Category Archives: Anxiety Disorders

High Narcissism (High Self-Esteem), Solipsism and Narcissistic Personality Disorder: Differential Diagnosis

Trash: NPD is sort of like Attention Deficit Disorder. The terminology is getting tossed around a great deal but I think a vast, vast number of people would fit its criteria.

No, Narcissistic Personality Disorder or NPD has very precise criteria, but clinicians do screw it up. I really doubt if true NPD is overdiagnosed. It is not an extremely common disorder. However, much has been written about how we are becoming more narcissistic as a society. That may be true, but that doesn’t mean we are in an NPD epidemic.

My last therapist told me I was a narcissist – not NPD but narcissistic traits. This took me aback because I am not real fond of these types. They really rub me the wrong way and mostly they are just too much. I have one in my family and he has been known on many occasions to not be a very unpleasant person. There is a real ugly and nasty side to this disorder when it gets bad. They truly do not care about you, are not interested in you at all, and they can be very mean and cruel. Not that they care about that either. Of course they are also utterly clueless.

My best therapist has told me that I am not a narcissist. He said I am self-centered, but that’s more of a case of being all wrapped up in my own stuff to think about others much rather than being selfish. It’s related to my OCD and a lot of OCD’ers are pretty much all wrapped up in their own stuff. This is often confused with narcissism, but it’s not the same thing. It’s more like solipsism. I admit I am pretty solipsistic. It’s not that I don’t care about others. I do, but I am so wrapped up in myself all the time that I do not have a lot of energy left over for others.

He also told me that I have high self esteem. This could also be called high narcissism if you believe that narcissism = self-esteem. In that case, low narcissism would be low self-esteem. However, high narcissism in the sense of high self esteem, though it may seem a bit much, and such folks are often conceited, vain and egotistical, is considered healthy in that generally empathy is fairly well preserved. It is typically considered to be a sign of good mental health. Personally, I think everyone should have high narcissism or high self esteem. Why not? What’s wrong with everyone thinking they are great? How is that bad?

The problem is that people keep going beyond high narcissism all the way into pathological narcissism or NPD. The problem here is that now self esteem has gone so high that as it gets higher and higher, one cares less and less about and has less and less empathy for others. To put it briefly, at some point, the more you love yourself, the less you love others. I am not sure why that is, but perhaps there is only so much love available in a human.

Also at some point, self esteem gets so high that you feel better than or superior to others. This tends to coincide with low empathy. I don’t claim to fully understand narcissism as it is an extremely complex subject. I have been studying it deeply for over a decade now, and it still doesn’t really make complete sense to me, but that’s typical of a lot of mental issues. I’ve also been studying sociopaths for most of my life, and they still don’t make sense to me. I can’t for the life of me see how anyone could be like that. To me they don’t make sense.

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Filed under Anxiety Disorders, Mental Illness, Narcissism, Narcissistic, OCD, Personality, Personality Disorders, Psychology, Psychopathology

The Dangers of Identifying Excessively with Your Mental Disorder

Let’s say you have OCD. OK, that’s a lousy illness, but are you OCD? Is OCD you? No. You are John Jones or Mary Smith, who happens to have OCD, but who also has all sorts of other attributes and things going on with them. The OCD is part of who you are, but hopefully it’s not the most important part, and there are many other parts of you that hopefully are just as important as the OCD if not more so.

I think there is a real problem with identifying with your illness too. In fact, it may even be better to deny that you have it as you go around town doing your business or even socializing. Of course you know you have it, but you sort of pretend that you don’t.

I find that when I go out into the world thinking, “I have OCD,” I end up focusing on symptoms. Since the symptoms are mental (thoughts), you are focused on the OCD and the OCD thoughts. Well what this does is it tends to bring the thoughts out. Other people seem to be able to go around with these thoughts in their head and be ok. Once I have these thoughts going on, everything tends to go downhill pretty fast. Principally, most people decide that they don’t want to talk to me. If they start up while I am socializing, a lot of people will try to just shut down the conversation and walk away.I just can’t seem to be around people while thinking this stuff. It seems like they pick on that something is wrong with me, they find it disturbing or even frightening, and they don’t like it.

Anyway, what seems to work better is to lie to myself and say, “I am completely normal. I am the most normal person on Earth. I don’t have OCD or any of that crap. There’s nothing even 1% weird about me.” Now that’s not true, but so what? It’s a nice little lie and when I go out into society thinking I’m as normal as a human being gets, I tend to act a lot better and get a lot fewer OCD symptoms. In other words, the OCD sort of goes away. And there’s no harm in telling yourself while lies anyway. If you go out into the world thinking you’re a little bit nuts, guess what? You tend to act sort of nuts. If you go out into the world thinking you are completely normal, guess what? You act a whole lot better and more normal. Behavior is often a self fulfilling prophesy.

