Category Archives: OCD

What Makes an OCD Thought More Rooted in the Mind and Makes It Even More Difficult to be Removed?

I understand exactly what you are talking about. OCD thoughts or obsessions have some peculiar power to them. Something “sticks” about them. I call them Super-thoughts and believe that they are much more powerful than regular thoughts. They seem to have some odd “pull” to them that seems to almost force you to think about them.

I have had clients who have told me that they feel that they have to think these thoughts. Unfortunately, I felt that way somewhat myself at one point. Keep in mind that OCD’ers often feel that they “have” to do all sorts of things. This is the compulsive nature of the illness, but the broken record nature of the obsessions also looks compulsive or habitual. If OCD is a disease of doubting, as the French say, it is also a disease of repetition.

To determine if something is an obsession or not, the great psychiatrist George Winokur told his med school students, “Look at how hard the patient resists the thought. The harder they resist and fight the thought, the more likely it is to be an obsession.”

I will take it even further. “If you try to stop it, it’s an obsession.” That’s not literally true, but it’s pretty much true.

The thoughts also become your friend in a sense because they are with you most of the time. In counseling, I sometimes tell my clients to think of the thoughts as your best friend. After all, they are always with you, and they will never leave you, right? Just like your best friend.

The thoughts also seem to be “alive” in a sense, and it seems like they do not want to die.

Before I realized I had OCD, I just thought I was going insane in my head. For some reason, this was projected out at the world, and everyone seemed to think there was something wrong with me.

The OCD had set up bizarre rules that I had to live my life by, mostly designed to make my life as miserable as possible. I was terrified to break the rules. Finally I had had it with these stupid and frankly masochistic rules, that I started to stand up and fight them. I remember every time I did that, the OCD would stand up and fight and “try to stay alive.” Finally, I would beat the OCD and the the OCD would back down, cower, and say, “Ok, you win.” But then it would come up with a new rule that was often not quite as bad as the previous rule.

In my opinion, it is almost as if these thoughts are living beings. Living beings do not wish to die, so neither do these thoughts.

This ties in with the bizarre nature of the illness where the sufferer himself thinks the thoughts are stupid or absurd, but they still can’t stop thinking them.

Many times I have heard, “Why in the Hell am I even thinking about this?…This is something I would like to think of as infrequently as possible, or never if I could…Of all the thoughts I could think, this is the worst one of them all…Please give me a new thought to think, OCD!”

So the person feels that the thoughts are preposterous, idiotic, and senseless, nevertheless the thoughts have this bizarre pull or stickiness to them as if they are almost demanding that you think about them.

People get so used to their obsessions because they think them all the time that some OCD’ers say, “There is a part of me that wants to stay ill for some reason…I’m afraid to kill the thoughts for some reason…as much as I hate them, the thoughts seem like my friend, and it feels sad to kill them.”

Now why obsessions have this bizarre stickiness, power, or pull to them, I still have no idea. I can’t even come up with a theory. But it’s definitely a part of this very strange illness.

Leave a comment

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

Does Borderline Personality Disorder Cause Obsessive Behavior?

Answered on Quora.

If by obsessive behavior you mean OCD-type behavior, there is no connection at all other than perhaps the coincidental incidence of both illnesses in some individuals.

However, the presence of BPD in an individual with OCD greatly complicates the OCD and makes much harder to treat than without the BPD.

Leave a comment

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

Does Fearing Homosexuality Make Someone Gay?

Answered on Quora.

No. I believe most straight men find the thought of being gay to be frightening if not terrifying. A number of straight men told me that they would rather get shot in the head then have sex with a man. Fear of being gay is fairly normal for straight men. There is even a type of OCD called Gay OCD in which straight people fear that they are gay. 0% of these people are actually gay.

There has been an attempt by PC types to conflate fear of homosexuality with hatred of homosexuals, but they seem to be very different things. Yes, there are a few closeted gay or (usually somewhat bi) men who overcompensate and engage in reaction formation or projective self-hatred by hating gays, but that’s not common.

Most gay haters are not gay at all; in fact, they are quite the opposite. I have known many homophobes in my life. In fact, I know some at this very moment.

Generally it is associated with masculinity. The more masculine the man is, often the more homophobic he is. Most of the strong homophobes I have known were extremely masculine men, I mean some of the most masculine men I have ever known. They were also probably some of the least gay men I have ever known. All were aggressively heterosexual and some had had sex with many women.

I would say that homophobia or hatred of gays is associated with masculinity, particularly hypermasculinity, extreme masculinity or as they call it toxic masculinity more than anything else.

