Obsessive Thoughts
Obsessive Thoughts
As a clinician who specializes in working with clients who have complex trauma, PTSD and spiritual trauma wounds; I do not have specialized training in treating OCD. However, I often work with clients who also present with OCD or OCD tendencies and it becomes an important part of our dialogue to offer them treatment options; such as Exposure and Responsive Prevention Therapy with another provider.
OCD?
I find that OCD is the diagnosis most often that clients are unaware they struggle with when they engage treatment with me. Many times, a client is aware of anxiety, depression, PTSD; but because of how OCD has been portrayed, many discount the possibility of the disorder in themselves. The classic images are someone washing their hands over and over again, checking the locked door multiple times or obsessively cleaning and straightening things.
Thought OCD
What I most often come across is individuals dealing with some kind of thought based OCD. This can be referred to as “PureO, Mental OCD.” This means the obsessions and the compulsions are based in the mind and not necessarily external behaviors. This could look like; an obsession with a fear of hitting a cyclist when driving then a compulsion of mentally arguing with this image or an obsession with saying the “wrong” thing in a social situation and mentally replaying a social interaction or mentally preparing for an upcoming interaction.
What are obsessions and compulsions?
According to the Yale-Brown Obsessive Compulsions Scale (Y-BOCS):
Obsessions are “unwanted ideas, images or impulses that intrude on thinking against your wishes and efforts to resist them.”
Compulsions are “urges that people have to do something to lessen feelings of anxiety or other discomfort.”
So we experience an obsession, “Oh no, what if this sexual thought about someone else means I am with the wrong person.” Then to reduce the distress of that thought, we engage in a compulsion, “I have to mentally review all the evidence about why I am with the right person.”
This then feeds the “Anxiety cycle,” because instead of learning how to tolerate the discomfort of the initial obsession, we take away the discomfort by filling its space with a compulsion. Then the next time the obsessive thought happens, we need the compulsion again, to feel better in the short term, yet in the long term, we are building our dependency on the compulsion.
The Diagnostic and Statistical Manual (DSM) which we use to diagnose clients states that to qualify for OCD, the obsessive and compulsive habits take at least one hour per day and are causing significant distress in important areas of life.
Less known about OCD patterns I see in my work with clients
Relationship OCD
This is when the obsessions and compulsions are focused on romantic relationships. The obsessions revolve around the status of the relationship; do they really love me, do I actually want to be with them, are they cheating on me, am I attracted to them, a focus on partner’s flaws, comparing partner to others.
The compulsions can be mental or behavioral; analyzing partner’s communication with you and others, ruminating on interactions with partner, seeking reassurance from partner or friends about relationship status, looking for evidence to support or go against obsessive thoughts.
Religious OCD (Scrupulosity)
This is when the obsessions and compulsions are focused on morality or religious beliefs. The obsessions revolve around wanting to be in line with religion or morality; am I a good person, am I going to heaven, does God hate me, am I doing the right thing, did I sin, is this wrong, will I go to hell.
The compulsions can be mental or behavioral; praying, confessing, asking others to confirm you are not bad, reading Scripture to cancel out other thoughts, reminding yourself why you are not bad, replaying scenarios to analyze if you did the “right/moral/good” thing.
Skin Picking (Excoriation)
Due to its compulsive nature, skin picking is classified among other obsessive and compulsive disorders in the DSM. This is when an individual picks their skin to the point of harm, has repeatedly tried to stop the picking and it causes significant distress in important areas of life.
Limerence
While limerence is not in the DSM, nor is it classified as an obsessive and compulsive disorder, it can benefit from similar ERP treatment. This is when someone has a mental obsession with another individual, a fantasy that this person will make life perfect and is fixated on this person’s behavior; analyzing their meaning, feelings and relationship. They may have awareness that this is a fantasy, untrue and also have a difficult time releasing the obsessive thoughts; similar to OCD. I recently consulted with a limerence specialist and they recommended a combination of ERP and trauma treatment such as EMDR or IFS to help the “limerent” part.
Treatment recommendation: Exposure and Response Prevention Therapy
ERP is the recommended gold standard for treating OCD. I recommend the International OCD Foundation to locate a qualified provider. If there is underlying trauma; I recommend a combination of ERP and trauma treatment.