So I am worried that this trend of identifying with your mental illness as some sort of badge. It is going to lock people into their illnesses and symptoms to the point where they start displaying symptoms just to show how special of a snowflake they really are. I’m gender nonbinary, so I’m going to act weird and genderqueer so people can’t figure out if I’m a man or a woman and this will show my specialness. I’m depressed, narcissistic and histrionic, so I am going to act out all these symptoms as a display of identity in order to show more of my special unique snowflakyness.

There is also a hypchondriacal attitude here. Just a lot of folks love to revel in their often imaginary physical illnesses, there are quite a few mentally ill people who really get into having a mental disorders. Quite a few Borderlines adopt the borderline label tot he point where they are wearing it like a badge. Unfortunately, they don’t act any better. They just as crazy as ever if not worse because now with this badge on, they have a reason and a right to act crazy. They’re ratifying and legitimizing their pathology. A lot so-called Multiple Personality Disorders nowadays also seem to be fabricated. These are often women with a Borderline diagnosis.

They get used to be nonfunctional, disabled and going to therapy and group meetings all the time. They go to meetings and go on and on about their “alters” and whatnot. A lot of them are probably just making up a lot of these fake multiple personalities for some reason. They will go into a child alter and suddenly start acting like a child, no matter where they are. I know a woman who used to carry around a coloring book and crayons in case her child alter came out. The child alter would come out when she was out to eat with others, whereupon she would whip out the book and start coloring in front of everyone while talking like a little girl.

This is part of the problem with identifying too strongly in “I’m crazy” as one of your identities. You wallow in your disorder and allow the disorder to become your identity. It is as if you walk around with a badge saying mentally ill on it. What I have noticed is that people who do this do not seem to get better. They get worse or at least stay the same. Wallowing in your disorder and making it part of your identity is not a way to reduce symptoms. If anything, it probably makes them worse or at least more chronic.

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

The Nature of Denial in Various Mental Disorders

It is very hard to accept that you have a mental illness. Even a minor one. Most people who don’t have one act like they would not accept it even if they did. I have known many people in my life with untreated and even undiagnosed issues that went on for years, if not lifetimes.

Anxiety disorders are different because they are so painful and ego-dystonic but even there a lot of folks don’t want to admit it. The fact that almost everyone has low levels of anxiety on a regular basis nowadays does not help matters and it enables you to think you are just like everyone else.

Manics are notorious for not admitting they were ill. I have known a number of them in my life and probably 50% refused to admit that they had it. It is not helpful that the manic seems quite normal to many of his friends drawn in by the overblown charm of the hypomanic. I have sat in rooms with flagrant, raving, idiotic hypomanics charming the whole room with their grandiosity. I sat there shaking my head. It’s obviously an illness. Yes, it’s possible to be too damn happy. Hypomania is a case of excessive happiness. They are so happy, they’re nuts! If you do not believe that hypomanics are crazy, spend some time around one if you get a chance. This is not normal, healthy happiness, which I actually believe that there cannot be too much of, despite society saying that being too happy is “not adult” and “acting like a child.”

Schizophrenics almost all deny that they are ill. It is a hallmark feature of the disorder. Even after they have been told countless times that they have schizophrenia, even after multiple hospitalizations, even after years on antipsychotic drugs, they still insist that they don’t have schizophrenia. This is not so much a denial mechanism as a feature of the disorder. The disorder is such that it blinds you to the fact that you even have it! This disorder feels completely real, as if this is the normal way that life is.

OK, suppose you went to classes at college yesterday. The next day you tell people that you went to college yesterday, and everyone laughs at you and says no you didn’t. And to make matters worse, says you’re crazy for thinking you went to school yesterday. What would you think.? You remember full well that you went to school the other day. You remember it loud and clear. How they can they say that some obvious thing that I clearly experienced did not happen. After a while, they start thinking it’s everyone else that’s nuts and not them.

Almost all people with personality disorders deny that they are ill, as mentioned above. Everything is everyone else’s fault, and they go through their whole lives like that.

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Filed under Anxiety Disorders, Mental Illness, Personality Disorders, Psychology, Psychopathology, Psychotic Disorders, Schizophrenia

Mental Health Diagnosis: More of an Art Than a Science

A commenter writes:

How can they be “pretty damn good” and “wrong”?

