Palm Beach Psychologist

Dr. Steven Seay is a licensed psychologist in Florida and Missouri who treats patients in Palm Beach, Fort Lauderdale, and Miami.      Read more...

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Sticky Situations: When OCD Gets Really Personal...

Alright, let's dive into the deep end... or maybe just the slightly damp, awkwardly sticky end... of the pool. We're talking about a topic that makes even seasoned therapists pause: Obsessive-Compulsive Disorder (OCD) that latches onto fears surrounding semen, sperm, vaginal fluids, and other intimate bodily substances. Yes, it's a thing -- a surprisingly common (yet incredibly isolating) thing... If your brain sounds the contamination alarm bells around these specific triggers, know this: You are not alone, you are not 'weird,' and this is absolutely OCD doing its usual mischief, just in a particularly sensitive area. Let's unpack this sticky situation with some understanding and, perhaps, a gentle chuckle at the absurdity of where OCD can take us.

Meet the Unwanted Roommate: OCD's Intimate Intrusions Contamination OCD, as many know, often involves fears about germs, dirt, or chemicals. But sometimes, OCD gets laser-focused on substances tied to intimacy and biology. Why? Because these substances can carry a heavy load of societal taboo, personal meaning, and yes, even legitimate (though often wildly exaggerated by OCD) health considerations. This specific flavor of OCD doesn't just whisper worries; it screams them through a megaphone, often manifesting in obsessions like:

The "Ew, Gross!" Factor (Disgust on Overdrive): This goes way beyond a typical "ick" reaction. OCD can amplify disgust related to sexual fluids to phobic levels. The mere thought, sight (even indirectly, like on laundry), or potential contact can feel overwhelmingly repulsive and 'wrong,' triggering intense anxiety. It’s like your internal 'yuck' meter is cranked up to 11 and the knob broke off.

The Morality Police (Feeling 'Dirty' or 'Immoral'): For some, contact (even imagined or indirect) with these fluids triggers intense feelings of shame, immorality, or impurity. This isn't about hygiene; it's OCD attaching moral weight to biological substances, making you feel fundamentally 'bad' or 'tainted.' It's as if touching a laundry basket suddenly makes you need to confess... something?

The Fear of Spontaneous Generation (Unintended Pregnancy Worries): OCD isn't exactly a biologist. It can conjure up terrifying (and biologically improbable) scenarios where minuscule, indirect contact with semen could lead to pregnancy. This fear can persist even when logical precautions are taken, or even when sexual activity isn't occurring. OCD whispers, "But what if...?" about situations that would make a health teacher weep.

The Microscopic Menace (Germs & STDs Blown Out of Proportion): While STDs and transmitting germs are real concerns in specific contexts, OCD takes this to extremes. It might fixate on the near-impossible transmission via surfaces, old residues, or infinitesimal amounts. A handshake with someone who might have touched something might have been near something... you see the pattern. Logic takes a vacation, and catastrophic fear moves in.

The Collateral Damage Fear (Contaminating Loved Ones): This is where OCD twists care into terror. The fear isn't just about you being contaminated, but about inadvertently spreading these 'contaminants' to cherished people – partners, children, family members, friends, even the beloved family pet who definitely doesn't understand or care about your complex anxieties. Suddenly, every hug, shared sofa, or laundry load feels like navigating a minefield.

The "Get It OUT!" Emergency (The Purging Urge): This is a particularly distressing obsession where contact (real or imagined) triggers an overwhelming urge to physically or ritually "purge" the substance or its influence. This isn't about hygiene; it's often driven by a desperate need to feel morally, religiously, or physically "clean" again. The feeling is one of intense internal pressure that demands immediate action to restore a sense of "rightness."

The Mental Contamination Minefield (Emotional Contamination): This one's sneaky. It's not just about physical contact. You might fear that unwanted sexual thoughts, memories, or experiences associated with these fluids will somehow "rub off" on or taint things you value – your hobbies, your relationships, your sense of self, your favorite song. It's like fearing a bad memory could permanently stain your favorite sweater just by thinking about it while wearing it.

The Result? Avoidance, Rituals, and a Shrinking World Naturally, these obsessions lead to compulsions: excessive washing, avoiding intimacy, scrutinizing laundry, cleaning obsessively, avoiding certain people or places or objects, seeking constant reassurance, and mentally reviewing every possible contact. Life can become exhausting and incredibly restricted.

Enter the Superhero: Exposure and Response Prevention (ERP) Okay, maybe not a superhero with a cape, but ERP is the gold-standard, evidence-based treatment for OCD, and it absolutely applies here. The principle is simple (though the practice takes courage!): Gradually and systematically face the feared situations, thoughts, and substances without engaging in the compulsive rituals (like washing, avoiding, or checking).

ERP Boot Camp: Facing the Stickiness (With Therapist Guidance!) Working with an OCD specialist is crucial here, as they'll help you create a personalized hierarchy, starting small and building confidence. Exposures for this theme need to be handled sensitively and creatively. Examples might include:

Starting Mild:

Saying or writing the feared words (e.g., "semen," "vaginal fluid").

Looking at clinical diagrams or educational materials about reproduction or STDs (non-graphic).

Touching surfaces near where fluids might be (e.g., a closed laundry hamper, the outside of a condom package, a bathroom counter far from the toilet).

Stepping It Up:

Handling previously-worn underwear.

If you worry about other people's body fluids, sitting on furniture after someone else (without checking/wiping).

If you worry about emotional contamination, touching an object or a piece of clothing that is emotionally-contaminated.

Touching a doorknob after someone who might trigger fears

Reading articles or watching non-explicit media discussing relevant health topics (STDs, pregnancy) without seeking reassurance afterwards.

Imaginal Exposure: Vividly imagining feared contamination scenarios without trying to neutralize the thought.

Higher-Level Exposures (Tailored & Guided):

Touching surfaces you believe could be contaminated (e.g., inside the laundry basket, a specific spot on the bed linen) and resisting washing or other decontamination rituals.

Hugging or having normal physical contact with loved ones while being in a "contaminated" state (without avoidance, mental review, or subsequent decontamination rituals.

Watching relevant media that may generate unwanted sensations while resisting all urges to check, wash, or avoid.

Purposefully generating unwanted sexual thoughts while interacting with shared/public objects in your environment.

Allowing yourself to re-engage in healthy sexual activity without rituals or avoidance.

The "Response Prevention" Part is Key! During these exposures, the goal is to resist the urge to:

Wash hands or body excessively.

Change clothes.

Clean surfaces compulsively.

Avoid people, places, or objects.

Seek reassurance ("Am I okay?", "Is this contaminated?").

Mentally review or check.

Pray or engage in other mental neutralization strategies.

It's about learning to tolerate the anxiety and uncertainty until it naturally decreases. You're essentially teaching your brain, "See? Nothing catastrophic happened. That alarm was false." It won't feel this way at first, but the more ritual-free practice you get, the weaker your obsessions will become.

Finding Your Funny Bone Sometimes, finding a sliver of humor in the sheer absurdity of OCD's demands can be a powerful tool. Laughing at the OCD (not at your suffering) can create distance. "Oh, OCD, you think that's how biology works? Bless your heart."

The Important Fine Print This blog post is for informational and destigmatization purposes only. It is not a substitute for professional psychological assessment or treatment. If these themes resonate with you, please seek out a qualified mental health professional, particularly one specializing in OCD and ERP. They can provide a proper diagnosis and tailored treatment plan.

Wrapping Up Dealing with OCD fears around sexual fluids is challenging, isolating, and frankly, exhausting. But it's treatable. With the right approach (hello, ERP!), courage, and support, you can reclaim your life from these sticky intrusions. You don't have to live in fear of biology or intimacy. Reach out, get help, and know that recovery is possible.

Questions?  Comments? Is OCD generating a "sticky situation" for you that's creating anxiety, guilt, fear, moral distress, or panic? Sound off below...

The post Sticky Situations: When OCD Gets Really Personal appeared first on Steven J. Seay, Ph.D..

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Scrupulosity Exposure Help?

Please help us complete this exposure for scrupulosity (religious OCD).

So this post is a bit different than my regular posts… Rather than discussing a specific aspect about OCD or anxiety, this post is a request for your assistance in completing an exposure.

Here’s the background…

I have a patient with scrupulosity (religious OCD) who is working to resist his prayer rituals. Oftentimes, his OCD will lead him to pray many, many times throughout the day in response to various triggers he encounters. One of his primary treatment goals is to be able to reduce unhealthy, OCD-based prayers throughout the day.

Scrupulosity treatment can be challenging, but he’s doing a great job. At this stage, we are trying to ratchet things up a notch by having him purposefully expose himself to situations where people request prayers from him directly.

Over the last week or so, I’ve been asking people who come to the office to write down “prayer requests” for him. After reviewing these requests, he is to actively resist praying on their behalf. The exposure goal is for him to know that there is actually a person out there with a real prayer need who is requesting help — BUT… to be able to actively resist the urge to pray and then effectively manage any resulting anxiety, guilt, or distress.

In other words, his ERPs involve receiving “message in a bottle” prayer requests that he then tosses back into the ocean without responding to them.

For those of you without OCD, this goal might seem strange. Why not pray for people who need help? This is because many people with religious scrupulosity find themselves getting stuck in prayer rituals for countless hours each day, even in situations where prayer is neither warranted nor appropriate. Prayer can become dissociated from its intended purpose and become more of an anxiety- or guilt-driven compulsion than part of a healthy spiritual life. For people with religious OCD, it becomes critically important to be able to perceive a need for prayer and yet not respond.

Scrupulosity (Religious OCD) Treatment (ERP)

Here’s where you come in… I’d like the ocean to be a bit bigger than my office (which is actually more pond-like). If you have a moment and would like to help someone else with their scrupulosity ERPs, please feel free to submit a prayer request in the comments below. For privacy reasons, feel free to use a FAKE NAME when you comment. However, please make it a REAL REQUEST. Remember, the point of this exercise is not to have prayers sent your way — but rather to give someone with OCD an opportunity to resist OCD-based urges to pray.

FYI, the comments below will not appear immediately after you post. They’re moderated, so keep that in mind if you participate. Also, I’m requesting that the comments remain a reassurance-free zone. Any replies that are reassurance-based will not be approved.

Lastly — if you also happen to have scrupulosity — feel free to incorporate the prayer requests below into an exposure of your very own. However, please respect the intention of the exposure and do not pray for any of the requests below. If you can’t resist, please click away now. 🙂

Thanks for your help!

Here are the instructions from our original “Message in a Bottle” exposure…

Dear Person Reading This,

Please help me with my exposure.

