Category Archives: OCD

My Life as a Peer Counselor

SkepticDoesNotMeanHater writes:

Robert, you stated in a previous post you work as a counselor/therapist, what is your degree/certification/license and area of study/expertise? Marriage? Youth? Behavioral? Psychoanalysis? Something different?

I have no degree or certification in counseling, therapy or any such thing. But in California as in most states in the US, you do not need such a credential to be a therapist/counselor. Literally anyone can hang up their shingle and call themselves “counselor” and accept money to talk to folks about their problems, try to help them out and give them any advice they think is appropriate. I do not make much money doing this. Most I ever made was $300 in a month. I charge between $20-40/hour and get it pretty reliably. Most clients say I do a great job. I have eight paying clients at the moment.

I only work with anxiety disorders and paraphilias, and even in anxiety disorders, I mostly focus on OCD. Even within OCD, I mostly focus on Pure O obsessives. I know this illness up and down, inside and out, north to south, east to west, and every which way from Sunday. I know it better than most therapists. I have been reading about it and how to treat it for decades. Better than that, I have it myself! Clients are amazed and say, “It’s like you can look inside my brain and you know exactly how I am thinking.”

Peer counseling is a good thing, and it’s growing. Lot of folks find it pretty helpful. These people are better off working with me than with their current therapist who doesn’t understand the illness.

I work a little bit with paraphilias, but I am not as good at that.

I am now an expert at sexual orientation and am often asked to determine if someone is homosexual, bisexual or heterosexual, and I can determine that very well – better in fact, than most therapists.

I am also an expert at diagnosing pedophilia and telling it apart from misleading things that look like it but are not true fixated pedophilia.

I am often asked to determine, “Am I a pedophile or am I not one?” I am getting very good at this, and I am better than most therapists now. And yes, I have worked with two fixated pedophiles. Neither was offending, so I was able to work with them. I probably work better with non-offending pedophiles than a lot of therapists because I don’t treat them like shit like so many clinicians do.

I have also worked with fetishists, voyeurs, sadists and people with urolagnia (piss freaks), including folks who were breaking the law.

I did couples therapy with one couple where the woman was concerned that husband was homosexual or bisexual because he had some interest in sex with men. I figured out his sexual orientation very fast (pure heterosexual), then I tried to explain what I thought was going on with the guy, but couples therapy is very weird and exhausting, and I am not good at it.

Other than that, I do not work much with other stuff. I have had depressives, but I really do not know how to deal with them, and I want to throw up my hands. Suicidals baffle me and seem untreatable. I cannot work with Borderline Personality Disorders at all, had one disastrous client and never want another one. I don’t see how any clinician can work with someone so impossible. I see a lot of low self-esteem but am baffled how to deal with it, and it seems intractable.

I just tell people straight up what I am good at and if they have stuff going on that I am not good at, I just tell them.

I am not allowed to give out legal DSM diagnoses, but I can give an opinion on diagnosis. If someone has a good dx in my opinion but has never been formally given a DSM dx, I tell them to go to a clinician and get one. I send clinicians and psychiatrists tons of business – they should appreciate me.

It’s all perfectly legal in California as long as you do not falsely advertise yourself. For instance, I cannot say I am a clinical psychologist, psychiatrist, LCSW or MSW. If I give myself one of those labels, it’s against the law. I tell clients I am a peer counselor rather than a therapist because it sounds less dicky and pretentious.

People usually see me for a couple of hours and then graduate on to a credentialed clinician, psychiatrist, social worker or psychiatrist. Like I said, I give these guys mountains of business.

If you lack a credential, you are just not going to get much business. Most people will pass and go for a credentialed clinician instead.

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Filed under Anxiety Disorders, Borderline, California, Depression, Law, Mental Illness, Mood Disorders, OCD, Pedophilia, Personality Disorders, Psychology, Psychopathology, Psychotherapy, Regional, Sex, USA

The Therapy of the Pedophile

I work as a counselor and for some reason mostly with clients who are all wrapped up in the idea that they are pedophiles, and I spend time every day talking to guys about this crap, so maybe that’s why it’s on my mind, as it wouldn’t be otherwise. The overwhelming majority of them are not pedophiles, and I have to convince them of this. A lot of this involves research into this question.

There is no shame in being a pedophile anyway, and I have worked with two pedophiles clinically so far.

With one guy, the main therapy consisted of trying to get him to not chop his dick off! That’s how bad he felt! He has contacted me again, and the poor fellow has a million problems. He knows what he is and he is going to go on anti-androgen drugs to kill his sex drive rather than take the chance. I don’t really like that idea but it’s his life.

When you have a rare client who is a pedophile, it is important to get them to feel good about their sexual orientation, as it’s not their fault they got wired up that way and there’s no way to fix them. Everyone deserves a rewarding sexual life in some way. If there is some interest in adults, cultivate that to the greatest extent possible to redirect away from the kid stuff, which should be blown off as unattainable.

There are a lot of issues around offending, but the two guys I worked with were apparently not offending and I didn’t even bring it up. They both had massive guilt about their sexual orientation and that had to go. There are groups online for pedophiles (Before You Act) that I highly recommend. In fact, a pedophile who corresponds with me is very active in that group and is not offending. Many or even most pedophiles may need to be in active therapy to keep them from offending, stay away from triggers and report any kids in their lives and what that is all about.

Deal with guilt and acceptance. Some of these guys just will not accept that they got wired up that way. They have to accept it and be ok with it, and I do not care what the consequences of that are. Acceptance is mandatory because there is no way to fix them.

Deal with self-hatred, shame, suicidality and desire for self-mutilation. It’s not uncommon but it’s not helpful as they’re not getting better.

Refocus: Ascertain to the greatest degree possible the sexual orientation of the client, all down to AOA. Find out if there is any attraction to matures, and then seek to redirect fantasy to that area and away from kids as an alternative. Also called Lovemap expansion.

Sexual fantasy is ok. I have guys tell me some pretty crazy kid stuff that was running around in their heads and they were getting off to it for real. It’s hard to say, “Wow, that’s great!” but you have to be nonjudgmental and let people think about whatever they want.

Offending: A big mess and I don’t deal with it. There are people who do though and redirect the person to those people.

Self-help: Discuss pedophile groups like B4U Act and see if they can join. Point out the consequences of offending.

Define pedophilia. I get people coming to me all the time with issues around arousal or feared arousal to kids. In most cases, it looks like OCD or an anxiety disorder. I also get lots of guys coming to me terrified that they are pedophiles because they find 13-16 yr old girls attractive. I laugh at them, say, “Congratulations on being normal” and say, “Why are you in therapy for being normal?” In general, most men with attractions to girls age 13-17 are not unhealthy at all, and in fact, that you are simply proves that you are a 100% normal and healthy male.

Differential diagnosis. Most of my cases go over to OCD or an anxiety issue. Once it’s OCD, I no longer worry about the person doing anything with a kid. If they tell me they are worried about molesting a kid, I generally laugh at them. In other cases, it looks more like paranoia. I had one client who seemed to be POCD, but he had no issues around arousal to little girls. Teenage girls, ok, but Lolita doesn’t count! In teasing it all apart, it turned out that his real fear was “other people think I am a pedophile” and not any worries about being one himself. This seemed to be part of some sort of a paranoid psychosis that I didn’t understand.

People with non-preferential desires mostly don’t want help anyway, but the few that do need to be told that they are normal as most men think this way sometimes. The only difference between a normal man and a pedophile is the degree of attraction. To a normal man, that mature woman is a Prime Rib. That 10 year old girl is a cold hamburger sitting in the fridge for 2 weeks and if you take a bite, the cops come to your door and arrest you, so you throw it away and don’t bother.

The steak or the hamburger. They’re both edible, but which one are you going to eat? Which one are you going to eat?

Issues around child porn. I have a few folks who were looking at this stuff and were terrified about getting caught. I advised them to wipe the drive, shut up and quit putting that stuff on their drive in the first place. One guy was terrified that any therapist would report him to the cops for having child porn on his drive, but the law doesn’t work that way, and most therapists are not cops. I kept telling him that clinicians are not cops but he just wouldn’t listen.

I don’t care what you tell me. If you confess to murder with me, it’s as good as a confession booth. I don’t wear a badge.

There was guy on the web getting a PhD in Psychology and he said he wanted to work with pedophiles because they fascinated him. He was told that unless you work in a prison setting, you will hardly ever see a pedophile in a normal clinical setting. This is because almost all of them think there is nothing wrong with their condition. Many have stated that if there was a drug to cure it, they would not even take it because they love being a pedo so much. They are typically very happy about their orientation.

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Filed under Anxiety Disorders, Child Porn, Mental Illness, OCD, Pedophilia, Pornography, Psychology, Psychopathology, Psychotherapy, Sex

Empathy and the Lack of It

First of all, what is empathy?

Empathy is the ability to share in another person’s emotions. The capability to be happy because someone else is happy, sad because they are sad, and so on. It is closely linked to love and compassion. Guilt, too, comes from the ability of a character to put themselves in the shoes of someone they’ve hurt. In other words, if you feel guilty at all, then you are an empathetic person de facto. Empathetic people are sometimes referred to as empaths.

Many persons are deficient in empathy. In my work with OCD patients, it is common to come across an OCD’er who is worried that they lack empathy. This is most common in the Harm theme of Harm OCD, where persons often feel that they are losing their empathy, that they do not care anymore, that they do not value human lives, that they no longer feel love, etc. Although it is controversial what exactly is going on here, I doubt if the OCD’er is really lacking empathy, doesn’t care, doesn’t value human life, no longer feels love, etc. This is because the OCD’er is deeply and profoundly upset by what feels like the loss of empathy and the change into a cold, heartless monster.

The truth is that folks who lack empathy do not care, do not value the lives of others, do not feel love, etc. as a general rule are not the slightest bit bothered by the fact that they feel this way. They like to feel this way. They do not want to feel empathetic, do not want to care, do not wish to value others’ lives, do not wish to feel love, etc. I have dealt with quite a few folks like this, and believe me, they are happy as clams being ruthless motherfuckers. If you are worried about your “lack of empathy” then in all probability, you are actually quite an empathetic person. Only an empath would be pained by the appearance of the loss of such an emotion.

The person who is deficient in empathy is an interesting character. One type is evaluated below:

These characters may feel fear, but not the fear of others, regardless of the situation. This kind of guy can walk calmly through a crazed mob. For good or ill, these folks are not susceptible to social panic. The reason is that these people generally do not care what people think of them.

This is where we differentiate between a sociopath and a narcissist.

A sociopath could literally care less what you or anyone else thinks of him as your opinion has no importance.

A narcissist deeply needs the love, respect and worship of others and will do anything to get praise or accolades.

Granted many narcissists are rather sociopathic and obviously the sociopath is the ultimate narcissist. The sociopath is, to himself, literally the only person in the world or at least the only one who matters. The world does not just revolve around him; the world is him.

