For many people struggling with OCD, the fear that they do not actually have OCD and are merely “in denial” becomes one of their most intractable obsessions. Lauren McMeikan, MA, and Tom Corboy, MFT, of the OCD Center of Los Angeles discuss “The Denial Obsession” and how to treat it.

Doubt, Denial and OCD

Fear that one doesn’t really have OCD and is “in denial” is a common obsession in OCD, especially “Pure O”.

Obsessive Compulsive Disorder (OCD) has often been called “the doubting disease”. OCD certainly lives up to this moniker, especially for those struggling with variants of the disorder that are often informally described as “Pure Obsessional OCD” or Pure O”. OCD plays on an individual’s greatest fears, leading sufferers to question fundamental aspects of themselves and their character. While those without OCD effortlessly dismiss most of the unexpected thoughts that pop into their consciousness, those with OCD get trapped in a seemingly endless loop of obsessions and compulsions. Some of OCD’s more common refrains include:

“What if I’m a murderer?”
• “What if I’m secretly gay?”
• “What if I am secretly straight?”
• “What if I don’t really love my partner?”
• “What if I am a pedophile?”
• “What if I have committed a terrible sin?”
• “What if, at my core, I am a bad person with bad intentions?”
• “What if reality, as I experience it, isn’t reality at all?”

You might notice something that ties all of these phrases together – the struggle to answer the question “what if …?” This phrase strikes terror into the hearts of those grappling with OCD. These two short words introduce enough doubt and anxiety into the minds of sufferers that they feel compelled to repeatedly perform compulsive behaviors in a seemingly endless attempt to reduce or eliminate their distress.
Read More »

    

Imaginal Exposure for OCD and Anxiety

Imaginal exposure is a powerful treatment technique
for OCD and related anxiety disorders.

What is Imaginal Exposure

For many people struggling with OCD and related anxiety disorders, one of the most beneficial treatment tools is imaginal exposure. In order to best understand this technique, it is first necessary to understand the basic idea of Exposure and Response Prevention (ERP).

ERP is a specific type of Cognitive Behavioral Therapy (CBT) that has consistently and repeatedly been found by researchers to be the most effective treatment for OCD. Simply put, ERP is the “B” part of CBT. Using this technique, a client learns to become less afraid of fearful situations by challenging the behavioral compulsions that they employ in an effort to reduce their fear. The basic principle behind ERP is that, by repeatedly confronting their fear (exposure) without doing any compulsive anxiety-reducing actions (response prevention), the client will become less afraid when faced with anxiety-provoking situations. This process is known as habituation, which is really just a fancy way of saying that we become less afraid of things as a result of repeatedly being exposed to them. Read More »

    

ROCD (Relationship OCD)

ROCD (Relationship OCD) is often misunderstood by
mental health professionals and the public.

Relationship OCD (ROCD) is a form of Obsessive Compulsive Disorder (OCD) in which the sufferer experiences intrusive, unwanted and distressing thoughts about the strength, quality, and “true nature” of their love for their partner. Obsessions in ROCD include a preoccupation with a partner’s appropriateness as a mate, overall level of attractiveness, sexual desirability, or long-term compatibility, and often arise in otherwise entirely healthy relationships.

When most lay people think of OCD, they envision hours of hand washing or compulsive lock checking. However, there are numerous equally exhausting sub-types of OCD in which the compulsive symptoms are less overt, and which together are colloquially described as Pure Obsessional OCD, or “Pure O”. But this term is a misnomer, as people suffering with Pure O exhibit numerous, albeit less obvious, compulsions. And while these compulsions are less noticeable by others, they still take a huge toll on sufferers. ROCD is one such sub-type.

Read More »

    

This is the third installment in our ongoing series on Scrupulosity, a sub-type of Obsessive-Compulsive Disorder (OCD) focused on religious or moral perfectionism. This article focuses exclusively on identifying and challenging common cognitive distortions seen in “moral” Scrupulosity.

Moral Scrupulosity

Those struggling with Moral Scrupulosity OCD can
learn to challenge their distorted thinking.

Previous articles in this series have focused on religious Scrupulosity, which is most easily described as a pattern of intrusive, unwanted thoughts related to one’s religious beliefs. These unwanted thoughts are counter to the sufferer’s faith, and lead them to perform compulsive behaviors in an attempt to nullify or extinguish the anxiety they experience related to these thoughts.

