Scrupulosity: Where OCD Meets Religion, Faith, and Belief
Many people mistakenly think of Obsessive Compulsive Disorder (OCD) solely as a condition in which people wash their hands excessively or check door locks repeatedly. There are actually many sub-types of OCD. In this ongoing series, Kevin Foss, MA of the OCD Center of Los Angeles discusses Scrupulosity, in which an individual’s OCD focuses on issues of religion, morals, and ethics. Part one of a four-part series.
One of the first documented references to Obsessive Compulsive Disorder (OCD) was in a 1691 sermon by Bishop John Moore of Norwich in which he discussed men and women who were overwhelmed with unwanted thoughts, and tormented by feelings of guilt and shame over what he described as “religious melancholy.” Priests had started to notice that some churchgoers were attending confession several times a day, and repeatedly confessing to the same sins and shortcomings that they feared would result in divine judgment and eternal damnation. Their penance and absolution would provide only a fleeting glimpse of peace, and then their fears would come roaring back.
In retrospect, we now know that this obsessive religious fervor is a manifestation of OCD known as Scrupulosity. People of various religions across the world are haunted by feelings of doubt, guilt, and anxiety that torment them by attacking that which they find most dear – their faith. Scrupulosity is a form of OCD in which the sufferer’s primary anxiety is the fear of being guilty of religious, moral, or ethical failure. Those afflicted with Scrupulosity fear that their effort to live according to their spiritual values not only isn’t good enough, but is in direct violation of God. › Continue reading
Mindfulness for OCD and Anxiety
Choosing a Different Route on the Anxiety Highway
“Mindfulness” seems to be everywhere these days. In the culture at large, mindfulness is becoming a common practice for many as a means to finding basic peace of mind. And in the field of mental health, mindfulness is quickly coming to be seen as a technique that can help relieve symptoms of OCD, anxiety, and other psychological conditions.
After reading the above paragraph, you may be thinking, “Sign me up!” After all, we live in an era of instant gratification, and most of us usually want a quick fix to our problems. But mindfulness is not something one masters overnight. It is a journey that requires effort, commitment, and dedication. While mindfulness may provide relatively rapid relief to one’s distress in certain situations, it is perhaps better conceptualized as a long-term shift in perspective that allows us to better manage the complexity of human psychological experience. Like learning a new language, mindfulness takes time and patience to master, and ongoing effort to remain fluent. › Continue reading
Hoarding, Cluttering, and Compulsive Shopping: My Childhood Story
Hoarding affects the entire family. Here is one woman’s story of her struggle as the daughter of multiple generations of hoarders. She has asked to remain anonymous.
I am the daughter of a hoarder. I am also the granddaughter of a hoarder. Somewhere amidst the cluttered chaos, I was a child. Competing with nine cats, three large dogs and compulsive shopping sprees was nothing but ordinary. Our 1500 square foot condo was stuffed wall-to-wall with dusty antique furniture, balls of cat fur, and the potent smell of animal urine masked by dozens of cheap burning candles. Taking in animals and acquiring things were my mother’s attempt to fill the absence of her husband and distract her from her long battle with cancer. She barricaded herself from the real world, consequently shutting down the needs of her only child and leaving no room for a relationship.
An unlikely suspect, my mother is an entrepreneur who dresses sharp, presents with confidence, and is admired and respected by her peers. What many people don’t know about the world of hoarding is that it is often a secret to outsiders. Although some hoarders can be detected by the clutter surrounding their homes, others present the exterior of their homes as well as they present themselves. From the outside world, we went unnoticed, further silencing my cry for help. › Continue reading
OCD and Thought-Action Fusion
Virtually everybody experiences unwanted thoughts from time to time, for we human beings are not always in charge of what we think. But for sufferers of Obsessive Compulsive Disorder (especially Pure Obsessional OCD), the problem is not just the presence of unwanted thoughts, but also the attention and meaning one gives to them.
OCD and Thought-Action Fusion
Obsessive Compulsive Disorder (OCD) not only produces constant mental noise and endless worry, but also often includes a cognitive process known as thought-action-fusion. The distorted thought at the heart of thought-action-fusion is the irrational assumption that just because a “bad” thought presents itself to your mind, then it is undeniably followed or accompanied by a specific “bad” action. In other words, thinking something makes it so. For some, this fusion is so strong that they believe that their thoughts actually cause actions to occur.