There is a very nasty type called the malignant narcissist or the narcissistic sociopath. They are often capable of great violence. They differ from sociopaths by their extreme vanity and conceitedness and in particular by their need to be respected and admired by others. These types do indeed care what others think. Notable malignant narcissists include Ted Bundy and Jeffrey MacDonald, the physician who killed his family.

Note that a character who lacks empathy can still be perfectly capable of cognitive empathy; that is, the ability to recognize and identify an emotion – they might not be able to share in somebody’s happiness or sadness, but they have learned well enough what happiness or sadness look like, and coupled with the lack of remorse this tends to result in a ruthlessly effective Manipulative Bastard.

These people are sometimes aware that others are bothered by what looks like their lack of empathy. In order to put on a good face and fool people into thinking that they care, they put on a display of empathy and try to mirror another’s happiness, sadness or whatever. But this is all fake, a show, a game, an act. The real feelings are just not there.

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

OCD and Homicidal Thoughts

Homicidal thoughts or harming thoughts are quite common in a type of OCD called “Harm OCD.” It can get pretty bad. As a counselor and a sufferer, I have dealt with many people who had this particular type of OCD. In fact, they come to me all the time! I typically do some sort of differential diagnosis with them to make sure it’s OCD and not something more serious.

Below are some cases of obvious OCD or OCD-like thinking:

1. OK so one day me and my sister were just talking and all of a sudden I get this weird urge to choke her. I would never do that to her. I can’t even kill a bug and I’m not bi polar. This has happened again recently with my other sister, the thought just randomly occurs. If it helps I have been diagnosed with panic disorder. Please don’t be mean and say I’m a psychopath or I’m crazy. I need to know if any one else has experienced this to. Please help!

2. I do too sometimes. Sometimes while I’m driving I feel the urge to swerve into traffic. Sometimes for no reason I get the urge to choke my dog or hit her to death. (Of course I’d never do it.) It feels like you have no control over yourself. It feels like your actually about to do it but you don’t.

3. Believe it or not I’ve been through the exact same thing I had violent and sexual urges that I couldn’t control but I never hurt anyone I just always felt like I would, some specific urges I had were to drown my sister in the pool , every time I was someplace high up I would have a strong urge to jump off. I had these urges from age 10-15 and I was scared to be around people but I found out it is OCD look up OCD violent urges online.

I finally talked to somebody about it and said I was worried I would hurt somebody and they said the reason the urges don’t make me a violent dangerous person is because I’m worried about it were somebody dangerous would either not care or enjoy it.

4. i think everyone thinks these thoughts, not because you want to do them, but because your brain can think it. Its just putting yourself into a scenario, kinda like a daydream. Ive thought that way…”what if i just punched her…what if i slipped and fell and hit my head….what if i swerve into traffic??” tons of things will cross your brain…you’re human and its curiosity. I think you’re just fine. Unless you start getting the urge to actually follow through with it, or attempt it. Don’t sweat it.

5. Guys… I have that too. Sometimes ill sit and watch tv and suddenly ill have a random thought of killing my mom or hurting my dogs. Anyone in my house hold. I’m completely fine when these thoughts occur. I’m not mad, nor upset. And my family never did anything wrong to make me think such things…I would NEVER hurt anyone…

And it scared me. Sometimes i avoid certain objects i could hurt people with and i stopped watching my favorite crime shows. It all freaks me out now.. Ive asked a friend, and he has it too but not as extreme. More of a “what if” thing. He says im fine and he thinks everyone has these thoughts at one point.

Some of these folks may not even have OCD, but at any rate, all of these thoughts have an OCD-ish feel to them. It’s quite common for non-OCD’ers to get thoughts like this once in a while.

This case is more difficult:

Hello. This isn’t very easy for me to let go into the world, but I would like people’s opinions. I am on the other end of a 1.5 year bout with OCD and being terrified that I am going to indulge in homicide. Things are much better now, but yesterday at work, I got all my issues worked up in my head and at one point I genuinely wanted to indulge in homicide. I actually wanted to do it.

During that I had slight panic attacks running and of course it worries me that the curiosity of doing such an act is attractive. Now, I have read many posts here on how to self help your OCD, but this is the first time I have ever been genuinely attracted to the horrible thing I’ve been afraid of for such a long time, and that’s the difference between being afraid of intrusive thoughts and being attracted to them. Is that normal psychology for an OCD sufferer, do you think my thoughts got twisted in knots and then I deceived myself into thinking I wanted to do it, or do you think I should seek some help?

The thread goes on and on, and some folks are are telling him to go to the ER and check himself in. The guy who posted this is worried that he felt like he really wanted to do it. However, many of the OCD’ers I have dealt with have told me that they feel like they want to act on these thoughts. In every case, they were given a diagnosis of OCD by multiple clinicians. The thing is that OCD itself can make you feel like you want to do these things. It can also make you feel like you might or would enjoy them. All of this causes more panic, anxiety and attempts at thought suppression.

So if someone comes to me with classic Harm OCD stuff and then tells me that they feel like they want to act on these thoughts, I am not particularly worried. It’s probably more the OCD convincing you that you want to act on the thoughts or that you might enjoy them more than anything else.

This case is much more disturbing.

Hello, My name is Ryan. I’m 17 years old. I’m posting this here today because for quite some time i have been obsessed with murder, blood, torture, and rape. When I see someone walking down the road, my mind unconsciously comes up with random ways of torture I could try on them, I’ve been doing this since I was around 15, but now something’s changed – I feel its getting harder and harder to control, I’ve had to start journaling and drawing what I would like to do to my victims.

I feel I could take countless human lives and not stress about it. Will someone please tell me what’s wrong with the way I think? My parents told me its a stage, but I know it’s more. Just someone please try to give me insight on why this is happening.

I am honestly not sure what is going on with this guy, but one thing it is not is OCD. No way does a Harm OCD’er journal and draw pictures about torture, rape and murder. Forget that. The OCD’er would be terrified of having the thoughts in the first place, would not enjoy them at all, and would most likely viciously fight them from the first time they showed up until they went away, if they ever did.

The OCD’er doesn’t want those thoughts or feelings in his head for even one second. He would never just indulge in them for pleasure or write journals and draw pictures that delight in murder, torture and rape.

Truth is most Harm OCD’ers are so scared of their thoughts, etc. that they start avoiding all situations that might set them off, including any TV shows, movies or writing that has to do with murder, rape, torture, etc. If they watch or read something along those lines, they will feel serious anxiety and nearly have a panic attack.

In the thread, a few of them ask him questions to see if this is OCD. He says he enjoys the thoughts and feelings very much. That doesn’t sound like OCD one bit. However, he does say that he tries to resist them at times, but he can’t. Now that is very odd. But there may be occasional resistance with non-OCD stuff.

The fact that he feels like he could kill countless people without a single worry in the world is also disturbing. No way would an OCD’er feel that way.

It is interesting that a number of other commenters said that they had similar thoughts and feelings, especially when they were teenagers, and at some point, they just went away. That is very hopeful. I had assumed that once you get to the point where you are fantasizing about rape, murder and torture all the time, even to the point of doodling and journaling about your fantasies, you are pretty much gone. But apparently this is not so, and people can easily move out of this kind of thinking. That is a very good thing indeed.

The following are some cases of homicidal thinking in schizophrenia:

1. Yes but not intentional homicidal thoughts more like random ones that come in my head like if I see a bus pass by me sometimes I would have thoughts of breaking the windows with a baseball bat and screaming at the passenger or punching someone randomly passing by me but not of anger I barely get angry anymore just random thoughts.

2. Hi, I’m new here to this board. I was just curious if anyone feels these symptoms. I feel this way all the time. Whenever someone looks at me wrong. All I want to do is hurt or kill that person. I was recently hospitalized a couple months ago. I’m always scared to death. All I wanna do is crawl in to a dark room and cry. Sometimes when I’m driving I think what if I just turn the wheel and kill that jogger running.

Seriously I see a pdoc and have seen the same doc since I was a little kid. My pdoc says it’s just delusions. But it’s so real!!! I was diagnosed with paranoid sz. about 3 years ago. Does anyone feel this way? Please anyone I would love to know that I’m not alone here.

3. Hello Weenska, you most certainly are not alone. I get homicidal thoughts too. The scary thing is that they are all about killing children. You see, I work in a children’s’ hospital, and for some reason my mind is set on hurting the patients there. I get so nervous when I have to go clean a room with a patient sleeping in there.

The nurses are outside of the room sitting at the nurse’s station, and I’m alone in the room with the patient. While I’m cleaning I get evil thoughts of how I could swiftly kill the child without anyone seeing. My mind comes up with so many ways on how I could get away with it too. It’s like I’m constantly fantasizing about being a secret, mysterious child killer. Isn’t that awful?

4. I know I’m not a bad person and could never harm anyone. You’re not a bad person either. Why we get these kinds of thoughts flowing through our head is beyond me. I want you to know that whatever filthy person our minds may try and persuade us to be, that its not who we really are.:)

5. Princess is right, you’re definitely not alone! I have homicidal thoughts about my hubby. I don’t sleep well at night so a lot of the times I am just sitting in bed watching my hubby sleep. I would think about what it would be like to actually commit a murder. I can picture myself smashing his head in with a baseball bat, or poisoning his food, I even can see my self sneaking up on him and stabbing him in the back.

I’ve told him and at first he thought it was kinda funny, but now I can tell he’s sometimes a little edgy around me. I love him so much and I don’t want to lose him…To me, this is so much more than some kind of delusion. Its like the devil himself is tempting me. I hate feeling so sick and twisted inside. Anywho, yes I can relate. I know I’m not bad, and I will fight these thoughts off as hard as I can for as long as it takes!

6. I’ve always been a real docile person, but when I got sick I had some homicidal thoughts.

7. In 1980, I had a lot of violence in my head and I was afraid for about a week that I would get violent. It scared me and made me feel bad, but I managed to control it.

8. I get these thoughts of hurting people sometimes too. I haven’t acted on them so far.

9. I used to get terrible homicidal thoughts. There were command voices, and there were the videos/images that played in my head about terrible crimes I was committing. I have been hospitalized over 20 times, and many of these were for homicidal ideation. I would be taken to the inpatient unit and put in isolation because I could not control myself.

But after the fact when I would get re-stabilized on meds, my T told me that she did not think I had it in me to hurt another person. I have never hurt another person. I am generally very kind and calm. She wanted me in the hospital because she was afraid I would hurt myself. After I had the homicidal thoughts I would feel SO guilty about having the thoughts that I wanted to kill myself because I was such a “bad” person. But, I am not a bad person. Now I have been stable on Clozaril for 6 years, and I no longer have homicidal thoughts… ever.

10. From my perspective, It might b “normal” 2 have homicidal thoughts about some 1 I don’t like or doesn’t like me. But I have homicidal about the ppl i LUV the most! It’s like the thought pops up in my head then I got a whole bunch of cause n effect scenarios.

