OCD Center of Los Angeles California
OCD Center of Los Angeles

Harm OCD Treatment: Mindfulness Based CBT

Thursday, May 3rd, 2012 Obsessive-Compulsive Disorder (OCD)

    

The OCD Center of Los Angeles discusses treatment of Harm OCD using Mindfulness Based Cognitive Behavioral Therapy.   Part two of an ongoing series.

Harm OCD is best treated with CBT that includes Mindfulness

Mindfulness Based CBT is a key component of successful treatment for Harm OCD

In our previous installment of this series, we 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.

To know that something is dark, we must have in my mind some concept of what it means to be bright. To understand peace, we must also have thoughts that are defined by their violent content. Otherwise there would Harm OCD testbe no frame of reference for understanding its opposite. For most, a thought of happiness is unencumbered by thoughts of sadness. But in OCD, the sufferer’s awareness of this “un-thought” is greater. This awareness is then responded to with fear and disgust, thus making it much more powerful and significant than it need be. This process is described well in Lee Baer’s landmark book on Pure Obsessional OCD, Imp of the Mind.

Violence exists. Therefore having violent thoughts is a normal and essential part of being conscious. For those suffering with Harm OCD, what makes this condition so challenging is the presentation of these normal thoughts at such an intense and intrusive level. If these intrusive, unwanted harm thoughts were simply passing by, we could overlook them. But these violent thoughts often hit hard and stick. For those with Harm OCD, it is not easy to acknowledge and accept the presence of these thoughts as being merely some sort of magnification of a “normal” thought process. For this, we must turn to treatment.

Treatment for Harm OCD

The only form of treatment worth taking seriously for Harm OCD (or any type of OCD) is Cognitive Behavioral Therapy (CBT). This approach to therapy for OCD has been repeatedly researched, and has consistently been found to be the most effective treatment for all forms of the condition, including Harm OCD. Within the overall framework of CBT, one will gain the most benefit from three specific CBT techniques: Mindfulness-Based CBT, Cognitive Restructuring, and a specific behavioral therapy technique known as Exposure with Response Prevention (ERP).

Mindfulness Workshop in Los Angeles ideal for Harm OCDMindfulness Based CBT For the Treatment of Harm OCD

If you look at the brain as a thought-generator, then you can define the mind as that which receives and processes these thoughts. Few thoughts make it from the brain to the processing center. Most thoughts are out of sight, out of mind. They barely register as blips on the radar screen and no matter how peculiar they may be, they are given little to no attention. When they do make it to the processing center, (i.e., to our full awareness), these thoughts are assumed to be relevant to our experience.

If I have a thought about the sky being blue, that will most likely not be placed front and center for further analysis. It doesn’t matter much what I do with that innocuous bit of information. But if I have a thought about something itching, then that thought will jump to the front of the line so I can assess what behavior it should be met with. Scratching seems appropriate, unless I’m posing for a picture or have peanut butter on my fingers. Then maybe I’ll just acknowledge the itch, but not respond to it.

The problem with OCD is that thoughts sometimes skip to the front of the line as part of a glitch in the system. They slip through a crack in the dam and show up uninvited. So the same part of me asking what I should do about my itch is suddenly appearing to ask what I should do about murdering my family.

You Are Not Crazy and These Are Normal Thoughts

I’ll have to sit with the uncertainty over how many readers have stopped at this point. After all, how can a thought about hurting a loved one or killing myself be called normal? To understand this, one must take a moment to consider what a thought really is. A thought is a mental event. It is a word we use to describe a link Mindfulness Workbook for OCDbetween a chemical reaction in the brain and our awareness of it. A chemical event occurs, something happens, and then we become aware of that thing and call it a thought. The judgment of “normal” vs. “abnormal” is used only to describe how we interpret that thought and what behaviors we choose to apply it to. The thought itself is nothing more than ones and zeroes, so how can it be anything but normal?

As I write this and I consider the kinds of thoughts that Harm OCD sufferers find themselves stuck on, the following thought pops into my head: “I will go home and murder my family when this article is finished”. Now, I can try to justify my awareness of this thought by attending to the context of what I was writing previously – that I was considering examples of typical Harm OCD thoughts. But I can’t know for sure if that’s the truth. Perhaps that thought actually represents a genuine, hidden desire to kill my family. How can I know for sure? Well, I can’t know and I don’t particularly care. After work, I will probably go home and have dinner. We’ll have to see what happens after that. In any case, the harm thought itself is not problematic. Its content may disturb you, but its existence is unimpressive at every level. It is, after all, just a thought.

As discussed above, harm thoughts, ugly as their content may appear, are normal, uninteresting events that occur in the brain. The problem is that individuals with Harm OCD judge these thoughts, over-process them, and distort them into threats. But thoughts are just thoughts, not threats. If a harm thought occurs, but there is no awareness of it, it either exists or does not, but in any case it is not a threat. If a harm thought occurs and we are aware of it, the tendency is to go straight into judgment and analysis. This immediately takes the concept of “thought” and changes it to an object of fear.

Treatment with Mindfulness-Based CBT focuses on training yourself to maintain an observational, rather than judgmental, stance towards your thoughts, feelings, urges, and physical sensations. It means letting go of the need to be the actor/director and taking the opportunity to simply be the camera instead.

For mindfulness to be effective at all, one must start from the perspective of accepting the presence of their unwanted harm thoughts. Note that accepting that a harm thought exists is not the same thing as accepting what the Harm OCD testharm thought implies after you judge it. The goal of Mindfulness Based CBT is disarmingly simple – to accept the reality of the existence of our intrusive, unwanted thoughts, without attributing any special meaning, value, or judgment to them. For those with Harm OCD, this means accepting that harm thoughts exist, without assuming that they must have some inherently profound meaning about our character and/or intent.

Because many Harm OCD sufferers fear that their thoughts represent a real and  imminent danger that must be immediately addressed, the very practice of mindfulness itself often becomes a challenging form of behavioral therapy known as Exposure with Response Prevention (ERP).  The following installments in this series will focus on ERP, as well as on a technique known as “Cognitive Restructuring”, and how modifying the way you think about the content of your thoughts can help you choose less compulsive behavioral responses to the unwanted thoughts of Harm OCD.

To take our free confidential online test for Harm OCD, click here.

