There are various subtypes of Pure O OCD, which is the type that I have. I won’t go into details about my symptoms, except that it is true that I am torturing myself. I realize I am an idiot for doing that, but I can’t seem to kick it. There is also a lot of guilt going on in my case.
When I say “appear psychotic” below, I don’t mean that they are psychotic. It means that the illness is so odd and severe that they appear to be psychotic even though they are not.
POCD: Pedophile OCD. The obsession that one is a pedophile. This theme has become a lot more common these days with Pedophile Mass Hysteria. People will obsess about whatever is the worst thing possible. Right now, being a pedophile is the worst thing you can be, so people are obsessing about just that. Pedophile Mass Hysteria is frankly driving the POCD wave.
In bad cases, they feel they are losing their attraction to adults and gaining a new one towards children. When they look at adults, the adult seems to “turn into a child” in their mind; that is, they see in their mind’s eye a child instead of an adult.
I have worked with countless folks who have this theme. I don’t mind working with them because frankly, it’s not exactly my theme. I’m quite certain that I’m not a pedophile!
There is some ignorance about this theme with clinicians, and I have heard of a few people being told that they are pedophiles. Other clinicians get forceful and demanding, aggressively questioning the patient about whether or not they are pedophiles. This isn’t helpful, and it just makes them worse. Many clinicians have simply never met anyone with this theme.
Rarely appear psychotic. Guilt level is extreme.
Harm OCD: Generally, the obsession that one is dangerous, will, may or has committed dangerous, violent or aggressive acts, is a killer, is a serial killer, etc. The obsession that one is a serial killer is particularly common as they are so much in the news nowadays, and it’s true that being a serial killer is about as bad as a human being can be.
I have worked with several Harm OCD folks, including one who had a terrible case. In one case I dealt with, a guy had the theme for 13 years in a horrible way.
In one variation, they are afraid to drive because of constant urges to turn the wheel into oncoming traffic. In another variation, they ride bikes and have urges to turn the bike into pedestrians or parked vehicles.
In some cases, their mind plays tricks on them. One girl repeatedly checked her parents’ bedroom to see whether or not she had “killed” them. She was worried she might have killed them somehow.
In another case, a college student walked around a campus with many deep ravines full of undergrowth and trees. She would walk around a bit, then think that she had “killed” someone walking by via pushing them into the ravine. She would plunge down into the ravines and search for the “bodies” for hours on end.
The school found her one day “searching for bodies,” and they took her in for counseling. Somehow she got a dx of schizoaffective disorder, which I was not sure about. She was put on antipsychotics, and they were not helping.
She also worried that she “killed” various people she ran into in her daily life. She would walk past a guy in a store, then afterwards would be convinced that she had “killed” him somehow. She would worry about this for a while, but then it would pass. This whole business seemed more like OCD than a psychotic disorder, but it was a tough case, and ultimately I could not figure out a dx.
In a number of cases, the person feels that they have lost their empathy for other persons. They say, “I feel like a sociopath.” They often feel like they have no feelings. One woman said, “I feel like I could kill!” A man said, “I feel evil!” He also said his empathy seemed to have gone, and when a relative died, it seemed as if he did not care.
In many cases, their mind urges them on to attack people and even gets mad at them if they don’t do it. In other cases, their mind tells they either must or have to act on the thoughts. At extremes, their mind orders them to act on the thoughts or tells them that God wants them to act on them. They sometimes say they have lost their fear of prison or execution because their mind tells them their life is worthless anyway and who cares if they die or go to prison. In one case, a woman’s mind told her to kill her father to get the insurance money.
Curiously, despite the bizarre and insistent nature of the thoughts, I am not aware of a single case of anyone acting on them. I feel that this is because deep down inside, the person knows the act is wrong and does not want to do it. “There are some doors that one cannot go through,” is a good description of this theory.
The thoughts are very frequently accompanied by feelings of wanting to kill or harm and urges to do so. The urges can be extremely strong and seem nearly irresistible. The person often feels they are just on the verge of committing the harm act, one millimeter away from doing it. One man said his urges to attack people were so overwhelming that he had to “literally sit on his hands” to keep from assaulting people with his fists. The feelings and urges are accompanied by extreme guilt because feelings and urges are stronger than thoughts.
I don’t mind working with these folks since I know this theme well.