It could b like if i c a hammer on the table, I could bash my loved one in the head. Or it could b some insecticide, n I could add a dash of death 2 a meal. I mean yea, I been thru some bad shit, but this is just fucked up! After i realize what I just wuz thinking, then I start feeling all bad, then the potential bad endings, n it bothers me. I mean, I’m ain’t necessarily a bad dude, but damn that shit ain’t cool, feel me?

11. I get homicidal thoughts when I am deeply disturbed. I make up shit in my head on how I could kill someone and get away with it. I have really good self control, and I’m a good person, and it bothers me deeply. Most of my homicidal thoughts are about my brother though because he is clearly the Antichrist. I talked to God when I was actually planning on killing him and he stopped me. He’s a crackhead and pill popper big time and only uses my disabled mother for more crack money.

Luckily he has found a place to live so he doesn’t bang on our doors at 530 or call my phone anymore. He threatens a lot towards our family, but I can do so much more harm than he could. My father passed away in January and he was the only person who could keep him in line. The constant family feuds we’ve been having has at times caused me to the point of pure insanity. I talk about killing him openly with my family and how he just needs to die.

Of course, they’re very freaked out. I’ve always had homicidal thoughts even before schizophrenia. But they have just been getting worse about my brother. I think about killing other people sometimes, but it’s mostly my brother because he’s a piece of shit. This morning he came by again and I couldn’t sleep. I haven’t heard voices in over a week, they come and go, but this morning voices were telling me to murder someone.

12. When I read this post, I immediately remembered my early teen years, when my illness really started getting bad. I had my first hallucinations when I was about 14 or 15, and that’s when I started having thoughts of killing people. At first the thoughts were of killing people at school, like a random school shooting, and then killing myself. Then came the thoughts about killing my family members and then myself. I skipped school all the time because of it. I feel sick just typing this. I want to delete it and pretend it never happened.

This one is deeply disturbing. Some sort of homicidal thinking she had actually led to her trying to kill her brother, probably when she had schizophrenia:

I’ve had thoughts like that before too. I used to go to school with a girl who I thought was perfect. I wanted to kill her because I felt so flawed next to her. The point is, NEVER act on these impulses. Never hurt anyone or you will regret it horribly. I tried to kill my brother once and he avoided me for years (can you blame him?).

As you can see, homicidal thinking is extremely common in schizophrenia. In fact, the vast majority of schizophrenics seem to experience it at some time or other. Some of this stuff looks very OCD-ish to me. Whether it justifies an additional diagnosis of OCD or not, I have no idea. You will notice that in many cases, anti-psychotic medication specifically for schizophrenia made the thoughts go away. This implies that it was not an OCD process driving the thoughts but instead it was a schizophrenic process. If it was an OCD process, the anti-schizophrenic drugs would not have worked.

The question is how does the schizophrenic homicidal thinking above compare to the OCD-type ideation in quality? Honestly, I do not have the faintest idea.

One way it differs is that in schizophrenia it can take the form of command hallucinations ordering the person to commit violent acts. Fortunately, they do not give in to the thoughts most of the time. There is something a bit similar in OCD where the person experiences thoughts inside their head ordering them to carry out various homicidal and violent acts. The difference is that in OCD it will be a thought and in schizophrenia it will be an external voice. And in schizophrenia, there is much more likelihood that the person will act on it. The chance that a person with OCD will act on the thoughts is just about nil.

However, in schizophrenia, this thinking is much more dangerous as it regularly leads to episodes of violence. However, as you can see above, only one of the schizophrenics above ever acted on their homicidal thoughts, so in many cases, they are able to control themselves.

I have never worked with schizophrenics, and I don’t know how to deal with homicidal ideation in schizophrenia. I imagine it is a very tricky area to determine a schizophrenic with this type of thinking is dangerous or not.

People come to me after reading my articles. They are basically self-diagnosing with OCD, or they have already been diagnosed by a clinician. I have found that people are pretty good at self-diagnosis for this condition. They often write me telling me that it is as I could see inside their minds and tell them what was going on in there. All of the people who came to me with homicidal or violent thoughts had OCD so far, so I haven’t had to worry much about differential diagnosis. I did have one client who was truly homicidal, but that person was thinking in a completely different way and it wasn’t OCD driving the homicidal ideation, it was something else altogether. There wasn’t much I could do about that person either.

Unfortunately, I think most of the people who are truly dangerous are simply not going to show up for counseling or therapy. They either like to feel this way or don’t care, and they don’t see any problem with their way of thinking.

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

Normal Guy With Irresistable Urge to Kill People

Link here, and see responses. I have written about this before. This guy is now convinced that he has OCD, specifically Harm OCD. I know Harm OCD very well as I have spoken with and worked with scores of people who have it. There is no way on Earth that this guy has Harm O. Forget it. Not possible. Harm O doesn’t work like this.

As far as what is wrong with him, I have no idea. Not all unwanted thoughts, feelings and urges are obsessions. Some might be more classified as “addictions.” We may be looking at more of an addiction here. I am also thinking, if he really doesn’t want to feel this way, why doesn’t he just knock it off? You don’t want to think about killing people? Great. Just stop doing it. It’s not that hard. That won’t work for an obsession due to the nature of obsessions, but it should work just fine for a non-obsession.

I’m a relatively normal, happy guy. I have an almost irresistible urge to kill people. What’s wrong with me?

READ FIRST/UPDATE AT THE BOTTOM: I guess I should clarify that I am definitely NOT going to kill anyone. I only want to. I know the difference between wanting something and having to have something, and have never once in my entire life actually tried to hurt anyone. The furthest my desires have ever gone is thinking about how I would go about doing it. I have never owned a weapon or thought about obtaining one outside of knowing that I would have to in my little day-dreams.

I am a normal guy in my early 20s. I work full time, I have lots of friends, people generally like me when they meet me, and I work very successfully in a people-oriented business. I care deeply about my friends and family, and I stand up for people I don’t know when I feel they’re being taken advantage of. I am of above-average intelligence, and I’ve been told by more than one person that I’m their favorite smart person because I never make anyone feel like I think I’m better than them.

I’m happy with the person I am, and I’m confident in the decisions I make on a daily basis. I don’t have any money problems that can’t be solved by budgeting for a week or two, and generally always have the time and means to pursue the things I want.

I am moderately successful with women; I’m no Casanova, but in general if I make an attempt to woo someone, they are wooed. I have recently been getting serious with a girl I’m really into. She’s smart and funny and full of life, if not a little talkative sometimes, which I find endearing.

My ambition in life is to be happy without damaging the happiness of those around me. I get along great with animals and would never intentionally hurt or kill one, and hearing stories/seeing pictures of people who torture or even just mistreat animals bother me. Something as simple as a neighbor leaving their pet out in bad weather can ruin my morning.

I don’t think I’m a psychopath or even a sociopath. I’m no more selfish than the average person, as far as I know. When I hurt people’s feelings I do everything I can to make up for it if I feel I was in the wrong, which is relatively often.

I also really, REALLY want to plan and execute a murder. Or several. Usually the first solution that pops into my head when someone is in the way of my happiness is to murder them. I’ve gone as far as learning someone’s schedule and patterns and planned a fairly thorough method of killing them and disposing of their body without getting caught. Most of the people I contemplate killing are not people that are close to me, though I do occasionally get intrusive thoughts about taking the life of friends or co-workers I genuinely get along with.

I don’t think I’ll ever go through with it, but if I did I would probably choke my victim to death with a thin, strong rope or wire of some kind. Guns don’t appeal to me and knives are messy.

The main thing stopping me from going through with it isn’t a fear of getting caught or the belief that killing is morally wrong (which I do believe, but I’m not so hypocritical that I’m going to pretend I don’t betray my morals every now and then), but a fear of what it would mean about me as a person. I don’t want to hurt anyone, I just feel like I need to sometimes.

Is there something wrong with me or are these just normal invasive thoughts? I feel like I should talk to someone but as far as I know I have my desires under control.

UPDATE: Thanks for all the feedback guys. I’m getting an equal mix of Dexter quotes, troll accusations, and suggestions to see a therapist. Rathosaur’s post here made me realize I have probably have a pretty serious form of OCD that I’ve just been managing internally for a while. I plan on talking to a therapist as soon as I find out what kind of mental coverage my insurance has. I don’t feel like I’m a dangerous person, but I also don’t like having thoughts that bother me in my own head. I really, truly appreciate the input of those who have offered help.

One thing that jumps out loud and clear in this post is the narcissism of this fellow. It is also disturbing that the only thing preventing him from acting on these fantasies – and that is what these are – fantasies – is what people will think of him if and when he gets caught. People will hate him so much that his self-esteem won’t be able to handle it. What stops him from killing is how it would affect him, not the people he kills, his victims. That is rather disturbing right there.

Posters post about how this guy is a sociopath or a psychopath, but I am not getting that. A sociopath could care less what anyone thinks of him. If he likes the idea of killing but does not do it (very common in sociopaths as many fantasize about homicide but few carry it out) it will be for reasons other than his own self-image and what others think of him, since by definition, the psychopath cares nothing about his self-image or what others think of him.

If the psychopath is not carrying out these acts, it may be because he doesn’t want to go to prison. Many psychopaths have very active antisocial fantasy lives, but they don’t engage in a whole lot of illegal activity because they don’t want to go to jail or prison. So they become “legal criminals” instead.

Here is what a poster posted about this fellow in saying he was a psychopath. Notice all checks by the narcissism stuff but almost no checks by the parasitic lifestyle stuff.

Factor 1: Personality “Aggressive narcissism”

**Glibness/superficial charm** [if he woos her, she’s usually wooed]
**Grandiose sense of self-worth** [he’s everyone’s favorite smart person]
Pathological lying
**Cunning/manipulative** [if he woos, she’s usually wooed; everyone likes him]
**Lack of remorse or guilt** [see immediately below]
Shallow affect (genuine emotion is short-lived and egocentric)
**Callousness; lack of empathy** [isn’t worried about hurting his would-be victims, but is concerned about *his* self-image if he kills]
Failure to accept responsibility for own actions

Factor 2: Case history “Socially deviant lifestyle”.

**Need for stimulation/proneness to boredom** [fantasizing about murder]
Parasitic lifestyle
**Poor behavioral control** [stalking people]
Lack of realistic long-term goals
Impulsivity
Irresponsibility
Juvenile delinquency
Early behavior problems
Revocation of conditional release

A Harm OCD’er would never, ever, ever plot of plan to kill anyone. They would never learn anyone’s schedule in order to fantasize a plot to murder them. It doesn’t work that way!

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

Problems in the Diagnosis of OCD

The criteria used to diagnose OCD give rise to a lot of confusion among sufferers and clinicians.

Resistance: Resistance is certainly the hallmark of OCD. Obsessions often provoke the most ferocious resistance. However, not all OCD’ers resist their thoughts. Some just hate them and want them to go away. Also, when the illness gets bad, resistance is often gone and the thoughts just take over and resistance is impossible. Others choose not to resist.

