Trichotillomania, Compulsive Skin Picking, and the Resistor’s High
Jon Hershfield, MA, of the OCD Center of Los Angeles discusses Cognitive Behavioral Therapy (CBT) for the treatment of Trichotillomania (compulsive hair pulling) and Dermatillomania (compulsive skin picking, or CSP).
My wife and I recently became vegetarians. Well, she started using the word “vegetarian” to describe already never eating meat. For me it required more of a lifestyle change. I grew up on a small beef cattle farm, so I was used to the idea that you could grow meat the same way you grow vegetables. Throughout my life it always felt as if meat was how one defined the difference between a “snack” and a “meal”. So as part health experiment and part social consciousness attempt, I have given up meat for the time being.
At first I felt like I was denying myself something purely enjoyable. I’m used to it, I like it, so why don’t I just do it? Saying, “I want to change” or “I’m not happy with the consequences” doesn’t seem to be much comfort. However, nearly 4 months into this experiment, I now get what can only be described as a “resistor’s high” – an addictive satisfaction derived from choosing not to eat meat. › Continue reading
Memory Hoarding in Obsessive Compulsive Disorder (OCD)
I was surprised to discover that Webster’s dictionary defines “hoard” as a kind of temporary fence put up around a structure being built, presumably with the intention of protecting it in a fragile state. Dictionary.com had a more familiar definition: “to accumulate for preservation, future use, etc., in a hidden or carefully guarded place.” Both definitions refer to the behavior of creating certainty around an uncertain state.
Squirrels hoard acorns to make sure they don’t starve during the winter. Armies hoard weapons to ensure they never run out. And some people with Obsessive Compulsive Disorder (OCD) hoard objects of uncertain value, usually with the belief that the object’s value may be revealed at an important point in the future. A classic example is the OCD sufferer who won’t throw out old newspapers for fear that he may wish to reference an article at a later date. Some people hoard various items of little or no real value for fear that they may need them some day, or fear that they may not be disposing of these items correctly and could cause unwanted consequences.
Not all people with OCD hoard. In fact, not all hoarders even have OCD. However, many people who suffer from OCD appear to engage in a form of mental compulsion I have come to call memory hoarding.
Memory hoarding is a mental compulsion to over-attend to the details of an event, person, or object in an attempt to mentally store it for safekeeping. This is generally done under the belief that the event, person, or object carries a special significance and will be important to recall exactly as-is at a later date. The memory serves the same function for the mental hoarder that the old newspaper serves for the physical hoarder.
People with memory hoarding OCD exhibit two major errors in information processing. The first error is the distorted belief that they will need this memory someday, and that it would be catastrophic if the memory weren’t 100% accurate. Second, people with memory hoarding also have the distorted belief that memories can be treated the same way as inanimate objects.
The value of a newspaper article can be debated, but the contents of that article will remain constant. A photograph can capture a certain image, and that image will remain constant as long as the material upon which it’s printed holds up. But memories do not obey the same properties.
Not only is a memory a complex amalgam of all of your senses (sight, hearing, smell, and so on), but it is also a function of the emotional state and cognitive processes of the person forming the memory, both at the time the memory is being formed, and when it is being recalled. Therefore the very act of forming or recalling a memory must, by definition, distort it. When you reflect upon an event, you are necessarily filtering the stored data of the initial memory through the present state you are in. So the belief that a memory can be hoarded makes the memory hoarding compulsion a guaranteed disappointment for the individual with OCD.
In general, the clients we have seen who engage in memory hoarding compulsions are concerned that moments in time will pass without them fully understanding, remembering, and appreciating them. The uncertainty surrounding whether or not they will be able to adequately reflect upon and evaluate the significance of specific events, people, or objects causes discomfort which they hope to avoid. Someone without OCD may best understand this concept as akin to that “last look” we all take the moment we leave an apartment from which we just finished moving all the boxes. You stop, you consider that this is the last time you will be this person in this place, and then you move on to the next chapter in life.
Someone with OCD who is engaging in memory hoarding symptoms is likely to feel trapped in a state of never fully being able to take in the true value of this moment. The twisted irony of memory hoarding is that the person trying to perfectly remember things frequently misses out on those very things because they are caught up in the mental compulsion trying not to miss anything. When we don’t allow ourselves to be present in the moment, we are losing a great deal of the value of life in the process.