I have scrupulosity (religious OCD), and I’m working on resisting urges to pray. To help me out, please leave your prayer requests below. My goal is to be able to read your prayer requests and then not pray for you. Feel free to make it challenging for me by sharing how much you need prayer or by telling me how much pain you’re feeling.

Thanks in advance for your help.

Scrupulosity Exposure Help? was originally published on Steven J. Seay, Ph.D.

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OCD Scriptathon 2017: A Group Scripting Experience

Take power back by leaning into your fears and putting your bad thoughts on display.

What: OCD Scriptathon 2017, A Group Scripting Experience

Where: Our office! Located at 11380 Prosperity Farms Road, Ste 209A, Palm Beach Gardens, Florida 33410

When: Tuesday, April 11, 2017 from 8:00 PM – Until It Ends

If you’ve ever practiced imaginal exposure, you’ve learned that having freaky thoughts on purpose can actually help you fight your OCD.

Please join us for Scriptathon 2017, a group scripting experience.  This is an opportunity to put your worst fears and most horrific thoughts on display for the world to see.  

Feel free to incorporate death, blasphemy, sexual thoughts, or any other distressing theme(s) that your OCD uses against you. This exposure experience is not for the faint of heart, and attendees should expect to hear things that might be disturbing or distressing. Also, please note that given the sensitive nature of the topics discussed, this event is for adults-only.

Goals: 1) To read scary, horrible, or distressing scripts out loud for the sake of habituating to these themes. 2) To deal with uncertainty about what others might think about you or your scripts. 3) To help support others in their own scripting exposures.

All attendees should bring 3 scripts to the workshop.  Click here for a blog post about scripting that includes some examples.

Your scripts may focus on the same theme or address multiple themes.  You can make your scripts as short or as long as you’d like.  Don’t censor yourself – feel free to lean into the most distressing version of the script without censoring or neutralizing.  Scripts may be written in first-person, third-person, or whatever form you’d like.  If you would like to present a conversation-style script (i.e., if your script consists of other people having a conversation about you), other attendees will be available to help you perform it.

This meeting will be a reassurance-free zone, so attendees are asked to refrain from providing reassurance.

Hope you can join us for this unique event!

OCD Scriptathon 2017: A Group Scripting Experience was originally published on Steven J. Seay, Ph.D.

[drstevenseay]

OCD and Uncertainty

Overcoming OCD involves giving up the need to know for sure.

These are difficult times.

Lately, it seems, each week brings with it something truly horrifying. A shooting or an act of terrorism, a hate crime committed against an individual, a disease that affects the unborn. You can hardly turn on the news without hearing about something that incites fear.

Yet… We get up every day and go about our normal lives. We get in the car, we drive to work, we come home to our families. We live as if we are untouchable. Technically, we’re not, but we’re often happiest when we live as if we are.

Some of us do this easily. The awareness of our own fragility doesn’t linger. Others of us are tortured by possibilities.

What if this happens to me? What if this happens to someone I love?

OCD brings with it superhuman attention to possibilities.

OCD wants us to think that the only acceptable world is a perfectly safe world. Unfortunately, the world we live in can sometimes be dangerous.

Although we may not often think about it, the possibility of danger is omnipresent; it’s all around us in nearly every moment of every day.

What if I get in a car wreck on my way to work…?

What if I fall down the stairs and break my neck…?

What if my child’s school is attacked by a terrorist…?

What if my food contains trace amounts of poison that could kill me…?

What if my pharmacist gave me the wrong medication and I have an allergic reaction to it…?

What if a plane crashes into my house…?

What if I forget to lock my front door and somebody breaks in…?

What if I “snap” and kill my family…?

What if I’m going to hell…?

What if I get hit by a meteor…?

Hopefully, some of these dangers seem a bit far-fetched to you; whereas, others may seem more plausible. In reality, they’re all possible. In fact, every one of them could come true today.

Although these thoughts can be scary when we actively think them, most of us are fortunate in that these possibilities generally live outside our conscious awareness. Ignorance can be bliss. Our brains often filter out these possibilities, or we attribute so little significance to them that they quickly get swept away in the stream of our thoughts. This process is generally automated and may occur so quickly that we may not even perceive that this is happening. Our minds can be incredibly adept at filtering out unimportant and irrelevant information.

However, even when we’re operating in that blissful state of ignorance, there’s always the possibility of danger. We just don’t think about it or feel it.

In some situations, we can become acutely aware of these possibilities.

For example, if you have recently been in a car accident, you might find yourself constantly scanning the traffic around you for signs of danger. The recent memory of the car accident is fresh, and it’s closely associated with driving-related cues. Previously neutral stimuli or activities (e.g., stop signs, merging traffic, changing lanes) can become linked to anxiety and panic.

Additionally, many individuals with anxiety disorders like OCD also experience changes or distortions in their perceptions of danger. They start to perceive excessive danger in situations that used to feel neutral or “safe.” This newfound fear can result in unhelpful avoidance behaviors or rituals that are designed to neutralize potential threats. In the end, avoidance and rituals keep fear from extinguishing and actually perpetuate greater fear.

Even if you have OCD, chances are that you don’t actively fear each what-if above. Your mind will notice some of the thoughts and then just move on — even though the thoughts are technically possible.

This is profoundly powerful. Why?

Because it shows you that you can tolerate uncertainty.

Yes, it might not be the specific type of uncertainty that you’re typically tormented by — but it shows that you can accept possibilities without needing to know for sure.

This is the goal of OCD treatment — to be able to extend an ability you have in most areas of your life into the domain that OCD has colonized.

In this way, you’re not really learning a new skill; you’re simply learning to generalize a pre-existing skill to a different situation.

“If I can do this in some areas of my life, I can learn to do it in other areas of my life.”

Should you take preventative action whenever you perceive the possibility of a threat?

Absolutely not.

This can have the unintended consequence of making your threat detection system even more sensitive.

Can you find a way to coexist with your doubts?

The problem with having an overly sensitive threat detection system is that it makes you more likely to respond to false threats as if they were true threats

This can be stressful and exhausting.

The other downside is that every time you misclassify a threat and neutralize or avoid a “safe” situation, you reinforce fear learning in your brain. In other words, by playing it safe and dodging today’s “bullet,” you make it more likely that you will be assaulted by a barrage of “bullets” tomorrow.

Every ritual–no matter how innocent–makes your OCD stronger.

This brings up another important point. How can we know what danger is real, and what danger is fake?

Unfortunately, we can’t. At least not perfectly.

We can never be absolutely certain.

However, there is some comfort in the knowledge that our perception of danger can be completely unrelated to the actual danger of any given situation. This principle motivates exposure therapies like exposure and response prevention (ERP). ERP involves choosing to defy your perception of danger and take the risk anyway. It’s like a leap of faith that can sometimes feel like jumping into darkness.

However, with each successful jump, you gain confidence in your ability to move through these experiences.

“To learn which questions are unanswerable, and not to answer them: this skill is most needful in times of stress and darkness.” ― Ursula K. Le Guin, The Left Hand of Darkness

Just because you’re not thinking of a potential danger doesn’t mean it won’t happen. Similarly, just because you are thinking of a potential danger doesn’t mean it will happen.

The situations and environments that OCD chooses are not arbitrary, in that they are most often meaningful to us. They often concern the safety of ourselves or the safety of people we love, important moral issues that may involve things like sexuality or religion, or other types of situations where we have responsibility. OCD wants us to be overly conservative when it comes to our ability to tolerate risks in these areas.

OCD can make us so risk-averse that we end up giving up the very things that we love and that make us who we are. How many parents with “bad thought OCD” willingly sacrifice time with their children, because their OCD says that it’s the only way to keep them safe? How many students with “bad thoughts” isolate themselves in their college dorm rooms and give up on their college careers because of the terrible thoughts in their heads?

Avoidance is not the answer — at least not in the long-term. In the long-term, it only hurts us.

Remember: We can tolerate risk. We can tolerate doubt. We can tolerate uncertainty. We demonstrate this countless times each day…even when we’re not paying attention.

This is true.

This is our source of strength.

We don’t need perfect proof to be okay.

Interested in OCD treatment in South Florida? Look no further than my South Florida OCD treatment center or call the phone number at the top of this page.

Questions?  Comments? What uncertainties do you tolerate with ease? Where do you need to expand your ability to tolerate doubt and uncertainty? Sound off below…

OCD and Uncertainty was originally published on Steven J. Seay, Ph.D.

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ROCD

Compulsions associated with ROCD include analyzing, checking, and comparing.

Although ROCD is often characterized by intrusive worries about your relationship, relationship OCD treatment often specifically targets the compulsions and avoidance behaviors related to ROCD (rather than the obsessions themselves).

This is because ROCD treatment is based on the premise that compulsions and avoidance behaviors are what strengthen and maintain the condition. In the absence of rituals and avoidance, relationship OCD symptoms tend to diminish and weaken over time.

This general principle is true for all types of OCD, not just ROCD.

As a quick refresher, this multi-part series of posts on rOCD (aka “relationship OCD”) discusses obsessive thoughts that are common in rOCD, ROCD intrusive impulses and images, ROCD compulsions and avoidance behaviors [THIS PART!], and ROCD in non-romantic relationships [FORTHCOMING!]. Let’s get to it.

What are common ROCD compulsions?

ROCD (Relationship OCD) & Compulsions/Avoidance Behaviors

Compulsions are the behavioral and/or mental strategies that individuals with ROCD use to reduce the distress brought on by their obsessions. Avoidance behaviors are also common to relationship OCD and are frequently used to avoid thinking about relationship-related doubts.

Compulsions About Being with the “Right Person”

Confessing doubts to your partner.

Getting excessive reassurance from your partner.

Seeking excessive advice from other people about how to proceed in your relationship.

Getting reassurance from others that you’re in the “right” relationship.

Avoiding dates and other activities with your partner.

Avoiding intimacy with your partner.

Checking your body for signs of arousal (e.g., groinal responses, etc.) when around your partner vs. when you’re around other people.

Analyzing and trying to determine if you are sexually attracted to strangers.

Comparing your current relationship to past relationships or to idealized relationships.

Excessively analyzing or reviewing the pros and cons associated with your current relationship.

Avoidance of places, activities, or situations that remind you of previous partners.

Avoiding movies or TV shows that depict couples.

Avoiding friends or family members who might talk about their own relationships or ask about your relationship.

“Obsessively” analyzing future events that could produce challenges for the relationship.

These checking rituals are often based around the premise that if one is in the “right relationship,” one shouldn’t experience any doubts about their relationship or their partner. Individuals with these types of OCD checking rituals compare current relationships to past relationships or to potential idealized future relationships.