I talked to a female OCD’er with Harm OCD who said she didn’t want to fight off the thoughts because that would be “going against who I really am.” This is a case where the obsessions have taken over so badly that the person is starting to believe them. Unfortunately, this is quite common in the illness, and the sufferer often feels that the obsessions are completely real, because that is how they feel. Nevertheless, resistance is still an excellent marker for OCD. My feeling is, “If you try to stop it, it’s an obsession.” And that’s pretty much true.

Resistance can turn into a cause of endless doubting and ruminations. I have talked to people who spend a good part of their time resisting and fighting off and trying to stop obsessions. Nevertheless, one of their worries was, “Am I really trying to stop the thoughts?”

Anxiety: Certainly, anxiety is prominent in OCD. However, as OCD goes on, the anxiety often attenuates and the person does not feel so much anxiety anymore about the obsessions. For instance the Gay OCD’er feels that the gay thoughts do not cause anxiety anymore, so this means that they are gay. The pedophile OCD’er does not feel much anxiety about the pedo thoughts anymore, so that means they must be a pedophile. The Harm OCD’er finds that the violent thoughts do not cause much anxiety anymore, so they must be a murderer or a psychopath. It is uncertain why the anxiety goes down in OCD. Some think that the body simply tires of being anxious all the time and simply becomes attenuated to the anxiety.

Feelings of numbness and lack of feelings: This is very common in OCD. Why this happens is not certain, but it may be because the anxiety has gone down.At any rate, numbness is very common. This often causes a lot of worry, particularly in Harm OCD, when the person feels that that they have lost their feelings and are turning into a psychopath.

Lack of desire to carry out the actions: It is often said that the difference between someone with OCD and someone without it is the lack of desire to carry out the actions associated with the obsessions. “The person with OCD does not really want to do these things,” is how it is often phrased. However, this causes a lot of confusion because in many cases, the OCD will make the person feel that they want to carry out the acts.

A person with Gay OCD will feel gay and feel like he wants to have gay sex, a person with pedophile OCD will feel like he wants to have sex with children, and a person with Harm OCD will feel like they want to attack or kill people. So this isn’t a very good barometer. However, in general, they do not want to have these feelings, and they fight them very hard. So you look at such things as unwantedness and resistance instead. Whether the person with OCD really wants to do these things is more of a philosophical question. They probably don’t, but OCD can make them feel like they do.

Obsessions as repugnant: While it is probably true that the OCD’er finds their obsessions repugnant on a deep level, hence all the discomfort, anxiety and resistance, this can cause problems because when the illness is bad, the OCD will try to convince the person that they like the thoughts and don’t want to get rid of them. I have spoken to many OCD’ers who were panicked because they felt they were starting to enjoy the pedophile, gay or violent thoughts. This is just OCD trying to convince you that you like something that you really don’t. But the repugnant criteria can result in endless ruminations along the lines of, “Do I really find them repugnant?…Maybe I don’t…Maybe I like them…”

Sometimes this leads to endless compulsions where the person tests themselves over and over again with the images to see if they are disgusted or not. A Gay OCD’er may look at gay images on the Net to see if they generate the proper amount of disgust. A pedo OCD’er may conjure up images of sex with children to see if they are properly disgusted by them. A Harm OCD’er conjures up images of crime scenes, homicides, or themselves committing a violent act over and over to see if they feel the proper amount of disgust and horror.

I talked to one OCD’er who had an image of himself slitting his father’s throat in his head. He had to conjure up the image over and over until he “got it right” and had the proper feeling towards it. This compulsion could take some time and was accompanied by some interesting physical maneuvers in conjunction with it.

“Am I really disgusted by the thoughts? Am I really horrified by them? Do they really bother me?…” These are the sorts of endless ruminations that one encounters.

“I am going to do X…”: It is actually fairly common for an OCD’er to think that they are going to carry out the unwanted act. For instance, a someone with pedophile OCD may think, “I am going to have sex with this child,” and someone with Harm OCD may think, “I am going to kill this person,” or, “I am going to shake the baby right now.” Often these more dramatic forms cause a lot of anxiety because the person worries that the thinking is too extreme to be OCD. However, this thinking is quite common in OCD.

Confusion of voices with thoughts: The person with OCD often describes the thoughts as “voices,” but what they are describing is their inner voice only, not external hallucinations. Also the inner voice in the person with OCD often goes through a lot of changes in tone, etc. to where it seems there are different internal voices going on. Sometimes the obsessions seem to be in a voice other than one’s own, and this is very frightening.

An internal voice is just a thought. Thoughts are internal voices. You hear them in your head, as the phrase “inner voice” implies. You can have one internal voice or many. It’s probably better to have as few as possible since otherwise you might find yourself confused. A hallucination is something you hear with your ears. It is external to the environment.

Confusion of “fake hallucinations” with real hallucinations: In the form of OCD called Schiz OCD, the person worries that they are developing schizophrenia. They often worry that they are starting to hallucinate. They listen intently for all sorts of noises in the environment and start to either mistake them for voices or wonder if they are really voices. A person with true hallucinations will be quite clear that they are hallucinating. Usually careful questioning can ferret out the fake hallucinations from the real hallucinations.

“Lack of empathy” in Harm OCD: In OCD, the obsessions often feel very real. So a person with Gay OCD feels 100% gay. A person with pedophile OCD feels that they are a pedophile. A person with Harm OCD feels like a killer. I have had many Harm OCD’ers tell me such things as, “I feel evil…I feel like the devil…I feel like I could kill!…I feel like a serial killer…I feel like a murderer…I feel like a psychopath.” The OCD simply creates a situation where the person feels that they have become the theme of their obsession.

In Harm OCD, many times persons report a “lack of empathy.” Many Harm OCD’ers have told me this. “I feel like I don’t care anymore…I feel like I don’t love people anymore…I have lost the feeling of love…I feel like I don’t care about others’ lives or value them…I feel like I could take a life and not even care…” One told me, “You know, when my grandfather died, everyone around me was sad, but I felt like I didn’t even care. I felt like I wanted to laugh.” He was terrified as he told me this.

On the surface, this looks like the lack of empathy associated with psychopathy and I have had OCD’ers tell me that their therapists told them that this sort of thing was not associated with OCD and was instead associated with psychopathy. This just caused them even more worry as they were already afraid they were psychopaths.

Typically, this person had felt decent empathy for others before the onset of the Harm OCD. They are generally alarmed that they “seem to be losing their empathy” and see this as a sign that they “are turning into psychopaths.” They make desperate efforts to regain their empathy and feelings of love, but it often doesn’t work very well. This often turns into a form of a compulsion where the person can spend hours a day “practicing feeling love or empathy for others.”

Presumably, a person with psychopathy or a true lack of empathy would not feel bad about it.

The “lack of empathy” is probably a “false feeling” created by the OCD.

Confusing obsessions with delusions: Unfortunately, many OCD’ers are still diagnosed with psychosis. I have had many of them come to me with a diagnosis of psychosis. In all cases, I felt the diagnosis was wrong. However, at times, obsessions take a very strange form in which the content looks like a delusion. In these cases, you look at how much the person believes in the thought, whether they are resisting it, etc.

Confusion of checking with interest: I have talked to some pedophile OCD’ers who had looked at child porn or had masturbated to pedophilic imagery as a form of checking to see if they were interested in it or not. They were now terrified that they did not have OCD and instead they had pedophilia. They were not doing this because they were pedophiles. Instead they were they were checking to see if they were pedophiles or not.

Concerns about escalation: It is quite common for OCD’ers to accept a diagnosis of OCD but to then feel it is “turning into something worse.” In other words, at first they had Harm OCD or Pedophile OCD, but now it is getting worse, and they are turning into pedophiles or psychopaths. Escalation is a strong worry in the form of OCD called Schiz OCD where the person worries that they have schizophrenia. Invariably these persons feel that they are developing schizophrenia. Realistically almost none of them are. I do not regard this as much of a worry. My feeling is, “Once it’s OCD, it’s always OCD.”

“Is it really OCD?” This is not so much a matter of diagnostic confusion as it is a hallmark of the disorder. I cannot tell you how many OCD’ers I have talked to who ask me, “Is it really OCD?…I am worried it is not OCD…What if it isn’t OCD?” It is called the doubting disease after all. My feeling is that if you are asking yourself over and over, “Is it really OCD?” then in all probability it may well be OCD. Sometimes a person without OCD will wonder if they have it, but they are not usually so obsessive about it.

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

Threat Assessment in OCD

This is an excellent article.

Examples of obsessions:

Examples of normal intrusive thoughts include the image of touching the genitalia of a child, worry (in the absence of any evidence) as to whether one had caused an accident on the way home, urges or impulses to attack a loved one with a kitchen knife, or thoughts and images of jumping onto a railway track in front of an oncoming train.

That is a pretty good list, and the author points out that 80% of the population report having these thoughts also.

The risk is that the patient will act on an obsession (e.g. suicide or sexual acts with a child) or impulsively act out an obsessional fear. At its simplest, this need never be a concern: there are no recorded cases of a person with OCD carrying out their obsession. By definition, such intrusions are unacceptable and ego-dystonic, and the person is no more likely to act on their intrusions than a person with height phobia is to jump off a tall building. The obsession represents a type of fear or worry that the patient does not want to happen; like all fears or worries, it concerns ideas that the patient wishes to avert at all costs.

That seems to be correct, however, when the illness gets severe, the person can become convinced that they actually want to carry out these acts. I have spoken to quite a few people with OCD who told me that the illness made them feel like they wanted to have gay sex or have sex with children or assault and murder people. This is probably correct though in that people with OCD do not act on their obsessions. I have not met one person who acted on an obsession of causing harm to themselves or others, or how did anything sexual to a child in response to an obsession.

However, there are cases of people with gay OCD who get so convinced that they are gay that they go out and have sex with someone of the same sex. Usually this is a complete disaster and I would not advise it.

There are also cases of people with Relationship OCD who have left their partners or spouses. Generally, this does not solve the ROCD dilemma.

Where compulsions are concerned, urges that are themselves obsessions need to be distinguished from urges arising as responses to obsessions. Once this is done, the risks are relatively obvious. Thus, if someone has an obsessional fear of cutting themselves, you can be very certain that they will not harm themselves.

However, if the idea of harming others is the obsession, they might respond by cutting themselves rather than harming someone they love. Secondary risks are often subtle. For example, a parent who is constantly preoccupied with their obsessions may become less responsive and emotionally available to their children.

This is interesting. I have dealt with a few OCD’ers who cut themselves. All were women.

The next part goes into differentiating Sexual OCD from the type of thinking that goes on in a sex offender.

OCD or potential sexual offender?