This irony is consistent throughout the OCD spectrum. The compulsive hand washer scrubs furiously over and over and yet still spends most of their time feeling dirty, no matter how much they wash. The washing actually informs the brain that dirt is on the offensive. The memory hoarder similarly feels a perpetual state of incomplete memory formation, despite all of the time-consuming and emotionally draining work they put into trying to form memories perfectly.
As in other manifestations of OCD, the form may change but the function remains the same. Here are some forms of memory hoarding we have noticed in our clients:
- Over-attending to, and dwelling on, an event of perceived importance while the event is taking place (i.e. a wedding, a graduation, a birth, etc.)
- Over-attending to the details of a significant moment (an important conversation, a kiss, a bite of food, etc.)
- Over-attending to the details of a location and what it feels like to be in it (a room, the inside of a car, etc.)
- Over-attending to memory triggers of significant life periods (i.e. a movie from your childhood, pictures from an earlier relationship, etc.)
- Trying to perfectly remember the physical details of a lover, friend, or family member.
- Mentally replaying an event multiple times to gain certainty that it was remembered correctly.
Treatment for memory hoarding is obviously not going to look the same as treatment for physical hoarding. The goal isn’t to remove memories. Rather, the goal is to be able to accept memories as they are and choose their value willingly, not compulsively. Thus, the practice of Mindfulness-Based Cognitive Behavioral Therapy should be employed in the order of its name.
- Mindfulness – Fully and willingly accept that you have thoughts which appear on the surface to pose a threat to your ability to fully and perfectly form or recall a memory. Recognize that these thoughts are not good or bad, but simply exist. Accept imperfect memories as they are.
- Cognitive (Restructuring) – Identify what distorted ideas you may have about your memories, and what the logical, rational, and evidence-based consequences are of having an imperfect memory of a given event, person, or object.
- Behavioral Therapy (Exposure with Response Prevention) – Intentionally seek out scenarios where you feel the urge to memory hoard, and resist the compulsion by moving through the event without over-attending to any specific detail for a significant amount of time. Leave an event, person, or object without checking to make sure it has been fully understood, remembered, and appreciated. Interrupt mental reviewing with more meaningful, attention-demanding activities.
It’s important to understand the meaning of “over-attend” in this context. One person’s version of savoring the moment in a healthy way could mean getting trapped in an obsessive-compulsive cycle for someone with OCD. The trick is to draw a distinction between enjoying a moment, and mentally seeking reassurance by asking yourself if you are completely enjoying and remembering a moment for sure.
Part of this phenomenon may have to do with an OCD sufferer’s difficulty accepting the permanence of the passing of time. Or perhaps memory hoarding is just another form of trying to do the right thing in the right way 100%. In any case, if the ultimate objective is to value and enjoy experiences in your life, then your best bet is to let those experiences happen without OCD telling you how to enjoy and remember them.
•Jon Hershfield, MA, is a psychotherapist at the the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions. He can be contacted jon@ocdla.com.
OCD and the Law – Part 3
Our two most recent entries discussed a Scottish case and an American case in which criminal defendants claimed that the crimes for which they were being prosecuted were a function of their having Obsessive Compulsive Disorder (OCD). This week, we examine a case of an Australian professional boxer who claims his assault on 70-year-old man came about as a result of his having OCD. Part three of a three part series examining OCD and the law.
On November 16, 2009, John Edward Lane, a 70-year-old retired Australian television executive boarded a ferry boat in Sydney harbor. Also on board was Grant Brown, a 31-year-old Tasmanian boxer who had previously held the Australian lightweight title for three years, as well as six Tasmanian boxing titles and four Golden Gloves titles. › Continue reading
OCD and the Law – Part 2
Last week we wrote of a case in Scotland in which a man accused and ultimately convicted of possessing child pornography claimed that his crimes were a result of having Obsessive Compulsive Disorder (OCD). This week we examine the case of a Kentucky man whose lawyer claimed that he murdered his wife due to OCD. Part two of a three part series examining OCD and the law.
