What to Read
What is Harm OCD?
There are dozens of categories of different obsessions and compulsions that make up the disorder known as OCD, and while these cover a wide range of differing themes, they all share many characteristics in common. These would include intrusive unpleasant thoughts, unceasing doubt, guilt fears of being insane, and crushing anxiety. While all forms of OCD can be painful, paralyzing, repulsive, and debilitating one of the nastier and more startling is the type known as morbid obsessions. This is particularly true of those obsessions in this category that are violent in nature and include thoughts of killing or injuring others or oneself, or of acting sexually in ways that are against society’s norms. I include thoughts of acting out sexually in this category as they really represent a form of violence and have little to do with sex.
Violent thoughts may involve both mental images and impulses to act. These can include those in which people see themselves hitting, stabbing, strangling, mutilating, or otherwise injuring their children family members, stranger’s pets, or even themselves. They may envision themselves using sharp or pointed objects such as knives, forks, scissors, pencils, pens, broken bottles, letter openers, ice picks, power tools, poison, their bare hand’s, or even their cars. The urges they experience may involve pushing or throwing themselves or others into the paths of trains or cars, out of windows, or off balconies, buildings, or other high places. Some report thoughts of hitting pedestrians, ramming their cars into bridge abutments on the highway, or steering into the path of oncoming traffic. Others fear snapping or going berserk in public and harming people. One patient of mine would have thoughts of opening one of the exit doors aboard an airliner.
In reaction, sufferers tend to fear being alone with anyone smaller and weaker they feel they could easily overpower, such as children and elderly people. They often avoid going to such places as train platforms, pedestrian-filled street corners or being in crowded public places. Mothers may experience repeated thoughts of acting violently towards their infants or small children. Sexual thoughts in this category usually involve raping or sexually abusing children or other adults. Fears of acting out other sexually inappropriate behaviors may also occur.
Although the number of people who suffer from this type of OCD is still not exactly clear, it is probably more common than most people think. When most of patients begin treatment, they believe that they may be insane and that no one else could think as crazily as they do. I am usually able to convince them that neither of these things is true, and this is further confirmed for them when they attend a support group and hear others report the same types of thoughts. Another problem these sufferers seem to be burdened with is a nagging doubt that causes them to ask themselves, “What kind of person am I that could think such thoughts? Why would I think these things if I didn’t really want to do them. I must be a psychopath or a pervert.” Not being able to resolve this doubt obviously results in a lot of anxiety. In years past, OCD sufferers who went for treatment via psychoanalysis were mistakenly informed that their thoughts actually represented repressed anger and that they unconsciously wished to do the things they were obsessing about. This only worsened the symptoms for these unfortunate people. Sad to say treatment of this type still continues in many places. In one case I know of, a woman confessed her obsessive thoughts of hurting her child to a psychiatrist. She was rewarded by this professional reporting her to state protective services who then promptly investigated her with an eye to removing her child from her home.
Compulsive thoughts and Anxiety
It is important for sufferers to understand that the thoughts are just thoughts and do not cause anxiety, but rather the anxiety is caused by the views sufferers take of the thoughts. They need to overcome the idea that, “If I think it, it must be real.” It should be noted that people who suffer from these thoughts have no history of violence, nor do they ever act out on their ideas or urges. Although OCD can project extreme and bizarre thoughts into people’s minds, it is not the thoughts or the anxiety as much as people’s solutions to having the thoughts that represents the real heart of the problem. It is the compulsive acts that people perform to relieve their anxiety that cause the paralysis that they experience. Compulsions are seductive in that they offer the illusion of immediate relief from anxiety, even if it only lasts a brief time. Compulsions, paradoxically, start out as solutions but eventually become the problem itself. They may grow from taking only a few minutes per day, to taking up hours at a time. Instinct tells people with OCD to avoid or run away from the things they fear and they erroneously believe that this is possible. Unfortunately, the opposite proves to be true, and the avoidance only worsens the problem and increases the fear. A person’s whole life may become oriented around never coming into contact with the things that make them anxious. In actuality you cannot run from what you fear. It must be faced. People with OCD do not remain in the presence of what they fear long enough to learn the truth of things, which is that nothing would happen, even if they did no compulsions. Regardless of the type of obsessions, treatment for OCD is all about getting sufferers to accept that their solutions do not work, and will never work, and that they have to finally face their obsessive thoughts while resisting their urges to do compulsions. Anything short of this will not be powerful enough to get the job done
Adapted from Fred Penzel, Ph.D..
This article was initially published in the Summer 2004 edition of the OCD Newsletter.
What to Watch
Please watch the videos below relating Harm OCD.
[VIDEO] [VIDEO]
What to Do
Create your ERP hierarchy following the example and instructions below.
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What to Measure