To read part one in our series on Harm OCD, click here.

To read part three in our series on Harm OCD, click here.

To read part four in our series on Harm OCD, click here.

The OCD Center of Los Angeles is a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related anxiety based conditions.  In addition to individual therapy, the center offers six weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment.  To contact the OCD Center of Los Angeles, click here.

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57 Comments to Harm OCD Treatment: Mindfulness Based CBT

  1. Excellent post that does a great job of explaining how thoughts are just thoughts and nothing more. I like how you describe the thoughts of OCD sufferers as often “skipping to the front of the line.” I look forward to to the next article in the series.

  2. Janet Singer on May 11th, 2012
  3. Thanks, Janet! Appreciate your comment and I’m glad the article resonated with you. Stay tuned!

  4. OCD Center of Los Angeles on May 11th, 2012
  5. I´m a CBT therapist in Buenos Aires, Argentina. Both articles of Harm OCD has been of great help in my practice (i have translated some parts of both articles for one of my patients). Thank you very much for sharing your knowledge!

  6. Patricio López on May 11th, 2012
  7. Patricio, thanks for your comment. Very pleased you have found the information here helpful for your clients. And what an honor to be translated!

  8. OCD Center of Los Angeles on May 12th, 2012
  9. I found the image at the top with the bloody knife extremely triggering. I almost avoided reading the article all together, which would’ve been a shame because it’s really helpful.

  10. Abby on July 18th, 2012
  11. I like the article sounds exactly like me I have had a anxiety disorder for 20yrs and never had these thoughts until one day it popped in my head then i went on a downward spiral now i constantly think like i am going to harm someone and it causes bad anxiety i hate it I hope this will help me Thanks!

  12. joe on July 23rd, 2012
  13. Hi Abby, thanks for your comment about the picture we chose for the article. This is a good example of how Harm OCD uses a cognitive distortion called “selective abstraction” to draw your attention to the negative aspects of things related to your obsession before allowing you to see the bigger issue. The picture of the knife is something found on a generic library of stock pictures, something anyone may encounter anywhere. But your ocd drives you to avoid these images because they are associated with discomfort. In treatment, you would not only want to be doing exposure to triggering imagery, but also working on mindful acceptance of the fact that these pictures trigger thoughts and these thoughts are not threats, despite their unpleasant content.

  14. OCD Center of Los Angeles on July 24th, 2012
  15. Joe, glad to hear you identified with the article. It’s not unusual for harm thoughts to suddenly appear after a long battle with anxiety. Try to remember that when you say thoughts of harm cause you anxiety, what you really are describing is your reaction to these thoughts after assessing them as meaningful and unacceptable. In Mindfulness-Based Cognitive Behavioral Therapy, you would work on changing the way you respond to these thoughts and would begin to see them as less threatening and less demanding of your attention.

  16. OCD Center of Los Angeles on July 24th, 2012
  17. It’s interesting that you say harm thoughts sometimes occur after a long battle with anxiety. I recently suffered a relapse and after a month of dealing with the theme that caused it, I suddenly began having harm thoughts. Is there a reason why this theme comes up after a long period of anxiety? Thanks so much.

  18. renee pearson on July 25th, 2012
  19. Hi Renee, sorry for the delayed response, missed your post. It’s very common for OCD to shift from one obsession to another. I think a good way to look at it is that the OCD is aiming for the most reliable food source. Compulsions are the food. Whatever you had been obsessing about previously, it was important enough to you that you were willing to do compulsions to try to escape it. When you stopped doing compulsions, the OCD just moved to whatever else might get you to do compulsions. This could have been anything, but happened to be Harm OCD. Or we could theorize that it was Harm OCD in particular because there’s something nihilistic about violent thoughts and it’s the place we go to when we can’t think of anything worse.

  20. OCD Center of Los Angeles on August 17th, 2012
  21. Hello, thanks for your blog, this is the first time I read something that named what I have which is harm OCD, I am seeing a psychologist right now and having cbt as treatment but all she say about what I am experiencing is anxiety. It happened a month ago and it changes a lot in my life. At first I would feel nervous and simply had hard time concentrating, I was shaking so bad that my teeth were chatting together I felt as is if cold. Then as I was chopping onion a thought occurred that what if I harm my family with the knife and then my hands started trembling. It seems my emotions evade me I can’t feel happiness or sadness and this made more worried. Thoughts of what if started to come. When with my sister’s baby i would feel that I might bite his ear and there is an urge that made me afraid, and when I saw someone in the hospital a woman operated, the smell of the iodine made me think of eating the part of her wound. Then sometimes I would think that what I have will progress to something that I will be crazy. When I hear someone talking about people loosing their mind I kind stop spaced out for a minute. Now with my psychologist help I was able to hold a knife again without trembling but there will be time that a thought will come what if I loose control and sway the knife while my nephew is playing. Sometimes I will just ignore the thought but sometimes I will be bothered by it because I want to do something that will stop it. My greatest assurance is God is in control even if I’m not and he would let harm come to me or to any of my family member. Hope you can give me more insight to this. Thanks.

  22. Mae on August 25th, 2012
  23. Hi Mae, thanks for your comment. It definitely sounds like Harm OCD. Anxiety plays a role in this, but people report feeling disturbed, unhappy, or disgusted by their thoughts as well, so chalking it all up to simple anxiety doesn’t really do it justice. Ultimately, you have ocd, a disorder that involves unwanted intrusive thoughts and compulsive behaviors that you use to deal with them. In your case the compulsions would be analyzing the meaning of your thoughts, avoiding triggers, seeking reassurance, and more I’m sure. That’s great that your therapist was able to help you be around knives again. The next step would be to work on your Mindfulness skills and start viewing your thoughts as thoughts, not threats. As thoughts, you can invite them in, let them go through you, and not put much attention toward what they could mean.

    Since you mentioned that your faith is helpful for you, you might find Ian Osborn’s book “Can Christianity Cure OCD” to be helpful. I also highly recommend reading Lee Baer’s “Imp of the Mind”, which helps explain why we become aware of thoughts like these.

