A discussion of Harm OCD and its treatment using Exposure and Response Prevention (ERP). Part four of a series.
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.
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.
My name is Robert and I have Obsessive-Compulsive Disorder (OCD). I am a thirty-four year old, single man and work as a personal fitness trainer. My story is not typical, but it is the only one I have . . .
I was four years old when I looked at a picture Bible and saw an image of Satan. My thought was, “Satan is cool!” He wore a red cape and was “ripped!” My obsession was that, since I thought he was cool, I was evil and I would go to hell. I knew that evil people hurt others, and I was terrified of hurting someone. It never occurred to me to tell my parents. I figured all kids thought this way too, but the other kids just seemed to be “managing” it better than I was. They didn’t appear bothered by the eternal consequences of their actions like I was. They were talking back, swearing, being disrespectful and acting cocky, but weren’t worried about going to hell. I figured that thinking Satan was cool and that I was evil was “normal”, and that I just had to be more laid back and figure out how to worry less.
One day when I was fourteen, I had an intrusive thought that I wasn’t funny. I couldn’t shake it and kept a journal of funny quips so I could be “funny” in social situations. I tried to keep up the compulsion of memorizing stuff from the “funny book” so I wouldn’t be “slow”. I wanted to be quick witted, playful and charming. The irony is people said I was funny – I just didn’t “feel” like I was. I fought to I remember “my lines” to get rid of the anxiety. At about the same age, I had the obsession that my penis wasn’t the right size. I was pre-pubescent and a “late bloomer.” When in the locker room at school, I compared the boys’ penises to my dad’s penis and thought, ”Wow! They’re tiny!” I even asked my mom one day, “Does size matter?”
OCD Center of Los Angeles
April 23, 2013
10:15 am
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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.
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.
“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.
Hoarding affects the entire family. Here is one woman’s story of her struggle as the daughter of multiple generations of hoarders. She has asked to remain anonymous.
I am the daughter of a hoarder. I am also the granddaughter of a hoarder. Somewhere amidst the cluttered chaos, I was a child. Competing with nine cats, three large dogs and compulsive shopping sprees was nothing but ordinary. Our 1500 square foot condo was stuffed wall-to-wall with dusty antique furniture, balls of cat fur, and the potent smell of animal urine masked by dozens of cheap burning candles. Taking in animals and acquiring things were my mother’s attempt to fill the absence of her husband and distract her from her long battle with cancer. She barricaded herself from the real world, consequently shutting down the needs of her only child and leaving no room for a relationship.
An unlikely suspect, my mother is an entrepreneur who dresses sharp, presents with confidence, and is admired and respected by her peers. What many people don’t know about the world of hoarding is that it is often a secret to outsiders. Although some hoarders can be detected by the clutter surrounding their homes, others present the exterior of their homes as well as they present themselves. From the outside world, we went unnoticed, further silencing my cry for help.
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. (more…)
The OCD Center of Los Angeles discusses resistance and certainty-seeking in OCD and related anxiety based conditions. Part one of a two-part series.
When treating clients with Obsessive-Compulsive Disorder (OCD) and other anxiety based conditions, two of the most important topics we discuss are “resistance” and “certainty-seeking”. People suffering with these conditions often have unpleasant and unwanted thoughts, feelings, and bodily sensations, and resistance to these experiences is a normal, natural reaction. Simply put, when faced with something uncomfortable or painful, we humans instinctively resist it, and quickly look for ways to reduce our discomfort through avoidance. But unfortunately, while resistance may internally feel like the correct response to our uncomfortable thoughts, feelings and sensations, it actually serves to inflame them.
For most people, it seems counterintuitive to reduce resistance and allow uncertainty to remain in the face of these uncomfortable internal experiences. Many are likely to think something along the lines of “I must find a way to keep this thought, feeling, or bodily sensation from happening again”. But this philosophy of resistance in regards to our unwanted internal experiences will actually cause them to become more powerful. As illogical as it may seem, oftentimes the best solution is to lower our resistance, surrender, and accept what is being offered.
A discussion of the treatment of Harm OCD using Cognitive Restructuring. Part three of a series.
In our previous installment of this series, we looked at Mindfulness for the treatment of Harm OCD, and how a change in perspective towards unwanted thoughts and feelings can lead to a change in compulsive behaviors. But as many sufferers well know, one’s response to intrusive harm thoughts is frequently automatic. Those with Harm OCD have conditioned themselves to respond to their harm thoughts in a certain way, and very little thinking may go into it.
Mindfulness encourages us not to waste time and energy attending to thoughts and feelings with urgency when those thoughts and feelings could be simply observed and allowed without response. This is not only difficult to do, but requires practice, training, and education that may not always be immediately practical early in treatment. If we must attend to the content of our thoughts directly, we should attempt to do so with as little mental ritual as possible. So we ask the question, “What is it that I am thinking about my thoughts that appears automatic, yet may be voluntary and may be pointing me in the wrong direction?