Clients who suffer from thought-action fusion often report intense fear because of their belief that their thoughts will come true. For example, a teenage girl may worry that if she has a thought of a home invasion happening to her family, then the break-in will undoubtedly occur. Or a college student might fear that he will wander out of his dorm room and harm someone without knowing it. If this student is struggling with OCD complicated by thought-action fusion, he might be overcome with a debilitating belief that, because he thinks this thought, then he is almost certainly a sociopath and is likely to act on it. › Continue reading
OCD, Anxiety, and Resistance
The OCD Center of Los Angeles discusses resistance and certainty-seeking in OCD and related anxiety based conditions. Part one of a two-part series.
When treating clients with Obsessive-Compulsive Disorder (OCD) and other anxiety based conditions, two of the most important topics we discuss are “resistance” and “certainty-seeking”. People suffering with these conditions often have unpleasant and unwanted thoughts, feelings, and bodily sensations, and resistance to these experiences is a normal, natural reaction. Simply put, when faced with something uncomfortable or painful, we humans instinctively resist it, and quickly look for ways to reduce our discomfort through avoidance. But unfortunately, while resistance may internally feel like the correct response to our uncomfortable thoughts, feelings and sensations, it actually serves to inflame them.
For most people, it seems counterintuitive to reduce resistance and allow uncertainty to remain in the face of these uncomfortable internal experiences. Many are likely to think something along the lines of “I must find a way to keep this thought, feeling, or bodily sensation from happening again.” But this philosophy of resistance in regards to our unwanted internal experiences will actually cause them to become more powerful. As illogical as it may seem, oftentimes the best solution is to lower our resistance, surrender, and accept what is being offered.
Harm OCD Treatment – Part 3: Cognitive Restructuring
A discussion of the treatment of Harm OCD using Cognitive Restructuring. Part three of a series.
In our previous installment of this series, we looked at Mindfulness for the treatment of Harm OCD, and how a change in perspective towards unwanted thoughts and feelings can lead to a change in compulsive behaviors. But as many sufferers well know, one’s response to intrusive harm thoughts is frequently automatic. Those with Harm OCD have conditioned themselves to respond to their harm thoughts in a certain way, and very little thinking may go into it.
Mindfulness encourages us not to waste time and energy attending to thoughts and feelings with urgency when those thoughts and feelings could be simply observed and allowed without response. This is not only difficult to do, but requires practice, training, and education that may not always be immediately practical early in treatment. If we must attend to the content of our thoughts directly, we should attempt to do so with as little mental ritual as possible. So we ask the question, “What is it that I am thinking about my thoughts that appears automatic, yet may be voluntary and may be pointing me in the wrong direction?
Cognitive Distortions Commonly Experienced in Harm OCD
The reason why a harm sufferer feels compelled to compulsively analyze, avoid, or otherwise over-respond to harm thoughts is because they are filtering these meaningless little ones and zeroes through distorted lenses that spit them out as unacceptable indictments. These lenses are called cognitive distortions. Here are some examples of common cognitive distortions experienced in Harm OCD: › Continue reading
OCD & Anxiety: Five Common Roadblocks to Successful Treatment
Cognitive Behavioral Therapy (CBT) is the gold standard for the treatment of OCD and related anxiety based conditions. But some simple mistakes can interfere with treatment. Kimberley Quinlan, MA, of the OCD Center of Los Angeles discusses five common roadblocks to effective treatment for OCD and anxiety.
Research has consistently found that the most effective treatment for Obsessive Compulsive Disorder (OCD) and most other anxiety disorders is Cognitive Behavioral Therapy (CBT). The cognitive component of CBT involves investigating and challenging the individual’s irrational thoughts related to their fears. These thoughts are described as “cognitive distortions”, and the process of challenging them is known as “cognitive restructuring”. This process takes place during therapy sessions, and is also practiced by the client between sessions throughout the course of treatment.
The behavioral component of CBT is more time intensive, and requires the client to be gradually, purposefully and systematically exposed to the very thoughts and situations which generate their discomfort, and to do so without responding with either compulsive or avoidant behaviors. This process is known as Exposure and Response Prevention (ERP). › Continue reading
Harm OCD Treatment – Part 2: Mindfulness Based CBT
The OCD Center of Los Angeles discusses treatment of Harm OCD using Mindfulness Based Cognitive Behavioral Therapy. Part two of an ongoing series.
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)
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 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
- Binge Eating Disorder / Compulsive Overeating
- Body Dysmorphic Disorder (BDD)
- Cognitive-Behavioral Therapy (CBT)
- Compulsive Skin Picking
- Eating Disorders
- Hypochondria / Health Anxiety
- Obsessive-Compulsive Disorder (OCD)
- Social Anxiety / Social Phobia