I love my boyfriend, but I can’t shake this nagging feeling that he’s not “the one.” He’s a wonderful guy, and he clearly would do anything for me. This makes me feel so guilty sometimes. I do love him, but I keep questioning the relationship. Surely, if I truly loved him, I wouldn’t be having these doubts. I don’t want to deceive him about where I’m at, so I keep telling him about my doubts. He says that it’s okay and that he understands, and that he knows that I love him.

Lately, I’ve found that I’m constantly confessing things to him. If I see an attractive guy, I tell him. If I think about my ex, I tell him. Honestly, all my confessing is getting out of control. It used to happen just once in a while, but it’s happening all the time now. We rarely go out on dates anymore, because the whole time we’re out, I’m confessing a thought I’ve had. I don’t know why my boyfriend hasn’t broken up with me. I really do love him (I think!), but this can’t be normal.           -Julia

Rituals About Your Partner Cheating

Monitoring your partner’s real-life or online activities.

Checking your partner’s receipts or credit card statements.

Checking your partner’s Facebook page and monitoring status updates by their friends.

Checking your partner’s emails, voicemails, or text messages.

Monitoring pictures of your partner on Facebook to see if anyone makes inappropriate comments.

Checking or monitoring your partner’s verbal or non-verbal behavior around other people.

Excessively questioning one’s partner about their feelings about their relationship.

Excessive reassurance seeking about their partner’s faithfulness.

Excessive questioning of their partner about their whereabouts or intentions.

Avoiding movies or TV shows that depict infidelity.

Checking your partner’s pockets, credit card statements, or receipts.

Asking your partner excessive questions about previous relationships or sexual experiences.

Checking your partner’s clothing for evidence of cheating (e.g., looking for traces of smeared lipstick, make-up, excessive wrinkles, etc.)

Checking your partner for unfamiliar smells (e.g., perfume, cologne, body wash, etc.) or t

These compulsions often involve looking for evidence that your partner is being unfaithful. Doubts can persist even in the absence of any true evidence.

I’ve been married for 2 years. My wife is a wonderful, loyal person, but I get this nagging feeling that she might be cheating on me. I’ve confronted her about it, but she denies it. She seems to be sincere. I want to believe her (and part of me really does), but I just can’t get rid of these doubts.

I’ve begun doing some things I’m not proud of. After she goes to bed, I often sneak downstairs and check her text messages to make sure that she’s not texting another guy. I also monitor her facebook and instagram accounts. I haven’t found anything terribly incriminating yet, but she’s smart, so she could simply be deleting the evidence. When we’re together, she sometimes receives texts from other people. If she smiles or laughs when reading them, I immediately become enraged and convinced that they’re from another guy. She always shows me the messages, and then I realize I’m just being paranoid. She’s been nothing but forthcoming whenever I’ve asked about something, but her patience with me is starting to wear thin, and she’s getting more and more upset that I can’t seem to trust her.

A large part of me knows she’d never cheat, but how come I can’t shake these doubts? These doubts must mean something, right?           -Peter

ROCD Treatment

Sometimes the only way to live a good life is to learn to accept and co-exist with life’s imperfections. Most individuals understand this logically, but it’s often easier said than done. Recovery from ROCD involves challenging black-and-white thinking and recognizing that good can be good enough, even for important things like our relationships. Recovery is also based on a willingness to accept uncertainty and compromise.

Is there a “better” person out there?

Absolutely. This is a certainty.

There are billions of people in the world, and our lives tend to run in tight circles. There is always someone better out there for everyone. No one ever finds their #1 perfect person. At some point, we all choose to accept imperfections (however large or small) and love the person we love, ending our search.

Imperfect ≠ “Not Enough” (Imperfect isn’t the same thing as “not enough.”)

These concepts are often incorporated into ROCD treatment, in combination with exposure and response prevention (ERP) and all the usual suspects. ERP for ROCD involves exposure to doubt-inducing triggers, while simultaneously refraining from all mental and behavioral compulsions. Consistent, repeated practice can dramatically reduce symptoms of ROCD.

Interested in ROCD treatment in Florida? Look no further than my South Florida OCD treatment center or call the phone number at the top of this page.

Questions?  Comments? What ROCD compulsion do you fall into the most? Which ROCD compulsions and avoidance behaviors did I forget? Sound off below…

ROCD was originally published on Steven J. Seay, Ph.D.

[drstevenseay]

OCD Treatment: Back to Basics

OCD is predicated on the formation of faulty beliefs that are maintained through negative reinforcement.

In previous posts, I have discussed various aspects of the “OCD Cycle,” but it never hurts to have a quick refresher.

After all, understanding how OCD works can help you see through its lies and help mobilize you to stand up and challenge it.

What is OCD, and how does OCD treatment work?

OCD has two mains parts: obsessions and compulsions. We’ll talk about the obsessions first.

Obsessions are unwanted thoughts, impulses, or images that intrude into your awareness, and cause significant anxiety or distress. Thoughts include such examples as, “What if I get sick?”, “What if I secretly want to harm my loved ones?“, “What if I just got sexually aroused by that child?“, and “What if I forgot to lock my front door and someone breaks in?“.

Impulses are experienced as urges to commit actions that you wouldn’t want to commit. Some examples of unwanted impulses include the urge to blurt out offensive or inappropriate statements, grab a policeman’s gun and shoot someone, or do something sexually inappropriate in public.

Images often consist of violent or disturbing mental imagery. You might be plagued by mental movies of extreme violence (e.g, seeing images of people getting killed or mutilated) or inappropriate or unwanted sexual contact (e.g., seeing yourself having sex with someone who you wouldn’t want to have sex with).

Compulsions (also referred to as “rituals“) are the behavioral or mental responses that you use to reduce the anxiety brought on by your obsessions. Behavioral compulsions include washing, checking, or rearranging. Mental rituals may involve analyzing thoughts, mentally reviewing past events, or mentally reassuring yourself.

There are many more examples of obsessions–as well as behavioral and mental rituals–than the ones I’ve mentioned above.

Avoidance behaviors are considered a type of preemptive compulsion that are used to prevent anxiety from spiking in the first place. Similar to other compulsions, avoidance is a way to control and reduce anxiety.

Obsessions (regardless of whether they consist of intrusive thoughts, impulses, or images) increase anxiety. Because anxiety is perceived as uncomfortable or intolerable, the individual engages in compulsions to reduce the anxiety they are feeling. Compulsions “work” at first, in the sense that they do directly reduce anxiety.

When a negative stimulus (e.g., anxiety) is reduced or taken away by the performance of a particular behavior (e.g., compulsions), that behavior becomes more likely to be repeated in the future whenever the negative stimulus is re-encountered. This phenomenon is more generally called negative reinforcement. Because compulsions “work,” they begin to be used preferentially as “coping strategies” in response to anxiety-producing situations. Compulsions quickly become the default ways individuals respond to their anxiety.

All is okay for awhile, but ultimately, there are some major downsides to using compulsions to reduce anxiety. First, compulsions tend to reinforce faulty beliefs and prevent people from developing healthy, more realistic beliefs about their anxiety triggers.

For example, let’s consider someone with contamination OCD who believes, “If I touch a doorknob and don’t wash my hands, I’ll get sick.” If this person consistently washes their hands after touching doorknobs, washing becomes seen as a necessary step to avoid getting sick (even if it isn’t). Continued washing prevents the person from ever realizing that washing is optional, and as a consequence, washing reinforces the false belief that health is fragile and that it can only be maintained through elaborate washing behaviors.

Before long, the person becomes uncomfortable with even the most innocent casual contact, because it is seen as potentially threatening. Fear begins generalizing to more and more situations, and soon the person feels uncomfortable touching anything that hasn’t been cleaned recently. The person’s tolerance for ambiguous situations is reduced, if not completely eliminated.

Furthermore, the anxiety-reducing properties of compulsions tend to diminish over time, and the person must typically expand their compulsions to get the same anxiety reducing effect. What began as a simple washing behavior soon expands to 2-, 3-, 4- repetitions, and the wash becomes longer and more elaborate.

Avoidance of anxiety-producing triggers has the same effect as performing compulsions. If people begin to avoid situations that cause anxiety, they never learn that anxiety is tolerable and will reduce on its own, even without performing rituals.

I’ve discussed handwashing quite a bit in the example above, but the same basic principles apply to ALL types of OCD.

The most effective treatment for OCD, exposure and response prevention (ERP), works by bucking this entire OCD system. With the help of a OCD therapist (or on their own), people with OCD develop the courage to begin violating the unhealthy, non-reality based rules that OCD has imposed on their lives. Through a series of calculated risks, they begin improving their tolerance for ambiguous situations. Through exposure and response prevention (ERP), they improve their ability to tolerate uncertainty.

By performing exposures without rituals, individuals with OCD also indirectly refine their beliefs about how the world works — replacing faulty OCD beliefs with healthier, more realistic beliefs that are not based on what-ifs or fear. Through consistent practice, the “OCD Cycle” is slowly dismantled, and the person begins to feel free again.

Questions?  Comments? What types of faulty beliefs form the basis of your OCD? What rituals and avoidance behavior does your OCD use to maintain these beliefs? Sound off below…

OCD Treatment: Back to Basics was originally published on Steven J. Seay, Ph.D.

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Relationship OCD (rOCD) - Unwanted Impulses & Images

Just like other types of OCD, rOCD can involve unwanted, intrusive impulses and images.

This multi-part series of posts will focus primarily on rOCD, also known as “relationship OCD.” Part 1 focused on obsessive thoughts that are common in rOCD.

This part discusses other relationship OCD obsessions, including intrusive impulses and images.

Part 3 will review common compulsions and avoidance behaviors that are typical in rOCD (relationship OCD).

Part 4 will discuss “Relationship-Focused OCD” more broadly in the context of other types of relationships, including friendships, parent-child relationships, and professional relationships.

As I mentioned in my previous post on rOCD, many people with “relationship OCD” experience recurrent doubts about whether or not they are with the “right” person. Many also infer that if they have doubts about their current relationship, they might secretly want to cheat (or will cheat). They may fear that they will be unfaithful, even if they’re committed to their partner and have no specific desire to cheat. They may believe that unless they can feel 100% certain that they’d never cheat on their partner, they are in the “wrong” relationship.

What Intrusive Impulses/Images Occur in Relationship OCD (ROCD)?

In my previous post, I discussed rOCD obsessions characterized by unwanted thoughts. However, some particularly confusing rOCD obsessions include intrusive impulses or images. These obsessions overlap extensively with the obsessions experienced by those with hOCD (which is more accurately described as “sexual orientation OCD“), pOCD, and other sexually-themed OCD.