Can run a terrible course, and it’s associated with a lot of avoidance, since they isolate themselves from others because they are afraid they are going to hurt or kill them. Others are afraid of having the thoughts out in public, so they isolate.
There is ignorance about this theme with clinicians, who often feel that the person may act on the thoughts, or that some killers are motivated by this type of thinking. I have never heard of a person with Harm OCD acting on the thoughts, and while people who kill are thinking in a variety of ways, I do not think that this is one of them. Many clinicians have simply never met anyone with this theme.
Can appear psychotic. Probably one of the worst guilt levels of all – after all, they think they are murderers!
ROCD: Relationship OCD. A very strange theme. The person is worried that they are not in love with their partner or spouse. They are in love with them, but their mind is telling them that they are not. Involves endless questioning of the relationship, etc. This is different from someone who has normal relationship issues, but I am not sure how it is different. I have not yet worked with any ROCD folks. Guilt level unknown. Do not appear psychotic.
Philosophical OCD: Interesting theme, but I don’t understand well how it differs from normal philosophical concerns. The person obsesses endlessly about philosophical themes that most of us would not bother with. “What is the meaning of life?” “What happens after we die?” Etc. But it can get a lot worse into some very abstract themes. It’s not uncommon for people to get stuck on questions like, “What if nothing is real?” “What if everything is fake?” “What if we are all in the Matrix and I am the only one who is real?” Etc. on and on.
I worked with a case of a man who I thought had Depression and Philosophical OCD, but he was hard to dx.
He was a nationalist of an Asian country (call it Slobovia). Rivals in a nearby country (call it Ruritania) say his country is fake and doesn’t even exist, as it’s all part of Greater Ruritania. He had made several trips back to his country. He got stuck on the thought, “Slobovia doesn’t even exist; it’s part of Greater Ruritania” to the point where he was depressed and almost suicidal. I wasn’t sure, but I thought it was Philosophical OCD.
No guilt. Rarely appear psychotic.
HOCD: Homosexual OCD or gay OCD. Extremely common theme, mostly with young people. It is probably driven by the notion that being gay is a very bad thing. Very common in young men, but also common in young women. Often runs a terrible course, and it’s not unusual for the person to be suicidal. I heard of one serious suicidal HOCD case who had been ill for 13 years. There is a board on the Internet that is full of these people.
Typical questions are, “Am I gay or am I questioning my sexuality?” “Maybe I am in denial about being gay?” “Maybe I am bisexual?” The person is often absolutely terrified. In every case I have seen so far, all persons were completely straight in orientation. However, there is also “Straight OCD” in which gay people worry that they are really straight!
A lot of times they start looking at gay porn to test their reaction to it and check and see if they are gay or not. Then they look at straight porn and compare the reaction. Many times they masturbate, testing the types of porn and what reaction they bring. They are often shocked to find gay porn somewhat arousing.
In many cases, they feel that they are losing their attraction to the opposite sex that they have always had. Men will say women don’t turn me on anymore; women will say guys don’t turn me on anymore. Terrifyingly, once it is in place, women feel that women turn them on, and men feel that men turn them on. They seem to be turning gay against their will. A lot of times they say, “I feel gay.”
Sometimes they have gay sex a few times. I recall one guy who had sex with guys twice, but he didn’t like it. He thought of women the whole time and was nearly suicidal for months after each incident. But in almost all cases, they don’t engage in gay sex. Runs a pretty rough course for some reason, but in some cases, it is completely abandoned in favor of a new theme.
I don’t enjoy working with HOCD folks, because for some reason the theme scares me, even though I don’t particularly worry about being gay.
Most clinicians are familiar with this theme, but some think the person is schizophrenic and has delusions about being gay. In other cases, the clinician repeatedly asks the patient, “Are you gay?” which is not helpful.
Do not appear psychotic. Guilt level can be high, but often is not.
Schiz OCD: A very strange theme where the person worries that they are psychotic, but they are not psychotic. They worry they will get delusions, so they get fake delusions. They worry that they will get hallucinations, so they get fake hallucinations. It can be tied in somewhat with Philosophical OCD.
I have worked with a few people who had this theme, but I’m not wild about working with them because the thought of being psychotic seems frightening to me.