Various factors differentiate the intrusive sexual thoughts of people with OCD from those of sexual offenders

  • Ego-dystonicity of the thoughts
  • Failure to act on or masturbate to the thoughts
  • Avoidance of trigger situations
  • Efforts to suppress the thoughts
  • Very frequent or constant occurrence of the thoughts
  • Dominant anxiety, distress and guilt about the thoughts
  • Overdisclosure of irrelevant past sexual history
  • Wanting help and seeking referral to mental health services
  • Presence of additional obsessive–compulsive symptoms

That is a pretty good list.

Assuming that in a sex offender, we are dealing with some sort of a paraphilia, I had one OCD’er who had obsessive thoughts of slitting his father’s throat. He was terrified that he was going to act on these thoughts and that he got some sort of sexual arousal out of them. His therapist told him that this was OCD, and that paraphilias are “about desire, not fear,” and “no resistance.” This is about right. I would expect to see little to no resistance in a paraphilia. OCD is a problem of fear and paraphilia is a problem of desire.

You are also looking at something that is occurring all or almost all of the time. If it is, it is likely you are dealing with an obsession. With paraphilias, they are much less likely to be going all the time, and when they are frequent, the person is likely to be fantasizing.

The anxiety, distress and guilt over the thoughts is often profound. I have had quite a few OCD’ers tell me that they were crying for hours on end, either could not sleep or were lying in bed all day or had even lost weight due to not eating. It is quite common for them to say that they are suicidal; however, OCD’ers usually do not attempt or commit suicide. I have only had OCD’er who attempted suicide and she tried twice.

Presence of another disorder like Borderline Personality Disorder is likely to greatly increase the risk of suicidality. In such cases, the suicidality is likely due to the BPD and not the OCD. It is curious that OCD’ers are so commonly suicidal but they rarely attempt or carry it out. The OCD’er is a shy, almost meek person whose dominant emotion is fear or even terror. Quite simply, they are too scared of dying to kill themselves, so the fear associated with suicide prevents them from carrying out the act. In contrast, a violent of sexual offender is likely to see the thoughts as fun or enjoyable, though sometimes they feel guilty for enjoying them so much.

Wanting help is a great one. When someone comes to me on the brink of suicide due to their “horrible pedo thoughts that popped up out of the blue,” I am quite certain that this person is not a pedophile. I have only have one pedophile come to me in all the time I have worked with OCD’ers, and he went away pretty quickly. In contrast, sex offenders or pedophiles will rarely show up for help. One man who was interested in working with pedophiles as a career was told that unless he was working in a prison setting, he would never see one in clinical practice.

Resistance is the hallmark of OCD. George Winokur, a famous psychiatrist, said, “Look at how hard the person fights the thoughts. That is a clue to whether you are dealing with OCD or with something else.”

Another interesting thing you will see is checking. So the person with pedophile thoughts will constantly conjure up pedo thoughts and then examine their reaction to them to see if they are properly horrified. A person with gay thoughts tests himself to see whether or not he finds gay sex repulsive. A person with violent thoughts frequently conjures up violent thoughts or scenarios to check to see if they are actually repulsed by them or if they are repulsed by them enough. Sometimes the thought or image must be repeated over and over until the person finally feels that they have obtained the “right” level of disgust. You will see much less resistance in paraphilias; in fact, typically, there is none.

Failure to masturbate to the thoughts is not a great checkpoint, as I have had quite a few folks who were masturbating to pedo thoughts as a way of checking to see if they were turned on by this sort of thing. In the paraphilias, the person masturbates, often compulsively, to the imagery of the paraphilia, pedophilic, sadomasochistic or other fantasies or pornography. They get great pleasure out of this, and they generally do not want to stop.

Ego-dystonic is excellent. Paraphilias are much more likely to be ego-syntonic. Although this one is a bit tricky, and the OCD will often argue with the person and tell them that they actually like the thoughts when they do not. This leads to a lot of confusion over whether they enjoy the thoughts or not.

They will avoid trigger situations.
Harm OCD’ers will avoid other people or avoid weapons, heights or pill bottles if they worry about self-harm. Pedophile OCD’ers will avoid children like the plague. Gay OCD’ers will avoid anything to do with gay people. Sometimes they avoid their own sex or even the opposite sex. In contrast, many pedophiles will actively seek out places where children are present.

Overdisclosure of irrelevant past. Many times, those with pedophile worries will reveal all sorts of incidents in their childhood past that they feel prove that they are pedophiles. Usually this is just harmless child sex play of the sort that all children engage in. A Harm OCD’er will reveal incidents in his past in which he was violent in order to prove that he is a murderer. Usually this sort of thing is sort of a back-checking and doubting sort of thing in which the mind is trying to come up with reasons why the obsession is true. In contrast, a sex offender will often hide their past due to fears of being caught.

Presence of other OCD symptoms. This is an excellent clue that you are dealing with OCD, and I use it often when I am trying to figure out if I am dealing with OCD or something else. With a sex offender, usually you will not find any OCD.

Factors suggesting OCD in thoughts of violence

  1. Ego-dystonicity
  2. Absence of past behavior consistent with the thought
  3. Presence of avoidance behavior (e.g. avoidance of knives or sharp implements)
  4. Frequent thoughts
  5. High degree of distress
  6. Strong motivation to seek help

The ego-dystonic nature of violent thoughts is often profound, and the resistance provoked by them is often extreme. In contrast, real violent thoughts are typically ego-syntonic and are quite pleasant to the person.

Absence of past violent behavior. The Harm OCD’er is typically a very nice, kind, sweet and gentle person – the last sort of person you would think would do such a thing. They typically have little violence in their past, certainly little violent crime or unprovoked attacks on innocents.

Presence of avoidance behavior. The Harm OCD’er is often afraid of knives, weapons, etc. and tries to put them away or hide them. In contrast, a violent person may be quite comfortable with weapons.

Frequent thoughts. When the violent thoughts are going all the time like a broken record, you may be dealing with OCD. Violent people do not necessarily think violent thoughts all the time. Instead they only think them some of the time.

High degree of distress. Harm thoughts provoke severe anxiety. Some people hospitalize themselves to avoid hurting other people. I talked to one woman who had been in a hospital for four years with Harm OCD. In contrast, violent people tend to like their violent thoughts and they think them anytime they want to with great pleasure.

An OCD’er with Harm OCD told me that they went to a forum for psychopaths and asked them about the harm thoughts that he was experiencing and whether they experienced the same thoughts. The sociopaths were mystified that the man felt the thoughts were abhorrent. One of them said, “Actually, one of the few things I like to think about is hurting people and killing people.” The rest of the sociopaths all endorsed that statement. Dangerous people like to think violent thoughts; they get kicks out of it.

Strong motivation to seek help. The OCD’er is panicked over is violent thoughts and desperately wants to be rid of them. By contrast, a truly violent person likes to feel violent and doesn’t want to feel any other way. I have not yet had a truly violent person come to me wanting help with violent thoughts so they don’t carry them out.

I had one homicidal person, but they very much wanted to feel that way, and there was nothing I could do to talk them out of it. The whole problem with this sort of thing is that the people who are actually going to carry out violent and sexual offenses, the people who are really going to do these things – well, they never show up. Instead the only ones clinicians see are the people who are never going to act on any of this stuff.

Resistance. I would add this one to the list. Violent thoughts often provoke furious resistance in an attempt to keep them out of the head. In contrast, someone who is actually going to carry out an unprovoked act of violence against an innocent person spends little if any time resisting thoughts. One Harm OCD’er was afraid he was a serial killer, but he had never committed any violent acts along those lines.

He asked his therapist, “What about a person who actually does these things? Do they ever try to stop the thoughts?”

“No.”

“Not even once.”

“No, not even once, of course not.”

So resistance or the lack of it really is a good marker for OCD versus something else.

Therapists often make OCD worse in various ways. Here are some of the ways that they can make it worse.

Examples of patients’ comments regarding their assessments

‘He gave me a differential diagnosis which made me panic as it increased my doubts about whether I did have OCD.’

‘She said that, to be on the safe side, it would be better if I avoided working with children until I had received treatment.’

‘He said SSRI’s might reduce my sexual urges so I assumed he must think there was a problem.’

‘She said I was unlikely to act out any urges but she was still obliged to notify Social Services.’

‘He implied I might have an unconscious wish to stab my baby.’

‘He said it was extremely rare for such thoughts to mean that someone was dangerous, but if I was still worried, I could go for a specialist assessment at the sexual offenders unit.’

‘She said it was very rare for this type of violent thought to lead people to act on it, but “as you obviously have a problem dealing with anger, then therapy would be a good idea”.’

There is no point in saying any of these things, and I try very hard not to make OCD’ers worse when I deal with them.

References

Veale, David; Freeston, Mark; Krebs, Georgina; Heyman, Isobel and Salkovskis, Paul. 2009. Risk Assessment and Management in Obsessive–compulsive Disorder. Advances in Psychiatric Treatment 15: 332-343

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

Asperger’s or Non-Aspergers?

Tai writes:

Well I strongly agree about your idea that many people who are antisocial or perhaps just a bit on the odd side are falsely diagnosing themselves with Asperger’s Syndrome or diagnosing others, I do not agree with the over simplification you suggest stating “people with Asperger’s” as in all people with Asperger’s do the exact same things.

I am a 20 year old female and I was diagnosed when I was 7 years of age by a child psychologist, Dr. Seymour.

Asperger’s Syndrome or Autism Spectrum Disorder (spectrum meaning a great variety of “symptoms” from person to person) is the Highest Functioning form of Autism. A diagnoses of Asperger’s excludes any mental retardation.

It is characterized by significant difficulties in social interaction, along with restricted and repetitive patterns of behavior and interests. Also hypersensitivity with touching, hearing, tasting and smelling.

Albert Einstein had ASD, and television characters Brennan from Bones and Sheldon from Big Bang Theory also have Asperger’s.

Though not everyone with ASD is a genius, they tend to be extremely bright in classes and situations that interest them and my excel greatly among their peers.

Some things take people with ASD longer to learn though, to which extra help and a new way of learning and patience will help them along.

For example, lets say 10 year old Bobby has Asperger’s. He knows everything about Dinosaurs and can memorize the lines 100% from his favorite movie. He is also very good with math and amazes his teachers and parents with his intelligence, as well as exhaust them when all he CAN talk about are his hobbies! Not all he chooses too, all he can do! However he still can’t tie his shoes, writing is very difficult for him and he has trouble making friends and adjusting to new people. People think he is odd, and he thinks everyone else is odd. He hates being touched and takes every thing he hears very literally. (when his mom asks got a Kleenex he says “sorry we only have tissue”.) He also hates LOUD unexpected noises like fire works. It hurts physically some how. And he can’t eat bananas or avocados because they “feel too mooshy” and he will “tantrum” if tried to force to eat them out of sensory overload causing him to panic.