I doubt if most homophobes really fear homosexuality all that much. Instead they just hate gay people for some reason or another. Gay people need to wake up and figure out that the “homophobes are all closet cases” is a big fat lie. There are a lot of people out there who are just assholes and openly hate gay people simply because of what they are.

They really ought to come up with another word. Gayhaters pretty much sums it up.

Leave a comment

Filed under Anxiety Disorders, Gender Studies, Heterosexuality, Homosexuality, Man World, Mental Illness, OCD, Psychology, Psychopathology, Sex

Borderlands: Obsession, Delusion and Their Differential Diagnosis

The Borderland between Obsession and Delusion

Anxiety processes can at times escalate all the way to psychosis. I have had some OCD clients who I had a very hard time figuring out if they were psychotic or not. With one, I told a retired therapist of their symptoms, and the therapist immediately said, “Well, they’re psychotic. That’s a delusion.” The things that they believed or almost believed did look like psychotic delusions. However, they did not entirely believe them. OCD with Overvalued Ideas was probably a better diagnosis. There are a few cases of Psychotic OCD. I have never seen one though, although this case was getting close.

When OCD gets very bad, they appear psychotic. However, they generally are not, and in 95% of cases, I can figure out that they are not psychotic. That is because Severe OCD That Looks Psychotic has this particular look, feel, or vibe (gestalt) about it where the cases all give off this particular vibe. It’s like they are all reading off the same script in a sense.

The Problem of Psychotic People Hiding Symptoms

You get a different look, feel, or vibe (gestalt) with an actively psychotic individual, but they can be hard to figure out too because sometimes they lie about their delusions.

I have caught them hiding symptoms from me.

Some people with psychoses learn to hide symptoms because they figure out that every time they say “The FBI is after me,” someone grabs them and hauls them off to the hospital. So they continue to believe the FBI is after them, but they learn to shut up about it.

You look at what the person is doing in reaction to the thoughts. They thought the neighbors were hacking into their computer so they disconnected their computer from the Internet? Delusion. A person who just had the fear or obsession that the neighbors were hacking in would not disconnect the computer, and their description of the fear would be full of all of these strange doubts and uncertainties.

The Difficulty of Differentiating between Thoughts and Voices

Psychotic people sometimes refer to thoughts as voices. I had one client who referred to thoughts telling him to do bad things, in this case, to kill animals. He had recently killed five puppies in response to these thoughts ordering him to kill these animals. I suspected these were more than thoughts, so I had him describe them, and he said, “It’s a thought, you know. You hear it like someone standing next to you and talking.” Ok if you hear it outside your body like that, it’s not a thought, it’s a voice.

Some people with schizophrenia hear their thoughts spoken out loud in the environment, and they fear or believe that others can hear their thoughts being broadcast out there. However, if you corner them on it, some will try to deny it by saying that they just have very loud thoughts in their heads, and the thoughts are so loud that they worry or fear that maybe others can hear them. That’s not quite precisely a delusion, and it’s not a hallucination like the thought broadcasting. It’s off into the obsession/delusion borderland.

Schiz OCD – OCD with the Fear of Psychosis Theme

There is a type of OCD where the person fears that they are going psychotic. OCD’ers have made up a term called Schiz OCD for this illness, which is really OCD with the Fear of Psychosis as the theme. Some clinicians have complained to me about these “hokey names” for the different OCD types and accused me of making them up. I didn’t make up any of them.

The sufferers make up these names for the different themes that they have. I feel that the sufferers have a right to own their symptoms and illnesses and call them whatever they want to call them. That’s their right as sufferers.

Who are we to tell them that their name for their symptoms is the wrong name? Do we have a better name? Of course not. “We” are just arrogant clinicians who think we know these illnesses better than the sufferers themselves know them. I realize Schiz OCD is a confusing name, but it’s the name they picked, and we don’t have a better one, so let’s go with it.

They develop all sorts of “psychotic” symptoms, including fake delusions, fake hallucinations, and even perceptual disturbances. Once again the Schiz OCD symptoms have a completely different quality – look, feel, vibe or gestalt – than you get with someone who has actual delusions and real hallucinations. In addition, all of the Schiz OCD symptoms have a very similar quality across many different people – once again, it’s like they are all reading off the same script.

The Problem of Misdiagnosis in Schiz OCD

I have now seen more people like this than I can count, and I’m an expert on this illness. But I still get people with this type of OCD coming to me all the time with diagnoses of various types of psychoses, schizophrenia, psychotic depression, etc. They received these diagnoses from qualified clinicians such as psychiatrists and clinical psychologists. They were misdiagnosed in 95% of cases, so you see even skilled clinicians can’t tell this OCD type from a psychosis in a lot of cases.