Because diagnosis of mental illness is much more of an art than a science, that’s why. It’s almost impossible to get it right every time. It’s not uncommon for people to have maybe 10-15 different diagnoses. This is because psychiatric diagnosis is murderously hard. I don’t blame most clinicians for getting it wrong. It’s nothing like the diagnosis of physical illness at all.

I see a number of people with OCD who got misdiagnosed as psychotic, but that’s actually pretty common, and looking at their symptoms, I don’t blame the clinician for dx’ing them as psychotic.

When OCD is very bad, they appear psychotic, and the people I am thinking of have symptoms that appear exactly like psychotic symptoms, except they are not. They have what I call “fake delusions”, “fake illusions”, “fake hallucinations”, along with a lot of derealization and depersonalization, etc. Sometimes they can even get actual perceptual distortions, which makes things even stranger.

These people who have a form of health anxiety where they worry that they are going psychotic, and then they develop a lot of “fake psychotic” symptoms psychosomatically in the same way that patients develop fake physical symptoms psychosomatically as part of some hypochondriasis.

I know more about this stuff than the vast majority of clinicians, and I have seen more people with this problem than most clinicians will ever see. I have seen scores of people with this problem, maybe 50-75. I have gotten to the point where I can tell “Schiz OCD” (OCD with the fear of schizophrenia/psychosis theme) apart from true psychosis, but it’s not clear or easy at all if you haven’t dealt with a lot of these people. Actually it is not even easy for me sometimes.

Furthermore, in the course of diagnosing these people, you will get a few people who are actually psychotic, and you have to tell them apart from the Schiz O’ers. They are much more ill than the Schiz O’ers, but their symptoms are extremely confusing and they seem to have OCD going along concurrently with some sort of psychotic process. They are very confusing.

I don’t think mental health workers are inept, and I work in the field myself. And I do not think they are crazy at all. Most of the ones I have dealt with were amazingly sane.

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

More Crap about IQ from the IQ Haters

From Facebook, referring to my posts:

I would never deny the value of a High-IQ person over a Low-IQ person. However, there are many things that might easily allow a Low-IQ person to beat a High-IQ person at any skill.

Patience and Discipline are the most important of those things, followed by Experience and Lowered Neuroticism. These are the qualities that can defeat a High-IQ person.

Any skill?

No way, but there is truth to what he says. You can certainly get far in life with a normal IQ or even a low IQ. Charles Oglivy, the founder of modern American advertising, took repeated IQ tests and always scored ~95. He was one of the most successful men in the history of this country. Elvis Presley scored 70 on an IQ in school but he was one of the greatest entertainers of all time. 70 is borderline IQ, verging on retarded, but it didn’t stop him from being famous and wealthy. Muhammad Ali had an IQ of 85. That’s low normal. But he was very charming, had delightful verbal skills almost like a pre-rapper and was funny as Hell. An IQ of below 100 is often not a barrier at all to success at least in America.

America is a nation of IQ haters. It is completely unacceptable to discuss this matter or even write about it. You would not believe the grief I get for even daring to write about it. Most people you meet flip out when you mention IQ, especially high IQ, and start getting upset and angry. However, almost all of these are people who apparently do not have very high IQ’s. Every single high to very high IQ person I have ever run into likes to talk about this subject, and they are not bothered by it at all. The truth is that most Americans hate IQ and high IQ discussions because their own IQ isn’t very high!

I fail to understand why Americans are so bizarre about this.

A high IQ is simply a talent, and inborn one, a gift. So many people are born with gifted talents. Think of all of the musical, artistic, literary, mechanical, thesbian, dancing, singing, mathematical, athletic and even socially talented born geniuses there are out there. Americans admire anyone who has any of these natural inborn talents.

“Ooohhh ahhhhh wow she is such a great artist, oh wow, impressive.”

All inborn talents, even beauty, are respected and even cheered on except for brains!

Yes lower IQ people can outperform higher IQ on many tasks and even jobs, and many lower IQ people can and do still earn a lot of money. Brains, even brilliant brains, will only get you so far in society.

Now to the suggestions in the argument above. I believe they are not valid. I have been around many people in my life, high to low IQ, and I would say that high IQ people are much more likely to be patient and disciplined than lower IQ persons. Yes, lower IQ people are less neurotic, but they also often suffer from other disorders such as mood, psychotic, character or substance use disorders.

I have a hard time understand why some anxiety disorder (neuroticism) is such a big deal. Generally speaking, these are pretty minor mental illnesses, you know.