  24. OCD Center of Los Angeles on August 28th, 2012
  25. Thank you so much for this! I recently started experiencing symptoms that are almost certainly Harm OCD (thoughts of hurting myself which morphed into thoughts of harming my loved ones) I’ve been reacting to these thoughts by having episodes of anxiety and depression. I initially thought that having those types of reactions was a good thing because it proved that the thoughts were totally abhorrent to me. After reading this article I realize that those reactions are NOT helpful because they lend power to the thoughts and do nothing to help me recognize them as simple ordinary thoughts. The phrase “unimpressive at every level” really stood out to me and is something that I will definitely keep in mind whenever those thoughts arise. Once again, thank you so much for this. It’s the best piece on the subject that I’ve found online and I anxiously (haha) await the next installment.

  26. Daniel on August 28th, 2012
  27. Daniel, thanks for your comment and I’m really happy the articles have resonated for you. You demonstrate good insight into the issue of using disgust as a form of self-reassurance. Seeing the harm thoughts as simple data showing up on your mind satellite will help you to respond to them like what they really are – thoughts. Here’s installment #3 by the way. http://www.ocdla.com/blog/harm-ocd-cognitive-restructuring-1721 The fourth installment will be up soon.

  28. OCD Center of Los Angeles on August 29th, 2012
  29. Thanks for your website. I have suffered from harming OCD since I was 12 (36 now). It has affected my life very much. It has been under control for many years with Paxil, though it takes outside stimuli as well. I recently had a relapse causing me and my family much stress. I am planning on moving to a happier place, and the OCD has begun to ruin these positives. I certainly will use your CBT techniques. Thanks to everyone!

  30. Kenny on September 4th, 2012
  31. This is a great article..and very helpful.. i suffered mostly hit and run ocd..and harm ocd..i have been treated with CBT..and after a good stress, a happiness which was a love feelling, a past idea came to my mind..Some years ago i went to a strangers house because i wanted to get reassurance, that i was not responsible for the accident that happenned to her relative..i remember didnt open the door, and she told me to leave, otherwise she would call the police..the idea that i upset her and caused her a heart attack or something, is killing me.. i would like to ask you: is it common for ocd that i feel guilt about the past? is it common for ocd that i thing i caused death to a stranger in the past? i always read about the fear that has someone to harm people in the future…what about me, that i thing i harmed people in the past? how will i be conveinced that i didnt caused harm to someone, and this guilt is an ocd symptom?
    thank you very much in advane!

  32. Maria on September 7th, 2012
  33. Kenny, thanks for your comment. I highly recommend getting treatment from an ocd specialist if you can. The techniques described in these articles work, but the guidance of a trained cbt therapist can be an important part of applying them.

    Be careful with the use of black-and-white hyperbole in the way you frame your experiences. OCD likes to think it can “ruin” “positives”. Unpleasant experiences happen in otherwise positive experiences, so describing them as “ruining” them rather than “affecting your enjoyment of” them plays into the ocd’s power.

  34. OCD Center of Los Angeles on September 9th, 2012
  35. Hi Maria, thanks for your comments and I’m glad the article has been helpful for you.

    To your questions:
    >>>is it common for ocd that i feel guilt about the past?

    —-Yes. The important thing to remember is that the presence of guilty feelings is not evidence of having committed a crime. Feelings come and go. Guilt feelings are often just a trap set by the ocd to get you back to your compulsive reviewing. The trick is to identify it as a feeling and not assume it is an important one.

    >>>is it common for ocd that i thing i caused death to a stranger in the past? i always read about the fear that has someone to harm people in the future…what about me, that i thing i harmed people in the past?

    —-In my experience of treating people with ocd, the report of thoughts about the potential of harming people in the future or having harmed people in the past is a 50/50 split.

    >>>how will i be conveinced that i didnt caused harm to someone, and this guilt is an ocd symptom?

    —When you stop trying to convince yourself of something that cannot be proven. If you spent all day trying to convince yourself that Jon Hershfield was responding to your questions, you would eventually begin to doubt it and be concerned that someone else was doing it. Instead, you look at the evidence (i.e. my name is printed below this post) and accept the uncertainty that remains. Thus, the assumption feels safe. Look at “trying to convince” as a compulsion to gain certainty, just another form of mental handwashing, something to be resisted.

  36. OCD Center of Los Angeles on September 9th, 2012
  37. Thank you so much for your article. Is comforting to know that there are others experincing the same thing and there is treatment for it. Can you develop ocd out of the blue? I’m 29 years old and I have always been a little anxious (don’t like speaking in public, worrying about what others think of me etc) but never to the point that I became obsessional. About a month a ago i had a panic attack after watching a show where a man killed his son. I found it so disturbing that I thought about it all night. I started having thoughts that I might become like this man and kill my children which quickly morhped into a fear of becoming a pediophile. I never in my life had such awful thoughts and the fact that I’m thinking them especially around my nieces and newphews is even more disturbing. Also, I have such a physical reaction (tingling sensations) that I’m worried it means I secretly enjoy these thoughts. I’m seeing a therapist now but i’m too ashamed to tell him the thoughts I’m having. Because I never suffered from ocd in the past I’m also scared that its not ocd and I truly am this pervert that i m scared of becoming.

  38. vicki on September 22nd, 2012
  39. Hi Vicki, thanks for your comment. I’m sure a lot more readers can relate than you might imagine. Late onset ocd is actually pretty common and I’ve seen many people with little or no ocd symptoms in their past suddenly develop an obsession (usually Harm ocd in my experience). This can be especially terrifying for someone not used to experiencing unwanted thoughts that stick around, often targeting a loved one. It’s not an indicator of the validity of your unwanted thoughts.

    No one really knows exactly why some people develop ocd symptoms in early childhood and some people develop them later on. I have seen it occur simultaneously with stress in late onset ocd, as if the stress beings the ocd to the surface, but that’s just anecdotal. In any case, the treatment is the same. You will want to share your experience with your therapist and ask if they know how to treat ocd with cognitive behavioral therapy and Exposure with Response Prevention. If you do not feel that sharing these thoughts with your therapist is safe, then seek out an ocd specialist directly. Feel free to contact me if you need help locating an appropriate treatment provider.

    “Tingling sensations” and other bodily responses to triggers are typical. Consider that attention given to ANY body part is going to cause some awareness of sensation in that part (think of your left ear really hard right now, for example). It’s just that we have difficulty resisting the urge to search for meaning in sensations that occur in some places more than others.

