I do not like to use the term complete cure when dealing with OCD because so often we are not dealing with total cures here. However, in two recent cases that I am familiar with, more or less complete cures were achieved.
Case 1: Young college aged gay male, extroverted, popular. He suddenly became stricken with a terrible case of OCD, pedophile theme (POCD). I forget the details, but I believe he had constant imagery of having sex with female children. As he was gay, this didn’t really make sense. He could not seem to get rid of the intrusive imagery , and when he came to me, he was nearly suicidal with despair.
He had already missed two weeks of classes and was in danger of flunking out of school. A doctor had prescribed an SSRI for him which was not working very well (possibly Zoloft).
I urged him to switch to Anafranil, which is the gold standard for OCD meds. He hedged at first, but as he became increasingly suicidal, he got the doctor to prescribe Anafranil for him. He told me later that I had “saved his life” by getting him on the drug, and he was eternally grateful.
I talked to him recently. He told me that he had experienced remission of the POCD thoughts on Anafranil, and then when he went off the Anafranil after a time, the thoughts never came back.
“The Anafranil got rid of the thoughts, and then when I was on it, I started to think about the thoughts and what they really meant. Then when I went off, they never came back.”
He did not use any psychotherapy in his treatment. I asked if the thoughts were really gone. “Yes,” he said. “They’re just gone. They never come anymore. Never, not even once.” He did say that he still had a bit of OCD, this time with the relationship or ROCD theme centering around his relationship with a boyfriend. However, this was nothing compared to the Hell of POCD.
Case 2: College student, age 22-23. He had been through a number of OCD themes before, but now he was hit with Harm OCD and POCD. The harm thoughts centered around killing people.
He worked at a grocery store and at one point, he broke down at work and started crying. Asked what was wrong, he said he was afraid he was going to kill someone. The supervisor suspended him from work due to safety concerns, but he was soon reinstated with a doctor’s note explaining that the condition constituted little danger.
He then moved on to the POCD theme, centering around molesting children. He became deeply worried that he was a pedophile. He had a female friend who had a 9 year old daughter who he was very attached to. He began to worry that he was attracted to her and that maybe he was in love with her. He worried that his feelings for her were too intense to be normal.
When he was around children, he experienced intrusive thoughts about molesting them. The thoughts would say things like, “Touch them!” He began avoiding children as a result.
He experienced strange, quasi-psychotic POCD symptoms. He was afraid to turn around in the shower because he was afraid the nine year old girl might be in back of him standing there naked. I told him there was no way she could be in the shower. He said, “Logically, I know that.”
The harm theme also showed quasi-psychotic symptoms. He began to fear that his mind was being taken over by the ghosts of dead serial killers. They were taking over his mind and would soon force him to go on a murdering spree. I told him once again this was not possible, and he said again, “Logically, I know that, but I’m afraid of it anyway.”
Quasi-psychotic symptoms are very strange OCD symptoms that are not psychotic at all, but may appear psychotic to the untrained observer.
His psychiatrist diagnosed him with “anxiety” and “psychosis” (no OCD dx) and put him on about four different drugs, a couple of which I thought were utterly useless. One was an atypical antipsychotic. I spent quite a bit of time telling him that the psychosis dx was in error, that the antipsychotic was dangerous and that he at least had OCD, which he should have been dx’d as. I experienced a lot of resistance to these efforts.
In addition, he did have a lot of floating anxiety that was hard to characterize. He often become “ill” after eating for inexplicable reasons and went on crying jags. I tried to discourage the crying jags but met a lot of resistance.
The OCD did not seem to be getting better, so I kept urging him to go on Anafranil. Finally, after what seemed like forever, he got the doctor to prescribe Anafranil.
I talked to him recently. The Harm OCD and POCD had disappeared. He was happy that the POCD was gone, because he said there sure were a lot of kids around his complex these days. He was able to be around kids now with no intrusions. The Harm OCD had also evaporated.
I asked him if he still had OCD thoughts. He said they went away on Anafranil, and then when he went off the drug, they never came back. He said he had no obsessive thoughts anymore, not even one. He had reconciled with the Harm and POCD thoughts. “I don’t have it in me to kill someone,” he said. “And I don’t have it in me to molest a kid either. I know what I am capable of.” He was now much happier and relaxed, and much of the earlier defensiveness was gone.
However, he continued to have anxiety issues for which he was taking some meds. The anxiety appeared to outside the scope of the OCD.
This goes to show that complete or nearly complete remissions are possible in serious obsessional OCD cases. Anafranil appears to be a drug of choice, though it is dirty. Remission continues for some period after the drug is discontinued.
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