Examples of ROCD Unwanted Impulses

ROCD impulses are experienced as distressing and unwanted, although sometimes the individual cannot discern if the impulse is something they actually want to engage in or not. Common OCD impulses in ROCD include:

Impulses or urges to kiss someone other than your partner.

Urges or impulses to sexually touch someone (other than your partner).

Impulses to break up with your partner.

Urges to scream or yell at your partner.

Unwanted, inappropriate impulses to grab someone’s breasts, buttocks, or genitals.

Impulses to cheat on your partner or have sexual contact with someone other than your partner.

Impulses to blurt out, “I love you,” to someone other than your partner.

Impulses/urges to ask another person out on a date.

I don’t know what’s wrong with me. Whenever I’m around an attractive man, I feel this overpowering urge to kiss him. These urges have gotten so strong that I’ve started avoiding being one-on-one with my male colleagues. I’m in an amazing relationship and I think I’m in love with my boyfriend, so I can’t understand why this is happening to me. Does this mean that I’m secretly unhappy or want to cheat on him?           -Maria

These impulses occur in the absence of “true” attraction or a “true” desire to cheat. This is similar to how someone with Pure-O OCD or harm OCD might experience unwanted urges to harm a family member. Likewise, someone with sexual obsessions might experience unwanted urges to do something sexually inappropriate to a child.

Some individuals with relationship OCD also experience their obsessions in the form of intrusive images, which are often sexual or romantic in nature.

Relationship OCD: Unwanted Sexual Images

Sexual or romantic imagery associated with an ex-boyfriend or ex-girlfriend.

Sexual or romantic imagery associated with friends or co-workers.

Sexual or romantic imagery associated with strangers.

Images of undressing in front of someone other than your partner.

Images of performing sexual acts with someone else you find attractive.

Intrusive sexual images of other individuals (e.g., seeing yourself having sex with someone else) while being intimate with your partner.

Intrusive sexual images of other people having sex with your partner (e.g., previous boyfriends / girlfriends, strangers, etc.).

My wife is the most amazing woman in the world, but I’m plagued by these crazy thoughts about my ex. I can’t stop thinking about having sex with her, and I keep comparing sex with my wife vs. sexual experiences I’ve had with my ex. Does this mean that I’m not over my ex-girlfriend?           -Kevin

Some images focus specifically on your partner’s sexual history.

I know that my girlfriend is faithful, but I can’t stop thinking about her previous sexual relationships. Is sex with me as good as sex with her ex-boyfriend? Is she as attracted to me as she was to him? She keeps telling me she loves being with me, but I can’t let go of the feeling that she had better sex with her ex. Even though I don’t want to, I find myself interrogating her about the specifics of her previous sexual relationships. I just can’t get over the fact that she has enjoyed sex with somebody else. What’s wrong with me?           -Chris

ROCD images are unwanted, spontaneous, intrusive, and distressing, and many individuals with ROCD feel intense guilt, shame, and confusion over not being able to control their thoughts.

Questions?  Comments? Do you have relationship OCD (ROCD) characterized by intrusive impulses or images? Sound off below…

Relationship OCD (rOCD) – Unwanted Impulses & Images was originally published on Steven J. Seay, Ph.D.

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ROCD - Relationship OCD

Symptoms of relationship OCD (ROCD) include pervasive doubt and uncertainty about interpersonal relationships.

In a previous post on mental checking, I talked briefly about ROCD (Relationship OCD), a form of OCD that involves pervasive doubt and uncertainty about interpersonal relationships.

This multi-part series of posts will focus primarily on ROCD in the context of romantic relationships. However, it will also discuss “Relationship-Focused OCD” more broadly in the context of other types of relationships, including friendships, parent-child relationships, and professional relationships.

Relationship OCD (ROCD) in Romantic Relationships

Many individuals with ROCD have symptoms that are most evident in their romantic relationships. They often experience significant doubt and distress about their chosen partners and may have a history of repeatedly breaking up or ending relationships due to recurrent doubts.

ROCD sufferers may worry that they’re with the wrong person, that they don’t feel as emotionally connected to their partner as they should, or that their partner has unacceptable flaws. Other individuals may worry that their relationship feels asymmetrical (i.e., that their boyfriend, girlfriend, or spouse is more in love with them than vice versa). Some individuals with relationship OCD have generalized fears about committing to one person, such as being afraid of “missing out” or not “being on the right path” with “the right person.” Others have more specific worries, such as the fear of hurting their partner’s feelings or the fear of being unfaithful.

As illustrated in the examples above, relationship OCD symptoms can be incredibly diverse.

Relationship OCD symptoms sometimes intensify when relationships undergo transitions. For example, events that may be associated with an exacerbation of ROCD symptoms include committing to an exclusive dating relationship, having sex or being intimate, getting engaged, getting married, or having children.

Individuals with ROCD may worry excessively about:

The ultimate compatibility of their partner (e.g., What if I’m dating or marrying the “wrong” person)?

The health or stability of their relationship (often in comparison to previous relationships or idealized relationships). For example, “What if i never find “the one?” or “What if I should’ve stayed with my ex?”

Their partner’s faithfulness (e.g., excessive concerns about their partner’s previous relationships, unreasonable suspicion that their partner is currently cheating or wants to cheat). For example, “What if my partner is cheating on me?” or “What if my partner wants to cheat on me? It’s only a matter of time…”

Their partner’s perceived flaws (including doubts about their own ability to cope with their partner’s perceived flaws). For example, “My partner has the most horrible nose. I can’t imagine waking up and seeing that every day for the rest of my life.” Preoccupations may focus on physical flaws or character flaws (e.g., “What if my partner isn’t intelligent or witty enough?”)

Their own capacity for cheating on their partner (including the fear that they may secretly want to cheat). For example, “What if I secretly want to cheat on my husband/wife? I think I’m a faithful person, but what if something deep inside me causes me to be unfaithful?”

These worries may lead individuals with ROCD to:

Repeatedly analyze their feelings about their partner. (e.g., “Am I really, truly in love? How can I know for sure that this is what love is supposed to feel like?”)

Repeatedly make comparisons to past relationships or ideal relationships.

Have high expectations for their emotional experience, especially with regard to interpersonal relationships. (e.g., “If I’m with the right person, I should know it and feel it completely. There’s no room for doubt in marriage, since I will be committing the rest of my life to this person.”

Use in-the-moment feelings or thoughts as evidence for predicting the long-term health of their relationships. (e.g., “Having doubts now must mean I’m with the ‘wrong’ person.”

Become hyper-aware of their partner’s potential flaws.

Repeatedly confess their doubts to their boyfriend/girlfriend/spouse or a trusted friend. (e.g., “I just saw an attractive guy and I thought I was attracted to him. Does that mean I could secretly want to cheat?”

Cognitive distortions, such as all-or-nothing thinking, catastrophizing, fortune-telling, overgeneralization, mental filtering, emotional reasoning, and excessive use of “should statements” may characterize relationship OCD. Just like other forms of OCD, ROCD is thought to be associated with hyper-responsibility, a tendency to view thoughts as being important, a need to control or escape unwanted thoughts, hypersensitivity to risk or threat in ambiguous situations, intolerance for uncertainty, and perfectionism. In my Palm Beach Gardens (South Florida) treatment center, relationship OCD beliefs that I commonly encounter include:

ROCD Beliefs

If I’m in love, I should feel in love.

If I’m with the right person, I shouldn’t have doubts.

There is one right person out there for me, and that person will be able to meet my needs perfectly.

If I’m already aware of flaws in this relationship now, it’s only going to get worse with the passage of time.

If I’m truly in love with my partner, I shouldn’t have romantic or sexual feelings about other people.

If I’m truly in love with my partner, I shouldn’t be thinking about my past relationships or partners.

I shouldn’t have mixed feelings about my relationship.

If I’m truly in love with my partner, I shouldn’t be thinking about my ex.

Like all forms of obsessive-compulsive disorder, symptoms of relationship OCD include obsessions and compulsions.

ROCD Symptoms: Obsessions

Obsessions are unwanted thoughts, impulses, or images that “pop” into awareness many times each day. These experiences are associated with anxiety or other forms of emotional distress. In severe cases of relationship OCD, these experiences may take up many hours each day. As such, ROCD can cause significant distress in interpersonal relationships. People with relationship OCD may be frequently bombarded by such thoughts as:

Examples of ROCD Thoughts

What if I don’t really love my partner?

What if there is someone out there who is better for me than my current partner?

What if I miss out on meeting my ideal partner because I’m currently in this relationship?

What if I don’t love my boyfriend “enough”?

What if I should have stayed in a previous relationship?

What if I’m more in love with my previous boyfriend than my current boyfriend?

What if I secretly want to cheat on my wife?

What if my husband is secretly cheating on me?

What if my spouse has a flaw that ultimately dooms this relationship?

What if I have a flaw that ultimately dooms this relationship?

What if I’m not as attracted to my boyfriend as I should be?

What if I secretly hate my partner?

What if I secretly want to break up with my girlfriend?

Does the fact that I found that other person attractive or had that dream mean that I should end my current relationship?

Do doubts about my current relationship mean that there’s somebody better out there for me?

Should I break up with my partner or stay in my relationship?

As you can see, the thoughts associated with relationship OCD are intense and can wreak havoc on romantic relationships. Examples of ROCD intrusive impulses and images will be discussed in subsequent posts.

Questions?  Comments? Do you experience symptoms of relationship OCD (ROCD)? What ROCD obsessions bother you the most? Sound off below…

ROCD – Relationship OCD was originally published on Steven J. Seay, Ph.D.

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Driving Fears & Driving Avoidance in Teens & Young Drivers

Driving fears and avoidance in teens may reflect normal development or possibly an emerging anxiety disorder.

Reader Question: My daughter just turned 15, and no matter what I say, I can’t seem to convince her to practice her driving.

It’s strange, because in the past, all she could do is talk about how excited she was to finally get her permit.

I truly thought that she’d be practicing constantly once she was legally able to.

Have you seen this before? Could her driving avoidance possibly be related to her OCD?

Sincerely, Stressed-Out Parent

Answer: Maybe, maybe not.

Driving Fears May Be Normal…

Driving-related anxiety is a completely normal phenomenon. For many people, learning to drive is the first time that they are individually responsible for handling a situation that could potentially be life-threatening. Although car accidents are (hopefully) rare for most individuals, accidents can be harmful (or deadly) when they do occur. Being in charge of a (potentially) deadly “weapon” brings with it an immense sense of responsibility. This can give rise to driving fears.

For that reason, even the most non-anxious person may initially balk at driving.

Nevertheless, for the majority of individuals, driving fears lessen with practice, and ultimately the person develops a sense of mastery over their driving. The act of driving becomes associated with pleasure and independence rather than with fear.