  40. OCD Center of Los Angeles on September 23rd, 2012
  41. It actually surprizes me there are other people with this problem. For many years since I was a small child I was too afraid to say anything to anyone about it, I still fear being put into a mental ward. All sorts of horrifying images in my mind haunt me every day, randomly popping up whenever they seem fit to. Its almost debilitating, elevators breaking down and falling while I’m inside, bridges crumbling apart beneath me or driving up over the side, driving on the highway and a semi-truck falling over on its side crushing my car with me and my kids inside, I cant get near windows pass the 3rd floor in a building in fear of what my mind might come up with. Even random objects become weapons for my mind to torture me with, spoons pop out eyeballs, pencils can be shoved into the neck or eye, i cant stand being in the kitchen when someone uses the garbage disposal I see whoever is using it hand inside it being ground up. Writing up all this is starting to bring on a panic attack because im seeing it all at once.

    The only things that ever kept me from thinking/seeing these thoughts in my head was sleeping, sex, acceptable mutilation such as tattoos and peircings (the numbing pain is distracting enough for a little while), unacceptable mutilation such as cutting (same reasoning). I have honestly thought of going extreeme to just stop seeing these images. Its getting to the point to where I’m not sure I can handle it anymore. Is there places in Virginia to go seek help?

  42. Kim on November 2nd, 2012
  43. Kim, the appearance of intrusive harm thoughts can take many different forms, including the association of meaningless objects as weapons or the visualization of things in your environment being destroyed, exploding, etc. These thoughts are normal events that occur in the brain and are problematic for you only because of the way you respond to them. Cutting and other self-mutilating behaviors are a strategy for regulating your emotions. In addition to cbt for your ocd, it would probably be a good idea to get DBT (dialectic behavioral therapy) for learning how to better regulate your more extreme emotional states. For ocd treatment, you can go to http://www.ocfoundation.org/findproviders.aspx and search for providers in your area.

  44. OCD Center of Los Angeles on November 2nd, 2012
  45. I am so, SO grateful to have found this site! I read the Imp of the Mind about 6 years and found great solace in it. However, naming it “harm ocd” and recognizing the compulsion to review thoughts/action as the “c” in “ocd” is new to me. I always just say that I have the “o”. The intrusive thoughts I’ve had since at least my early 20′s (am 40 now) and luckily I have finally found a therapist who is helping me address them. I’m finally at the point where I am able to recognize them just as thoughts, I refer to them as “faulty coping mechanisms” as they usually come up if I’m in an uncomfortable situation where I, for example, have to stand up for myself. I could absolutely relate to the person who wrote about spoons and pencils becoming instruments of destruction in her mind. It’s horrible!! Sewing needles are one of my old obsessions, >proceed with caution< I used to worry that I would sneeze and stab myself in the eye with it. Like others, I was terrified for years that I would get locked up if I spoke about it. I made the decision a year ago to "say ALL my crazy out loud" and here I am, not in the least bit locked up and far happier than I've been in years : )
    I'm so glad to know that this has a name, and that your center exists. Thank you!

    Also, comedian Maria Bamford has fantastic skits about this, she is also someone who gives me great hope.

  46. Jen on December 17th, 2012
  47. Hi Jen,

    Thank you for your comments and for your kind words.

    The “Imp of the Mind” is a superb book, and we recommend it to all of our clients with Harm OCD (and any other variant of OCD that is considered “Pure O”).

    It is great that you are becoming more adept at recognizing that your thoughts are just thoughts. Everybody has irrational / unwanted thoughts that don’t deserve their time or attention.

    I am not familiar with Maria Bamford, but I will look for her as I am now curious about her work. Thank you for bringing her to our attention.

  48. OCD Center of Los Angeles on December 20th, 2012
  49. Found your website searching the web and I have to admit I laughed a lot because when you see your symptoms written down by someone else you realise that even though these thoughts are so painful that on the other hand they can appear rudiculous.

    My own Harm OCD started many years ago I am now 45 but I was abused in a remote location by a stranger at age 13.Since my late twenties I started to become exposed to children as my siblings began to have children. I noticed in their company that I felt very uneasy specifically if I was left alone with them.Therefore I avoided any physical contact and would refuse to babysit for anybody for fear I may harm them.My on off girlfriend became pregnant when I was 41 and when my son was born .I was feeding him 3 days later and had a flashback that I was the abuser and my son was me.I had a what I describe as a panic meltdown and medicated myself heavily to reduce the thoughts.

    Since then I am totally terrified that I may hurt him either sexually or physically which distresses me greatly as I love him more than anything in this world.I have pushed myself to do things that escalate these thoughts ie changing his nappy because I love my son.I now live alone as I feel I cannot hurt anyone but these demons as I call them attack me on a constant basis they can be applied to anyone even my little dog which is crazy I know.

    I now find myself kind of numbed out which makes the OCD worse as I push the intrusive thought to try to get a feeling which does not come and makes me feel worse about myself.Apologies for the long intro here but was wondering which kind of therapy would suit me best I have done talk therapy for several years on and off without success.Keep up the good work

    Warm regards

    Terry

  50. terry on December 30th, 2012
  51. Hi Terry,

    I’m glad to hear that you were able to laugh at the symptoms described in our article. One of the most important steps in treatment is to stop taking one’s thoughts so seriously – to be able to laugh at just how ludicrous our thoughts can be.

    You mentioned a number of compulsive and avoidant behaviors you have done or are currently doing, all of which are counter-productive. Specifically:

      ~avoiding physical contact with children
      ~choosing to live alone for fear of hurting someone
      ~refusing to babysit
      ~self-medicating in an effort to reduce your anxiety
      ~trying to generate a certain kind of (good) feeling

    Unfortunately, while these types of behaviors may work in the very short term, in the long term, they only serve to reinforce the OCD, and ultimately lead to more obsessions (which of course leads to more counter-productive compulsions).

    As for the best treatment, the research is conclusive that the most effective treatment for OCD is Cognitive Behavioral Therapy (CBT). You can learn more about this therapeutic approach at http://www.ocdla.com/cognitivebehavioraltherapy.html and at http://www.ocdla.com/mindfulness-cbt-ocd-anxiety.html.

    Take care.