Conversely, the obsessions experienced in “moral” Scrupulosity are focused not on matters of faith, but rather on one’s personal sense of morals and ethics. Those suffering with moral Scrupulosity experience commonplace thoughts, feelings and actions that they misinterpret as being evidence that they are ethically flawed or morally bankrupt. As with all sub-types of Obsessive Compulsive Disorder (OCD), those with moral Scrupulosity seek relief from their anxiety through various compulsive and avoidant means in an effort to ensure that their obsessive fears do not come true. In other words, they perform compulsive behaviors that they hope will prevent or eliminate the feeling that they are a “bad” person.

Read More »

    

This is the second installment of a multi-part series on Scrupulosity, a specific variation of Obsessive-Compulsive Disorder (OCD) that focuses on religious and moral perfectionism.  This article focuses on how one can learn to identify and challenge common cognitive distortions seen in Scrupulosity.  Please note that this article will focus exclusively on religiously-focused Scrupulosity, and that future installments will address Moral Scrupulosity.

Scrupulosity in OCD

Cognitive Restructuring can be a valuable component of treatment for Religious Scrupulosity in OCD

Scrupulosity is a type of Obsessive Compulsive Disorder (OCD) rooted in irrational, distorted thoughts (obsessions) related to one’s religious beliefs, morals, or personal ethics.  An individual with Scrupulosity experiences these unwanted thoughts as being at odds with their faith, their relationship with God, or their moral and ethical values.

As with all types of OCD, the individual with Scrupulosity responds to their obsessions with compulsive behaviors that they employ in an effort to reduce, eliminate, or reverse their unwanted thoughts and the anxiety they cause.  Scrupulosity becomes a clinical issue when an individual’s behaviors are motivated by a desire to control anxiety rather than the pursuit of a genuine connection to their faith, morals, or ethics.

Read More »

    

Kimberley Quinlan, MFT, of the OCD Center of Los Angeles discusses the diagnostic overlap between OCD and eating disorders.  Part one of a two-part series.

OCD and Eating Disorders

It can sometimes be difficult to differentiate between the symptoms of OCD and those of an eating disorder.

I was recently asked by a client if there was any functional difference between eating disorders and Obsessive Compulsive Disorder (OCD). After all, if OCD is defined as experiencing obsessive thoughts and compulsive behaviors, wouldn’t an eating disorder be categorized in the same way, given that those with eating disorders have obsessive thoughts about their weight and appearance, and respond to these thoughts with compulsive behaviors?

When looked at along these lines, it is obvious that OCD and eating disorders indeed have many similarities.  But it is important to consider certain distinctions between these conditions before formulating a diagnosis.

To provide a better understanding of OCD and both its differences and similarities with eating disorders, clinicians rely upon specific diagnostic criteria.  Recently, the American Psychiatric Association (APA) refined these criteria in the newly published Diagnostic and Statistical Manual (fifth edition), also known as the DSM-5.  This manual is used by clinicians to differentiate between various psychological conditions, thus assisting in the development and implementation of appropriate treatment.

Read More »

    

A discussion of Harm OCD and its treatment using Exposure and Response Prevention (ERP).  Part four of a series.

Harm OCD treatment

Exposure and Response Prevention (ERP) is the key component to effective treatment for Harm OCD.

In our three previous articles in this series, we discussed the primary symptoms of Harm OCD, along with how one can use mindfulness and cognitive therapy to address unwanted harming thoughts.  In this installment, we focus on directly challenging the behaviors associated with Harm OCD by using Exposure and Response Prevention (ERP).

What is Exposure and Response Prevention

The primary behavioral therapy tool used when dealing with Harm OCD is called Exposure and Response Prevention (ERP).   While cognitive therapy challenges the content of our intrusive thoughts, and mindfulness addresses our perspective towards those thoughts, ERP directly confronts the behaviors done in response to those thoughts While mindfulness and cognitive therapy set the table, ERP is the main course.  This is where the real work gets done.

Read More »

    

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, MFT 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.

Scrupulosity OCD

Those with Scrupulosity experience profound feelings of anxiety and guilt related to religion, morals, and ethics.

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.

Read More »


Choosing a Different Route on the Anxiety Highway

Mindfulness for OCD and Anxiety

Mindfulness can greatly enhance Cognitive Behavioral
Therapy (CBT) for the treatment of OCD and Anxiety.

“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.