…But Driving Fears May Also Reflect An Anxiety Disorder

There are times, however, when driving anxiety becomes excessive or maladaptive. I’ve discussed driving-related fears in several previous posts, and it’s important to acknowledge that driving fears may sometimes reflect an underlying anxiety disorder, such as panic disorder or hit-and-run obsessive-compulsive disorder (OCD). I won’t reiterate the differences between hit-and-run OCD and panic disorder with agoraphobia here, but both of these conditions are associated with significant anxiety that should be addressed in the context of therapy.

In my own South Florida psychological practice, I see a tremendous number of young drivers who are debilitated by anxiety. Many young, eligible drivers simply don’t realize that their driving fears are driven by an anxiety disorder, and they choose to forego taking their driving tests because of anxiety.

Oftentimes, their parents never even realize that anxiety is a factor in their driving avoidance (i.e., the teens would never say as much)… Yet, these young drivers postpone taking their driving tests over and over again. At first, the excuses are plausible:

“I don’t really care about driving. I’ll get around to it one of these days.”

“It’s really not a big deal for me. The parking situation at school is terrible anyway. What’s the point?”

“I don’t even have my own car. Why learn to drive if I don’t have my own vehicle? I’ll practice driving and take the test when I have a car.”

“There’s no point in me driving. All of my friends already have their licenses, and they’re more than happy to give me a ride.”

Meanwhile, parents are lamenting…

“What’s wrong with my child? Why won’t he/she get his/her driver’s license?”

“Why does my child refuse to practice driving?”

“What causes my kid to not care about getting their driver’s license?”

“Why is my child not driving when all of their friends have their licenses already?”

Why? Because driving fears can be intense.

When you worry that driving, an optional behavior, might ultimately cost someone their life, you make use of any and every excuse to avoid driving. Because anxiety over learning to drive is normal, you blend in at first. Most parents can relate to the fear of driving, as they likely experienced some element of it themselves when they began to drive.

Yet, teens and young adults with driving-related anxiety may avoid driving for months — if not years or decades — before taking steps to overcome their anxiety (if they do so at all).

Never fear, though. If you or your child has excessive driving-related anxiety or driving fears, there IS effective therapy for this condition. It’s called exposure and response prevention (ERP), a type of cognitive behavioral therapy (CBT) that was designed specifically to reduce anxiety symptoms.

Questions?  Comments? Have a child who is avoiding getting their driver’s license? Sound off below…

Driving Fears & Driving Avoidance in Teens & Young Drivers was originally published on Steven J. Seay, Ph.D.

[drstevenseay]

Hit-and-Run OCD vs. Other Driving Fears

Hit-and-run OCD can be distinguished from other driving-related fears on the basis of a person’s core fear and his/her response to it.

What is hit-and-run OCD?

Hit-and-run OCD (sometimes called MVA-OCD) is a subtype of obsessive-compulsive disorder that involves persistent and recurrent worries that you’ve hit someone while driving. While most people with hit-and-run OCD worry, “What if I accidentally hit a pedestrian?”, some worry about unintentionally causing car accidents, bike accidents, or property damage.

Hit-and-run OCD is frequently misdiagnosed as panic disorder given that many people with panic disorder (with agoraphobia) also report a fear of driving. However, hit-and-run OCD and panic disorder are distinct conditions that may often be differentiated on the basis of their core fears.

Driving Fears Related to Panic Disorder (with Agoraphobia)

For someone who has panic disorder with agoraphobia, driving fears might arise because:

Driving may have been associated with panic attacks in the past. Some people with panic disorder have a history of having had panic attacks while on the road and they’re fearful of this happening again.

If you’re in the car and have a panic attack, escape isn’t easy. You may be fearful of getting trapped in your car while your anxiety escalates. Some people with panic also fear the potential for embarrassment if they panic in public.

Panic disorder with agoraphobia is also associated with the fear of being vulnerable and helpless to anxiety or panic.

In essence, panic disorder involves the fear of panic itself. In fact, panic disorder is often described as the “fear of fear.” Many people with panic tend to misinterpret the physical sensations of anxiety and panic as dangerous (e.g., “What if my chest pain means that I’m having a heart attack?”, “What if my racing thoughts mean that I’m going crazy?”). These fears (e.g., the fear of dying, the fear of going crazy) are fairly distinct from the obsessions that characterize hit-and-run OCD.

Driving Fears Related to Hit-and-Run OCD

Although people with hit-and-run OCD may experience panic attacks while driving, these panic attacks themselves are not fundamental to their anxiety. Instead, panic is a byproduct of the person’s anxiety related to their underlying OCD fears. Hit-and-run obsessions often involve fear or uncertainty about the possibility of having caused harm to others (e.g., “What if I hit someone with my car?”, “What if I drove carelessly and caused an accident?”). In that way, OCD-related panic is obsession-driven.

While both panic disorder and hit-and-run OCD may be associated with driving avoidance, OCD is distinctly associated with a variety of behavioral and mental compulsions, which are not typically present in panic disorder. People with OCD may engage in a variety of physical or mental checking behaviors when driving. They may make excessive use of mirrors or visual checks to make sure that they haven’t hit someone or caused an accident. They may retrace their driving routes to scan for signs of an accident. They might also check the news for stories about car accidents or hit-and-run incidents, or check their own vehicles for signs of damage that their car may have been involved in an accident. Beyond these overt checks, people with hit-and-run OCD may engage in mental review, such as mentally replaying their drive home to make sure that nothing bad happened. At first these checks may be minimal and may take only a few minutes to complete. However, if these compulsions aren’t addressed, they may grow into complex, time-consuming rituals that may take up many hours per day.

The distress associated with these rituals can be so intense that the person may begin placing restrictions on their driving. They may drive only when necessary and restrict their driving to familiar roads and familiar places. They may avoid driving at night, avoid busy intersections or highways, or avoid roads that pass by schools, shopping areas, or construction zones (i.e., any places that might have ample numbers of pedestrians). They may also ask close friends or family members to drive them places or complete errands for them.

Hit-and-run OCD can quickly become debilitating, and it can result in significant job-related impairment. Moreover, some individuals become so disheartened by their symptoms that they quit their jobs. Many of the individuals I treat in my West Palm Beach psychological practice are initially disabled due to their inability to drive to work or (even) therapy.

Because this type of OCD is highly treatable through exposure and response prevention (ERP), giving up on overcoming your hit-and-run OCD is especially tragic. You really can overcome your driving fears.

Effective treatment for hit-and-run OCD occurs primarily outside of the office — on roads. Consequently, you should find a local therapist who is willing to leave the office and implement the types of in vivo exposures that are most effective for reducing hit-and-run OCD symptoms.

ERP for hit-and-run OCD involves confronting anxiety head-on through in vivo and imaginal exposures. People with hit-and-run OCD will need to take to the road with their therapists and do a variety of therapeutic exercises designed to confront and reduce their driving-related fears. They will initially construct a driving-related hierarchy that may include:

ERP for Hit-and-Run OCD: Exposure Ideas

Driving at various times of the day, including driving at night, as well as driving during the day.

Driving in areas that are either unoccupied OR are full of pedestrians, such as construction areas or driving past schools.

Driving in remote places OR driving in busy parking lots, including mall parking lots that have many pedestrians.

Driving on roads that include bike lanes.

Driving on highways or busy roads that involve merging into traffic.

Making right-hand turns on red, which can be especially triggering if there are pedestrians or other vehicles present.

Practicing parking (backing in and backing out) in empty OR busy parking lots.

Driving with “normal” distractions, such as driving while listening to the radio.

Initially, you and your therapist will assemble a list of triggering driving scenarios and rank them 0-10 in terms of anticipated anxiety/distress. Individuals will usually begin with driving exposures that are ranked as “2′s” or “3′s” on their scale and then systematically progress up the hierarchy. Exposures should be repeated frequently, under many different types of circumstances.

Some high level driving exposures may initially be completed with a “driving buddy” before you progress to doing these exposures independently. Your “driving buddy” may be your therapist, but it could also be a trusted friend or family member. It’s important that this person refrains from giving you reassurance while you drive. As you progress, your “driving buddy” should become less and less involved in your exposures.

Sometimes an intermediary step of fading out your driving buddy involves driving with your buddy while they close their eyes or wear a blindfold. This gives you the benefit of still having them there for moral support (NOT REASSURANCE SEEKING), while learning to rely solely on your own perceptions of the road. This is important because some people with hit-and-run OCD feel reassured simply by having another pair of eyes present. This is because the person with hit-and-run OCD may believe that if anything bad truly did happen, their driving buddy would surely have noticed it and mentioned it.

Avoidance is a core component of hit-and-run OCD, so driving itself will be one of the most important elements of effective treatment. However, exposure to triggering situations via imaginal exposure will also be key to achieving a lasting recovery. Scripting (imaginal exposure) is a core component of effective OCD treatment, as is using the right type of video-based exposures. These treatment strategies may include watching youtube videos of triggering traffic situations or hit-and-run accidents.

If you have hit-and-run OCD, there is much reason for hope. Find a local hit-and-run OCD specialist who can guide you in ERP for OCD, and you’ll soon find yourself taking to the road with newfound confidence.

Questions?  Comments? Have a recovery story about hit-and-run OCD you’d like to share? What exposures have been instrumental in your recovery? Please sound off below!

Hit-and-Run OCD vs. Other Driving Fears was originally published on Steven J. Seay, Ph.D.

[drstevenseay]

OCD & Pets: Sexual Thoughts & Scrupulosity

OCD tends to target what we care about the most. In this case, our pets.

Obsessions focusing on pets and animals incorporate all the common themes: contamination, checking, harm, scrupulosity, and sex.

In this 3-part blog series, I’ll discuss some of the common ways obsessions may target our lovable, snuggable friends.

Part 1 focused on harm obsessions, including the fear of accidental and intentional harm, and Part 2 covered contamination obsessions. This final part, Part 3, will address sexual obsessions and scrupulosity, as they pertain to pets.

Our animals are members of our family. We treat them as our own. It’s not surprising, then, that OCD extends unwanted thoughts to our furry, fluffy companions. OCD loves to attach taboo thoughts to things we love, and our pets are no exception. Just as many parents struggle with obsessions that target their children (e.g., What if I secretly want to harm my child?; What if I secretly am sexually attracted to my child?), so too, do pet owners have obsessions that may involve taboo thoughts about their pets.

Some of the most distressing and confusing pet obsessions focus on sexual themes, such as the fear of being sexually attracted to your pet. These obsessions may come out of the blue or may be triggered when one notices physical sensations of “sexual arousal” occurring in the presence of a pet.