  52. OCD Center of Los Angeles on December 30th, 2012
  53. I am so happy that i found this blog and this website – its so comforting to know I am not alone in these strugles, and that we have some hope. Vicki – I could have written your comment, I feel like our story is so similar.

    I am 29 and have always been a worrier, in fact my friends would describe me as the stress head ( worrying about public speaking, if i had offended someone, if i had misplaced something important,or hadnt performed something to the best I could). I was always second guessing myself but no obsessive checking or compulsions that i can remember, although now i know the mental compulsions may have been there. Around 3-4 years ago I developed a health obsession where I became obsessed I was dying from a chronic illness, or in particular had MS and i visited every possible health practioner I could find.I had many tests, complained of tingling in my legs and felt that i was having all the symptoms, although i know now i was focusing on this and thats why i felt like i was having symptoms. After finally confessing to family I was able to move on from this, only to be replaced by this awful fear of being a pedophile and intrusive thoughts on this theme.

    I was worried that because I was only 25 perhaps my sexual orientation was changing. I have spent the last 4 years worrying about this. i have also panicked that I am having a nervous breakdown, that I am truly going crazy and will end up in prison or was so unstable i would end up in an institution or hospital.

    The symptoms were random and out of the blue for me, and as such were so terrifying and I thought i was losing my mind. It was only recently that I discovered i am not the only person to have suffered from this and I really am not a terrible person. I ruminate all day long and search for answers. My husband and I have been talking about starting a family and this has caused me intense stress, although I would love to and feel this is ruining the experience for me. I try and conjure up thoughts about being a mum, what scenarios i would be in to see if i like it, am good at it and worse if i am what i fear. I have been scared to seek treatment for fear it will not work or that I will realise that I am really evil and this OCD condition is not me at all. I also get the physical sensations, that i find terrifying and can often be completely unrelated, but really stress me out.

    I have coped in the past by labelling my thoughts, trying to recognse that it is a disease and not me. I use the concept of an OCD monster and i picture it in my head, attributing everything to him trying to torment me. This does assist in detaching myself, but the thoughts are still there, and i have bad days. When i have the days that i dont feel the anxiety, but get the thoughts, then it worries me that im liking them. The fear of being a mum is now starting to destroy me as we should be so excited about this phase of our life but instead i cannot take my mind of the possibility that these thoughts mean something. Have you found that exposure helps as a parent? I plan to get this under control before I take that step, so i am doing all i can to get help. And i also vow to not let this destroy my experience as a mum or make me decide i dont want to do it – it will not win!

    Thanks so much for your blog, i really appreciate it and im sure it has helped a lot of people.

    Linda

  54. Linda on January 9th, 2013
  55. Hi Linda,

    Thank you for comments.

    Your symptoms, including how they have “morphed” over time into various new symptoms, are quite common in OCD – especially in the more obsessional variants that are colloquially known as “Pure O”.

    It sounds like you have a good start (i.e., labeling the thoughts in a more accurate manner than your mind initially believes), but I encourage you to seek treatment. A good therapist who specializes in Cognitive Behavioral Therapy (CBT) could help you learn how to manage these thoughts with less distress and less impact on your life. Take care.

  56. OCD Center of Los Angeles on January 20th, 2013
  57. I was wondering if I have OCD, because I obsess about a dream a former college friend had about me where I came in and shot the whole class. I think and fear that it will happen often. This dream was many man years ago but I believe or worry it will come true, that people have premonitions. It is not something I wish to happen but I believe it could be destined to happen and I cant do anything to change it. :(

  58. Jessi on February 18th, 2013
  59. Jessi,

    Thank you for your comment.

    While I cannot provide a diagnosis via blog, the symptoms you describe are consistent with those of OCD – specifically Harm OCD. Keep in mind that one can obsess about anything, even dreams and memories.

    That said, I think it is important that you challenge the idea that your friend’s dream was some sort of “premonition”. You might start by re-framing your friend’s dream as just that – a dream. Every human has all sorts of wild, unrealistic images and ideas that appear in their dreams. Furthermore, I doubt you have any evidence to support the thesis that your friend has special predictive powers. In other words, rather than jump to the conclusion that the dream was meaningful, why not challenge that idea with an alternative idea that is far more likely to be accurate – namely that your friend, like all of us, sometimes has weird dreams.

    Finally, I want to encourage you to read our follow-up to this article, which explores using a therapy technique called “cognitive restructuring” to challenge unrealistic thinking related to harming obsessions. You can read that article at http://www.ocdla.com/blog/harm-ocd-cognitive-restructuring-1721.

    Take care

  60. OCD Center of Los Angeles on February 18th, 2013
  61. I have been practicing mindfulness for about three years and it has helped me weaken my ocd quite a bit. While there are some good books on mindfulness and anxiety, I have not found a book that focuses specifically on using mindfulness to treat ocd. Do you know of any such books? Thanks.

    Mike

  62. Mike on March 4th, 2013
  63. Wow, great article. My fiancé has OCD and its different types, he used to have violent thoughts now its homophobia. What can I do to help him ? Also is it possible that he could act upon those bad thoughts?

  64. Victoria on July 8th, 2013
  65. Hi Victoria,

    Thanks for commenting. Is is great to hear that you are interested in being supportive of your fiancé. Sometimes partners and spouses get freaked out about OCD, especially about Harm OCD. Rest assured that those with Harm OCD are extremely unlikely to act in a violent manner – in fact, they are no more likely to act violently than the general population. My experience with treating clients with Harm OCD is that they are absolutely horrified with their harming thoughts precisely because these thoughts are antithetical to who they are.

    It is quite common for the content of people’s OCD to “morph” over time, so it is not at all surprising that your fiancé’s thoughts have become more focused on sexual orientation, which is a subtype of OCD commonly called Gay OCD or HOCD. You can read more about that in our series of four articles on the topic at http://www.ocdla.com/blog/sexual-orientation-hocd-gay-ocd-treatment-1010.

    The best things you can do are : 1) get educated about OCD and its various permutations; 2) be supportive; and 3) avoid the trap of over-accommodating his obsessions.

  66. Tom Corboy, MFT ~ OCD Center of Los Angeles on July 9th, 2013
  67. Hello again, I have come back here after a while :) my therapy has gone good, although there are sometimes that it hits me back, no longer as “hocd” though.

