Thought-Stopping for OCD: Does it Work for South Asian American Women?
As a South Asian American woman therapist, I've noticed a troubling trend in South Asian Mental Health™ especially among those struggling with OCD or rumination. Many, especially South Asian women, find themselves trapped in a cycle of self-doubt and anxiety, often exacerbated by the pressure to conform to societal expectations. Many therapists mistakenly assume that OCD and rumination can be treated just like anxiety, especially for women of South Asian descent, in the name of “culturally competent” mental healthcare and call this “Eldest Daughter Syndrome”. Many CBT therapists believe that OCD can be treated with thought-stopping.
One such case report found that for one female patient in North India, thought-stopping in combination with exposure and response prevention (ERP) was effective for her religious obsessions with no overt compulsions. But this case report wasn’t a study, was observed with just one patient, and this patient received sessions supervised by her husband. This likely limited how honest this patient was during treatment.
Actually, the International OCD Foundation, a non-profit that brings awareness to OCD and nd effective treatment, doesn’t recommend thought-stopping as an effective treatment for OCD. This is because thought-stopping can create a “rebound effect” where the upsetting thoughts can come back stronger. Trying to argue with your negative thoughts can make them worse!
As a “Bad Indian” therapist who operates with a trauma-informed lens, I strongly believe that familial, cultural, systemic, and geopolitical circumstances can make OCD worse for Indian and South Asian women who are struggling, and that OCD treatment needs to be tailored to account for this reality. Therapy is not one-size-fits-all!
If you’re a South Asian woman constantly stuck in the cycle of self-doubt, guilt, shame, and maybe even disgust with yourself, here’s why your symptoms might look like OCD on the surface:
The Illusion of Perfection
The "Perfect Indian Girl™" is a term that I coined myself! It refers to the stereotypical expectations that Indian and Indian American women are expected to live up to. While I specifically use the term “Indian”, any South Asian woman might resonate with these expectations. The Perfect Indian Girl™ tries to excel in academics, tries to always have a smile on her face, and tries to have it all together. She tries to make her family look good and be the “ideal” and “suitable” life partner for a future man. But behind the facade, she often faces a relentless internal battle with self-doubt, anxiety, and intrusive thoughts. She might even struggle with focus and concentration, and have a hard time sitting with feelings of guilt, shame, and disgust when unable to do something about them, like correcting a mistake, or controlling the narrative.
Notice I said I tried to. A common misconception about being a Perfect Indian Girl™ is that she has to already be perfect. You don’t need to be perfect to struggle with perfectionism. In my work, I find that many South Asian women who struggle with perfectionism don’t see themselves as perfect or “good enough”, and believe that they’re constantly a work in progress. If this is you, you might have a hard time believing that you’ve already reached your goals, and that you’ll be happy once you feel like you reached them.
Isn’t this the Elder Daughter Syndrome?
Eldest Daughter Syndrome is an unofficial diagnosis used to describe a commonly experienced phenomenon that highlights the unique challenges oldest daughters face. Some symptoms include a strong sense of responsibility, perfectionism, and people-pleasing tendencies. Many eldest daughters of immigrant parents can relate to this phenomenon, but these symptoms aren’t always about family or birth order. Youngest daughters are also held to the same unrealistic expectations, even if their older sisters paved the path for them. Not to mention that eldest sons can also experience a strong sense of responsibility, perfectionism, and people-pleasing tendencies. In fact, South Asian men aren’t immune to perfectionism and OCD. Gender roles and expectations don’t exist in a vacuum and can exist in context of bigger phenomenons. Eldest Daughter Syndrome doesn’t account for existing cultural and societal pressures that are the products of a history of European colonial influence, casteism and current geopolitics.
The pressure to be perfect doesn’t just exist within the family, but on a broader scale to be a “brand ambassador” for the diaspora, and to protect the reputation of the family, caste, and culture. For instance, the pressure that Indian and Indian American women face to find a male partner within their specific culture and religion (Malayali Catholic, Punjabi Sikh, Gujarati Hindu) can be explained in the context of endogamy, or the practice of marrying within one’s caste. While caste is considered “yesterday’s problem”, and many Indian Americans (specifically non-Hindus) doubt that it’s still a problem in the US, endogamy can be especially difficult for Indian American women or women of Indian descent living in the West, where finding a partner of a specific Indian culture can be limited.