At any rate, IQ is correlated very well with work performance, attendance, discipline, all the sort of things that lead to success on the job. I would hire a higher IQ person over a lower IQ one in a heartbeat.  IQ is correlated with many things that will help you be successful and healthy in life.

A lower IQ person is no more likely to have a lot of experience than a high IQ person is. Anyway, all of the Renaissance Men I have known who were experienced and very good at all sorts of things had high IQ’s. Your lower IQ guy is often good at one thing, say being a short order cook in a taqueria.

Also, below a certain level, low intelligence is downright dangerous. Dumb people are sort of dangerous solely on account of being dumb. Haven’t you noticed that in life?

Stupidity is dangerous!

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Filed under American, Anxiety Disorders, Celebrities, Culture, Dangerous Idiots, Intelligence, Mental Illness, Psychology, Psychopathology, Regional, USA

Introverts, Extroverts, Pure Introverts and Frustrated Extroverts

Gregory Chelli writes:

I think introverts generally have a lower social intelligence than extroverts.

Autistics are true introverts, they don’t like to be with others because they don’t understand them well. They are like naturally bad at maths people who don’t like maths as a result of their incapacity. There are probably no bad at maths people who fantasizing about equation and maths problems, as there are no autistics fantasizing about being in a conversation with people.

The frustrated extroverts or extroverted loners you are talking about are generally persons with high social intelligence who can’t fully use their gift in real life because of some emotional problem, like timidity for example. So, as you said, they end up created imaginary social situations in their mind to relax themselves. An analogy would be a math genius who is prevented to do maths for some reason, like being in jail. He would be thinking about imaginary maths problem most of the time without being able to do real math stuff on a blackboard or in a notebook.

There are probably true introverts with high social intelligence and true extroverts with low social intelligence. But these ones are exceptions. People generally like to do what they are good at.

NB: people with extremely high social intelligence may not be interested in people, because the general population would look autistic, and thus not interesting to them.

What do you think of this comment?

I suppose it depends on the definitions of introvert and extrovert. Supposedly 80% of the population are extroverts, whatever that word means. True introverts are only 20% of the population, whatever that word means. I suppose extroverts really like to be around people. Introverts like to be around people a little of the time but not a lot of the time. They need their space. I know introverts will talk at a dinner table for a bit and then retreat to their bedroom with a book. Or you will talk to them at a table for a bit, but then they want to stop talking and read the paper.

Introverts absolutely do not sit around fantasizing about being around people all the time when they are alone. Forget it. And anyone who does that is not an introvert. Forget it. They’re just not. Normies would probably insist that this person is an introvert or a “loner” just because they are alone all the time. But Normies are retarded.

I would say that just because you are alone all the time doesn’t mean you are a loner! How about that?

Now we need to define the word loner. Normie retards say that loners are people who are alone all the time, but that’s not the definition of a loner. A true loner or real loner is someone who really has need or use for other people and simply prefers to be alone all the time because that is what makes them happy. If they are forced to be around people, they probably try to leave after a while because they start to feel uncomfortable.

If you are alone all the time but you don’t enjoy it or you hate it and you dream of being around people, you are not a real loner. Really you are not a loner at all. We might call you a “fake loner.” In this case, we are looking at the difference between real loners and fake loners.

I think introverts like being alone, but they don’t want to be alone all the time, although there are some who do.

I do not think shy people are necessarily introverts. Nor are social phobics for that matter. Normies say they are, but Normies are idiots. For instance a shy person who does not really like to be alone a lot but ends up being alone due to shyness is not an introvert. Forget it. Especially so if the shy person is fantasizing about being around people all the time.

I would gather that that person has probably not been shy their whole lives. Perhaps there was a time when they mingled with people much easier, but then something happened to them, and they turned shy. The reason they are fantasizing being around people all the time is because at one point in their life, they were doing this, it was going well, and they were having a lot of fun. In other words, they want the old times back again.

Or perhaps they may have an anxiety disorder. Quite a few extroverts develop anxiety disorders. If a person develops an anxiety disorder, it doesn’t really matter how good their social skills are because they will not be able to use them well. They may well know all the rules and have all the skills, but when the anxiety comes out, it’s all for naught because 100% of the people around them are going to reject them in one way or another. They may well even be extroverts who like the idea of being around people, but the anxiety kills off all the fun by making everyone reject them and makes being around people a great big drag. Eventually they might just stop trying.

Normie idiots think only introverts get anxiety disorders, but that’s just not so. I have even heard of cases where wild, hypersocial, life of the party types in their teens developed social phobia at age 18 to the point of hardly being able to leave their houses. There has been no actual personality change here, and true personality change is not common anyway. The person has simply become ill. Theoretically, if you could cure that illness, the shyness would go away, and they would be their old hypersocial selves again because that is who they are deep down inside.