    Is it also part of the anxiety and OCD, that now whenever I hear some bad news I get this thought that maybe deep inside me I’m enjoying listening to the bad news? Like for example if I hear about a train crash, I get a fear that somewhere on my unconscious it is something delightful or such for myself? yeah I guess it is..

  68. Matteo on July 30th, 2013
  69. Hi Matteo,

    It is not unusual for OCD to change over time. So while your OCD symptoms related to sexual orientation have decreased, it sounds like new OCD symptoms have cropped up with a different theme. Again, this is normal and to be expected.

    It is also quite common for people with Harm OCD to obsess about the possibility that they enjoy hearing about other people’s suffering. The basic fear is “what if I am some sort of sick person who actually likes the idea of other people suffering, or likes these terrible thoughts”.

    The best way to manage this new OCD symptom is to use the same tools that have been helping you manage your unwanted HOCD thoughts. It sounds like you have been getting treatment, and I encourage you to discuss your new symptoms with your therapist. Take care.

  70. Tom Corboy, MFT ~ OCD Center of Los Angeles on July 30th, 2013
  71. Hello again,

    Currently my therapist is on holidays, so well.. I think is nice entering here to speak.

    I wanted to know if you have treated people that feel badly about laughing of dark jokes, or maximizing to an extreme the schadenfreude?

    I ask, because lately I have found myself with a vulnerability towards the fact of laughing at dark humor. There’s this thing that make you think that if you laugh at something fictional but tragic, it won’t be any different if one day you witness such situation in real life. What is your advise?

  72. Matteo on July 31st, 2013
  73. Hi Matteo,

    Your concerns about laughing at dark humor are fairly normal for Harm OCD. Keep in mind that the basic fear for those with Harm OCD is “what if I am a horrible person capable of doing horrible things”. So it makes sense that you would question your character on the basis of finding dark humor funny because it focuses on things that most people consider so unacceptable.

    My advice is to laugh at whatever you find funny, without analyzing why you find it funny. Enjoy your dark sense of humor, which has no bearing on real life.

  74. Tom Corboy, MFT ~ OCD Center of Los Angeles on August 4th, 2013
  75. Hey again!

    I’ve been feeling much better, the thoughts of other things dont cause me fear any longer. Funnily, there’s something new: distrust in memory, whether if I heard what I think I heard some hours ago and such. I’m paying not much attention to it, as to not make it increase. Tell me, have you heard of such cases?

  76. Matteo on August 17th, 2013
  77. Hi Matteo,

    Doubting one’s memory is extremely common in OCD. So common that the disorder is sometimes called “the doubting disease”. I encourage you to pay no attention to the doubt – when you have doubt about your memory, live with the doubt. Analyzing the doubt will not make it any clearer to you.

  78. Tom Corboy, MFT ~ OCD Center of Los Angeles on August 18th, 2013
  79. Hey, I’m sorry if I’m annoying you with the multiple messages.

    Since the end of last week I have had a strong flu, which by some reason has led me to have a strong flare up, must be the lack of strenght to be mindfull.

    Anyway… This morning I read somewhere online the case of a man that under LSD had cut the head of his cat. At first I thought “I hope this doesn’t keep in my mind” well.. for most of the day nothing happened, but during the evening while I was eating in the kitchen along my mother, and two cats, the image of choping his head came to me. I wasn’t mindful and didn’t realize at which I point I started contemplating the content of the thought. Even fearing that I would go berserk, grab my cat, and cut his head off with a knife.

    The thought didn’t go for about an hour, and I was in a peak of anxiety. So I decided to do an exposure exercise by myself. I grabbed my cat with one hand, and on the other took the knife. Just contemplating what feelings arised. Of course, no desire of harming my cat at all arised. I thought this had been a success and went to my room as if nothing had happened. But once here, my mind started analyzing “you see Matteo, you have already done an exercise of this kind, you were actually holding a knife on one hand with your cat on the other, next time you’ll definitely go berserk and stab your cat” the thought was trying to tell me that the exposure wasn’t really proving that I love my cat, but instead that I have lost my mind, and soon could do him harm :/ That by doing an exposure exercise, I was being some kind of madman.

    What do you think of this? Was my exposure exercise effective? or what backfired?

    Second thing: I read somewhere else that most of the pain and obsession appears because of the urge of wanting to control, to know exactly I would NEVER harm anyone. But that this is impossible, and so I should say sincerely to myself, “well I don’t feel like doing so, I can’t speak for the future” Do you think this actually brings freedom? Because I’m fearful that by saying this, I’m admitting that maybe I could do it in the future.

    I hope to not have annoyed you! God bless your webpage, it has helped me lots. Unfortunately my therapist has gone to live elsewhere and so our therapy is done. I started practicing meditation two weeks ago which is fantastic, however sometimes, and specially now with this flu I feel with a lot of anxiety, that’s why I come here.

  80. Matteo on August 28th, 2013
  81. Matteo,

    Thank you for your comments.

    Your reaction to your exposure with your cat was quite typical. When people with OCD do exposures to unwanted thoughts, their brains often respond with new thoughts such as “see, you are capable of…”. Also, it is important to remember that OCD is not going to be vanquished with one exposure – it is going to repeatedly look for any way it can to try to convince you that you are a monster.

    As for your second question, the desire for absolute certainty is at the very core of OCD. And as you correctly point out, absolute certainty is impossible because we cannot predict the future. For all I know, I may go berserk today and kill someone – or 100 people! Based on my experience, I have no reason to actually believe that will happen, but I cannot provide you, myself, or anyone else with absolute certainty that I will not kill someone today.

    You are afraid that by allowing your unwanted thoughts to exist, that you would somehow be admitting that you could be a killer in the future. But we all could be killers in the future. Real freedom comes from allowing your unwanted thoughts to exist without trying control them, and without paying so much attention to them. They are just thoughts, and everybody has all sorts of weird thoughts that are not based on our true character and intentions.

    I encourage you to discuss these issues with the therapist you mentioned in a previous comment. If that therapist is not an OCD specialist, then it would be best to find one who is.

  82. Tom Corboy, MFT ~ OCD Center of Los Angeles on August 29th, 2013
  83. I mean, not like I listen voices of someone speaking to me. Simply, I’m confused on how to define a thought. In this case, it was merely the idea of seeing what a girl would think of me. So what I did, was simply “to think what she would think of me” is this common?