Dr. B.R. Ambedkar, who is considered the leader of the Dalit Rights Movement in India, argued that endogamy affects women’s rights and limits their options, often putting Indian women in abusive marriages and situations. In this regard, choice can be elusive for Indian women when expected to find a partner that improves and maintains the family reputation rather than what makes her happy and safe. The pressure on Indian women to be the “perfect partner” and to find the “ideal” son-in-law for her parents exists to maintain the caste status of both families, and to uphold the caste system that continues to be the cornerstone of Indian culture today.
But Perfectionism Has Increased Globally. This isn’t a Culturally Specific Thing!
Although a 2019 Study has shown that yes, perfectionism has increased globally over time, that doesn’t mean that the intersectionality of race, gender, religion, class, and caste are not important factors. Perfectionism is a common phenomenon, but can manifest differently based on contextual and cultural factors. Cultural factors impact how perfectionism shows up for people of Indian descent. Perfectionism that isn’t helpful can be related to higher levels of depression, anxiety, and lower self-esteem.
Women are often the symbols of a culture, and Indian women are not an exception. There are growing expectations for Indian women to represent the perfect image of Indian culture. This might be because Hindu nationalism convinces Indian women that nationalism, the identification with nation and national interests, will empower them. This might also be because of the Model Minority Myth in the US. The model minority myth positions Asian Americans as the “good” minority and renders the racism that we experience invisible. South Asian Americans, namely Indian Americans, are part of a growing number of Asian Americans who are considered “role models” that other minorities are compared to. This creates unrealistic expectations of success within our diaspora. Perfectionism is enforced as a method to reach unrealistic standards that aren’t an actual reflection of who we are.
So while perfectionism has increased globally, the way that it presents and its effects look different culturally, and personally, I believe that perfectionism is the symptom of global nationalistic efforts. And there are mental health ramifications.
What’s OCD got to do with it?
The pressure to be perfect and uphold a perfect image can increase emotional distress and behaviors that look like OCD. A popular misconception about OCD is that it is driven by anxiety, and while anxiety can certainly be a part of OCD, it’s more of a surface-level emotion. Really, the core emotions of OCD tend to be guilt, shame, and/or disgust or “moral dirtiness”. Neuroticism, a personality trait that describes a person's tendency to experience negative emotions and have difficulty coping with stress, is positively linked with OCD and perfectionism and can have negative outcomes, such as intense anxiety and depression. People with OCD can be really hard on themselves and tend to blame themselves often, seeing mistakes as failures, especially when unable to act on intrusive thoughts.
Does this sound familiar? Perhaps as a woman of South Asian descent, your social-oriented perfectionism might look like OCD. You might be constantly afraid of doing the wrong thing based on societal pressures and rules, and have a deep need to prove your worth by correcting your perceived flaws. If the diagnosis of OCD helps you make sense of your behavior, then great, but there’s no need to feel ashamed about it either. Please know that mental health diagnoses are rooted in Western psychology, and do not describe the full picture of your story. OCD does not define you!
The Limitations of Thought-Stopping
Thought stopping is a cognitive behavioral technique that involves interrupting and replacing negative thoughts with more helpful ones. But thought-stopping isn’t always helpful, and can feel like toxic positivity, which involves dismissing or invalidating negative emotions and experiences. Ever felt like you're trying to hold back a flood of thoughts, emotions, and sensations? It's like trying to dam a river with your bare hands. Thought-stopping, often recommended for OCD or rumination, can feel like that. It might seem like a quick fix, but it's more like putting a Band-Aid on a gaping wound! For South Asian women, thought-stopping can feel particularly dismissive, especially when your intrusive thoughts are a reflection of unrealistic religious and cultural expectations that are placed on you! It's like being told to shut up and to ignore the voices inside your head, even though those voices are often shaped by years of cultural expectations, societal pressures, and personal experiences. It's like saying, "Your feelings don't matter. Just stop thinking". Thought-stopping can be problematic because it sends a message that your intrusive thoughts are not true or are useless, when they can actually be data points to help you better understand the context of your situation. Thought-stopping may make you feel crazy, when in fact, your thoughts aren’t crazy at all.
The Weight of Cultural Expectations
Growing up in a South Asian culture can often mean facing immense pressure to conform to traditional gender roles, family expectations, and societal norms. These expectations can contribute to feelings of anxiety, but especially guilt and shame. Often, these cultural expectations may be rooted in the idea that all Indian people, or even all South Asians, are supposed to be culturally the same, and that we should all strive for the same ideals, when this is far from the truth.
