Two Pure O OCD Cases with Complete Cures

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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36 Comments

Filed under Anxiety Disorders, Mental Illness, OCD, Psychology, Psychopathology, Psychotherapy

36 responses to “Two Pure O OCD Cases with Complete Cures

  1. Hi Robert,

    I too had an OCD while growing up. Fortunately my obsession was quite harmless. I was obsessed with the concept of balance.

    For example if I had accidentally bump onto the left side of my classmate, I would feel the compulsion to also bump onto his right side to balance out. If I had bump him twice on the right I felt that I needed to bump him twice on the left. If I had bump him on a certain spot on his right side, I felt that I had to bump him on the exact spot but on his left side (symmetry). So this is basically balance in terms of number and symmetry.

    Another type of balance that I strove to achieve while I had OCD was balance in spatial attributes. This is more complicated, Let say I had a carpet in my room. I would try to align this carpet so that its left side and its forward side are the same distance from the wall of my room. Just imagine setting up margins on your MS-Word document. That was what I tried to do with my carpet. If during this alignment process I touched the left side of the carpet twice, I would feel compelled to also touched he forward side twice. So this is a combination of number, symmetry, and spatial.

    As you can see this psychological condition is quite time-consuming and annoying. This OCD appeared in my final year primary school. Once I graduated primary school and went to middle school, the OCD just disappeared. It would seem that this is related to stress, because the final exam for schools in Indonesia is very competitive, so maybe my subconscious could not handle this. However I’m not completely cured. I still do repeated checking every now and then :)

    Now here’s the funny part, my mom was trying to cure me. She took me to a witch doctor/shaman/paranormal. This guy also has a legitimate medicine degree and was a practicing physician!. He basically gave me a potion to drink every day. When I went there with my mom he also chanted some mumbo-jumbo while touching my ribs. So the next time you’re doing therapy with your patient, you can try this technique :D

    I’m just grateful my obsession is not as scary as some of your case studies :)

  2. Bhabhiji

    A daily meditation practice is the cure. Let them become OCD about that instead of this sick stuff.

  3. t1993

    Hey Mr/Dr. Lindsay!
    I’m just curious about the whole POCD thing! I’m an 18 year old male (going into college) who started having instrusive thoughts about kids about a month and a half ago. I’ll be honest I don’t know how some of your patients made it so long with this! At times it feels so real. . . I’m taking 150 MG of Zoloft everday and a 150 MG of Trazadone for Insomnia. I’m doing ERP with an ocd pure o specialist. . .(It has not been fun so far and has been a rollercoaster.) I’m mostly wondering what percentage of people experience severe side-effects like the hallucinations, or increased suicidal thinking I’ve seen mentioned.) I’m definitely not going to be running to my psychiatrist saying switch me to this drug but I’m hoping the work I’m doing with ERP is going to work. However, anafranil sounds like if there are minimal side-effects than it’d be worth a try. I’m definitely going to stick with ERP before risking the side effects of this drug. I’m just curious as what are your reccomendations towards using this drug. Like how long should I wait to inquire about using it, if I should not even consider an option since I’ve only had instrusive thinking on this particular thing about for a month. Anways, hope you reply! Oh, and one more thing, I came across this hypnotherapy for obsessive thoughts and I was kind of skeptical about it. Anyways, if you have listened to it I’d like your thoughts about it!http://www.hypnosisdownloads.com/addiction-help/obsessive-thoughts Here’s the link to it! It is money though so I’m not expecting you to listen to it! I would really like your thoughts on anafranil if nothing else! (Sorry my thinking is kind of scattered right now because I’m really tired!)

    • Hi, I really hate to recommend Anafranil due to all of the side effects, but I must say that Anafranil has helped me more than any other drug by far! Also I have put various people on Anafranil, and they really did get dramatically better. Two people got complete cures on that drug. I have not yet been on a drug ever again that made me as well as that stuff.

      Check out the side effects and see if it’s for you.

      You won’t get increased suicidal ideation on Anafranil, and I doubt you will get hallucinations.

  4. Daniel Greenshields

    Hi again Robert, just would like an opinion on using Anafranil, as you know I suffer from POCD and obsessions about suicide, as well as a sort of obsession about going mad, would you recommend this? I have tried avoiding meds as the suicidal ideation involved , but I had to stop therapy and am now back on a waiting list, so it would be good to use this until then as I have important university work and could do with OCD being less of a pain whilst I wait for therapy.