Cognitive Distortions Commonly Experienced in Harm OCD
The reason why a harm sufferer feels compelled to compulsively analyze, avoid, or otherwise over-respond to harm thoughts is because they are filtering these meaningless little ones and zeroes through distorted lenses that spit them out as unacceptable indictments. These lenses are called cognitive distortions. Here are some examples of common cognitive distortions experienced in Harm OCD: (more…)
Cognitive Behavioral Therapy (CBT) is the gold standard for the treatment of OCD and related anxiety based conditions. But some simple mistakes can interfere with treatment. Kimberley Quinlan, MFT, of the OCD Center of Los Angeles discusses five common roadblocks to effective treatment for OCD and anxiety.
Research has consistently found that the most effective treatment for Obsessive Compulsive Disorder (OCD) and most other anxiety disorders is Cognitive Behavioral Therapy (CBT). The cognitive component of CBT involves investigating and challenging the individual’s irrational thoughts related to their fears. These thoughts are described as “cognitive distortions”, and the process of challenging them is known as “cognitive restructuring”. This process takes place during therapy sessions, and is also practiced by the client between sessions throughout the course of treatment.
The behavioral component of CBT is more time intensive, and requires the client to be gradually, purposefully and systematically exposed to the very thoughts and situations which generate their discomfort, and to do so without responding with either compulsive or avoidant behaviors. This process is known as Exposure and Response Prevention (ERP). (more…)
The OCD Center of Los Angeles discusses treatment of Harm OCD using Mindfulness Based Cognitive Behavioral Therapy. Part two of an ongoing series.
In our previous installment of this series, 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. (more…)
Natalie Najera, of the OCD Center of Los Angeles, brings a wealth of knowledge and experience to our team as our Social Media Manager, as well as her own personal experience and recovery from OCD. […]
Brandi Roberts, MS, AMFT, of the OCD Center of Los Angeles, shares her personal experience and recovery from religious scrupulosity OCD and spiritual bypassing, as well as discusses the dynamics and treatment of this common OCD subtype. […]
Mikayla Rodin, MA, AMFT, of the OCD Center of Los Angeles, discusses a subtype of OCD called Contamination OCD, as well as sharing what the symptoms and treatment may look like for someone experiencing this condition. […]
Erica Russell, LMFT, LPCC, of the OCD Center of Los Angeles discusses the symptoms and treatment of Postpartum OCD and reflects on her own personal experience with the postpartum anxiety journey as she returns from maternity leave. […]
Mikayla Rodin, MA, AMFT, of the OCD Center of Los Angeles discusses the connection between VasoVagal Syncope and Anxiety, as well as sharing what the symptoms and treatment may look like for someone with this condition. […]
Daniel Safavi, MA, AMFT, of the OCD Center of Los Angeles, discusses the sometimes sensitive and extremely powerful use of disclosure of one's OCD, as well as some helpful guidelines when determining to self-disclose. […]
Brandi Roberts MS, AMFT, of the OCD Center of Los Angeles, shares her personal experience and recovery from relationship OCD (ROCD), as well as discusses the dynamics and treatment of this very common OCD subtype. […]
Kristen Taylor-Ladd, MA, AMFT, of the OCD Center of Los Angeles, discusses the differences between, and often co-occurring, afflictions of OCD and GAD, as well as shares her personal experience with and way to recovery from both of these conditions. […]
Chanel Taghdis, LMFT, of the OCD Center of Los Angeles, discusses the efficacy of Exposure and Response Prevention (ERP) for OCD and related conditions when conducted via teletherapy. […]
Chris Cincotta, LMFT, of the OCD Center of Los Angeles, discusses how to implement an effective mindfulness-based response prevention approach for the treatment of OCD and anxiety, and how to prevent mindfulness from becoming just another compulsion. […]
Kelley Franke, Lauren McMeikan Rosen, Elena Fasan, and Mary Sponaugle of the OCD Center of Los Angeles will be giving three presentations at the Online OCD Conference being held October 8-10, 2021. […]
Trichotillomania is a condition in which sufferers repeatedly pull out their hair. Chanel Taghdis, MA, of the OCD Center of Los Angeles discusses her personal experience with, and recovery from, Trichotillomania, and how she treats clients struggling with this condition. […]
Laura Yocum, Lauren McMeikan, and Kelley Franke of the OCD Center of Los Angeles discuss Relationship OCD (ROCD) at the Online OCD Conference on August 2, 2020. […]
An interview with Tom Corboy, MFT, of the OCD Center of Los Angeles, about the use of online therapy for the treatment of OCD and related conditions. […]
Debra Dalton Stein, MFT, of the OCD Center of Los Angeles describes her journey as a psychotherapist from working primarily with eating disorders, to becoming an OCD specialist. […]
OCD is often misdiagnosed as Generalized Anxiety Disorder (GAD). The OCD Center of L.A. reviews diagnostic & treatment differences between these conditions. […]
People with Pure Obsessional OCD ("Pure O") often feel overwhelmed by intrusive, distressing thoughts. Tom Corboy, MFT of the OCD Center of Los Angeles discusses Pure O and its many permutations. […]
Excoriation (Skin Picking) Disorder is an obsessive-compulsive spectrum condition in which sufferers repeatedly pick at their skin. Crystal Quater, MMFT, of the OCD Center of Los Angeles discusses her personal experience with, and recovery from, Excoriation Disorder, and how she treats clients struggling with this condition. […]