I do not believe that the deep down inside person really changes in most cases. Normie morons insist, “Anyone can change their personality,” but that’s just wrong. You are what you are. Your personality is your personality. You’re stuck with it. Get used to it. It’s yours. All yours. That said, no one is stuck with a lousy personality.

One theory is that there are good and bad sides to all personality types. The good side of Antisocial personality is Aggressive Personality. The good side of Narcissistic Personality is Confident Personality. The good side of Borderline Personality is Sensitive Personality. I believe the good side of Dependent Personality is Devoted Personality, and the good side of Paranoid Personality is Cautious Personality.

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Filed under Antisocial, Anxiety Disorders, Autism, Borderline, Dependent, Mental Illness, Narcissistic, Personality, Personality Disorders, Psychology, Psychopathology

Aggression and Violence in Mental Disorders: Extroversion and Introversion

Jason Y writes:

Movie.

I think the Keifer Sutherland character could be Robert, SD even more so (no doubt), and I’m starting to doubt my sanity.

We really need to get away from this notion that mentally ill = dangerous.

It’s quite tiresome. I work in mental health, so I ought to know about this sort of thing.

Mental illnesses do not necessarily increase the rate of violence. Some like the anxiety disorders seem to actually dramatically reduce the risk of violence. In fact, if you cure someone of an anxiety disorder, their potential for aggression, violence or dangerousness statistically might get a lot higher. And if a violent person somehow got an anxiety disorder, the anxiety disorder would probably dramatically reduce their aggression and violence. There is something about that phobic type of worried and often guilty fear that seems to act like a force that actually propels people in the opposite direction of aggression and violence.

I cannot speak for other mental disorders, but I would say OCD’ers are about the farthest away that a human could possibly get from being a serial killer. If there was an absolute antithesis of a serial killer, it would be an OCD’er. And this even applies to OCD’ers when they are about as insane as they can get. There is something about the illness that makes the person quite harmless, statistically speaking anyway.

People with OCD are the least likely of any humans to ever commit any irrational violent act. Any random person, male or female, walking down the street is much more likely to commit an irrational serious violent act or homicide than an OCD’er.

People with GAD like one of our commenters are very unlikely to commit violent acts. Same applies to Panic Disorder and any of the phobias. There is something anxiety disorders that not only does not cause aggression, violence or antisocial activity but actually seems to dramatically propel the person in the opposite direction. If there was an utter antithesis of a violent or dangerous person like a psychopath, sort of like if Psychopaths were +Violent/Dangerous, then the anxiety disorders would be -Violent/Dangerous. We can think of them as “Anti-Dangerous.”

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Filed under Anxiety Disorders, Crime, Mental Illness, OCD, Psychology, Psychopathology, Serial Killers

You Can’t Hide Crazy

Between 1982-1986, I was probably crazier than I have been for most of my life. The only thing that comes close is another terrible episode for maybe eight months in 1991 when I got so out there that I thought I was going psychotic.

I did have a major theme at the time. It started off a with a classic well known theme that I will not reveal, but later it morphed into all sorts of weirdness. There was war in my head between the Crazy and the Sane. They did ferocious battle  for some time. At some point, the Sane side simply surrendered and said, “Ok Crazy, you win. Do what you gotta do. We are tired of fighting you. We give.”

And then the Crazy pretty much took over and OCD had control over my life to the point where I had to do whatever nutty thing it was telling me to do. Mostly it was telling me to do things that were more or less normal behaviors.At one point, Crazy set up something called The Rules. It set these up because Sane kept being bad and breaking whatever Rule Crazy had set up. Crazy would set up some evil rule that I would have to live by. Sane was furious about the Rule, and at some point it  would try to break it and succeed.

This just made OCD mad, and it would simply come up with a new Rule. I do not want to go into the nature of these Rules too much, but one Rule was that I could not be happy. I would start enjoying myself and then the Rule would come crashing in and I would feel that I had to obey it. The Rules were very powerful, almost as if they were coming from God or better yet, a child’s parent, and I was very frightened of them and usually felt compelled to obey them due to this scary power that they had. There were lots of other Rules, but they were rather weird and I do not want to go into them right now.

But during the 80’s episode, none of the craziness was outward, though I did have a some rituals like having to tap my back pocket two or three times on occasion, especially when I went through a doorway. Actually one of the Rules was that I had to be crazy, but that the craziness had to be hidden and secret and my outward behavior had to be as normal as possible. But the rituals were nothing anyone would pick up. I tried to make my outward behavior as normal and sane as possible, and I was in school and working the whole time. I earned a teaching credential at USC while I was out of my head, and then I worked very regularly as a substitute teacher for the Los Angeles Unified School District.

