Category Archives: Sociopathy

Psychologists Say Trump Is Severely Mentally Ill

Well, we knew that.

The particular illness he has s called Malignant Narcissism. Although it is not in the DSM and has never even been proposed, it has a theoretical long history in psychiatry. Karen Horney did some of the best early descriptive work on it, and Otto Kernberg added to that with a superb monograph in 1984. Unfortunately, most of the writing about this disorder is coming out of the psychoanalytic community, where dubious theory is common.

Think of narcissism as self-esteem. They are the same thing, and don’t let anyone tell you otherwise. Almost all human beings are narcissistic, and narcissism is an essential part of the makeup of any healthy human. However, as with most things, even water, you can have too much of a good thing.

Narcissism, like most things in abnormal psychology (or for that matter, on Earth), exists on a continuum.

At the far left, we have low narcissism, which could be seen as low self-esteem. This is not a good condition, but it is very hard to fix once it gets set in.

Healthy narcissism is the sort of thing that most people have.

High narcissism is better seen as high self-esteem and it is generally regarded as a sign of good mental health. Some people might find these people a bit too much, and some people refer to them as vain, conceited, or self-impressed. At worst, they can be arrogant, condescending, and cocky and they can wear out their welcome after a bit. However, if the downside of the feeling (arrogance, condescension and cockiness) are played down, high self-esteem does not generally get too much in the way of functioning well as a human being. In addition, many of these people retain a lot of empathy for others,  but as they tend towards arrogance and cockiness, they can start to seem unempathetic.

Beyond that, we move into the toxic zone of Narcissistic Personality Disorder, which may also exist on a continuum of mild NPD, moderate NPD and serious NPD. If you told the first two that they had NPD, they would laugh in your face and turn it into an attack on you. The latter may well recognize that they have this condition, but they don’t care that they do, or else they like it.

Beyond NPD, we move into the area of Malignant Narcissism. This is a poorly understood construct, but I believe that it does exist and should be in the DSM. This could be seen as narcissism heading off into psychopathy. They are sometimes called Narcissistic Sociopaths.

A lot of people think that narcissism and psychopathy are on the same spectrum , as the sociopath is the ultimate narcissist. In a way he is, but it is in an odd way. To the narcissist, other humans exist, but he just doesn’t care about them.

For the sociopath, in a sense, the sociopath is the only person in the whole world. Not only does the world revolve around them but even worse, the world is them and they are the world. Other humans don’t exist as such. They exist in a way, but they are not really human. Instead, other humans are like the hammers and screwdrivers in your tool chest. Sure, they come in handy sometimes, but they’re not exactly alive. And I can take that hammer or screwdriver and do whatever I want to with it. I can throw it away, set it on fire, throw it in a river, or smash it to pieces. Which is about how a sociopath sees you – as a handy tool that is about as alive as a rock which can be destroyed or tossed aside if he desires to without any more of a thought as you would give to tossing away any nonliving thing.

Here is a good schematic on the Narcissistic continuum:

Low Narcissism (Low Self Esteem) -> Healthy Narcissism -> High Narcissism (High Self Esteem) -> Mild Narcissistic Personality Disorder (NPD) – Moderate NPD – Serious NPD -> Malignant Narcissism -> Various degrees of sociopathy and psychopathy ranging from 20-40 on Hare’s Psychopathy Scale

They kept saying Trump had NPD, but I always wondered about that. I have met a few NPD’s in my life, and I have known at least one quite well. Sure, they are insufferable, and they can be serious jerks, but they didn’t seem to have the same level of crazy as Trump. I kept thinking, “Well, severe NPD is a pretty nasty illness,and they can seem pretty nuts,” but I was unsure about that statement.

And now it all makes sense. The reason he seemed so extreme for an NPD is because he is not an NPD at all.

Instead, he is something considerably worse, a Malignant Narcissist. It is separate disorder from NPD, past NPD on the road to sociopathy. But I do not understand this illness well, and it has never been in the DSM, though it ought to be.

NPD’s can definitely be dangerous, but in general they are too obsessed with their wonderful greatness and their superb lives to commit serious violence and risk imprisonment. They also might not want to hurt their glorious public image.

The one thing you need to know about Malignant Narcissists is that they are dangerous. Now that doesn’t mean that they are ever going to do anything truly bad, and they may go through their whole lives without spending an hour in jail. But the potential for some serious bad behavior all the way up to serial murder is there.