A gentleman once told me, “Everything was fine until I enrolled my dog in that puppy class. During our final exam, my dog excelled. He had mastered all the skills we were practicing, and he was literally at the top of his class. That’s when it all started. My dog had finished the final exam, and was clearly victorious — when I noticed a terrifying sensation in my groin. It was all downhill from there… My OCD exploded.”

For other people, intrusive sexual thoughts about pets or animals may be triggered initially by an accidental genital grazing when you’re holding your pet, noticing your pet’s genitals, or cuddling with your puppy at night and feeling relaxed… These situations seem innocuous until doubt and uncertainty strike. Then everything changes…

What if I’m a sexual deviant? What if I’m into bestiality? What if I’m a monster? What if I could actually do that? What if I have a fetish?

The list is endless.

For still other people, there’s no obvious trigger. The thoughts just start coming over and over and over again. These thoughts may be what-if thoughts like those above, or they may consist of graphic mental images or impulses to act inappropriately.

Obsessions about Animals – Sexual Obsessions About Pets

Like it or not, OCD sexual obsessions can attach to our beloved pets. People with sexual obsessions about pets or animals fear the possibility of attraction or the possibility of acting in a sexually inappropriate manner toward their pet.

What if I touched my pet inappropriately? How do I know for sure I didn’t do that on purpose? Maybe I wanted to… Why did I hold it like that? Surely, I would’ve known that that would cause my hand to graze his penis. How can I know for sure that I’m not a sick person who intentionally touched his genitals?

Why am I looking at her genitals? Why did I even notice that? Who thinks about that? What kind of person would even be aware of their pet’s private parts? Only a sick person would look.

Oh my gosh, I think I’m aroused by my pet. When I look at their private parts, I felt aroused — I really think I was aroused. I can’t stop looking. I noticed all the normal arousal sensations…yet they were linked to looking at my pet. What kind of disgusting person gets aroused by their pet or other animals?

I was just petting my dog, and everything was fine at first. But then I noticed that I was getting sexual arousal sensations (e.g., groinal sensations, an erection, vaginal sensations). I can’t believe this is happening. This is proof that I’m sexually attracted to my pet!

Oh my gosh, it’s getting worse now. I’m having movies and pictures in my head of performing sexual acts on my dog. I can actually see myself doing these disgusting things.

I know for sure I’m a pervert now. I’m sitting here, petting my dog, and I feel like I’m about to lose control and touch my pet inappropriately. I’m literally fighting the urge to do something terrible and disgusting. I think I’m about to do it!

Similar to sexual obsessions, OCD scrupulosity involves the fear that you’re doing something morally wrong in relation to your pets. These obsessions involve the fear of causing harm to your pets, or causing them to experience unnecessary pain or suffering. People with scrupulosity about caring for their pets may find it difficult to leave their pets for even brief periods of time, for fear that their pet would miss them or suffer from the absence.

Obsessions about Pets – Scrupulosity about Harming or Mistreating Pets

These animal-focused obsessions may often involve the fear that you have committed a morally- or religiously-dubious act. These thoughts then make you question who you are as a person.

I’m a terrible person. I got frustrated with my dog, and I actually lost my temper and screamed at him. What kind of horrible person would do that to an innocent animal? I must surely be a monster!

Oh my goodness, I just did the most terrible thing. I lost my patience and jerked my dog’s leash, and I’m terrified that I hurt her. It’s possible that I messed up her neck or spinal cord, and that she’ll never be the same.

I am the worst person ever. My dog was taking forever to go to the bathroom, and I totally lost it. I yelled at him and jerked his leash, and he was so traumatized that he put his tail between his legs. I think I emotionally scarred him forever. He’s never going to get over how awfully I treated him.

My pet is so sensitive to separation anxiety that I can’t bear to leave him. Every time I run an errand, I can hear him barking and scratching at the door and freaking out. He is totally losing it and it’s all my fault. He probably thinks that I’m abandoning him and that I’m never coming back. Yes, I have to work to pay the rent, but I’m also terrified that he must hate me for it. He must be so lonely and depressed when I’m gone. Did you see the movie, “The Secret Life of Pets?” That proves that leaving him during the day is inhumane. I’m a horrible for even considering leaving him.

Excessive fear (and avoidance) of “normal” behaviors that may stress out your pet.

And last but not least — for those of you who can’t relate to any of the above…

Scrupulosity about not having pet obsessions. Example: I must not love my pet enough if I’m not having obsessions about it. (That was a joke. Kind of. I know that there are some of you out there who are freaking out about not having moral obsessions about your pet.)

The good news is that even if you have OCD about pets, all the normal rules of OCD treatment still apply. You don’t need to reinvent the wheel. Exposure and response prevention (ERP) remains the treatment of choice.

Just as I’ve mentioned in my Exposure and Response Prevention (ERP) Tips series, optimal exposures will meet the following criteria:

What can I do (on purpose) that will bring on my fear?

What can I do that will give my fear the opportunity to come true?

Effective treatment for OCD involving pets or animals will typically include a combination of in vivo exposures and imaginal exposures for OCD.

Enough talking. Time to get to work.

Let’s show our pets we love them by incorporating them in our exposures.

Questions?  Comments? Do you sexual or scrupulous obsessions about your pet? Sound off in the comments below.

OCD & Pets: Sexual Thoughts & Scrupulosity was originally published on Steven J. Seay, Ph.D.

[drstevenseay]

Pets & OCD: Contamination

Who could ever hurt a face this adorable? If you listen to OCD, you’ll start to think it’s possible.

Obsessions focusing on pets and animals incorporate all the common themes: contamination, checking, harm, scrupulosity, and sex.

In this 3-part blog series, I discuss some of the common ways OCD obsessions may target our lovable, snuggable friends.

This article, Part 2, will focus on contamination obsession associated with pets and animals. Part 1 covered harm and violent obsessions related to pets. Part 3 will address sexual obsessions and scrupulosity, as they pertain to pets and animals.

Most everybody loves that shower fresh feeling, right? Not only does it feel good, but it’s probably good for us too. Throughout history, cleanliness and good hygiene practices have been instrumental to reducing our vulnerability to germs, disease, and illness. For survival’s sake, to a certain extent, we’re probably biologically-programmed to prefer clean, hygienic environments, over dirty, disgusting ones.

Yet, at the same time, our human weakness for all things cute and cuddly leads many of us to choose to co-habitate with wild — or rather, domesticated — animals. This choice brings with it all sorts of opportunities for OCD to stir up contamination worries. Dogs and cats walk around barefoot outside or in litter boxes, and they tend not to wash their paws or bottoms very often (and when they do, it’s only with our assistance). Moreover, dogs have a predilection for both sniffing other dogs’ rear ends and licking themselves in inappropriate places… Naturally, this licking always tends to happen right before they decide to run up to us and lick us on the face. YUCK!

So yes, animals can be gross sometimes. But fortunately, most of OCD’s error messages about how dirty, disgusting, dangerous, and unacceptable this is, tend to be overblown.

OCD contamination obsessions about pets and animals come in a couple different varieties. Today, we’ll focus on identifying obsessions related to the fear of contaminating your pet, as well as the fear of being contaminated by your pet.

Pet Obsessions – Fear of Contaminating Your Pet

These pet obsessions involve accidentally contaminating your pet or making it sick.

What if I make my pet sick by accidentally feeding it food contaminated with household chemicals or cleaning products?

What if the air freshener I spray gets in my cat’s lungs and makes him sick?

What if I accidentally feed my dog tainted or spoiled food?

What if bugs accidentally got into my kitten’s food?

What if I accidentally spread germs to my dog when I was petting him and he then makes my other family members sick when they pet him?

What if I have an illness that I spread directly to my pet?

What if my friend’s dog was sick and then I accidentally bring home germs and make my puppy sick?

What if, when I was cleaning my cat’s bowl, I didn’t get all the soap off, and she gets sick?

My dog came up to me when I was sitting on the toilet, and I petted him. What if that makes him sick?

I think I might have dropped raw meat on the floor when cooking, and my dog immediately ate it. What if he gets salmonella or e coli?

When I was getting in the shower, I dropped my dirty clothes on the floor, and I think my dog licked my underwear. What if she gets sick?

I have the flu, and my puppy keeps climbing all over me. Can I spread the flu to my puppy?

OCD and Animals – Fear of Your Pet Making You Sick

Although they’re cute, pets can be a little bit gross sometimes. These obsessions focus primarily on getting sick as a result of interacting with your pet or another animal.

Can I get sick from the poop in my cat’s litter box? What if my cat’s paws track feces and pee throughout my entire house?

What if I have poop on my hands from picking up my dog’s poop and then it spreads to my personal items (cell phone, computer, etc.), and then makes me sick?

Can I get sick from petting my dog? After all, my dog isn’t entirely clean, and whenever I touch him, I might be touching poop that got stuck in his fur.

What if poop from my bird’s cage falls on the floor and then spreads throughout my house?

Can I get sick from my pet’s cage? What if I come into contact with his urine or feces when I’m cleaning his cage?

Can poop from my dog’s butt be transferred to my furniture and make me sick?

Can I get sick from allowing my dog or cat to sleep in my bed? What if poop from my dog’s feet or my cat’s litter box gets on my pillow?

Can dogs carry deadly illnesses or germs? What if a sick person pets my dog and then their germs get on me?

Can I get AIDS from a cat with feline HIV?

Can I get sick from touching my dog’s food? What if there are dangerous germs, bacteria, or viruses in her food?

Should I keep my dog or cat from walking on my carpeting? Is it possible to get sick from dog poop that gets transferred to my carpet?

Can I get infected with salmonella from reptiles or amphibians? Is it possible that germs from my frog, lizard, or snake could kill me?

Is it possible that my kitten could make my baby sick? Could my cat’s litter box kill my child? What happens if my toddler touches my puppy’s rear end by accident?

How long can poop germs live on furniture? What if my dog smears poop on my furniture and then I touch it and accidentally spread it to my face? Can that kill me?

What if my cat walks across my countertop right after using its litter box? Can that make me or my family members sick?

Can I get sick from letting my dog lick my face? What if my dog smelled another dog’s butt before licking me and their poop is transferred to my face? Can that kill me or make me sick?

What happens if my dog licks his private parts and then licks my face? It’s totally disgusting, and I’m worried that it can make me sick.

My dog is a poop eater. What if my dog eats poop and then licks me? Can that kill me or make me sick?

Whenever my dog pees, I’m afraid that some of his urine dries and gets stuck in his fur. Can that urine spread to my furniture and make me ill?

That’s quite a list of worries, isn’t it? What’s interesting is that most of these thoughts are perfectly normal. Most people will have these thoughts at some point — at least fleetingly… And most will do a pretty good job of acknowledging the thoughts and then living with the uncertainty.

