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in Obsessive-Compulsive Disorder
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In this section, we will examine the three main categories of obsessions and effective strategy number one: Rational Argument. The three main categories of obsession include: harm; lust; and filth.
3 Categories of Obsession
♦ Category #1 - Harm
The first category of obsession is harm obsessions. Harm obsessions are acts of violence that the OCD client involuntarily acts out in his or her mind. Often, these mental acts of violence are spontaneous and rarely if ever become reality. However, the client still suffers from an irrational fear that their obsessions might get the better of them.
Shelly, a 32 year old mother, would have violent thoughts about harming her two year old daughter Samantha. Shelly stated, "Sometimes, when I’m giving her a bath, I picture myself drowning her. Then, when we’re in the kitchen, I’ll glance at a set of knives, and think about stabbing her over and over again. Why do I have these awful thoughts?! I must be a terrible mother! "
I asked, "Shelly, I want you to consider whether or not you believe yourself to be a bad person. Could you really do these things you picture yourself doing?" Shelly stated, "I don’t think so, I mean I hope not! The only consolation I have is that I can kill myself before I hurt Samantha." Thoughts of suicide as a preventative measure are common in OCD clients like Shelly, and they should be taken seriously.
Think of your Shelly. Could he or she be harboring thoughts of suicide in addition to his or her harm obsession?
♦ Category #2 - Lust
The second category of obsession is lust. Thoughts of inappropriate sexual acts characterize this obsession, and these clients develop an acute sense of shame especially if the thoughts include friends or loved ones. As a result of these shameful feelings, clients who have sexual obsessions lose their self-esteem and self-worth.
They believe themselves to be "bad" people, and could develop a mantra obsession in which they repeat to themselves over and over again a phrase to ward off or blow apart the "evil" thoughts.
Crystal, age 21, had intruding sexual thoughts about her younger brother Jake. Crystal, who was raised a Pentecostal Christian, developed a mantra obsession in which she repeated the phrase, "Holy Spirit deliver me" sometimes hundreds of times in a row.
Crystal stated, "I feel that this is the devil in me trying to take over my soul. The only way I can defeat it is to call upon the Holy Spirit." However, Crystal’s "solution" had in fact become another obsession which affected her life almost more so than the lust obsession.
Think of your Crystal. Could he or she be developing a mantra obsession? What would you say to him or her about the acute sense of shame he or she may be experiencing?
♦ Category #3 - Filth
In addition to harm and lust, the third category of obsession is filth. The fear of filth or becoming filthy also covers a wide range of other obsessions as well such as: germs, sickness, and anything that may carry these manifestations of filth. Clients who suffer from a this type of obsession will commonly become ritualistic washers or cleaners and experience high levels of anxiety.
Jerry, age 39, refused to shake hands or use a computer. He stated, "Whenever anybody reaches out their hand to shake mine, I become so paralyzed with fear that I just let their hand stay in the air. It’s become really awkward meeting people if my friends haven’t told them about my condition. I mean, I’m really nervous about meeting people. What if they judge me for my OCD? I get really self-conscious and can’t think straight. I try to avoid confrontation at all costs." In addition to avoidance, Jerry has developed several cleaning rituals as well.
Jerry stated, "I have a whole closet full of bleach and disinfectant, and that’s just for the upstairs. Downstairs, I have a spray bottle of antibacterial cleaning solution which I spray on the kitchen counters before and after I eat. I’m so nervous all the time. If I’m not cleaning, I might be getting sick. I can’t go to a restaurant because I don’t know if they clean their tables properly." Obviously, Jerry is suffering from a severe filth obsession
Think of your Jerry. What is his or her specific obsession? What rituals has this led to?
♦ Cognitve Behavior Therapy Technique: Rational Argument
CBT Strategy number one is the Rational Argument Exercise. One of Jerry’s specific concerns was with his anxiety arising from meeting new people. To help Jerry relieve himself of anxiety and at the same time help him battle his obsessive thoughts, I asked him to try the Rational Argument Exercise.
As you can see, Jerry had begun to fear engaging new people, not because he was xenophobic, but because he believed that they would judge him or label him as "eccentric" or even "crazy." The Rational Argument exercise is designed to help Jerry conquer that specific fear.
I gave him the following questions to answer in his ritual journal:
- When I’m in any situation that causes anxiety, what is my automatic negative thought or thoughts?
- What is the core negative thought—the notion that goes to the heart of what makes me anxious?
- Is this core negative thought both logical and true?
- If the core negative thought is not logical or true, or mostly exaggerated, what is a more rational response? Can I construct a thought that is both more accurate and more compassionate toward myself and other people?
Jerry stated, "Whenever someone holds out their hand to shake mine, my automatic negative thought is ‘I’m not going to shake their hand, and they will think I’m strange.’ What really makes me anxious is that if people do judge me, I will never meet anyone special and I’ll be alone for the rest of my life. I don’t believe this core negative thought to be true. People generally seem at ease around me after we’ve met. In all probability, no one judges me, but I’m sure they feel as confused as I do. I’m sure that if I explained to them my condition, they’d feel less awkward around me."
Although this exercise does not directly tackle Jerry’s filth phobia, it does address one of the fears Jerry had developed that was related to his OCD. We will discuss anxiety associated with OCD more thoroughly in a later section.
Think of your Jerry. Is he or she having trouble meeting new people? Could the CBT Rational Argument benefit him or her?
In this section, we discussed the three main categories of obsessions and effective strategy number one: Rational Argument. The three main categories of obsession include: harm; lust; and filth.
In the next section, we will examine four steps in effective behavioral strategy number two: Creating a Ritual Journal. The journal will include the following four steps: defining compulsions and obsessions; a compulsions chart; an obsessive thought chart; and an exposure story.
Peer-Reviewed Journal Article References:
Cludius, B., Külz, A. K., Landmann, S., Moritz, S., & Wittekind, C. E. (2017). Implicit approach and avoidance in patients with obsessive-compulsive disorder. Journal of Abnormal Psychology, 126(6), 761–773.
Gámez, W., Chmielewski, M., Kotov, R., Ruggero, C., Suzuki, N., & Watson, D. (2014). The Brief Experiential Avoidance Questionnaire: Development and initial validation. Psychological Assessment, 26(1), 35–45.
Liggett, J., & Sellbom, M. (2018). Examining the DSM-5 alternative model of personality disorders operationalization of obsessive–compulsive personality disorder in a mental health sample. Personality Disorders: Theory, Research, and Treatment, 9(5), 397–407.
McKay, D., Abramowitz, J. S., & Storch, E. A. (2021). Mechanisms of harmful treatments for obsessive–compulsive disorder. Clinical Psychology: Science and Practice, 28(1), 52–59.
Olatunji, B. O., Ebesutani, C., & Tolin, D. F. (2019). A bifactor model of obsessive beliefs: Specificity in the prediction of obsessive-compulsive disorder symptoms. Psychological Assessment, 31(2), 210–225.
Wheaton, M. G., & Pinto, A. (2017). The role of experiential avoidance in obsessive–compulsive personality disorder traits. Personality Disorders: Theory, Research, and Treatment, 8(4), 383–388.
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