To give you an example of how dangerous a Malignant Narcissist can be, Ted Bundy was a malignant narcissist.

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Donald Trump: DSM Diagnosis – Axis 2: Narcissistic Personality Disorder (Severe), Prognosis – Grave

Whitedawg: I was kind of wondering, commenting about the personality traits/qualities of regular everyday people or elected officials, more so than Teddy. There is little doubt Ted crossed a lot of lines.

But it’s not so evident to most that President-elect Trump may have some serious problems that can influence his decision making and tweeting. Many people know non-serial killing psychopaths, sociopaths, and malignant narcissists. And some of those traits are looked at as positive.

Whitedawg, I am not sure if Trump is a Malignant Narcissist. However, a lot of people think Trump seems crazy. He seems very nuts or off to me too. The answer to the question is that Trump is indeed seriously nuts. He has a personality disorder. He has a serious or severe case of Narcissistic Personality Disorder. Some say it has gone over to Narcissistic Sociopath (not sure what that is) or Malignant Narcissism. I am not sure myself. Narcissistic Sociopath would not be a bad description of Mr. Trump.

If any of you ever wanted to know what a serious case of NPD looks like, study Mr. Trump good and hard. He’s a textbook case X 10.

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Can Ted Bundy’s Crimes Be Blamed on Porn?

Jason Y: It sort of reminds me of happened to Ted Bundy in the 70’s, an otherwise, well-liked pretty boy who had been driven insane by something, some have claimed it was a BDSM porn addiction.

That is just an excuse. There was something wrong with that boy from Day One I am afraid. His home environment was horrible. His adoptive father was a cruel, wicked man who beat the family pets and hated Jews and Blacks, who he often went on tirades against. He was a real terror.

At age three, one of Ted’s aunt’s was visiting. She lay down to go to sleep in the bedroom, and when she woke up, there was little three-year-old Ted standing at the foot of the bed with an evil smile on his face. He had taken 10-15 knives from the kitchen and had arranged them all around her sleeping body with the blades pointed towards her. This guy was a Bad Seed, probably a born incurable psychopath.

Ted probably committed his first murder at age 14. He was working as a paperboy when an 8 year old girl disappeared right from his own neighborhood. He was friends with her, she had been over at his house before, and she had been seen over at his house at night in the few weeks before the killing. She had been abducted from her bedroom via a bedroom window. Tennis shoe marks were found below the window sill.  The size matches Ted’s shoe size.

The girl was never seen again. There was construction work going on at a nearby community college, and a large pit had been dug there. Ted was seen at the site of that construction pit watching over the workers two days after the disappearance. He had an evil little smile on his face.

Many years later, a native American woman complained that when she was near the school library, she often heard the horrible screams of a young girl. She kept making these complaints. At some point, an area near the library was excavated for some reason. The girl’s body was found buried there, many years after her disappearance.

Before Ted committed his first known murder, he made a couple of trips back to visit relatives on the East Coast near Maryland. He stayed there for a few weeks each time. During one or both visits, young women were raped and murdered near where Ted was visiting, say within 50-100 miles. The young women were college-aged. So Ted is suspected of 2-4 murders on the East Coast while he was still a university undergrad. All of these women were killed during the precise few-week periods when Ted was visiting the area. I believe that Ted killed these women.

Ted never fessed up to these killings, though he did admit to 36 murders. However, in privileged conversations with his attorney, the lawyer once asked Ted how many murders he had been responsible for. The lawyer threw out a figure of around 30. Ted smiled and said, “Add another figure to that.” This implies that Ted said he was responsible for over 100 murders. Since his execution, no new murders have been added to the 36 he is already suspected of, although there are quite a few cases of rapes and murders of young women near the various areas where Ted was living over the years.

Ted used to leave the bodies on rugged mountains. He would then go back to these kill sites and visit the bodies in the days after the killings. He would lie next to the bodies, put makeup and lipstick on the girls’ faces and have sex with the dead bodies, even days after the girls had died. He took a skull of one of the young women that he killed and hid it in his fireplace for a long time.

Ted’s victims often showed bite marks, typically very deep bite marks on the breasts. Ted seemed to go into some sort of a wild animal-like frenzy when he killed, beating the women to a bloody mess with clubs and tearing at their flesh around their breasts like a wild predatory animal, which is basically what he was. It takes a lot more than some exposure to “porn” to create such a depraved beast of a man. In fact, such monsters are probably more born than created.