In many cases, clinicians diagnose these people as “psychosis,” “slight psychosis,” “atypical psychosis,” or worst of all, “schizophrenia.” I have worked with folks who had all of these dx’s. In every case, I told the person that I strongly disagreed with the dx, and that they were not psychotic. I also told them to go get another clinician! All were being put on antipsychotic meds, which were in general not helpful.
There is serious ignorance with clinicians about Schiz OCD, since they tend to dx it as “psychosis.” I am trying to change that. Few clinicians have ever met anyone with this theme.
Typically appear psychotic. Guilt level is unknown, but may be high in some cases.
AIDS theme: Person worries endlessly that they may have contracted AIDS, often from a single sexual experience with one partner. AIDS tests do not solve the worry, and they keep thinking they might have it anyway.
I don’t mind working with these people.
Guilt level very high. Do not appear psychotic.
Running people over theme: This theme is pretty common, but I have met only one person who had it. Person is afraid to drive a car because they are afraid that they run people over just about every time they go out. In some cases, they have to go back and check all along their route to look for the “bodies.” In other cases, they freak out every time they hit a bump, because they think they just “ran over” someone.
Guilt level extreme. Do not appear psychotic.
Racist OCD: A fairly uncommon theme, but I have known a couple of people who had it. One, a Black woman, was worried that she hated White people. Another was a White man who worried that he hated anyone not White. Another White man was often bothered by thinking the word “nigger” while talking to Blacks. In all cases, the person thinks racism is wrong. Clinicians are very unfamiliar with this theme and typically just think the person is racist. Often they tell the patient that they are a racist. This is not helpful and only makes them worse.
Guilt is quite strong. Do not appear psychotic.
Theme change: Often one theme is completely abandoned for another theme. The old theme will be dropped 100% as someone goes on to a new theme and completely blows off the old one and even laughs about it.
Compulsions in Pure O OCD: There are always or nearly always compulsions in Pure O OCD, so it’s not really Pure O. Many clinicians are very confused about this and say that there are no compulsions because they associate compulsions with behavior. Further, many have only worked with people with observable compulsions, so Pure O compulsions mystify them.
The compulsions are:
Checking: Person checks endlessly related to their theme.
Schiz O patients check endlessly to see whether or not they are psychotic, read about psychosis, etc.
HOCD persons check the opposite sex to see if they are still attracted to them. They check the same sex to see if they are attracted to the same sex. They check both types of porn to see their reactions and compare them.
POCD people sometimes have deliberately create fantasies about kids, masturbate to them, check their reaction and test it against adult fantasies. They look at kids all the time to check to see if they are attracted to them or not. Then they look at adults to check and see if they are attracted to them.
Some persons with Harm O check to see whether or not they “killed” anyone.
In some cases, they become so convinced that they “killed” that they turn themselves in and confess to homicide. They are rarely held, usually because they can’t even say where the body is, when the crime happened, who was killed, or what any of details are. They often ask detectives, “How do I know whether I killed someone or not?” Detectives tend to shake their heads and dismiss the suspects.
Some patients check newspapers diligently every morning to look for any homicide cases and see whether or not they “killed” the person.
AIDS OCD patients get AIDS tests over and over but are never satisfied with the results.
Checking typically doesn’t work very well. Patients check over and over and are never satisfied with the results.
Asking for reassurance: People with various themes repeatedly ask whether they are this or that. HOCD patients ask for reassurance that they are not really gay. POCD patients look for reassurance that they are not really pedophiles. Harm OCD patients can ask others whether or not they are killers, but they don’t often do so due to fear. Many persons with OCD ask for reassurance that they really have OCD.
I am ashamed to admit that although I have been diagnosed with OCD ~25 times, I still worry that maybe I don’t have it! Is that stupid or what?
AIDS OCD patients ask for reassurance that they don’t have AIDS. Schiz OCD patients ask for reassurance that they are not psychotic.
In many cases, the reassurance doesn’t work. It makes them temporarily feel better, but soon after, they start right back up again with a new worry.
Positive thoughts: Patients recite positive thoughts over and over to try to counteract the bad thoughts. POCD patients think, “I’m not a pedophile,” etc., think of how much they hate pedophiles, how evil they are, or imagine how horrible it would be to go to prison for that crime.
Harm OCD patients think thoughts of kindness, tell themselves endlessly that they are not killers or how terrible it is to kill, think about how evil killers are and imagine the Hell that would await them after they kill. Some think, “I would never do such a thing,” over and over.