The Hidden Struggles
If you’re a Perfect Indian Girl™ who struggles with decision fatigue, analysis paralysis, or the mental gymnastics of rumination, you might be
Hungry to be believed: Your experiences are often dismissed or minimized, leading to a sense of isolation and invalidation.
Avoiding the grief of reality: You might cling to outdated beliefs or expectations to avoid the pain of acknowledging the truth about your family or relationships.
Stuck in the belief that you don't have options: The pressure to conform can make it feel like there's only one "right" path, limiting your sense of agency.
Afraid of being socially outcast: Fear of judgment or rejection can keep you from expressing your true self or pursuing your own desires.
Trying to suppress your thoughts and feelings is like trying to hold your breath underwater. It's uncomfortable, it's stressful, and it can make you feel even more anxious and on edge. If you've never been given the space to feel and be believed, it can be even harder to break free from the cycle of rumination. The right therapist will hold space for your truth!
How to Cope:
If you struggle with OCD or OCD-like symptoms, here are some general ways to cope. I strongly recommend using these techniques with the assistance of a licensed therapist who specializes in OCD:
Accept that your intrusive thoughts are true. They are true, will happen, and most importantly, probably already have happened. The worst thing you imagine has already happened and is still happening. When you have OCD, you work so hard to prevent the worst thing from happening that you forget it already has, regardless of how hard you work to prevent it. That doesn’t mean you don’t do anything about it. But that also doesn’t mean that you must do something about it right now, or that you have to do everything. Maybe you can do something about it five minutes from now. Or, maybe you can do one thing about it, instead of all the things. The goal is to increase the amount of time between your triggering intrusive thought and when you act on it.
Make it worse to make it better. With the assistance of a licensed therapist, take your intrusive thought and exaggerate it. Make it worse to the point where it feels ridiculous, maybe even a little silly. And even if it’s real, make it even MORE WORSE in your head. Exaggerate it so much that at some point your brain naturally goes, “Okay, everything else could happen, but I’m not sure that little tid-bit is likely to happen…”. This is how you poke holes in your intrusive thoughts.
Hold space for the scary monster. When you run away from something, the scarier it becomes. So instead of avoiding your intrusive thoughts, talk to it like it’s a friend. Give it a name, a color, a job, hair, etc. Personify your intrusive thoughts.. Can you hold space for the scary monster and see that your intrusive thought is actually a human just like you?
Ask yourself if you’d rather stay boxed in with your rigid rules, or if it’s worth taking the risk and stepping out of your box every once in a while? As a South Asian woman with OCD, you might act on rigid rules that have been placed on you by societal and cultural expectations. These rules may be important and keep you safe in your relationships with family, friends, and work. But are there situations where it’s okay to take the risk and step outside of this box? It doesn’t mean you have to let go of these rules. But it means that you don’t always have to follow them.
These techniques may vary depending on the type of OCD you have. Consult your licensed therapist to troubleshoot accordingly!
Remember, feelings are data points. They're not good or bad, they just are. And the way you respond to your feelings is what matters. You might be ruminating because you're trying to make sense of everything, or because you're trying to avoid conflict, or because you're desperately trying to be enough. Those behaviors might make sense to you, even if they're not always helpful.
Finding Healing and Support If you’re a South Asian woman struggling with OCD, a therapist who offers both a psychodynamic and an evidenced-based approach can help you better manage symptoms. If you’re new to therapy, a psychodynamic approach can help you build insight and make better sense of behaviors. If you find that thought-stopping is helpful for you, there’s no problem with that! I recommend working with a therapist who can give you the space to make sense of your behavior, connect it back to identity, and provide skills to help you improve mindfulness, cognitive flexibility, confidence to sit with difficult physical sensations, and approach uncomfortable emotions.
OCD is very common, and you’d be surprised how common rumination and thought-spiraling are in our diaspora. By seeking help and challenging harmful stereotypes, you can begin to break free from the cycle of self-doubt. It’s important to find a therapist who understands your unique experiences and can provide the support and guidance you need..
If you're ready to take the next step toward healing from possible OCD symptoms, I'm accepting new clients in California! Book your free intro call below to see if we're a good fit.
Do you struggle with intense feelings of guilt and shame? Enroll in Detoxify Your Guilt today and I can help you navigate unhelpful feelings of guilt.
For more information on OCD research in India, please refer to this comprehensive review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146215/