Harm OCD Treatment – Part 2: Mindfulness Based CBT
Jon Hershfield, MFT, of the OCD Center of Los Angeles discusses treatment of Harm OCD using Mindfulness Based Cognitive Behavioral Therapy. Part two of an ongoing series.
Mindfulness Based CBT is a key component of successful treatment for Harm OCD
In our previous installment of this series, I defined the symptoms of a sub-type of Obsessive Compulsive Disorder (OCD) known as Harm OCD. The defining characteristics of Harm OCD are intrusive thoughts of a harming/violent nature (obsessions), and the behavioral response of engaging in physical and mental strategies (compulsions) in an effort to relieve the inherent discomfort one experiences when having these thoughts. In upcoming articles in this series, we will discuss each of the main elements of Cognitive Behavioral Therapy (CBT) used to treat this form of OCD.
Psychoeducation and the Treatment of Harm OCD
The first step in treating Harm OCD is psychoeducation. Unfortunately, sufferers who are not already well-versed in OCD are likely to approach treatment with extreme apprehension and doubt. This is because the pain of being burdened with unwanted thoughts of causing harm has worn them down to a point that they may genuinely believe it’s possible that a therapist will take one look at them, smile, and call the men in white coats. So before any discussion of treatment can begin, a Harm OCD sufferer has to have a better understanding of the nature of the condition, and why some people are hyper-aware of these types of thoughts, while others appear not to be. › Continue reading
Treatment for Dermatillomania / Compulsive Skin Picking (CSP)
Cognitive Behavioral Therapy (CBT) is the most effective treatment for Dermatillomania (compulsive skin picking)
In my previous article on Dermatillomania (also known as Compulsive Skin Picking, or CSP), I wrote about a classification system for skin picking. Let’s review “The ABC’s of Skin Picking”:
An “A” is something that almost anyone would pick. This could be a piece of dry skin hanging off your arm, a pus-filled whitehead on your chin that pops at your mere touch, or a scab that’s barely hanging on which you can easily detach.
A “B” is a “bump”, pimple, scab, etc. that only a skin picker would pick, frequently causing it to bleed, ooze, scab, and possibly become infected. This in turn will cause two additional problems – it will cause the picker significant distress, and it will give him or her something new to pick at later. In my experience, clients with Compulsive Skin Picking classify at least 50% of their picking as “B’s”. › Continue reading
Harm OCD: Symptoms and Treatment – Part 1
"Harm OCD" is a common variant of OCD, and is very treatable with Cognitive Behavioral Therapy (CBT)
Harm OCD is a manifestation of Obsessive Compulsive Disorder (OCD) in which an individual experiences intrusive, unwanted, distressing thoughts of causing harm. These thoughts are perceived as being ego-dystonic, which simply means that the thoughts are inconsistent with the individual’s values, beliefs and sense of self. Harming obsessions typically center around the belief that one must be absolutely certain that they are in control at all times in order to ensure that they are not responsible for a violent or otherwise fatal act.
It is not fair to say that one form of OCD causes more pain than another. In my experience of treating individuals with OCD, those with compulsive hand washing appear to be in no less pain than those who live in fear of being sexual deviants or psychopaths. What sets Harm OCD apart is the way in which it attacks the things we love the most, and does so with such brutality and lack of mercy as to astound even the most creative minds. The moments that we most want to be highlighted by memories of peace and contentment suddenly become contaminated by mental imagery of horrific violence and feelings of relentless guilt. › Continue reading
Orthorexia: Where Eating Disorders Meet OCD – Part 2
Effective Strategies and Predictable Complications in the Treatment of Orthorexia
In our previous article about Orthorexia, we described this relatively unknown and misunderstood condition. In this, the second and final installment in this series, we discuss strategies and pitfalls in the treatment of Orthorexia.