In March of 2010, the lawyer for Jerry Seidl of suburban Louisville, Kentucky claimed that his 68 year-old client murdered his wife of 47 years as a result of Obsessive Compulsive Disorder (OCD). The couple had separated in 2008, and his wife Dorene had moved out of the family home. On August 7th of that year, after filing for divorce, Dorene sought a protective order on the grounds of domestic violence. In the petition, Dorene claimed that her husband had previously put a gun to her head, and on a separate occasion had told her “I’m just going to kill myself and get it over with. Do you want to go with me”. Despite this, the request for a protective order against her husband was rejected by a local judge on August 20th. › Continue reading
OCD and the Law – Part 1
Recently, there have been a number of legal cases in which criminal defense lawyers have claimed that Obsessive Compulsive Disorder (OCD) was the cause of their client’s illegal behavior. This is part one of a three part series that examines these cases.
In March 2009, the Edinburgh Evening News of Scotland reported the case of Iain McKinlay, a father of three who claimed that the huge amount of child pornography that he had amassed on his computers was a result of his suffering from Obsessive Compulsive Disorder (OCD). McKinlay was caught after he used his personal credit card to access child pornography web sites. When the local police raided his home in April 2008, they found 3,557 illegal pictures on two separate computers. › Continue reading
OCD Stockholm Syndrome
The “Stockholm Syndrome” is a term used to describe the phenomenon of hostages defending their captors. As a psychotherapist specializing in Cognitive Behavioral Therapy (CBT) for the treatment of Obsessive Compulsive Disorder (OCD), I have seen something akin to the Stockholm Syndrome many times. Clients struggling with this issue often have a mysterious internal debate that goes something like this:
“If I hate OCD so much, why do I fight so hard to keep it around? Maybe my OCD is a good thing. Maybe I need my OCD. After all, If I am not my OCD, then who am I?”
This scenario typically (although not always) presents itself several months into therapy, long after the client has gained some autonomy from their OCD through the use of Cognitive Behavioral Therapy.
Athletes With Anxiety
Last week, we discussed recent news reports about professional baseball players struggling with Social Anxiety. This week, we broaden the topic to cover athletes in numerous sports with various anxiety disorders. Second of a two-part series.
As we noted last week and in prior posts, the past few years have seen a significant increase in the number of professional baseball players going on the disabled list due to Social Anxiety. This trend is remarkable for numerous reasons, the most noteworthy being that the issue of mental health in baseball is being openly discussed at all. The overall issue of mental health has long been shrouded in secrecy and shame, leading many public figures to go to great lengths in order to ensure that their mental health issues remain private. So when professional baseball players not only acknowledge their psychological issues, but actively seek help for them, this is a sign of cultural progress. › Continue reading
Social Anxiety in Baseball Revisted
This is part one of a two part series on anxiety disorders in sports.
This past week marked the arrival of the 2010 Major League baseball season. And as with last year, this season already has three developing stories of athletes dealing with Social Anxiety. › Continue reading
Treatment of OCD and Anxiety: A Brief History
As long as people have been having thoughts, they have been having unwanted ones. For most people, unwanted thoughts are little more than a nuisance or a curiosity. But for those with Obsessive Compulsive Disorder (OCD) and related anxiety disorders, these thoughts can be a debilitating nightmare. Unwanted thoughts often trigger unwanted emotions (anxiety, panic), which in turn lead to compulsive attempts to avoid, suppress, and control these emotions.
Traditional Treatment Strategies for OCD and Anxiety
Before the development of psychological treatments, disorders such as OCD and other anxiety conditions were often considered spiritual problems. The sanctioned response was to do your compulsions harder and more frequently. And for those who drew too much attention, a not uncommon result was persecution, imprisonment, or being subjected to brutal, misguided experiments. › Continue reading
Tiger Woods, Sex Addiction, and OCD – Part 2
This is the second and last of a two-part series that discusses the differences between sex addiction and Obsessive-Compulsive Disorder (OCD).
In part 1 of this series, we discussed the growing interest in sex addiction in the wake of recent revelations that Tiger Woods has had a wealth of mistresses. We also discussed how many people, including professional psychotherapists, inappropriately conceive of sex addiction as a form of Obsessive Compulsive Disorder (OCD). Finally, we reviewed the inherent experiential differences between these two conditions, as well as the innate problem of trying to treat sex addiction using therapeutic techniques known to be effective for the treatment of OCD.
In light of the significant differences between these two conditions, it seems clear that sex addiction is not OCD. So what is it? › Continue reading
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