Some individuals with contamination OCD, however, may have a harder time dismissing these thoughts. Consequently, they may be more likely to take defensive action in response to these thoughts, such as cleaning, disinfecting, or avoiding potentially contaminated objects (or their pets themselves). In addition, some people with OCD may take overly long showers after coming into contact with pets or other animals.

Compulsions often begin as normal and reasonable responses to contamination. However, OCD is never pacified by normal preventative action. It demands more…and more…and more… Before long, the OCD cleaning and avoiding spirals into something unmanageable, unreasonable, and counterproductive.

The “solution” to the problem quickly becomes worse than the “problem” itself.

Whether you’re fearful about making your pet sick or getting sick from your pet, exposure and response prevention (ERP) can help. My OCD treatment clinic in the West Palm Beach, Florida, area is pleased to offer treatment or consultation for OCD, including OCD related to pets and animals.

Love your pet unconditionally, and don’t let OCD put conditions on your affection.

Join me next time for Part 3 – Sexual Obsessions and Scrupulosity Involving Pets and Animals.

Questions?  Comments? Do you worry about contaminating (or being contaminated by) your pet? Do you have any pet-based contamination success stories you’d like to share? Can you think of any “what if’s” that weren’t mentioned in the lists above? Sound off in the comments below.

Pets & OCD: Contamination was originally published on Steven J. Seay, Ph.D.

[drstevenseay]

OCD About Pets and Animals: Harm

Unfortunately, not even man’s best friend is immune from OCD’s influence. Pet obsessions may focus on harm, violence, contamination, scrupulosity, and sex.

Obsessions focusing on pets and animals incorporate all the common themes: contamination, checking, harm, scrupulosity, and sex.

In this 3-part blog series, I discuss some of the common ways obsessions may target our lovable, snuggable friends.

This article, Part 1, will focus on harm obsessions; Part 2 will cover contamination obsessions; and Part 3 will address sexual obsessions and scrupulosity, as they pertain to pets and animals.

Pets. You gotta love ‘em. They’re so cute. They’re so cuddly. They always get excited when they see you.

So why does OCD hate them so much anyway?

Probably because we love them.

Just as OCD tends to torment parents who love their children, OCD also loves to torment pet owners who love their pets.

Get ready to brace yourself for all sorts of violent and horrific thoughts about pets and animals.

It doesn’t matter what type of pet you have. Dogs, cats, birds, ferrets, bunnies, snakes, flying squirrels, chinchillas, mice, rats, guinea pigs, gerbils, potbellied pigs, fish, horses, cows, chickens, frogs, turtles, lizards, YOU NAME IT! The list goes on and on. Obsessions about pets and other animals can occur across all species.

Let’s begin by identifying some examples of pet- and animal-focused OCD harm obsessions:

OCD and Pets – Fear of Accidental Harm

These OCD violent obsessions often focus on preventing possible harm to pets or other animals. Worries include the fear of causing harm through negligence or irresponsibility. Here are some examples…

Fear of not locking a fence/gate properly and having your dog escape and be injured or killed.

Fear of leaving on an appliance (e.g., a stove, curling iron), starting a fire, and burning down your house…thereby killing your pet.

Fear of forgetting your cat or dog’s medication and causing some type of resultant harm.

Fear of accidentally hitting your dog with your car.

Fear of accidentally trapping your puppy or kitten in the oven.

Fear of unintentionally putting your mouse in the microwave.

Fear of inadvertently trapping your dog or cat in the dishwasher.

Fear of your cat or dog getting stuck in the washing machine or dryer.

Fear of trapping your dog in a hot car or other vehicle.

Fear of not closing the front door properly and having your cat or dog escape and be hurt or killed.

Fear that you may accidentally harm your rabbit/puppy/kitten while holding it (i.e., break its neck).

Fear that a wild animal nearby may be in danger and feeling the need to seek it out and protect it (in the absence of any information that this is actually occurring). For example, you may “sense” that a deer nearby is about to be hit by a car and then feel compelled to seek it out and protect it.

Fear that your dog’s leash may break during a walk and your pet might be killed.

Fear that you may not be able to protect your pet in a dangerous situation (e.g., when approached by another animal).

Fear that you may drop and injure your guinea pig while holding them.

Fear of accidentally choking your dog with its leash.

Fear that you may roll over and crush your puppy or kitten in your sleep.

Pets and OCD – Fear of Intentional Harm

These OCD animal obsessions often focus on intrusive thoughts that you are a bad person or the fear that you might secretly want to harm your pet. Similar to obsessions in other forms of Pure-O OCD, these violent obsessions often evoke a preponderance of Pure-O OCD mental rituals.

Fear of being a serial killer or sociopath and taking action to harm, murder, or kill your pet.

Fear of becoming possessed and killing your pet.

Getting mad and then fearing that you secretly want to harm your pet.

Intrusive urges/impulses to murder or maim your pet while holding him/her (e.g., the impulse to break its neck, strangle it).

Intrusive images/movies in your head of harming your pet.

OCD and Animals – Fear of Losing Control and Harming Your Pet

These violent obsessions are similar to those above but focus on a loss of control. They often involve “what if” thoughts about the possibility of harming your pet while in an altered mental state.

Fear of sleepwalking and causing harm to your pet in your sleep.

Fear of losing consciousness and harming your pet.

Fear of harming your pet while intoxicated (e.g., while drinking, using drugs, etc.).

Fear of blacking out and harming your pet due to the effects of a new medication you’re taking.

Fear of “going crazy” and harming your dog or cat.

Fear of becoming possessed and harming your pet.

Pets, Animals, and OCD – Magical Thinking and Fear of Harm

These OCD-based animal obsessions involve magical thinking, which is when you perceive connections between two events that are not logically related. For example, you may perceive that if you don’t do a certain ritual, something bad may happen. For many pet-related violent obsessions, you may fear that resisting certain compulsions could result in your pet’s injury or death.

Fear that if you don’t perform a certain ritual, your dog or cat will get sick or die.

Fear that if you complete a certain behavior while having a bad thought, the Pure-O OCD bad thought will come true. For example, if you have a thought about your dog getting hit by a car while walking through a doorway, you may feel the need to reenter the doorway while having a “safe” or neutral thought.

Fear that if you don’t tap a certain number of times, something bad will happen to your cat.

Intrusive, violent images/movies in your head of your pet being harmed that you feel you must neutralize through a compulsion.

As you can see, we have the potential to worry a lot about our pets, our trusted animal companions. Just as with other family members, we’re invested in their survival and well-being, which is exactly why OCD tends to target them.

Whether you’re experiencing the fear that you might accidentally be responsible for causing harm to your pet, or you’re fearful that you might secretly want to harm your pet, it’s important to learn to use exposure and response prevention (ERP) as a tool to stand up to your OCD.

In vivo and imaginal exposure for OCD can be transformative for reducing your symptoms.

OCD wants you to take animal obsessions seriously. OCD wants to you to ritualize by analyzing your violent thoughts, checking your thoughts and intentions, and verifying that every door and gate is locked and secure.

At first, it can be difficult to ignore and resist these rituals. After all, compulsions tend to be framed in the most helpful of terms. Who wouldn’t take a few seconds — a few minutes — a few hours to make sure that everything’s okay? Only a bad person would ignore those thoughts, right?

WRONG!

Overcoming OCD involves learning to notice your thoughts, your feelings, your inclinations to act…and then deliberately choosing a non-response, rather than choosing an action based on OCD guilt or fear. It involves staring your fear in the eye.

Sometimes this is uncomfortable. You may feel negligent, irresponsible, careless, or evil.

But that’s just the tactic that OCD uses to manipulate you in order to keep itself strong.

In reality, doing rituals and following OCD’s directives is short-sighted. Although compulsions may feel good initially, rituals and avoidance provide only short-lived relief and ultimately perpetuate OCD’s game plan.

If you’re not doing rituals, what should you do instead?

Hug your pet, hold your pet, and walk away from the gate without looking back.

Join me next time for Part 2 – Contamination Obsessions Involving Pets and Animals.

Questions?  Do you experience OCD about pets or other animals? Harm-based worries getting you down? Sounds off below.

OCD About Pets and Animals: Harm was originally published on Steven J. Seay, Ph.D.

[drstevenseay]

Anger and OCD - Getting Mad...

Anger can be a mobilizing emotion, but too much anger directed at OCD can give it unnecessary power.

“I hate having OCD! Why can’t these thoughts just stop?!?! How can I be the person I was before?!?!”

Many people with OCD are extremely familiar with the anxiety-related aspects of the disorder. OCD is an anxiety disorder after all, so it’s not terribly surprising that anxiety is often core to its experience.

But anxiety is certainly not the only emotion that shows up in OCD. I’ve discussed briefly how some people with OCD have symptoms of guilt, shame, disgust, and depression, and how treatment may sometimes need to be modified when these emotions are primary aspects of the disorder.

Today, though, I’d like to comment briefly on anger and OCD, which I don’t think I’ve mentioned explicitly in previous posts. Anger can be a powerful force in many people’s OCD.

What’s the relationship between anger and OCD? Actually, the relationship between OCD and anger is complex, in that it’s mediated by obsessions, compulsions, or even reactions to developing the disorder.

Anger and OCD: Anger as a Trigger for Obsessions

Anger is sometimes entwined with anxiety and contributes directly to some types of Pure-O OCD. For example, anger can be a trigger for some people who have harm OCD (e.g., What if getting mad means that I’m capable of harming my family members?). Individuals with violent OCD obsessions may fear becoming angry, because they may fear that it will lead to them “snapping” or losing control.

Anger is also sometimes present for those who have OCD with suicide obsessions. For example, “If I feel that I hate my life or am angry with myself, that might mean that I’ll end my own life.” In this context, anger also signals danger and is linked to fear.

OCD and Anger: Examples of Anger Triggering OCD Obsessions

I felt really mad at my parents, and then I almost felt like I wanted to hurt them. Does that mean I’m a dangerous person?

I was arguing with my mom, and I felt an urge to punch her in the face, and I think I actually wanted to. What does that mean?

I felt really mad and frustrated at my children, and I wanted to lash out at them. Does that mean that I could actually physically hurt them?

I yelled at my kids, and I KNOW I enjoyed it. How messed up is that? Does that mean I really want to hurt them? Am I sadistic?

My baby was crying and I couldn’t get it to stop. For a second, I felt like I wanted to throw my baby down the stairs. Does that mean that I’m capable of harming my baby? Does that mean that I ACTUALLY WANT to harm my baby?

I screamed at my students today, and I think I felt a rush of enjoyment. What’s wrong with me?