I was seriously nuts the whole time I was teaching school, but it didn’t  affect my work performance because my outward behavior was quite normal.

I was also running all over LA trying to break Wilt Chamberlain’s record by screwing half of the hot women in LA, and while I never got even 1% of the way to 20,000, I still dated a lot of women and had a ton of sex.

I was seriously out of my mind while I was running around LA trying to screw every other hot chick I saw. I don’t know I managed to date so much when I was that nuts, but I somehow pulled it off. But the women all picked up that there was something wrong with me. They usually called it “anxiety.” But I rampaged through the female population of LA nonetheless, craziness being nut much of a barrier. I may have even gotten some battle wounds in the process while on sexual duty. You know, the kind that make you go to the doctor?

Women were not the only ones who caught on. And at both USC and especially while teaching, most of my colleagues and instructors caught on that there was something seriously wrong with me.

Problem is when you are not right in the head, you can act like the most normal person on Earth, and everyone will still call you nuts. That’s because if you are “secretly nuts” the way a lot of neurotics or OCD’ers are, it still shows in your eyes, on your face, and possibly in body language.

If your head is nutty, you will give off nutty nonverbal vibes, some in body language but most in the way we can sort of read people’s minds by looking at their faces, eyes, etc. A lot of “secretly crazy people” will appear distracted, disconnected, terrified, haunted, stunned, nervous, anxious, out to lunch, off in space, or on their own planet somewhere. Stares, both thousand yard and blank, are common and lead to a lot of people labeling these folks as crazy. You see a guy with a thousand yard stare, and it really doesn’t matter how normal he otherwise acts. That Nam vet stare alone will cause most folks to think he is somehow not right in the head at all.

You really can’t hide crazy.

The more mentally healthy you are inside, the saner you will appear to others. The crazier your head is, the more you are going to seem a bit nutty or “off” to others, to say the least.

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

Severe OCD: The Borderlands between Obsession and Delusion

For about eight months in 1991, from March-November, I was about as crazy as I have ever been in life. I wasn’t psychotic, but I was getting some weird perceptual alterations, and my mind had seriously gone off. On the one hand, I was painfully aware of these things. On the other hand, I was pretty convinced that I was going psychotic, mostly because of the way I felt. I got into therapy within a few months. The psychologist did go round and round a bit about whether I was psychotic or not, but he and the psychiatrist agreed after a bit that I wasn’t psychotic. He said, “The only delusion you have is that you think you’re nuts.”

When OCD gets very bad, they can appear psychotic and they often feel like they are going psychotic themselves. They often present as being either afraid they are going psychotic or convinced that they have gone psychotic. It is not not uncommon for them to get a diagnosis of psychosis or even schizophrenia. I deal with people with this type of OCD or OD theme all the time. In fact, I currently have two clients with this theme and another one is waiting in the wings. There are others I am talking to who have not signed on.

It is best described as Fear of Psychosis, but on the OCD boards they call it “Schiz OCD.” That is a misleading name, but it means that they have OCD with the Schizophrenia or Psychosis theme. That theme translates into  fear that they are schizophrenic or psychotic or that they are going to become that way soon.

I have had some OCD clients with Schiz OCD and a couple with the Harm and Pedophile themes who were all misdiagnosed as psychotic, and a few were misdiagnosed schizophrenic.

The Harm theme (Harm OCD) means they are afraid they will attack or kill other people or fear of harming others. The Pedophile theme (Pedophile OCD or POCD) is entails the fear that one is a pedophile.

Harm OCD’ers are generally completely harmless in spite of their creepy symptoms. These are simply completely harmless people who fear that they are murderers, rapists, or violent people, etc.

Pedophile OCD’ers are almost always not pedophiles at all. They are simply sexually normal people who fear that they are pedophiles. They are generally harmless to children, though I am familiar with a case where a woman with Pedophile OCD actually molested her three year old boy, though not seriously. Anyway, three year olds hardly remember anything that happened to them at that age. She was arrested and charged with child molestation, but the charges were dropped on the basis that she was in treatment. She has as whole team working with her, and the main thrust is to keep her from molesting the boy again.

Most of the psychosis diagnoses I have seen with my clients (see below for exceptions) were in error, and these folks simply had OCD. But if the clinician doesn’t understand how OCD can look like a psychosis but not be a psychosis, they might misdiagnose someone. It boils down to the difference between an obsession and a delusion. The two can be confused, and clinicians do misdiagnose obsessions as delusions. The difference can be a bit fine-tuned, but generally it is straightforward.