  84. Matteo on August 29th, 2013
  85. Matteo,

    Trying to discern the difference between a “thought” and an “idea” is a compulsion. All of the issues you write about appear to be OCD. Again, I encourage you to discuss these issues with your therapist.

  86. Tom Corboy, MFT ~ OCD Center of Los Angeles on September 30th, 2013
  87. Hello,

    I have also found this page very interesting and at times quite reassuring, so thank you for this! I suspect that my OCD also began due to a period where I was obsessed about my health and being ill, along with always being an anxious individual anyway e.g. worrying about people, what others think, am I good enough? Etc.

    I am currently seeing a therapist however there are many things that I forget about and should write down… But I feel that the doubting and questioning myself side of things is really manifesting itself.
    I wondered whether anyone else/is it normal for people to wonder whether they would feel guilty or not if they were to do something?
    I have always been a very caring and compassionate person, and have ALWAYS had a good sense of right from wrong etc. however I feel somewhat emotionless at the moment compared to my normal self – and this scares me!

    Also I sometimes just say things in my head and almost argue with myself for example I have sometimes thought – I want to do it – but then I’m like – no you don’t… Is this normal?! Sometimes I have thought what if the only way to get rid of these thoughts would be to just do it – although I know I wouldn’t want to.

    I’m only 21 and am worried about this affecting my life :(

    I would really appreciate it if anyone could help me and let me know what they think.

    Thank you x

  88. NJ on October 2nd, 2013
  89. I have recently tried to just accept the thought and not respond to them. While I suppose the thoughts now are not as frequent I am now bothered because the thoughts don’t bother me. I know that may not make to much sense but I feel like im not having enough anxiety over the thought and therefore may prove that I am really evil. Is this normal for harm ocd? I want to get better so badly I hate these thoughts. I suppose I am also scared that even if I don’t care about the thoughts they will just stay there anyway, and then it would just prove that I am a sociopath

  90. Rachael on October 11th, 2013
  91. Hi Rachael,

    The phenomenon to which you are referring is called a “backdoor spike” In short, a back door spike is when a person with OCD starts to see a reduction in their anxiety, and then starts to obsess that the reduction of anxiety means that they really are going to do the thing they fear they will do. It is an extremely common occurrence in Harm OCD and for those with sexual obsessions such as HOCD. It doesn’t indicate that you are evil oro a sociaopath – it indicates that you have OCD.

  92. Tom Corboy, MFT ~ OCD Center of Los Angeles on October 15th, 2013
  93. Hi NJ,

    Thanks for your comments.

    The symptoms you report are quite normal for OCD, and specifically suggest Harm OCD. For example, you mention a history of worrying about people, worrying about what people might think of you, and wondering if you are “good enough”. All of these are quite common thoughts for most people, and are often magnified for those with Harm OCD. Also, your doubting and questioning of yourself regarding whether you would feel guilty if you did something improper is an extremely common experience for those with Harm OCD, as is your concern about not being emotional enough in response to certain thoughts. Finally, you mention the internal arguments you have with yourself about whether you actually want to do something improper, which is very typical of Harm OCD.

    Let me also note that you wrote about your thought that perhaps the only way to get rid of these unwanted thoughts is to do the very thing you fear. First, that wouldn’t work. If you were to do the thing you fear, you would almost certainly be filled with a tremendous amount of guilt, and then you would obsess about the fact that you actually did it.

  94. Tom Corboy, MFT ~ OCD Center of Los Angeles on October 15th, 2013
  95. Hiya, is it normal to have groinal responses to harm thoughts?? I hate it but a lot of the time I will get a strong reaction down there to the thoughts and it scares me :( also I have suffered with the harm thoughts for around 3 months now and today felt like I made a break through and haven’t felt as anxious and felt more confident in myself, but I have been feeling anious around my cat so I tested myself and put my hand around his neck to see how I’d feel I didn’t feel anxious but felt like I could hurt him and got a groinal response :( I didn’t feel really anxious but imediatly started questioning myself and now I’m scared I will act on my thoughts please help :(

  96. sam on October 16th, 2013
  97. Sam,

    Thank you for your comments.

    It is normal to have feelings in one’s groin on a regular basis. The only reason you are noticing these groinal feelings when you have certain thoughts is that you are looking for them. If I asked you to look at a blank piece of paper and to then very closely monitor your groin, you would also likely report feeling something. Your groin doesn’t merit so much attention, and if you were to stop paying so much attention to it, you would likely report fewer feelings.

    Also, when you conduct “tests” such as you did with your cat, you are doing a compulsion. I strongly encourage you to immediately stop checking your groin and to stop conducting tests that only make your OCD worse.

  98. Tom Corboy, MFT ~ OCD Center of Los Angeles on October 21st, 2013
  99. Hey everyone, im a fellow sufferer. I took confidential test and im on the high scale. I do psychodynamic therapy but we dont focus on the symptom with my therapist that much, so not to reinforce it. I will ask him again to put into practice behavioral techniques. Still i have terrible thoughts and a particular obsession at the moment. I ve put so much effort into this not to give in to mentual compulsions and rituals. My OCD has transformed pretty much in all forms from gay ocd to harm ocd, plus in seeking out a perfect answer for detail matters. While i was in army, i was asked to vaccinate soldiers. Accidentally i vaccinated one with probably used injection from a previous soldier. An event I forgot. Now my worst fear is that this guy would have been infected with AIDS or whatever. Its killing me and Im on my limits right now. Not to mention that Im a therapist and it takes so much energy from me, makes me feel miserable. God, i wanted to share this with you. (i dont look for a reassurance here, just you to empathise with me).

  100. George_greek on February 6th, 2014
  101. Hi George,

    Thanks for commenting. It is extremely common for OCD to morph from one obsession to another (i.e., to switch from gay obsessions to harm obsessions to whatever). I encourage you to stop looking for “perfect answers”, and accept that these thoughts are just OCD thoughts.

    Also, keep in mind that you have absolutely no evidence that you infected your fellow soldier. Just because you thought it doesn’t mean it has any basis in fact. And by the way, that same injection may have saved his life due to the vaccination!