6 Comments

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

A Few Words About Schizophrenia and Psychosis in General

I do not know much about schizophrenia. I have met two people who were schizophrenic who discussed their symptoms with me.

The young man was medicated but he was still too ill to work and lived off disability. The woman may also have been medicated and she also lived off disability. This is a typical outcome for this illness, sadly.

Her diagnosis was a true grab bag, and she had been diagnosed with everything in the book, including OCD and frequently Borderline Personality Disorder. I was not sure what her complete picture was, but in adolescence and early adulthood, she underwent what looked like a classic schizophrenic prodrome process. There’s nothing else that looks like that. Afterwards a lot of psychotic symptoms developed including visual hallucinations. Also she did not believe she was ill, which is typical of these folks.

I could not really see the Borderline PD. The problem with these schizophrenics is that the schizophrenic process is so complete and totalizing that it essentially swamps over all sorts of other or lesser symptoms.

 

 

The man also had an OCD process going on, and he denied his symptoms were caused by mental illness. He was also trying to hide symptoms from me, which they do sometimes after the illness goes on for a while. It’s not that they believe the symptoms are crazy – they think it is actually true that the man in the TV said, “It’s going to rain today” and that really is a secret message to them telling them to go to the store and buy a pack of cigarettes. Incidentally that is a common type of psychotic symptom and they are called delusions of reference and they are common in schizophrenia. I have someone close to me who had Bipolar 1 Disorder with prominent psychotic (schizophrenic-like) features who had symptoms exactly like that.

The thing is that even chronic psychotics are not stupid and are driven by the pleasure principle to avoid pain. Eventually these people often figure out that when they say certain things like that the CIA is after them, people tend to get alarmed, call the police and they get hospitalized. Being more rational than you would think, they learn to keep some of these symptoms to themselves if only to stay out of the hospital.

He had a lot more insight than a typical schizophrenic which may be due to the OCD, which would introduce a chronic doubting nature into the psychosis, which would be good for any psychosis, as they are based on hard belief. There are new theories about an illness called Schizo-obsessive Disorder which looked a lot like what this man had. Paranoia, Shneiderian symptoms, and a better prognosis are among the features. To give you an example of the Shneiderian features, for instance, this man heard his own thoughts spoken out loud in the exact same way as if you were to speak your thoughts out loud – how creepy! He was afraid to ride the buses as he feared that the others on the bus could hear his thoughts as he thought them as they sounded as loud and clear as if there were someone talking right next to you.

2 Comments

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

Differential Diagnosis in Psychiatry – Separating “Symptomatic” Processes from “Core” Processes

In an anxiety disorder, the main thing you see or the “meat” of the illness is the anxiety – I call it an “anxiety process.” In this sense, even some anxiety disorders that have gone psychotic, say Psychotic OCD or Body Dysmorphic Disorder, are still basically anxiety disorders at their core and not psychotic disorders.

The primary disturbance or process if you will is anxiety and the psychosis is just growing out of that process.

What we are doing here is looking for the core essence of the problem – the Gestalt if you will. We are ignoring symptomatic features on the outside and looking underneath them to see what the core or basic process is underneath.

In the same sense, mood disorders that have gone psychotic or even resemble schizophrenia are better seen as mood processes. In Bipolar Disorder, the primary disturbance is one of mood. The psychotic features, if any, are only present during the mood disturbance – the depression or mania. The psychotic features are flowing out of the mood issue and not the other way around as in the case of some schizophrenic persons who get depressed due to the depressing nature of their illness.

If you clear up the mood process and the psychosis is still there, it tends to go over to Schizoaffective Disorder. This is a controversial category, but it is valid. No one quite knows what it is, but I believe the best explanation is that this is simply Schizophrenia and a mood disorder – Major Depression or Bipolar Disorder – occurring in the same person. Persons with Schizoaffective Disorder tend to be heavily loaded genetically for both mood disorders and schizophrenia, whereas someone with a core mood disorder will tend to have mood disorders in their family history and someone with schizophrenia will tend to have relatives with schizophrenia.

2 Comments

Filed under Anxiety Disorders, Depression, Mental Illness, Mood Disorders, OCD, Psychology, Psychopathology, Psychotic Disorders, Schizophrenia

What Is the Most Misdiagnosed Mental Illness?