I got really mad at my dog today. He was taking too long to do his business, and I got frustrated and almost lost it. I wanted to yank his leash so hard. I really wanted to (and maybe I actually did).

Anger and OCD: Anger Linked to Compulsions/Rituals

Anger and self-hatred can also be associated with compulsive behaviors, such as compulsive self-harm behaviors. In such situations, self-harm may provide relief from anxiety and guilt. For example, if I’m worried that God is mad at me (or if I’m a bad person), then self-punishment may be (wrongly) rationalized as a good and proper thing. It may feel like the right thing to do. Response prevention in these cases (i.e., resisting self-harm or self-punitive behaviors) may initially result in intense guilt and anxiety. However, response prevention (and good CBT) can help remediate these cognitive distortions.

Every situation is different, which is why a comprehensive, function-based conceptualization of your symptoms is important. For OCD treatment to be effective, you must understand your obsessions thoroughly, as well as the functions that your compulsions serve. Understanding the functions of your Pure-O compulsions (i.e., mental rituals) is just as critical as knowing their forms.

Many Pure-O rituals related to anger involve analyzing the feeling to try to determine whether or not it’s dangerous.

OCD and Anger: Examples of Mental Rituals Related to OCD Anger

If I get really mad, what does that mean about me as a person?

Does feeling intense anger mean that I’m capable of hurting someone?

What’s the difference between me and someone who actually would intentionally hurt other people?

How can I know for sure that I’m not dangerous?

What causes someone to finally snap and lose control?

What makes me different from all those crazy people on TV who snap and hurt people?

Anger and OCD: Anger About Having OCD

One of the most prevalent (but often overlooked) manifestations of anger in OCD, though, is reactive anger. This anger is less primary to the disorder and is more of a secondary reaction to having OCD.

If you have OCD, you know this experience well.

“Why did I have to get this stupid disease?!?! I hate OCD!!! I’m so mad about having OCD!!!”

If you go back to its roots, the capacity to feel anger originated as an adaptive function. In other words, anger was designed to be a good thing. Anger is supposed to be a motivating emotion that serves as a catalyst for action and change.

Even in OCD, anger can be a healthy motivator — at least, at first. For example, “I’m so angry at OCD that I’m going to do everything in my power to stand up to it.” This can be a great motivator early in treatment.

Unfortunately, the positive, mobilizing aspects of anger can be temporary. When we stew in anger too long, it can have unintended negative side effects.

Too much anger directed at OCD gives it power. It labels OCD as the victor–the thing that stands in the way–blocking us from being who we want to be.

Too much anger directed at OCD results in “wishing away” compulsions. Comparing your current life to the life you “should’ve had” doesn’t help. It magnifies distress related to the current situation. Persistent, unmanaged anger makes you feel powerless against OCD and impedes acceptance of the situation you’re in.

This is also true for anger-related emotions like frustration and annoyance. Fan the flames of these emotions, and you may be giving up control to OCD.

I don’t expect you to not be angry about winning the OCD lottery. Nobody wants it. Nobody signed up for it. It just happened.

But I do want you to find a way to have OCD and be present in your life today, even if it’s not so easy. I do want you to find a way to choose to be you, under not so great circumstances, and to consider yourself heroic for making that choice. I want you to celebrate the best of yourself and be proud of yourself for embodying your values, even when it’s hard.

Choosing to live in this moment, and to work on accepting its imperfections, brings victory–even though it may not exactly feel that way at first.

I’ll leave you with a challenge today:

Find a small way to manage your anger in relation to your OCD. Use it, but don’t be held back by it.

Anger and OCD – Getting Mad… was originally published on Steven J. Seay, Ph.D.

[drstevenseay]

ERP Tip of the Day #2

I’m going to do this and ride the anxiety wave no matter what. Bring on the bad thoughts.

It’s ERP tip time. This series of posts focuses on tips to enhance the effectiveness of your exposure and response prevention (ERP). If you’re interested in more ERP tips, click the following link for all the posts in this series. Exposure and Response Prevention (ERP) Tips for OCD

Without further ado, here’s another ERP tip to consider when designing your next exposure.

ERP Tip #2

When completing your next exposure, avoid rules that dictate what you’re allowed to think during the exposure. If you try to complete an exposure without having a certain bad thought, chances are that you’re setting yourself up to think that very thought. Instead, design your exposure around having that very same unwanted thought.

I love it when people with OCD do exposure, but I don’t love it when they have a long list of impossible preconditions that dictate the form of their OCD exposure.

The most glaring example of this is when people dictate the thoughts that they should have during exposure.

OCD ERP Tip Don’ts

What I don’t like: I’m going to touch that doorknob, but I really hope that it’s not wet or slimy. When it’s wet or slimy, it makes me think that it has blood on it, and that I might really be contracting AIDS. I really don’t want to die, so I’m okay with touching that doorknob, just as long as it’s dry as a bone, so that it doesn’t freak me out.

What I don’t like: I’m willing to walk across that mystery spot in the parking lot, just as long as it doesn’t look at all red or brown or sticky or possibly organic in some form or another. If it looks that way, it really freaks me out and then it makes me think that I’m tracking AIDS blood everywhere.

What I don’t like: I’m willing to look at pictures of kids, just as long as I don’t have sensations in my groin. When I have those sensations, it really freaks me out and I think there may actually be something wrong with me.

What I don’t like: I’m okay with holding my baby, just as long as I don’t think about throwing him down the stairs, snapping his neck, or doing something inappropriate to him. If those violent OCD thoughts show up, I’ll be really freaked out, and I won’t be able to handle it.

What I don’t like: I’m okay with looking at pictures of the devil, just as long as I don’t have unwanted religious thoughts like praying to him while I’m doing it. I mean, I’d really like to have negative thoughts about him while looking at him, but if I happen to have good thoughts, well then that would really freak me out.

OCD ERP Tip Do’s

What I like: I’m going to do this and ride the anxiety wave no matter what. Bring on the bad thoughts.

Here’s what happens when you use exposure and response prevention (ERP) tips and choose to do an OCD exposure and purposely think a bad thought: 1) You have taken control back and are offensively striking back at your OCD. 2) You are approaching a bad thought with a pro-coping mindset (instead of approaching it with surprise or shock). 3) You’re guaranteed an opportunity to face your fear. You’re not leaving it up to chance. 4) If your OCD has the tendency to try to one-up you, you are one-upping it.

If you don’t want to have a certain thought, that very thought will be the one that shows up. Save yourself some time, and just go for that thought. Yes, I mean that thought.

Implement this OCD ERP tip in your exposures for maximum benefit!

Questions?  Comments?  What has been your experience in embracing unwanted thoughts?Sound off below.

ERP Tip of the Day #2 was originally published on Steven J. Seay, Ph.D.

[drstevenseay]

Contamination OCD - Long Shower Exposures

Long shower times because of contamination OCD? Use our ERP shower exposure room to shorten your shower times!

Long shower times? Just a quick announcement… I’m pleased to announce that with our recent office renovations, we now have a spa-like therapeutic shower room that is perfect for individuals with contamination OCD who have excessively long shower times. This room is ideal for those with contamination OCD who wish to work on shower-based response prevention.

For individuals with contamination OCD who take really long showers, we are now able to provide office-based interventions for reducing your long shower times. We’ve had great success with reducing our patients long shower times from multiple hours to a mere 10-15 minutes.

Reduce Long Shower Times to Short OCD Shower Times

We do this first by developing shower-based response prevention guidelines and modeling non-OCD based shower behavior in-session. We essentially use a shower script to help individuals identify normal shower routines (which, to many of our patients’ surprise, DO NOT include hand-washing behaviors between washing each body part). We practice these routines out of the shower so that our patients can get individualized coaching on these routines. These simulated showers are first performed in our therapy rooms with a therapist, but then are performed in virtual reality (VR) in a virtual model of our office-based shower therapy room.

Our shower scripts are then digitized and downloaded to our patient smart phones, and we then have our contamination OCD patients practice these routines in self-directed exposures in their own homes (in their own showers, but without running water). Due to this practice, long shower times start give way to shorter shower times. We also have individuals with OCD complete imaginal exposure.

Next, we have our contamination OCD patients practice their showers in-office (with running water) in a spa-like shower room. Although our shower is sterilized after each exposure, the very act of using a public shower is, itself, an exposure.

To facilitate these shower-based exposures, we use the same digitized audio script that we used in our simulated exposures to guide the shower. Importantly, we’re also available live via specialized audio technology to coach our patients in implementing this protocol. Patients have full privacy in our spa-like shower room, yet they have the benefit of a live therapist coaching them remotely.

In the event that a patient deviates from their script and begins taking a long shower, we can pause the script, get them back on track via coaching, and then resume the scripted shower routine. We also have the option of terminating the water flow remotely, should the need arise.

Many of our contamination OCD patients with excessively long showers have found that having the option of in-office shower based exposures has been instrumental in helping them get a better handle on their OCD. We also provide in-home sessions, when possible, to generalize treatment gains to our patients’ homes.

I hope that you find this new novel treatment options useful for your contamination OCD ERP! Turn your long shower times into shorter shower times!

Contamination OCD – Long Shower Exposures was originally published on Steven J. Seay, Ph.D.

[drstevenseay]

Scary Thoughts as Costumes: The Illusion of Danger

(Image by Anday [click picture for source]) It's nearly Halloween, and kids around the country are digging through dusty closets and plundering the aisles of local Halloween shops in search of the perfect costume. Halloween is the one night of the year when we give ourselves permission to be silly, scary, or fantastical. We can act a little weird, and nobody will disapprove. On Halloween, it's normal to see the ghastly holding hands with the divine; fairy princesses walk amongst zombies, lions, and super heroes. There is something thrilling about handing over the reins to your imagination...even if it's only for a single night. But what would happen if the masks got stuck? What if every goblin remained a goblin and every ghost remained a ghost? The children underneath the make-up would still be our children, but their appearance would remain altered. How would we feel then? At first, it would be scary to inhabit a world populated by monsters. We would be angry. We would be confused. However, eventually we would learn to distrust our senses in the knowledge that beneath every scary facade is simply a child. Despite appearances, there is no danger here. We might wish that things could go back to the way they used to be, but eventually we would accept this new world as our reality. Sometimes our thoughts like to play dress-up, too. Scary, unwanted thoughts can masquerade as truths. Possibilities can take on the form of probabilities. Although these thoughts may have the appearance of danger, their form is intended to deceive. The semblance of danger is not danger. In the real world on Halloween night, beneath every sheet, mask, or painted face is a smile. Beneath every scary thought is simply a person. *     *     * Read more about OCD and unwanted thoughts, be it in the context of sexual thoughts, violent thoughts, or religious thoughts.