That is one example of someone with AS. Another person with AS might love fireworks and hate the sound of car motors, love mushy things but hate crunchy things, be able to tie shoes but can’t jump rope, knows everything about his favorite cartoon instead of dinos and is an excellent writer but a poor learner with math. They may be able to NOT take things as literally but are unable to look someone in the eye.

It is a spectrum disorder. Because of this is can be hard to get a proper diagnoses. However I would suggest to all people who assume they have AS to go get evaluated. And to get evaluated by 2 or 3 doctors for more professional opinions. Falsely diagnosing oneself can only lead to issues, especially if there is another psychological problem.

My understanding is that Aspergers comes on at an early age, say age 2-3. In 100% of cases, symptoms will be present from a very early age. Any adult who has previously functioned well, or God forbid very well, cannot possibly have Aspergers.

People’s functioning varies with time. I know people who used to function perfectly but now they can barely leave their houses. So functioning can dramatically collapse in any given individual.

One thing that I noticed was that many people self-diagnosing as Aspies had anxiety disorders. I work with OCD patients, and many of them think that they have Aspergers. I generally do not think that they have it. Aspies do not seem to be very common. I think I met one in my life so far and another couple on the Net.

The problem is that a very large number of people are odd, weird, strange or out of it in some way or another. I run into them all the time. They can’t possibly all have Aspergers. Schizophrenics are obviously pretty odd. I have met some odd OCD’ers. A lot people with anxiety disorders can seem pretty weird. Many very shy people seem out of it and odd. Just being weird doesn’t mean you have Aspergers!

In addition, many introverts to super introverts are identifying as Aspergers. Obviously many introverts have problems in social interactions, but just because you have problems dealing with other humans because you are an introvert does not mean that you have Aspergers!

I read a recent paper that said that Aspergers and introversion are along a continuum, with introversion at one end and Aspergers at the other. I agree with this, and this is where the confusion sets in.

Although I am quite an introverted person and many people think I am pretty damn weird, I certainly do not have Aspergers. For one thing, my social skills are actually excellent, but my brain works in funny ways so that right there turns people off. They see my brain apparently working in a weird way and they just don’t want to have a conversation. But I am a master of social rules and not only that, I understand other people very, very well. I even know what they are thinking most of the time, to the extent that you can do that at all. Of course I know what they are feeling too. I read people very fast and I respond very fast too. I get all the subtle little nuances in conversation, the tricks and hints and whatnot and usually respond to them right away.

Things that I think are odd about Aspergers:

Not wanting to be touched. WTH?

Sensory overload. I don’t really get it, but we introverts have a bit of this. Parties are a bit much for me anymore, but the Aspie sensory overload just seems downright bizarre.

Not wanting to eat something because it’s too mushy or too crunchy? Huh? I eat anything and I don’t care what it feels like in my mouth. Who cares!

Hypersensitivity with hearing, touching, smelling or tasting. Ok that is just weird to me.

Wanting to talk about one thing all the time and not shutting up when you are boring people. I do this too sometimes, but I usually shut up when it seems like people don’t want to hear what I am saying.

Think everyone else is weird. Huh? No way, they are normal.

Takes everything very literally. This makes no sense to me either.

Hates loud unexpected noises like fireworks. Looks like sensory overload to me. I don’t care about fireworks. They are going off around me for the last few days now, and I don’t even care. Someone lit one in the street near the path of my car the other night and it was no big deal, but it was a little weird to drive past the burning, fizzling, crackling thing.

Why would I love one loud sound but hate another. They are all the same to me, just another loud sound. You get used to them sooner or later.

Ten years old and can’t tie your own shoes? Sorry, but you have major, major problems, kid.

Excellent writer but bad at math or great at math but poor at writing. This I can relate to, and I have known many non-Aspies who are like this. Intelligence is variable, and abilities differ even within the individual.

Can’t look someone in the eye. I have been accused of this myself sometimes. A lot of very shy people have problems with eye contact. I have gotten a lot better at this over time, but I still hardly think this is diagnostic because you are going to suck in a lot of introverts. Although I imagine an Aspie might be quite strange about not looking you in the eye to the point where it seems they are just being strange about it as it is so extreme.

As you can see, I obviously do not have Aspergers at all. But believe or not, some folks have insisted that I must have it!

Introversion and Aspergers are not the same thing, but they make both be part of a spectrum.

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Filed under Anxiety Disorders, Asperger's Syndrome, Autism, Mental Illness, OCD, Personality, Psychology, Psychopathology

This is a Gay Website

Repost from the old site.

I have a little secret. Lots of people think that I am gay. It’s actually a problem.

I get a girlfriend, and if she is not a total moron, she asks if I am bisexual. Or if used to be gay. WTF is this “used to gay” BS? Once a homo, always a homo, right gays I mean guys?

If she’s a moron, she asks if I still am.

This is supposed to be some sort of a horribly embarrassing and humiliating thing for me, as my enemies love to use it to attack me. I must suffer sexual confusion. I must indeed.

I never really understood precisely why people think this way, as I have never seen myself on videotape. I consider myself a fairly masculine acting guy, and that’s how I feel deep down inside and that is what I identify with, but hey, I grew up in the 1970’s when everyone was sort of androgynous, and this is how I sort of ended up.

I have a very soft voice and I like to walk in a fluid way. I’m still kind of skinny in a stupid and now 10 pounds overweight and can’t lose an ounce kind of way. I cross my legs sometimes. I call it relaxing, but others call it gay. Can’t a guy kick back and enjoy himself?

Maybe it’s gay relaxing, in which case, dude, I am all fagged out, but that is ok. One thing you can do if it seems like half of the sentient universe thinks you are a fag is to find a nonsentient partner, who are easy to acquire in our inner cities.

Or else you can get an Asian chick. Asian chicks never think you are gay, cuz compared to Asian guys you are probably like Sylvester Stallone. I was in bed with this Asian woman once, and we still had our clothes on but not for long, and she asked, “So, are you feeling lazy today?” It’s true I was, but actually I was totally exhausted and plus I was totally stoned out of my gourd, as what better to do an Asian chick, then to take a couple of massive bong hits and then go to town on her?

As I am one lazy-ass mofo, and anyway truth is we all are, even so-called workaholics (GMAB), but yet I was insulted, yet I should have agreed and bragged about how I was swindling welfare or something equally lumpen and parasitical.

So Asian chicks think I am lazy but they never think I’m queer, except this Vietnamese woman who pointedly told me, “You look like a gay!” Well, that was nice of her, blaming God and all that. Thanks bitch.

It’s true! My face is all fagged out and I have the queerest features around, and let me tell you man, there’s nothing better. You get girls and guys both after you in whole armies sometimes, and it’s good to be loved.

One consequence of the Dang is that dude fagged out or what? thing is HOCD, or homosexual OCD. This is easily the stupidest mental illness on Earth, except they are terrified they are queer even when they are not, and it totally ruins their life over absolutely no damned good reason whatsoever.

So in a way it is a nihilistic sort of mental illness, a mental illness that only Kafka could have invented, an absurd mental illness that has no right to exist at all, kind of like most of us, you know?

I have done therapy with some HOCD sufferers online. It’s an interesting experience, but it’s also terrifying in a stupid way. If you ever got caught up in the straight person worried they are queer illness (Man, this that the lamest mental disease on Earth or what?), I do have some therapies for you.

First of all, admit it. Admit you are queer, take pride
in it and advocate it in everyone around you. If you are really insane, you can even make sexual offers to the males around you. This is fun, because since you are straight (Yeah sure! LOL) you don’t really want to do it.

It’s the ultimate expression of macho to say you’re queer and shout it to the skies. You hope everyone knows it’s a lie, but if not, you were just gay for a day, and that’s always a blast.

If I were comfortable with this, it would be one thing, but really I am not. I don’t like effeminate behavior in men, and I try to stay as far away from gay and bisexual men as I can. I’ve had far too many experiences with regular guys, married guys, on and on, to not be wary. I can’t even count the number of guys who I felt were getting way too friendly with me.

At least 25% of males are bisexual or at least opportunistically gay, except in Afghanistan, where the figure is 50% or more. Male bisexuality is everywhere, especially with omnisexual men in their 20’s, who will do it with anything, even a hole in a melon, I guess (I understand that this is the best sexual experience of all, surpassing anything a man can do with a live male or female).

Second of all, advocate for gay rights, now that you are gay and all that. Imagine that you are driving down the street and there is a billboard that has your name and picture on it and says, “[YOUR NAME] IS GAY!” And it has your photo and everything.

And then the paper comes and your pic is on the front page with a headline about how you are REALLY GAY! And everyone is laughing at you and calling you a fag and all, but that right there is a great reason to party, so just make one. Now when someone asks you to sign your name, you want to lie and write “Gay fag McCoy” and just leave it at that, but for the sake of social peace, you resist the urge.

Anyway, it took me a long time to just figure out that I am what I am. Not only do I dislike effeminate behavior in males; I also dislike wimpy males. Deep down inside, there is a part of me that is as macho as any man that ever lived – a lumberjack, a trucker, a fisherman – you name it, I can play that role. Not only that but it’s really me, it really is, and if you disagree with that, will kill you will no regrets as my inner Viking dictates.

I guess there is another side to me, and that’s ok. I always idolized Mick Jagger, Steve Tyler, the New York Dolls, Mott the Hoople and all the androgynous rock stars of the 1970’s. We all grew up with that, and it’s just normal to be that way.

These dudes dressed up like chicks and even wrote totally fagged out songs, but really they were just a bunch of gangbangers, a White Crips and Bloods, and they never queered around, or not too much anyway, or at least I don’t even care who fagged off and sucked on knobs and who didn’t.

If I could just tell folks, no, I’m straight, thank you very much, and it would be over, that would be ok. But the questions never stop coming, and the doubts never end. I must say it is discouraging, but only because this is such an important question.

A certain type of woman gets asked if she likes women, says, “No, I’m strictly dickly”, and the questions end, but for us guys, the doubts just linger. Is that stupid or what? I mean, bitch, I mean woman, I said I’m straight and that means I’m straight! You either understand that or you get tied to the bed again, is that understood? And you will answer Sir!”

Society must find male homo- and bisexuality much more upsetting than the female kind.

Anyway, as there is nothing I can do about this, and this unfortunate issue with remain with me for life, I assume, I hereby anoint this website an officially gay website. We will just make macho fraternity jokes about fags and stuff, and guys who are bi-queerious, I mean bi-curious, but all the while we won’t even fag off, not even once, and if he’s real cute, we promise. Kind of like a great bachelor pad or frat house.

I must admit that there is a part of me that loves being called gay. It’s just so wrong. I’ve gotten to the point where the best way to deal with it is to laugh uproariously and say, “I LOVE it when people think I am gay!”

Then I dance around the room and do my best gay imitation while hopefully some dudes go, “Whoa! Is this guy really is a queer?”, in their friend’s ear, and that makes it even better, as long as they don’t try to kick your ass or anything.