Answered on Quora. A lot of the other answers are also very good if you are interested in psychiatry.

I work for the most part only with persons with OCD. I don’t even claim to be able to treat any other mental disorders. When I get people with other disorders, I refer them out, especially if they badly need help.

OCD seems to be poorly diagnosed. I get people who obviously have OCD who have been misdiagnosed as something other than OCD all the time. A lot of the time, the clinician simply does not know what is wrong with the person. At other times, they diagnosis is simply something like “anxiety,” which is not very helpful, as there is a lot more to OCD than just anxiety. The people given a diagnosis of “anxiety” in general were not being properly treated.

The second one I get a lot of is some form of psychosis. It is very common for people with OCD to get a misdiagnosis of some form of psychosis. I see a lot of “psychosis”, “mild psychosis”, “mild schizophrenia”, “psychotic depression”, “schizophrenia”, “manic psychosis”.

Almost all of these people are being treated with antipsychotic drugs, and in almost all cases, the drugs are not working or are even making them worse. I simply tell them that they are not psychotic, the diagnosis is in error, please fire your psychiatrist, and look around for another one until you find one who figures out that this is OCD.

The problem is that people with OCD quite commonly appear psychotic when the illness is bad. They “appear” psychotic, but if you examine them very closely, it becomes glaringly obviously that they are in fact not psychotic at all!

In addition there is a form of OCD called by its sufferers “Schiz OCD” in which the person worries and obsesses that they are going psychotic. They often worry that they are developing schizophrenia. I have seen more people with this problem than I can count. Some of them were properly diagnosed, especially by clinical psychologists, but many others were not.

The condition is further muddled by the fact that the person will start to develop a number of “psychotic-like” symptoms that can even include perceptual alterations. They develop “fake auditory hallucinations” where they think they are hearing voices but actually they are not. They are just misinterpreting ordinary sounds in the environment as hallucinations. They also develop “fake delusions” in which they worry that they believe crazy things when in fact they do not.

I am now very good at differentiating fake hallucinations from real ones and fake delusions from real ones and worrying that someone is psychotic from actually being psychotic. But it took me a long time to figure it out, and it’s not clear or obvious at all unless you are very good at diagnosing this particular condition.

Also the obsessions themselves or the illness itself can simply look like a psychosis. I could give you some examples, but space is limited here. Suffice to say that OCD can be a very strange, weird illness and the obsessions can look like delusions. You have to be good at differentiating between an obsession and a delusion, and the distinction is not clear at all.

However, an obsession that looks like a delusion has a particular “feel” about it that an actual delusion simply does not have. It’s more of a Gestalt, intuitive or impressionistic conclusion than a logical one.

Suffice to say that people with OCD often have a certain sameness about them. I like to say “they are all reading off the same script.” After you have seen enough of them, you can practically spot them 1/2 a mile away blindfolded at night, but few clinicians see that many people with OCD.

When OCD is extremely bad, it does indeed look like a psychosis, and the difference between severe OCD and “psychotic OCD” (which actually exists) is not clear at all. I had people who I mulled over for months whether they were actually psychotic. However out there they are though, generally reality testing is still somewhat intact.

You can start getting into the territory of some truly bizarre symptoms. I remember describing one girl’s symptoms to a retired LCSW with decades of experience. She said, “Well, this person is psychotic. That’s all there is to it.” I actually now believe that she was not, but if I told you the very weird ideas going through her head, you would probably immediately say psychosis too.

The problem is that in order to get good at this sort of micro-diagnosis, you have to see a lot of people with the disorder. After a while, you start seeing a common syndrome and a diagnostic picture develops. But a clinician who only sees people with those symptoms rarely if at all has little opportunity to hone his diagnostic skills.

If any clinicians are reading this, you can see that I am complaining that many clinicians do not understand this condition well, hence it is often poorly diagnosed and treated. I believe it is important for clinicians to understand this poorly understood disorder better. How to go about doing that, I do not know. That is for you to decide.

1 Comment

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

Do People with OCD Enjoy Thinking about Their Obsessions, or Is It Always an Involuntary/Unpleasant Experience?

Answered on Quora:

Do people with OCD enjoy thinking about their obsessions, or is it always an involuntary/unpleasant experience?

Actually enjoying your obsessions (or repetitive thoughts) is a rule-out for OCD. If you enjoy your repetitive thoughts, OCD is literally ruled out. I sometimes come across people who enjoy their repetitive thoughts and think they had OCD. I told them that they did not.