Orthorexia can be effectively treated with Cognitive Behavioral Therapy (CBT) and Mindfulness
Orthorexia, being a somewhat new conceptualization of a psychological disorder, is under-researched and often misunderstood within the mental health and medical communities. Many mental health professionals have found success treating individuals with Orthorexia using evidence-based treatment methods that are used to treat other Eating Disorders, OCD, and related OC Spectrum Disorders.
Cognitive-Behavioral Therapy (CBT) and Mindfulness are two highly effective treatment methods used to treat Orthorexia. Using CBT, individuals with Orthorexia learn to challenge and change their distorted thoughts (cognitions) related to their body and the foods they eat. Education about nutrition and what is considered “healthy” should also be integrated into CBT when treating Orthorexia, using logical, evidence-based strategies. › Continue reading
Casey Anthony, Reasonable Doubt, and OCD
The concept "reasonable doubt" may help some better understand OCD
When most people think of Obsessive Compulsive Disorder (OCD), they think of people excessively washing their hands or repeatedly checking their doors and windows to see if they are locked. But there are many variations of OCD, including a subtype in which people have intrusive, unwanted thoughts about harming spouses, friends, co-workers, strangers, or even their own children. Sometimes called “Harm OCD”, this condition falls under the category of what is commonly called Pure Obsessional OCD, or “Pure O”, because both the obsessions and the compulsions are primarily mental.
People with Harm OCD often perform mental checking rituals just as others with OCD might physically check their stove over and over again in an effort to feel sure that they haven’t accidentally left a burner on. They might repeatedly monitor and analyze their mental processes in an effort to convince themselves that they will not act on their unwanted thoughts, and that their intrinsic character or their love for the other person is strong enough to prevent them from doing some sort of harmful action. They may also repeatedly seek to determine whether they are a bad person for even dreaming up such a thought. And it is quite common for those with harming obsessions to repeatedly ask others for reassurance that they have not harmed someone or that they are not going to do so. But as anyone with Harm OCD knows, these efforts to gain certainty almost never provide the desired reassurance for the OCD sufferer, and the unwanted thoughts almost always increase in frequency and intensity. › Continue reading
The ABC’s of Dermatillomania / Compulsive Skin Picking
Not all skin picking is the same.
Everybody picks their skin sometimes, right? If you tell your friends or family that you pick your skin, many of them might say “Oh, I do that, too”. So, how do you know if your skin picking is severe enough to warrant a diagnosis of Dermatillomania, also known as Compulsive Skin Picking or Chronic Skin Picking (CSP)?
There are a variety of ways in which assessment of skin picking occurs. Self-assessment might occur by the person doing the skin picking when an individual realizes that he or she is causing scabs, scars, and/or infections. A person with Dermatillomania may also be aware that he or she is avoiding social situations, including work, school, and/or social functions such as weddings and parties. After all, those who have picked to the point of bleeding and scabbing may be too embarrassed to be seen by others who might judge them or ask questions about their skin. › Continue reading
Gay OCD / HOCD / Sexual Orientation OCD: Challenges to Treatment
Jon Hershfield, MFT, of the OCD Center of Los Angeles discusses common challenges seen in the treatment of Sexual Orientation OCD, also known as HOCD or Gay OCD. Part four of a four-part series.
Sexual Orientation OCD - also known as HOCD or Gay OCD - is best treated with Cognitive Behavioral Therapy
In my previous blog on Sexual Orientation OCD (aka HOCD or Gay OCD), I looked at some of the potential sub-types that appear in this condition. While they are all treated with various Cognitive Behavioral Therapy (CBT) strategies, crippling fear can lead people toward beliefs that impede therapy. Here are some thoughts about treatment issues I commonly hear from HOCD clients.