Then I love to tell gay stories just to freak people out and keep them guessing. Like, “I’m not gay or anything, but I once went to a gay bar and drank 13 Penis Coladas, one after the other. Oh, man were they great!”

But hey, I was young and experimenting and lots of guys do crazy things once or twice, even Hugh Hefner fucked a guy once, and if you call me a queer one more time, I am going to have to seriously kick your ass or maybe even kill you, do I make myself understood?

So it’s time for an obligatory gay post. How about Heroic Homo Sex? I love to talk about this website, because every time I do, everyone starts freaking out and looking at me like, “Shut up you idiot! Are you a FAG or what?” All the more reason to talk about it more and more and not just piss off a few people, but piss off as many people as possible!

Anyway, even if you are not gay, this is a great site. This is a site that deals with homosexuality and masculinity, gay culture and effeminate men, AIDS and the contours of masculinity. The author is gay himself, and the site has quite a bit of gay erotica and pornography. If that freaks you out, you better not go there.

But it’s definitely worth the look. The purpose of the site is to attack several aspects of modern gay life: anal sex and promiscuity. These are gay men who are not into anal sex; they think it is painful, dangerous and degrading.

And they have a fascinating thesis.

The thesis goes like this: Before gay liberation, gay men met and had relationships and engaged in all sorts of sex behaviors. Anal sex was not even that popular, and gay men were not tremendously promiscuous. But with gay liberation, came the normalization of gay anal sex.

According to the various articles linked on the site: the obsession with anal sex has been linked to gay liberation – gay lib mandated anal sex as a substitute for heterosexual intercourse. But the site painstakingly points out that the two types of sex are not the same. A vagina is designed by evolution to take a heavy duty penis-pounding, after all, this is one of its purposes.

It’s hard to damage a vagina, as it has a lot of redundancy in its walls. Hence the vagina is relatively refractory to getting blood-borne diseases like AIDS and Hepatitis C and B. You pretty much need to bleed a bit to get a disease like this, and it’s not so easy to make a vagina bleed. It amazingly accommodates a full-grown baby easily, another of its purposes.

An anus is not like this at all. Evolution designed it for elimination, and it has a very thin wall that is easily damaged, if even slightly, during anal sex. Bottom line: bleeding, even microscopic, usually occurs during anal sex. HIV is transmitted easily this way, as is Hepatitis B.

Furthermore, no one ever talks about this, but the site points out that regular anal sex causes anal leakage and fissures (small tears in the anus). More heavy duty stuff like fisting (that a lot of gays are into) can cause anal incontinence, fistulas and all sorts of nasty stuff. Anal prolapse can occur with years of this sort of sex.

Yet the gay community relentlessly promotes anal sex in gay pornography and even gay medical sites. On the medical sites, gay docs tell you to go ahead and engage in anal sex and don’t seem to steer men away from it.

Heroic Homo Sex feels that anal intercourse is ultimately damaging, if only slightly, to the anuses of gay men. Plus they are repulsed by the whole act.

They also promote a fascinating theory: it is not possible to get fucked, anally or vaginally, without having to play a submissive role. Getting fucked makes a person submissive. So gay sex, or being on the receiving end of it anyway, makes gay men submissive and ultimately effeminate. This because getting fucked is feminizing. Fucking is masculinizing.

Andrea Dworkin tried to say much the same thing about the violence inherent in the normative heterosexual sex act, but she was raked over the coals.

It is rape, dammit! That’s why you need to encourage your female partners to engage their rape fantasies to the fullest, since tons of women love to think about getting raped. So rape and rape and rape away, and make a satisfactory adjustment to married life anyway, as the old Abnormal Psych textbooks used to say.

Women act feminine in part because they get fucked. Men act masculine in part because they fuck. Have you ever noticed that when a woman wants to get fucked, or if you are getting ready to fuck her, she tends to act more and feminine, to the point where she is some kind of a silly Barbie Doll Southern woman thing?

Then in the sex act itself of course, tons of women want and love pain (trust me), as (my theory) being a woman is so painful, so if you’re a woman, you either become a bit of a sub and enjoy life or you are screwed and miserable and all bitched out.

The sex act itself, and the role one plays in it, has carry-over effects into nonsexual life.

The guys at Heroic Homo Sex are some interesting gay men. Not only are they repulsed by anal sex, but they are also sickened by the effeminate behavior of gay men. They propose an alternative: that gay men should become more masculine. As, deep down inside, I love masculine behavior, I have to cheer this on. This is great: there is a positive value in masculinity for any male, even a gay one.

The site is full of images of masculine gay men acting masculine, and it promotes a masculine mindset among the gay men who go there. Hear hear!

What they promote is something called frottage, which is basically two guys more or less rubbing their dicks up against each other. This is often combined with masculine images like wrestling and various forms of martial arts.

I guess there are variations on this theme, but it’s quite safe in terms of VD (a horrific problem with gay men due to the wild homosexuality many of them pursue), and it enables gay men to have sex with each other and at the same time retain a masculine identity.

They take the theorizing a bit further. They suggest in some of their essays that anal sex is inherently degrading in and of itself, at least as it is practiced in the gay community. So not only does anal sex make gay men effeminate, it also degrades them and makes them into “sluts”. This has been a part of gay porn culture too – the promotion of anal sex and rampant promiscuity in gay men.

The two are connected, the website suggests. For a man to get fucked anally turns him effeminate and has the effect of “turning him into a slut”. Gay culture promotes the image of the gay man as slut, whore, pig, prostitute, etc. The use of degrading terms is encouraged. So getting fucked effeminizes men and degrades them, turning them into promiscuous “fuck pigs”.

There is ample support for this theory if one takes the time to peruse gay culture. Check out the gay personals of any gay website, if you dare, and you will see tons of insane and rampant promiscuity along with a lot of dangerous anally-focused sex and the continuous promotion of the gay slut-pig sort of fellow.

Not that I am against slut-pigs at all, but more of them should be female and disease-free. This is my only wish at age 50 where Viagra moments become normative events.

The site goes so far as to term this whole gay degradation and sluttification process as a death cult. With AIDS raging through the gay community, that’s not just idle talk.

Anyway, interesting website from some gay men who are looking to turn gay culture seriously on its head. In the meantime, they are promoting some fascinating theories to explain hard to explain phenomena – theories that at least look good on paper.

And they promote an alternative image of gay men as sexually responsible, disease free, and masculine in a warrior sense. As a straight man who values masculinity in myself and other men, I have to cheer it on.

There are links all through the site leading to variations of their main theoretical issues, and you need to click around to get a feel for their whole worldview.

I sort of still have a “terror of gay stuff” OCD thing, so it’s really therapeutic for me to click through all this totally fagged out stuff, just to flood myself some more.

You cannot run from your fears. They must be embraced, head on, like diving into a swimming pool from a high board with no worries. Then you climb out and do it again and again and soon it’s nothing.

The author of the site is a gay man who went through the whole hippie thing in the 1960’s like a lot of us. His partner and the love of his life had a similar developmental trajectory and later acquired AIDS and died of it. The whole site is sort of a tribute to this man who he obviously still deeply loves. I found this touching in an odd way, though normally gay romance doesn’t do much for me.

Warning! There is lots of gay male erotica and even gay male porn on that site. I don’t mind; I just kind of speed through that stuff as it isn’t very interesting to me and it bothers me on some level. So if you can’t handle that sort of thing, don’t even go there. If you have HOCD, you need to go there, stop everything, hold the horses, not now, yesterday!

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Filed under Anxiety Disorders, Culture, Gender Studies, Health, Homosexuality, Illness, Man World, Mental Illness, Music, OCD, Psychology, Reposts From The Old Site, Rock, Sex

Harm OCD Versus Other Conditions: Differential Diagnosis

A very frequent complaint in OCD patients is thoughts of harm, either harming oneself or others. The general rule is that the person never acts on the thoughts, although this is somewhat controversial. Some say there have been a few cases of OCD sufferers acting on their harm obsessions. It’s just that I have personally never heard of a case.

In addition, as a counselor, I have worked with countless OCD sufferers who have this particular theme over the past eight years as they come to me for help. I haven’t met one person yet who acted on the thoughts nor have I heard of anyone who has, and I have known people who have had this theme for more than 25 years.

However, sometimes sufferers start to commit the act, but they stop before they are able to carry it out.

In one case, a man had an obsession about turning his bicycle either in parked cars and pedestrians. Sometimes he would just start to act on the obsession and turn his bicycle towards the people or cars, but every time he did this, he simply crashed his bike. No one was hurt other than himself.

Generally, people read my articles and simply self-diagnose as OCD with whatever theme they have going. 100% of the people coming to me self-diagnosing as Harm OCD were in fact suffering from that very condition.

What to look for:

Resistance: I would look first and foremost for resistance. Look at how hard the person fights the thought. The harder the person fights the thought, the more likely it is to be an obsession. In fact, I would say that thoughts that are ferociously resisted are always or almost always obsessions.

Resistance to thoughts is not commonly seen in other conditions if it is seen at all. Most persons without OCD simply do not ever try to stop or fight off their thoughts. If you ask them, they will say things like, “I only think things I want to think,” and “I don’t have unwanted thoughts.” So resistance to thoughts in people who do not have OCD is probably not common.

Although it is often said that resistance is a bad sign in OCD as it makes OCD worse, I don’t mind seeing resistance. The reason is that if a person is ferociously resisting and doing so successfully, then first of all, I am quite sure I have a case of OCD so the diagnostic conundrum is over and also I know that the the OCD is simply not that bad yet.

As OCD gets worse and worse, resistance gets harder and harder. I have talked to a number of people who have gotten to the point where the thoughts have simply taken over the person’s mind and are going all the time. They can’t resist them anymore, if they ever could. Inability to resist thoughts or thoughts that have completely taken over is a sign of a more serious case.

Ego-dystonic: The person hates the thoughts, or at least it seems as if a large part of the person hates the thoughts. The new theory is that the entire self hates the thoughts and that no part of a person wants an obsession, but this is a bit controversial. Nevertheless, this is what I believe. One  hears OCD sufferers say things like, “I hate this with every fiber of my being.” That’s a good sign when they can think like that. As the condition worsens, the person gets more and more confused about whether they like the thoughts or not or want to get rid of them or not.

In an advanced case of Harm OCD, the person will feel evil and it will seem as if they like the thoughts and do not want to get rid of them. This can cause diagnostic confusion. Feeling evil, feeling like they like the thoughts and feeling like they don’t want them to go away are all aspects of advanced Harm OCD. The key here is ego-dystonicity. These feelings cause alarm and profound anxiety in the person as they feel that they are turning evil against their will or that they are becoming something that is in opposition to their true self.

Ego-alien: The person is often confused as to why they are even thinking these thoughts. One  hears such things as, “I have thought a million times, why the Hell would I even think of this stuff even one time, ever?…I love my mother/father/husband/wife, etc. so why am I thinking about killing them?” If you ask the Harm OCD sufferer if they feel angry, they will usually say that they don’t. The person is often frankly mystified why they are even having these feelings in the first place.