Read More »

Thought Action Fusion in OCD

Thought-Action-Fusion is a common
problem for many struggling with OCD.

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.    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.  Thought-action fusion is particularly common in the Pure O variant that is colloquially known as Harm OCD.  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 Harm 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. Read More »

  • Doubt, Denial and OCD

    A discussion of “The Denial Obsession” in OCD, in which sufferers obsess that they don’t really have OCD, but are merely “in denial”. By Lauren McMeikan, MA, and Tom Corboy, MFT, of the OCD Center of Los Angeles.

  • Dermatillomania: A Skin Picker’s Guide to the Dermatologist

    How one woman with Dermatillomania finally opened up to her dermatologist about her longtime struggle with skin picking.

  • Imaginal Exposure for OCD and Anxiety

    Imaginal exposure for the treatment of OCD and anxiety is discussed by Tom Corboy, MFT, of the OCD Center of Los Angeles.

  • ROCD: Relationship OCD and The Myth of “The One”

    ROCD (Relationship OCD) is an often misunderstood variant of OCD. By Sheva Rajaee, MMFT and Tom Corboy, MFT of the OCD Center of Los Angeles.

  • Moral Scrupulosity in OCD: Cognitive Distortions

    Cognitive distortions are common in the Moral Scrupulosity subtype of OCD. Part three of a multi-part series.

  • OCD in the Family

    One mom’s story of her son’s battle with OCD and its profound impact on their family, as told to Elizabeth Kassel, MSW, of the OCD Center of Los Angeles.

  • Scrupulosity in OCD: Cognitive Distortions

    A discussion of cognitive distortions in the religious Scrupulosity subtype of OCD. Part two of a multi-part series.

  • OCD and Eating Disorders

    Diagnostic similarities and differences between OCD and eating disorders are discussed by Kimberley Quinlan, MFT, Clinical Director of the OCD Center of Los Angeles.

  • Harm OCD Treatment With ERP

    Harm OCD treatment using Exposure and Response Prevention (ERP) is discussed by Tom Corboy, MFT, Executive Director of the OCD Center of Los Angeles .

  • My Life with OCD

    The impact of OCD and related anxiety based disorders on the family is often overlooked. In this multi-part series, we present first-hand accounts of the ongoing impact of OCD, BDD, and Bipolar Disorder on one man and his family, as told to Elizabeth Kassel, MSW, of the OCD Center of Los Angeles.

  • Scrupulosity: Where OCD Meets Religion, Faith, and Belief

    The Scrupulosity sub-type of OCD is discussed by Kevin Foss, MFT, of the OCD Center of Los Angeles. Part one of a four part series.

  • Mindfulness for OCD and Anxiety

    Using mindfulness to enhance traditional CBT for OCD and anxiety is discussed by Kimberley Quinlan, MFT, Clinical Director of the OCD Center of Los Angeles.

  • Hoarding, Cluttering, and Compulsive Shopping: My Childhood Story

    One woman’s story of her life as the child of multiple generations of hoarders.

  • OCD and Thought-Action Fusion

    Thought-Action-Fusion is a frequent problem for those with OCD. This issue is discussed by Laura Yocum, MFT, of the OCD Center of Los Angeles.

  • OCD, Anxiety, and Resistance

    Resistance and acceptance in OCD and related disorders is discussed by the OCD Center of Los Angeles.

  • Harm OCD Treatment: Cognitive Restructuring

    Harm OCD is often misunderstood, but it can be effectively treated using an integrated treatment plan that includes Cognitive Restructuring. Part three of our ongoing series that explores “Harm OCD” and its treatment .

  • OCD & Anxiety: Five Common Roadblocks to Treatment

    Learn the five common mistakes that interfere with successful treatment of OCD and anxiety. By Kimberley Quinlan, MFT, Clinical Director of the OCD Center of Los Angeles.

  • Harm OCD Treatment: Mindfulness Based CBT

    Harm OCD is an often misunderstood condition that can be effectively treated using Mindfulness integrated with CBT. Part two of a multi-part series from the OCD Center of Los Angeles.

  • Dermatillomania / Skin Picking Disorder Treatment

    Treatment of Dermatillomania (Skin Picking Disorder) with CBT. Part two of a series from the OCD Center of Los Angeles.

  • Harm OCD: Symptoms and Treatment

    This is the first installment in a series of articles in which The OCD Center of Los Angeles demystifies both the symptoms and the treatment of Harm OCD.

 

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