The problem is that many clinicians simply have no idea how to tell an obsession from a delusion. Obsessions can get unbelievably bizarre, and at first look, they can appear in content like the sort of delusions that psychotics get.

I did have two very ill people come to me, (call them Mr. A and Ms. B.), who seemed to have both OCD and schizophrenia, among other things.  It took me a while to figure out that they actually had both conditions at once as opposed to one or the other alone, and Mr. A was a diagnostic confusion for a while. But both of them did seem to have some sort of psychotic process going on. Mr. A had had a clear psychotic break around age ~19-20, and another had gone through an obvious schizophrenic prodrome in late adolescence and early adulthood.

Ms. B was hallucinating most of the time, including a lot of visuals. Mr. A also appeared to be hallucinating, as he was experiencing his thoughts being broadcast out into the environment, and he was afraid people could hear them. Both were both functioning very poorly, were on disability, and working or in school. Mr. A was living at home and had had a conservatorship set up for him. This entailed some sort of trustee who doled out the monthly SSI check Mr. A as they saw it, so Mr. A had no control over his finances. Mr. A was also in and out of the hospital on involuntary hold on a pretty regular basis.

What is odd is that both of them so lucid during our email conversations  you wondered how they could be psychotic.

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

A Typical Case of Harm OCD

James writes:

Might not be the correct place to ask this, but does this look OCD-ish to you? I’ve always suffered from being a worrier as my Mum puts it. Ive been scared of getting someone pregnant from swimming near them for over 2 years despite knowing chlorine kills semen. I’ve been scared of wetting the bed before that, it’s just who I am.

But these have never been as scary as this to me. So about late September I started getting issues with my eyes, and this along with a relationship with a girl not working out led to some kind of depression.

And it was around this time I acquired a curiosity that I may be a psychopath. I like violent video games, the Walking Dead and have a dark sense of humor. This curiosity made me very nervous. I began to look online a lot at of tests and kept checking with friends and relatives to see if I was a psychopath. It was just something I kept looking up. Considering it was 4 months ago, I can’t quite remember the extent of the worries, but it was getting really scary. I asked loads of questions on forums, and it managed to keep me calm whenever I felt I was worrying to much.

It was about November 10th were I got an intrusive thought/urge of hurting my mother with a knife. I was not angry with my Mum or anything – it was just something that happened. One minute I was cutting up biscuits to take through to my family and the next I was in shock. I managed to serve up the biscuits in the lounge with the knife in an attempt to prove to myself I wouldn’t do such a thing. Is that a thing in OCD, normally people with OCD would be scared of knifes not use one to prove their a psychopath? Anyway I swiftly ran upstairs and felt the most scared I have ever felt ever in tears and upset by the fact I was thinking like this.

I discovered it may be OCD, and I told my mum all about it; she claimed it was normal. The thought never really occurred much, maybe as I was exposed to knifes and my family when washing up every night after that. However, the fear still remained strong. There was a period of time after that where I was so scared I felt I was in a dream almost detached from reality. The fear changed/adapted, and I began to obsess that I was a school shooter. Thoughts like, “I used to kill ants as a child, so that must mean I’m psycho because psychopaths are cruel to animals when they are young” and “School shooters like video games just like me”.

I looked at Wiki articles on mental illness associated with the school shooters and took online tests multiple times on separate occasions, and no matter the results, the anxiety would only go for sometime, and soon after, I was yet again convinced I was a homicidal maniac.

I would make myself be extremely nice to people. I have this thing were I check taps and stuff and do typically OCD actions to make myself feel like I have OCD, reinforcing that I’m OCD and not psycho. One of my most effective ways of getting rid of anxiety was looking at posts like this on my phone to read over when I got scared (I’ve read this loads).

Recently I have got back in to playing somewhat violent games and TV, but I still get slightly uncomfortable. January was when it got worse. I got convinced I wanted to do it. Similar to the case on the homicide above, I was convinced I wanted to do it. Let me make this clear.

I never planned to do a school shooting, and I have never bought a gun. I was really scared by that. How do I know that it is OCD and not me actually wanting to do it? I have been depressed recently possibly due to OCD. How do I know that it’s not that and that I’m actually homicidal? My doctor suggested it was anxiety. Any answers will make me happy, so go ahead. Finally thank you for your posts and such – they’re really really helpful.