    Daniel

  5. Laura Aspen

    I am positive I have Pure O, in the past I have tried many things that didn’t help. The anafranil helped some but it had terrible side effects and I couldn’t take it. I had terrible stiffness and could barely walk at all. When I stopped taking it, things got better joint wise. I have Pure O harm thoughts and have for two years. It started out as inappropriate sexual thoughts for the therapist I was seeing. I had to stop seeing him as it was too hard to work through with him. I’ve been misdiagnosed a lot though. There was a diagnosis of Bpd that doesn’t even fit. I did have a life of trauma and have had a ptsd and mdd diagnosis a long time. I wish I could get some good help. I’m in Ottawa, Canada. The psychiatrist I see now isn’t on the same page as me at all. I feel alone and upset that things aren’t getting any better yet. Is there any natural supplement I can try like vitamins and minerals?
    Thanks L

  6. Marco M

    Hi I have harm and POCD and cant seem to stop this. Please help.

  7. Roger E. Stevens

    There was a time when if I had a thought or an image in my head that was disturbing I would obsess over it.
    But now my life philosophy is the thoughts and images in my head are not me. Sometimes junk thoughts or junk images might pass through my head and it means absolutely nothing about who I am as a person if it’s not influencing my behavior.
    But what if it influences my behavior?
    I don’t worry about that, because I believe I know myself well enough, something that would’ve been difficult to convince myself of as a teenager.
    I’m really beginning to think that what I thought was OCD was just adolescence.

  8. jayjay

    OCD is usually cover for repressed feelings. You have a repressed head son?

  9. Nadir

    Before getting or not, it is important not to resist your OCD thoughts. I do not mean embrace them, but simply distract yourself with something else. Resisting is the mean fuel source of OCD, especially pure.

  10. Megan

    Robert,

    I recently lost a beloved pet of 12 years to a prolonged illness. My husband and I had to make the decision. After that, I went through a state of mild depression, then extreme anxiety. I couldn’t leave the house without panic attacks. During one panic attack, I told my wonderful husband “I love you” then my mind said “do I”. I know that I do but this though literally spiraled out of control to the point I have what seems to be ROCD (relationship OCD). I’ve never had OCD tendencies and I had never had a terrible thought like that before. We have been married a long time and we are soulmates. I don’t want my obsessing to interfere with my wonderful marriage. My Pdoc started me on Paxil about 2 weeks ago. Would Anafranil help more? Thanks!

  11. Andra

    Hi, I’ve had ROCD for about 2 months now, and have been seeing a therapist for about 2 weeks and she’s treating me with CBT. As homework, she’s asked me to keep a record of all my thoughts, but said nothing about medication. Instead, she mentioned something about Bowen therapy along with psychotherapy. Should I ask her to put me on meds? I’m from Europe btw, so I’m not sure we have Anafranil here. Thank you

  12. drummer_boy

    Hi there, Robert. I will tell my story quickly. I’ve been suffering this Relationship OCD for the last ten years. Recently I broke up my 2-3 year relationship with an ex girlfriend (back then I went through RODC too) mostly because there was no love on my side for her: the day came when I realized I could perfectly live without her, but I was in a comfort zone with her after all and just stayed there. Then this foreign ex-coworker girl appeared on my horizon and my heart went crazy for her. I don’t remember ever feeling like this ever. Since she is in Eastern Europe and I live in the West, our relationship is being fundamentally kept in the distance. We have met in different cities several times and she just…I am in love with her and it is mutual. Now this is how ROCD kicked in: one day going through some old files in my computer I stumbled upon my ex-girlfriend’s movies and I felt so much pity for her. Only minutes previous to this event I had shared an extreme euphoric loving situation with my now-girl. So, coming to these files and feeling so much pity for my ex initially seemed like a total contradiction but I came to the conclusion one thing (loving my girl) had nothing to do with the other (feeling sorry for someone I cared not long ago). The problem is that after 24 – 36 hours I couldn’t get rid of that. It became an obsession that later triggered the worst part: every now and then, out of nowhere, flashes of the beginnings with my ex started popping up. 1 second long flashes under different early circumstances (mostly street places we may have visited together), not related at all with the final moments shared with my ex-girlfriend. At the same time, my feelings towards my current girlfriend have become so deep and so evident that these flashes randomly popping in my head seem like it doesn’t make any sense, so in the end it all comes to blocking my current feelings (because the whole thing’s gotta mean that I’m still willing for my ex, against the massive evidence pointing at the contrary and my massive love for my current girl) and leading into anxiety. These random intrusive flashes come unannounced and I feel I’m completely vulnerable. I’ve decided to take Anafranil, but I’m so scared this won’t help me rid of my intrusive flashes. Do you honestly believe I have a chance of succeeding here?