  102. Tom Corboy, MFT ~ OCD Center of Los Angeles on February 6th, 2014
  103. Hi,
    First of all i want to apolologize for my bad english and poor choice of words, because english isn’t my native language, as i am from belgium.

    When i was about 10 years old, I think i had a form of OCD.
    It was like there was a voice in my head ( but it was really me ) saying that i had to do certain things or something would happen to my family. Turning lights on and off, always checking things. Or when there was a sound i needed to touch the back of my bed.

    Then when i was 12 i had e peeing obsession. ( or i think it was ). Right before bed i went to the toilet. But i bed i immediately had to think about peeing again, so that gave me the feeling that i needed to go again. So i would go for 5 times. But when i was at the toilet, i coudn’t go anymore.

    With all this i already knew i wasn’t normal like the other kids. I was silent, always turned in myself. like there was a mental war going on in my self.

    Then this passed.
    But in highschool i developped a sort of anxiety. I stood up being nervous, always going to the toilet. And in class, i couldn’t pay any attention because of the nervous feelings and sitting there fighting against the feeling of running to the toilet and taking a dump because of the tensions.
    I also had rapid heartbeating, sweating, tired,…

    Then when i went to university and i always had a fear for the big rooms with 500 people. It was like i was going to yell and lose control. I always sat at the exit.
    Because of this i couldnt pay attention. I failed and stopped.

    Then a year later i develloped nystagmus.
    I see things “flikkering” and moving double.
    they don’t know what causes this and i have been struggeling with this for seven years.
    I even stopped working now.

    But now for about 3 years i have these “thoughts” and images of hurting my mom.
    When i saw a knife, i saw an image.
    but know i have this with every possible object.
    When i see or even think about a belt, i see it wrapped around a neck. Or when i’m at the tables, i see me smashing a yar of mayonaise against a head.
    Also whes she is speaking to me it is like i am always yelling inside my head.
    when she is telling me something, i try to listen, but automatically thoughts like “shut up” “die” pop in my head.
    Then i start to sweat and feel weird.
    My mom always supported me and helped me and i want to give her the world, but now i feel all of this.
    I’m starting to avoid conversations.
    But even when she is not near, it is like it is also going “on” in my head.
    A few months ago i had this fear of losing my mother and that i would be lost and now i have these exact opposite thougts.
    Then after all these years you start to think that these thoughts are things you really want.
    When i hear her comming to my room i have such a feeling like o no, here she comes, it will happen. But i can’t break this feeling.
    It can’t be the solution to just never see her again.
    Because sometimes you think that is the solution.
    My parent say that maybe i should move out to make it stop.
    But isn’t that lettting the thoughts win??
    I don’t want her to die and later think back that always having these thoughts were my relationship with my mother.

    Kind regards

  104. Ben on April 28th, 2014
  105. Hi Ben,

    Thank you for your comments.

    These types of thoughts are extremely common for people suffering with Harm OCD. Unfortunately, the thoughts experienced in Harm OCD often focus on those who matter the most – parents, children, spouses, etc.

    Moving out and never seeing your mother again would be just about the worst possible response to these thoughts. First, you would lose a relationship with your mother. Second, it would almost certainly not succeed in eliminating these thoughts. And third, if you did manage to see a reduction in these thoughts, they would likely change into harm thoughts about someone else.

    Avoidance is one of the four main ways that people try to manage unwanted thoughts, and it is almost guaranteed to backfire. In other words, avoiding your mom would make things worse, not better.

    My recommendation is simple – you need to seek treatment with a psychotherapist who specializes in Cognitive Behavioral Therapy for OCD. If you would like to discuss online treatment options with one of the therapists at our center, please contact us via our website at http://www.ocdla.com.

  106. Tom Corboy, MFT ~ OCD Center of Los Angeles on April 28th, 2014
  107. hi,

    Thank you for responding.

    I think that i have a mixture of all the OCDtypes.
    Like the fear in the aula’s at university, fear in class.
    Most of them are a result of a fear of losing control.
    I also have a fear of flying. Not the flying itself. Because when i picture flying alone in an empty plane, there wouldn’t be a problem.
    But when there are people, everything changes.
    Its like i’m yelling inside. Fear of losing control. Fear of yelling out loud. And then you are looking at the Door and stuff. Like you are going to open it.
    I’ve read that this is also a type of OCD. Fear of losing control.

    I even had a period of time at my work, when i was closing the register and was working with the money. There always was a thought like “take it”

    It is also like my mind is never at ease.
    always thinking and talking to myself in my mind.
    always aware of my breathing and hartbeat.
    everytime i breathe, its is as I am always saying “in…. and out” “in…. and out”

    Or when i am in the bathroom with the heater on, its like i can’t get loose of the noise. Its like i am always repeating the noise in my head

    somethimes i don’t know if something is normal or ocd.

    kind regards

  108. Ben on April 28th, 2014
  109. Hi Ben,

    The human brain is very creative. But that doesn’t mean that the thoughts our brains generate are particularly important. In fact, the great majority of things we think about are totally unimportant. So here are the thoughts you listed:

    Thoughts of losing control
    Thoughts of losing control on a plane
    Thoughts of losing control on a plane and opening the door
    Thoughts of taking the money from the cash register at work
    Thoughts about your breathing
    Thoughts about your heartbeat
    Thoughts about the noise that the heater makes

    These all have one thing in common…they are just thoughts.

    Your goal is to recognize and accept that your brain produces a lot of unimportant stuff. And to then pay no excess attention to it (with the full knowledge that it will continue to create unimportant stuff).

  110. Tom Corboy, MFT ~ OCD Center of Los Angeles on April 29th, 2014
  111. Hi

    I am afraid that i will ruin our friends wedding,that i will say or do something craizy and everyone will think i am craizy….All this started on my own wedding when i had this kind of impulses .i am afraid of becoming craizy and do all kind of craizy things..and then my life will be ruined,even my husband will look at me with fear…i know it is ridiculous, but it feel anxiety and i suffer a lot…can i call this craizy ocd?…

  112. lory on May 28th, 2014
  113. Hi Lory,

    This all sounds like OCD. We frequently treat people who obsess about the possibility of saying or doing things that are uncharacteristic of them.

  114. Tom Corboy, MFT ~ OCD Center of Los Angeles on June 2nd, 2014

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