Most common differential diagnoses were Prodromal Psychopathy (person is developing psychopathy but does not yet have it), Pedophilia, GAD and Obsessive Compulsive Personality Disorder. Also things like Homosexuality which are not even illnesses. None of them are common. The only one I have seen more than once was Pedophilia.

But by and large, people who come to me suspecting they have OCD are correct almost all (98%) of the time. Clinicians despise self-diagnosis and say it has no credibility, but with OCD at least, many persons are quite certain that they have it, and they are correct in their self-diagnosis.

Usually what happens is they get symptoms and cannot figure out what is wrong with them, so they start doing research. They come across articles that describe OCD in great detail or are case histories of OCD’ers. They read that, and something instantly clicks. They say, “That’s me exactly! The person who wrote that could have been crawling around in my brain reading my thoughts.”

Pure O OCD symptoms are remarkably similar. I also like to say I can spot Pure O OCD symptoms half a mile away, blindfolded, at night. That’s not true, but you get the picture. It’s like they are all “reading off the same script.”

The symptoms are so clockwork-like that it has led me to think there is something wrong with a person’s brain who has OCD. The symptoms are classic, almost all of them display the same core symptoms and you can go down a checklist to figure out who has it, or just recognize it by sheer intuition. In that sense it is very much like how physician diagnoses a physical illness he is familiar with quite quickly via sheer intuition. In that sense, OCD resembles a typical physical illness very much.

2 Comments

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

Can OCD Be the Root Cause of Other Mental Disorders? If So, Can It Possibly Be the Cause of Schizophrenia in Some People?

Answered on Quora. 

There are definitely some other disorders you can get as a consequence of having OCD, such as Depression, Panic Disorder, Social Anxiety, and suicidality. However, schizophrenia and psychosis is not one of them.

But many OCD’ers worry that they may get schizophrenia or that they are in the process of getting it. Sufferers call this S-OCD, Schiz OCD or better yet OCD with the Schizophrenia or Psychosis Theme. This is simply someone with OCD who has adopted the theme of a fear of going psychotic. As with most other forms of OCD, the fear can cause symptoms that seem to mimic the fear itself. In this case, it can cause symptoms that mimic schizophrenia or other psychoses on the surface, however, careful prodding and questioning generally makes a differential diagnosis between OCD and Schizophrenia fairly straightforward.

Nevertheless, many S-OCD’ers sadly get diagnosed with schizophrenia or other psychoses by ignorant clinicians and as a result are medicated inappropriately. This subtype of OCD is very poorly known and often misdiagnosed.

I run into S-OCD’ers with incorrect diagnoses of Psychotic Depression, Schizoaffective Disorder, Schizophrenia, etc. on a fairly regular basis. The fact that when OCD is very bad, OCD’ers appear psychotic on the surface (but are not psychotic) confuses matters even more. It takes an experienced clinician to figure out what is OCD appearing psychotic and what is an actual psychosis.

At times the two illnesses are found in the same person, and sometimes in these cases it can be hard to figure out where the OCD ends and the schizophrenia begins or figuring out if a given symptom is best seen as one illness or the other. When the illnesses occur in the same person, it is sometimes called schizo-obsessive disorder. These people, who have much better insight than other schizophrenics, sometimes have a tendency to hide symptoms, which makes diagnosis even more confusing.

But having OCD is not going to give you schizophrenia. That’s not possible.

3 Comments

Filed under Anxiety Disorders, Depression, Mental Illness, Mood Disorders, OCD, Psychology, Psychopathology, Psychotherapy, Psychotic Disorders, Schizophrenia, Symptoms

Could People Who Have Intrusive Thoughts Also Have Sociopathic, Etc. Tendencies?

Answered on Quora.

Psychopaths don’t have intrusive thoughts about violence or much of anything else for that matter. Intrusive thoughts about committing acts of violence tends to rule out sociopathy right there because sociopaths don’t experience these thoughts as intrusive. Rather they just like them. If they want to think them, they think them. If they don’t want to think them, they don’t think them. But they are not going to experience intrusive violent thoughts in my opinion.
OCD and sociopathy pretty much rule each other out. You have one or the other and it would be very hard to have both. These disorders are the opposite of each other. OCD’ers experience tremendous guilt and never commit any irrational acts of violence and sociopaths experience no guilt and commit an incredible amount of violence. So you see we are dealing with two things that are the polar opposite of each other.
PS if you were a sociopath, you would not be fussing and worrying about thoughts like this, much less going on line to try to fix them. Sociopaths don’t think there is anything wrong with thoughts of hurting and killing others. They like to think about these things.

6 Comments

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