  13. Laetitia Buisson

    Dear Robert could i get in touch with you by e mail Im desperate I have been on all ssris and they give me severe tinnitus I know anafranil has tinnitus in the side effects but do you think by helping with ocd and anxiety anafranil can help i also have ocd about not being able to sleep and i cant work because of my chronic insomnia which is caused by anxiety and fear of not being able to sleep thank you I am really at the end of the rope

  14. Vicky

    I have been seeing someone with Pure-O for the past 6 months. He has used CBT techniques for the past 7 years since proper diagnosis and has been very successful in all areas of his life but despite really loving me, he says that he can no longer be in a relationship with me or anyone as it is making him ill. He was in a very distressing state when I last saw him. I know that his OCD is more sexual OCD.He also copes very badly with moving house. He says that he must stay well for his son and in order to keep a roof over his head, which is completely understandable. And I know that his greatest fear is of being ill and I don’t want to make him ill. He has said for some time that if he could spend the rest of his life with someone, it would be with me. But last week, he said that his health had to come first and his feelings, second. I am devastated and think that by avoiding me, he has relieved himself of the many instrusive thoughts that must have been bothering him and had become intolerable. I don’t know what to do. Do I leave for a few weeks to get well again and become more in control of his OCD. He says my love and devotion is too intense for him. And I’m worried that I’m just a trigger for all of these thoughts and that there is no hope. But, he’s 40 and I also can’t see that he will spend the next 50 years avoiding all serious relationships. His relationships over the last few years have been much more casual and I don’t think he has been in love with any of them. Can you give an advice at all for me? I’ve said I’m happy to go with him for a refresher session with the OCD specialist. But, he doesn’t seem able to discuss a future with me at all. We have had a very rough time over the past few months which made everything much worse. Any helpful comments gratefuly received. I don’t want to say or do the wrong thing. Kind regards, Vicky

  15. Amanda Goodin

    Hi, I was just praying for God to help me get past this disease or illness or whatever you want to call it but I came across this site and feel that anafranil may be of some use to me! I am currently on Zoloft 150 mg. I have moments when the pure ocd is gone and when I get In a stressful situation, feel insecure or not safe, and especially the time of the month it comes back! I developed this a couple of years ago when a trauma happened in my life and it took me a while, like two years to fully recover. Then It happened again a second time several years later when i went through a nasty divorce, working long hours and hated my job and I was plagued w it again and followed by severe depression. I had to quite my job bc I was having one panic attack after the other due to the pure ocd thoughts. It scared me that bad! I’m going to therapy and it has helped but I want to return to normal life again! Its been six months and have returned to work only two days a week but I still have an anxiety about going to work. I make myself go and tell myself this is helping me get better but it’s really hard going and working on people (I’m a hair dresser). I don’t really understand pure ocd and why such rediculous scary scenarios scare me and why I would think I could do any of it! I’m so aggravated and find myself shouting out loud to the ocd that it will not win!!!! Anyways do you think the medication will help and what are the side effects? Thankyou

  16. dasdddsdd

    I have had somekind of OCD like years not that bad though… because nobody know that I have it, Unlike many others I dont have just one symptom but actually I have had like 50x different kind of OCD symptoms… recently I have had “urge” go to piss every hour. It isnt really stopping my life or making me anxious… but it is kind of annoying, my sister and my mum have had too OCD symptoms so maybe it is genetical.

    Idk could any meds help me since I am not really anxious, maybe I try just some meditation and stuff… Most likely I will have OCD rest of my life though..

    well life is

  17. Adam

    Hi Robert,

    If it would be possible could I get your opinion on something I’m suffering with it’s really driving me mad and I don’t know what to do, I’d just like the opinion of someone who knows what they’re talking about, I know this is a long shot but I hope you can get back to me.

    Thanks

  18. Danielle

    My boyfriend of 6 years has just been diagnosed with ocd. I love him with all my heart but I don’t know how we can stay together if he can not work and help to contribute financially? Also if we were to have kids would it be passed onto them?
    Thanks

  19. Sarah

    I’m desperate for help. I’ve had Pure O for 10 years and meds work for awhile and then suddenly don’t. I’ve tried Anafranil after seeing this post and I’m not really sure if it worked or not – I had to stop taking it because of the side effects. I wish I could figure out what to do. I can’t take this anymore. I’m extremely anxious and depressed as well. Should I try Anafranil again? I just want to get past this.

  20. Khatiza

    Hi iam going crazy my thoughts keeps changing all the time I feel like I can’t recognize the world myself my family unjust want to die my therapist said I will have pure ocd for life which is killing me inside he the work manageable even scared me help

  21. Im sssooooo jealous pf those two. Smh im about to start taking anafranil hopefully it works wonders for me.

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