Another part of the ego-alien aspect is that the person feels that the thoughts are not even really their own. They know that the thoughts are just thoughts and they know that the thoughts are coming only from themselves and not from an outside entity, but nevertheless the thoughts are so alien to the person’s identity that they often seem like they are not the person’s own thoughts.

The person’s inner voice can become split into a “sane voice” and an “OCD voice.” The OCD voice can sometimes sound like it is someone’s else’s voice other than the person’s own inner voice. Really it is just the person’s inner voice morphing into a new form. This experience is so alarming that the person often fears that they are going psychotic.

Thoughts go against the person’s morals: This is the reason for all of the distress, resistance, anxiety and alarm. The thought of hurting or killing random others or loved ones or certainly people one is not angry at all with seems profoundly wrong on at least some level to the Harm OCD sufferer because typically deep down inside the person with this theme is paradoxically enough, an extremely moral person.

And oddly enough, they are often remarkably passive and non-violent. This clashing of one’s morals is what engenders the strong resistance, discomfort, anxiety, worry, and alarm.

Differential diagnosis: There are apparently quite a few people with ego-syntonic fantasies of hurting and killing other people. Sometimes it is someone they hate, and sometimes it is anyone in general, women in general, or some particular ethnicity, race or religion in general. The major problem with thoughts of harming others is that the people who are never going to do it are often the main or only ones who show up clinically.

That is, often the only people showing up inn therapy are the Harm OCD sufferers or in other words, the only people who show up for therapy are the people who are never going to commit these acts.

The people who are really thinking seriously about hurting or killing other people or who like to think about such things it and are not bothered by these thoughts, feelings, urges or plans, and they simply do not seek help. This is a real problem: truly violent people generally simply do not show up clinically asking for help to try to stop acting on their violent urges. It would be nice if they did, but they just do not.

These people are variable. Some go through life choosing to think these violent thoughts, and sometimes it is just a phase that they give up at some point. This is often seen in an  adolescent male. In some cases of course, they act on the thoughts of harming others, and these are the people you read about in the papers.

But in many other cases, they never act on the thoughts and can go years, decades or a lifetime with frequent thoughts of harming others that are never acted on even once. For every one person running around being a serial killer, there are probably 100 more  who dream of such things but due to various controls or fears, they are able to avoid acting on their fantasies. People have more control than we think. Nobody has to do anything.

Sociopathy: This is not OCD. Sociopathy develops in childhood and adolescence and is generally a long-standing problem. A non-sociopathic person simply cannot turn into a sociopath in adulthood de novo; it’s not possible. If you’re not a sociopath by age 18, you will never be one.

An informal survey of sociopaths on an Internet forum for sociopaths revealed that most to all sociopaths said that they enjoyed thinking about harming others. A typical comment was: “Thinking about hurting or killing people is one of the few things that I actually enjoy thinking about.”

So we see that most sociopaths take great pleasure in thinking about hurting or killing people. They think about it whenever they want to. If they want to think about it, they do, and if they don’t want to think about it, they don’t. The harm thoughts are ego-syntonic. They don’t feel bad about having these sorts of thoughts. Thinking about these things is simply their idea of a good time.

Unfortunately, most sociopaths never show up in a clinician’s office. Just thinking about something is fortunately not grounds for hospitalizing someone. Anyone can fantasize about being any kind of criminal that they want to be. As long at they don’t do anything, there’s nothing that the law or psychiatry can do.

Lack of guilt: You will sometimes run across people who have violent fantasies about people they hate. This is not OCD. They will often tell you that they are not going to act on the thoughts, but the fantasies sounds like a good idea since they hate the person so much. They do not feel guilty about these thoughts; instead they enjoy them. The thoughts are not resisted. A famous psychiatrist said, “A homicidal fantasy a day keeps the psychiatrist away.”

In more florid cases such as Borderline Personality Disorder or Bipolar Disorder, the person is making overt threats and seems to be capable of carrying them out. They generally don’t act on the threat, at least not homicidally, although they often commit minor acts of impersonal violence, damage property, and are generally menacing. Obviously in some cases they do commit acts of serious violence thought. But in my experience, the overwhelming majority of homicidal threats are simply empty threats.

Nevertheless, if presented clinically, this is cause for alarm, and in the US, under the Tarsakoff Rule, persons making homicidal threats can be hospitalized for making specific threats towards a specific person. In other words, in the US, if a person says, “I feel like killing people,” there is no grounds for commitment. There’s nothing to act on.

But in the US, if a person is making a specific threat towards a certain known individual that seems to be a credible threat, clinicians have to notify the person being threatened, and the person making the threats may be legally involuntarily hospitalized, although in many cases, they are not committed, or if they are, it is only for the 1-3 day minimum.

Note that it is very hard if not impossible to determine in a clinical setting exactly who is dangerous and who is not.

Potential serial killer stopped: A recent case history along these lines in a journal is instructive. A man had Bipolar Disorder. At some point in the disorder, he developed elaborate fantasies of being a serial killer. He had assembled a very fancy murder kit, including all the implements he might need. He also had a list of ~20 people he was going to kill. He had been following and observing them for some time and had taken precise notes on many aspects of their locations, travels, and behavior. He had notebooks with elaborate plans on how he planned to kill these people.

It’s not known how or why he revealed this in therapy, but he did. The threat was considered credible enough to be actionable. He was hospitalized for 1.5 years in an institution in which he underwent intensive therapy and was given medication. At the end of the period, his fantasies and desires to be a serial killer had been completely eliminated.

The team said this was a very unusual case of successful intervention. They noted that he was not a sociopath, and this was probably the only reason that he volunteered his plans in therapy and was able to renounce and be alleviated of his desires, and return to society as a healthy member. The man had some ambivalence about his plans, and this was due to his not being a sociopath.

This was not a case of OCD.

He enjoyed his elaborate plans, had been planning them for some time, had assembled kits and stalked potential victims and had elaborate, pleasurable, long-standing and ego-syntonic fantasies about homicide which were not resisted.

A person with Harm OCD will never assemble a murder kit, write down elaborate plans for how they are going to kill people, stalk potential victims or even carry weapons. The overwhelming emotion in Harm OCD is fear, and the tremendous fear will prevent them from doing any of those things.

Harm OCD sufferers often go to great lengths to keep from acting on their thoughts. Some “disarmed” themselves before they went to see another person. They would remove all “potential weapons” from their person so they could not use them to attack the person they were with. They would also   “disarm their vehicle” when another person was getting into it. They would take all potential weapons and hide them under the seat of the car so they would not use them to attack the person.

Sexual sadism: Sexual sadism is a paraphilia that almost always develops in its strong form in childhood or adolescence. The person’s preferred means of arousal involves hurting, humiliating, degrading, insulting and abusing an other person. These are people who like to hurt other people. They get off on it sexually.

A very large number of serial killers are sexual sadists. They kill in order to get off sexually. Their masturbatory fantasies since childhood or adolescence have typically involved sadism, torture or even homicide.

It is very common for serial killers to have a history of kinky sex with their wives or lovers. The kinky sex usually involved bondage, discipline, sadism and masochism.

In addition, the severe sexual sadist may have an erotic arousal to images of women who are either dead or appear to be dead. These people, typically men, collect photos of dead bodies or women who appear to be dead.

Unfortunately, sexual sadism tends to escalate over time. There have been cases of serial killers or murderers who could only orgasm if they were pretending to strangle their wives.

A rather typical case might look like this:

A gay man with sexual sadism presents for therapy. Sadism is extremely common in the gay community. His sadistic activities have been slowly escalating over time. The last time he had sex, he burned a man with cigarettes. He got so excited that he wanted to kill the man, and he had to restrain himself from doing that. He presented to therapy thinking he was out of control. He was afraid he would kill the next man he had sex with.

This is not OCD. Fantasies in paraphilias such as sexual sadism are typically very pleasurable. The thoughts, images, feelings and urges are either seldom or never resisted. So what we look for her is an ego-syntonic syndrome with a lack of resistance. In addition, we are looking for strong sadistic sexual fantasies, typically dating from an early age, that are powerfully arousing. Such fantasies will be absent in Harm OCD.

The potentially confusing aspect of paraphilias and OCD is that while the paraphilia gives the person a great deal of sexual pleasure, and they often spend a lot of time masturbating to the paraphilic fantasies, it is rather common for them to feel strong guilt after they have an orgasm and the excitement fades. Alternately they can feel a lot of guilt about the paraphilia itself as in the case of exhibitionism, voyeurism or body part fetishes.

What is going on here is something like an addiction. Paraphilias look like addictions to drugs, alcohol, gambling or pornography. The paraphilic “addict” loves his paraphilic “high” and often feels out of control with wild pleasure almost like a roller coaster ride when they are caught up in the high of the addiction. They often describe themselves as feeling out of control in this phase.

When the drug run is over or the addict wakes up with a hangover or an empty wallet at the casino or drug party, there is a crash in which the addict feels terrible that they are so powerless over their addiction. They also feel guilty and pained that they are suffering the aftereffects of the addiction. Feelings of self-loathing are common in this phase.

However, in some very bad cases of Harm OCD, violent and sadistic thoughts about torture, murder, cannibalism etc. intrude quite often during masturbation or possibly sex. This is not sexual sadism; it is OCD. This is relatively common in Harm OCD, and the sufferers often describe it as being  extremely unpleasant. The difference here is the intrusive nature of the thoughts which are generally not present in sexual sadism, where instead of being intrusive and resisted, the thoughts are pleasant and welcomed.

On occasion, a sociopath or potential serial killer will present to someone or other, more often law enforcement than a clinician. Usually they present only once and then go away. Possibly years later, they may begin killing. In one case, one of the prime suspects for the possible Smiley Face Killer Gang presented to a police station about powerful urges to drown young men. He was afraid he was out of control, and he was going to act on them. The police could do nothing to retain him.

This is not a case of OCD.

This is a sociopathic person who simply feels out of control.

In a case in the UK, a serial killer gave a warning years before killing that he felt he was out of control and was afraid he was going to kill someone.

Once again, this is not OCD.

It’s another sociopath who fears they are losing control. This person will be having strong, long-standing ego-syntonic fantasies of homicide which are not resisted. They are pleasurable to the person, but they do not want to act on them, probably due to fear of going to prison. Over time, homicidal fantasies may become stronger so that the capacity to resist putting them into action becomes more difficult. This is what happens when these people fear they are losing control.

In short, a diagnosis of Harm OCD is relatively straightforward and should prevent few problems.

What we are looking at here is the difference between problems of fear and problems of desire. OCD is a problem of fear. These other problems are problems of desire.

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Filed under Anxiety Disorders, Borderline, Crime, Mental Illness, Mood Disorders, OCD, Personality Disorders, Psychology, Psychopathology, Psychotherapy, Serial Killers, Sex, Sociopathy