OCD obsessions are just fake news that your brain makes up. From the OCD Center of Los Angeles. Helping clients in California and around the world since 1999. […]
HOCD is a type of OCD in which the individual obsesses about their sexual orientation. Here are 30 things you should know about HOCD. From the OCD Center of Los Angeles. […]
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. […]
A review of cognitive distortions seen in Moral Scrupulosity OCD, and a discussion of how to effectively challenge them. From the OCD Center of Los Angeles. […]
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. […]
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 using Exposure and Response Prevention (ERP) is discussed by Tom Corboy, MFT, Executive Director of the OCD Center of Los Angeles . […]
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. […]
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. […]
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 . […]
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 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. […]
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. […]
Kimberley Quinlan, MFT, of the OCD Center of Los Angeles discusses Cognitive Behavioral Therapy (CBT) and Mindfulness for the treatment of Orthorexia. Part two of a two-part series. […]
Orthorexia is an eating disorder in which people obsess about eating only "pure" and "healthy" foods. By Kimberley Quinlan, MFT, of the OCD Center of Los Angeles. […]
Many people mistakenly think of Social Anxiety as nothing more than shyness. In this two-part series, the OCD Center of Los Angeles discusses Social Anxiety and its treatment with CBT. […]
Binge Eating Disorder, also known as ‘”compulsive overeating”, can perhaps best be described as a condition in which one periodically consumes extremely large amounts of food. Kimberley Quinlan, MFT, Clinical Director of the OCD Center of Los Angeles, discusses Binge Eating Disorder and its treatment with Cognitive Behavioral Therapy (CBT). […]
Increasing numbers of teens are having elective cosmetic surgeries to address body image issues, without fully considering the physical and psychological risks involved. […]
A discussion of BDD and recent news reports about the condition. From the OCD Center of Los Angeles. Serving clients in California and internationally. […]
Many people with OCD engage in 'memory hoarding', a mental compulsion to over-attend to the details of an event, person, or object. Memory hoarding is done with the belief that the event, person, or object carries a special significance, and may be important to recall exactly as-is at a later date. […]
An Australian pro boxer assaults a 70-year old man on a ferry boat and claims his OCD made him do it. Last of a three part series on OCD and the law. […]
A Kentucky man murdered his wife and then tried to claim that his OCD led him to kill her. Part 2 of a 3 part series. From the OCD Center of Los Angeles. […]
Mental health has long been shrouded in secrecy and shame. So when public figures like professional athletes actively seek help for anxiety, it is a sign of cultural progress. Here are some who have gone public with their struggles. […]
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. […]
Sex addiction is misconstrued by many to be a type of Obsessive Compulsive Disorder (OCD). This article reviews various factors relevant to determining what diagnosis might be more appropriate. Second of a two part series. […]
Many people, including professional psychotherapists, incorrectly think of sex addiction as a type of Obsessive Compulsive Disorder (OCD). This article reviews the essential differences between these two conditions and, how therapeutic strategies used for the treatment of OCD are unlikely to be successful when treating sex addiction. First of a two part series. […]
The drug Latisse is prescribed to lengthen eyelashes, but it has significant, under-reported side effects. This raises two questions - is Latisse safe, and does its marketing exploit women's body image concerns? […]
The American Psychiatric Association (APA) has proposed significant revisions to its "Diagnostic and Statistical Manual, Fourth Edition" (DSM-IV). Tom Corboy of the OCD Center of Los Angeles discusses changes planned for the new DSM-5, specifically those relevant to Obsessive Compulsive Disorder (OCD) and related anxiety-based conditions. […]
Those with OCD and other anxiety based conditions often seek reassurance that their unwanted thoughts and feelings are not a threat. The OCD Center of Los Angeles discusses the problem of using reassurance seeking as an anxiety management strategy. […]
Many with Body Dysmorphic Disorder turn to cosmetic surgery in an attempt to alleviate their insecurities. Unfortunately, there are plenty of cosmetic surgeons who are more than willing to cash in on those with this serious psychiatric condition. […]
OCD and anxiety were in the news throughout 2009. Here are our votes for the top stories of the year about OCD and related anxiety based conditions. […]
Emetophobia is the fear of vomit and/or vomiting. Tom Corboy, MFT, Executive Director of the OCD Center of Los Angeles, discusses Emetophobia and its treatment. […]
The twin explosions of television and the internet have spawned a sharp increase in Hypochondria, and spawned a new mental health issue - 'Cyberchondria'. […]
A discussion of compulsive overeating (aka binge eating) and how it differs from OCD. From the OCD Center of Los Angeles. Serving clients internationally. […]