EPGAH writes:

I have OCD myself, and my brain is wired differently. I think in scenarios. You might even say I plan too far ahead.

I think that’s all your brain is doing, “What if I did this?”
Something like the cartoon of Dragon’s Lair, if you’re old enough to remember that, or if not, just think of it as looking ahead in chess. It’s not so much you WANT to do that, it’s your brain is saying “What IF I did this?”

I work as an OCD counselor and see clients very much like this (but often not with this theme) almost every day, and EPGAH is 100% correct. This guy does not even want to do any of these things! Not only that, but no part of him wants to do any of these things! A general rule in psychology is “Intrusive thoughts do not represent real desires.”

So this guy is not having violent fantasies at all! He’s probably not even angry. And actually the Harm OCD’ers (that’s what he has OCD with the Harm theme) are actually the most gentle, meek, kind and nice OCD’ers of them all! This guy is suffering what I would call “irrational fears.” Why has he latched onto this theme? Because at the moment, this is biggest fear! That’s all this is – his biggest fear. It’s 100% fear and 0% anything else.

Also, if you really want to make sure someone doesn’t attack you, go hang around with one of these Harm O’ers. Not only are they generally very nice, but Harm O’ers are in the category of humans who are least likely to carry out a violent act!

Whether these people ever act on these thoughts is controversial. Some say they never do, but others say there have been a few cases. Generally they do not act on the really nasty stuff, but sometimes they act on the milder fears.

One guy had Harm O about turning his bicycle into pedestrians and cars along the side of the road. He would actually start to do it, but before he could actually do it, he would simply crash his bike.

Another man had a fear of throwing the car into reverse while driving fast down the road. Well one day he was driving along and he just did it – he threw his car into reverse!

There is an OCD theme called ROCD or Relationship OCD where the person is going round and round about whether they love their significant other (SO) anymore. It could be a spouse or a lover. There is also Gay OCD or Homosexual OCD where completely straight people fear they are either turning gay or are really gay. Bizarrely enough, there is even Straight OCD, where gay people are terrified that they are turning straight or that they are straight! I have actually seen a couple of cases of this!

The thing with OCD is that when they get really deep into it, they can become convinced that the obsession is true, even though it is 100% not true.

I have heard of Gay OCD cases where the person becomes so convinced they are gay that they actually go out and have gay sex. They usually only do this a handful of times. Of course, that doesn’t settle matters at all and in fact it tends to make them dramatically worse, even suicidal. It’s not a good idea.

I have also heard of ROCD cases where they become so convinced that they do not love their spouse or lover that they break up their marriage or end the relationship. Of course, this resolves nothing and often makes them worse.

I have personally never heard of anyone acting on a Harm OCD obsession and committing a violent act, but many of them are convinced they are going to do violent things. Some even start thinking that they have to do violent things. “I am going to have to do this violent thing,” is how the thought goes. Sometimes the OCD will egg them on and try to get them to commit the violent act and keep upping the ante on them when it doesn’t work.

Commonly, the violent urges are so strong that they say they have to “sit on their hands” to keep from lashing out and striking people. It feels as if their limbs have gone on autopilot.

The strange thing is that as weird and terrifying as Harm OCD gets, in general, they never act on any of these violent thoughts. In other words, these people are harmless, even laughably harmless.

It is often said that Harm OCD’ers never act on these thoughts, but some clinicians say there have been some cases of people acting on harm obsessions. But then again, if you take a random sample of people walking down any busy street, a certain percentage of them are going to commit a serious violent act the future, probably even in the near future. You could calculate the risk that any average person would do such a thing and come up with an odds figure of what the odds are that any given person will commit a serious violent act in the future or near future. We could assign that risk to all of us, as we are all part of the random population.

The bizarre thing though is that no one is less likely to commit a serious and irrational violent act in the future or near future than someone with Harm OCD! In other words, the illness is preposterous.

Lately there are a lot of people with the pedophile theme, Pedophile OCD or POCD. In almost all cases, these people are 0% pedophilic and have no more interest in children than you, me or anyone else. These are people who are worrying about being something that they are not!

Although it is said that POCD’ers never act on their thoughts, I have in fact met one woman who did so. She did sexual things with her 3 year old son. I do not think they were very serious, and he will probably never remember it anyway.

Somehow she got caught and was arrested and charged with child molestation. However, mental health intervened and I do not know how it happened, but charges were dropped on the demand that she be monitored by clinicians as long as the illness was present. She presently has a whole team working with her. She has not done this act any more times.

Curiously, she did not do this act for a sexual reason at all. In fact, she did it for another reason altogether which I do not have time to go into now.

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