinking.

If you have OCD you can find relief from your symptoms by talking with a mental health professional and receiving treatment.

You can start looking for an OCD specialist by using the International OCD Foundation’s resource directory. Psych Central’s How to Find Mental Health Support resource may also help.