Schiz OCD patients endlessly tell themselves that they are not psychotic or that they don’t have schizophrenia and that the “delusions” are ridiculous and stupid.
Many patients with a variety of themes repeat meaningless or relatively meaningless thoughts endlessly in order to fill up their mind and keep the obsessions out. An example would be, “Bla ba da be dum be dum Bla ba da be dum be dum Bla ba da be dum be dum Bla ba da be dum be dum,” etc. repeated for quite a long period of time. Often as soon as they stop, the obsessions start right up again.
I do engage in a lot of thought compulsions, but I don’t mind because they make me feel better. On the other hand, with thought compulsions going on, you can’t concentrate so well on what is in front of you, what people are saying, the radio, TV, or your reading. You have to ask people to repeat what they said a lot, and it seems like you’re not listening to people. I am not sure that thought compulsions have worked very well for me – perhaps they have not.
Repeating positive thoughts for negative thoughts often doesn’t seem to work well.
Pathological doubting: This is seen in most themes and is nearly pathognomic for the illness. The person grasps onto the slightest doubt or worry and blows it up into a huge mess. Part of them knows this is stupid, but they can’t seem to stop. This then evolves into endless ruminations over the doubts to try to arrive at a “solution.” I admit that doubting gets pretty serious in my case when I am worse.
Memory problems: Memory problems are an interesting area of the illness. As the illness worsens, “memory problems” increase, but only about the areas in which the person is obsessing. I’m not sure these people really have memory deficits, and I think instead it is related to a problem of “knowing” and pathological doubting. Memory deficits can lead to checking. I admit that I have some pretty ridiculous memory issues when I am worse.
Ruminations: The pathological doubting leads to endless ruminations, which are often fruitless or provide only momentary relief. As soon as one doubt is resolved, a new one seems to spring up. Ruminations are not really obsessions, but people do ruminate about their obsessions. I admit that I ruminate a lot when I am worse.
The ruminations are often not very helpful as the person never seems to arrive at the correct solution no matter how much they turn it over in their mind.
Resistance: Obsessions are often accompanied by resistance. Although clinicians often feel resistance is bad and makes the thoughts worse, I disagree to an extent and think it is a good sign in at least one way. Surely, resisting the thought or trying to stop it means you really don’t want to have that thought! Further, in an untreated patient, when I see resistance, at least I know I am dealing with OCD! However, clinicians are correct that as a therapy for OCD, resistance, like all compulsions, often doesn’t work well.
As the disease worsens, the ability to resist declines, and in many cases, there is no resistance at all. In these cases, the obsessions have basically taken over the mind, and resistance has been defeated. Not trying to stop the thoughts is associated with worse illness. In even worse illness, any attempt to stop the thoughts, even for seconds or minutes, is utterly futile because the thoughts are so powerful.
I like to see resistance in a patient at least in the sense that to me it means a less severe case. There is still a strong sane part of the person that is fighting like Hell to defeat the crazy thoughts, which to me is healthy, and the thoughts are clearly hated and unwanted since they are so fiercely resisted. So we know it’s OCD, number one, and number two, we know it’s a less severe case.
In more severe cases, it is hard to tell if the thoughts are unwanted or not due to no resistance and the fact that the person’s mind tells them that they enjoy the thoughts. In these cases, intense questioning of and deep listening to the patient will usually give you a general picture of OCD.
Supposedly, trying to stop the thoughts makes them worse, but I have found that if I can keep the thoughts out of my head or substitute good thoughts for bad ones, I feel better and get along better with people. When I let the thoughts take over, I either feel scared or uncomfortable or else people don’t seem to like it. When I was on meds that worked very well, I was able to keep the thoughts out in a very good way, and I got along better with others than I ever had.
If keeping the thoughts out of your head by resistance works for you even temporarily, all the power to you.
I am ashamed to admit that I spend a lot of time resisting unwanted thoughts. To be honest, I am not sure how well pure resistance works for me, and much of the time, it doesn’t work well. It may even increase symptoms for me as OCD “fights back” against attempts to stop the thoughts.
It is important to note that resistance, like all compulsions, does not work well in many cases. It is even claimed to make the illness worse. Resistance is not considered to be a good therapy for OCD.