My Big Gay Secret Self
Many HOCD sufferers, regardless of sub-type, become preoccupied with the idea that other people might think that they somehow “appear” gay. As a result, some men with HOCD may over-attend to the way they dress, opting for baggy, neutral choices rather than fitting, stylish choices that they might associate with homosexuality. They may pay special attention to the way they speak or even the way they hold a drink, trying to eradicate any possibility that a person may mistake them for being gay. Women with HOCD may over-attend to the length of their hair, or whether their clothes are “feminine” enough. Both men and women with HOCD are likely to obsess about their body type and whether there is something inherently “gay” about it. › Continue reading
Orthorexia: Where Eating Disorders Meet OCD
Orthorexia – The Not-So-Healthy Obsession with “Healthy” Eating
Individuals suffering with Orthorexia exhibit symptoms similar to those of OCD and Eating Disorders.
Orthorexia Nervosa (also simply known as Orthorexia) is a relatively new term within the psychological and medical fields. Simply defined, Orthorexia is an eating disorder in which an individual has an excessive and ultimately unhealthy obsession about maintaining a diet that is totally “healthy” and “pure”. Because of their extremely restrictive eating, individuals with Orthorexia are often severely underweight, and frequently lack the proper nourishment to perform basic daily activities. Like most cases involving an eating disorder, the outcome of Orthorexia can be severe malnutrition and a significant reduction of one’s quality of life.
Orthorexia has not yet been accepted as a formal diagnosis by the psychiatric community, and has not been defined within the Diagnostic and Statistical Manual (DSM-IV). However, since first being described by Dr. Steven Bratman in 1996, many health professionals have observed the often debilitating results of this condition. › Continue reading
OCD and Thought Suppression
Thought suppression is a common feature of OCD, especially for those with Pure Obsessional OCD (sometimes called "Pure O")
Over the last few weeks, I have had a secret. For most people, this secret would not have been seen as important, but to me it was. Every time I had these thoughts I became overwhelmed with anxiety, fear and an almost palpable sense of terror. As soon as the thought of this secret flashed through my mind, I would have visions that would take me to its worst-case outcome. As I played these thoughts out in my head, I physically experienced extreme anxiety, as if the discovery of my secret was actually happening.
Just a few days ago, I was on the treadmill and the thought flashed through my mind again. I was immediately plagued with heightened anxiety. Even the lady on the treadmill next to me noticed and commented that my face had a strange look on it. In response to the thought, I did what most people would do. I tried not to think about it.
At that point, I started a conversation with the lady next to me…and the thought popped up in my head. After the conversation was over, I read a trashy magazine… and the thought popped up in my head again. I then began running as fast as I could, dripping with sweat and breathing deeply, and the thought still managed to surface. Actually, not only did it surface, but it continued to inflate in my head, as if it was going to soon explode. › Continue reading
Gay OCD / HOCD / Sexual Orientation OCD: Common Subtypes
Jon Hershfield of the OCD Center of Los Angeles discusses treatment of Sexual Orientation OCD, also known as HOCD or Gay OCD, using Cognitive Behavioral Therapy (CBT) and Mindfulness. Part three of a four part series.
There are many variations and sub-types of Sexual Orientation OCD (also known as Gay OCD or HOCD)
When I initially wrote the part one and part two of my article on Sexual Orientation OCD (aka “Homosexual OCD”, aka “HOCD”, aka “Gay OCD”), it was intended solely to reflect this rather common form of the disorder as I saw it presented in several of my clients. I had not anticipated such a significant online response, with so many additional questions and angles on the subject.
Sexual obsessions in general are under-reported because of shameful feelings associated with them. And yet there is probably a somewhat higher prevalence of sexual obsessions in OCD than any other obsession for this same reason – the thoughts are unwanted! This seems so very evident in Sexual Orientation OCD because the feared consequence appears so tangible. In other common OCD obsessions, such as “Harm OCD”, the idea that someone might be in denial of violent impulses is plenty terrifying. However, there is an understanding that being violent is unacceptable in and of itself. With Sexual Orientation OCD, the sufferer generally does not see anything wrong with being gay per se, as long as it is not themselves being gay. This causes a lot of confusion and a lot of resistance to seeking treatment. › Continue reading
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