Authorities long suspected Ted of having committed that first murder when he was 14 years old, and they tried many times to get him to fess up to it. But Ted always turned rigid and defensive whenever that case was brought up. Even the worst criminals have a hierarchy of evil. Some things are beyond the pale even for them.

Ted did not mind at all being thought of as the killer of beautiful young college-aged women, often with long brunette hair like his former girlfriend who broke up with him and broke his heart. He seemed to take some sort of pride in being a rapist and killer of beautiful young coed types.

He even went so far as to confess to the rape and murder of a 12 year old girl in Florida, one of the crimes that earned him the death penalty. The girl had been so savagely attacked that parts of her flesh had been actually ripped out with Ted’s teeth as he did his human predator frenzy routine on her. But a 12-year-old girl is on the edge of puberty, so she could seem to be heading towards a woman. And he got caught for that crime, and there was little he could do but confess.

Ted Bundy was a malignant narcissist or narcissistic sociopath like our current President-Elect Donald Trump, and indeed, Mr. Trump reminds me of Bundy in some ways. Malignant narcissism is where narcissism has gone clear over into sociopathy. The two problems are similar, and there is a lot of overlap. Most narcissists are a bit sociopathic, but the sociopathy usually stays rather limited because as sociopathy increases, your chances of success in life start to diminish, and the narcissist is all about being successful and especially being seen as successful in the face of others. Narcissists would probably like to do a lot more bad things than they actually do but are stopped due to the consequences, which they are painfully aware of.

Sociopaths on the other hand could care less what anyone thinks of them. They think they are the center of the world or perhaps that they are the only people who exist at all. Others are not even really humans to them but are seen more as objects like the tools in your toolbox that you can use for whatever purpose you wish or even destroy or throw away if you are so inclined.

In Malignant Narcissism, the narcissism has gone all the way over into sociopathy and you have what is for all intents and purposes a sociopath. And malignant narcissists can be pretty bad sociopaths. Bundy is not the only serial killer with Malignant Narcissism. However, in Malignant Narcissism, the sociopath craves the attention of others which he eagerly seeks out. He is very attentive to the opinions of others. Negative opinions can be devastating, and positive opinions can serve as sources of narcissistic supply.

Yes, Ted was extremely vain and also susceptible to the negative views of others. While being a coed killer might be just fine for Ted, there is little worse than a child killer. I suspect that Ted’s massive ego simply could not handle the blow to it that would have occurred once Ted got labeled a child killer. Ted could see himself as some heroic coed slayer, but no one likes a child killer. There is no criminal so reviled or despised. There is nothing even possibly heroic or noble in killing a little child, even for a man as depraved as Ted Bundy.

Based on Ted’s history, I would say that porn played little role in his development. Obviously Ted developed the BDSM fantasies of a severe sexual sadist early on in life somehow, maybe as early as age three. The “porn” Ted references is not even pornography. Ted liked to read and apparently masturbate to detective magazines. I am not sure if these are still around, but they used to be when I was younger. There were often many photos of rigged-up crime scenes with masked men holding knives or guns to struggling, captive, and often bound and gagged women. There’s nothing erotic there unless you get off on violent rape or even murder. Ted was already set up that way anyway, but the images in detective magazines simply fueled his pre-existing tendencies.

There was no porn problem with Ted Bundy. The porn thing was just made up by Ted the narcissist to attempt to take the blame away from his crimes and make his crimes the fault of something other himself. Of course narcissists are rarely wrong, and everything is the fault of some other person or entity. “Detective magazine porn made me do it” is just Ted’s narcissistic way of saying that all those murders were not really his fault.

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When a Psychopath Enters Your Life…

She’s in Parties writes about the difficulty of diagnosing psychopaths:

You don’t notice them until the damage has been done.

I am afraid that’s about it.

Over and over again, reading stories of those who have seen the damage of the psychopath up close and personal, you see a tale that looks something like this:

A psychopath is like this charming tornado that doesn’t even seem like a tornado that worms its way into your life, whirls you around and about in what you think is a dance but is really a shakedown and a beating and then quickly whirls away, never to be seen again.

You are left dazed and surrounded by destruction, and it finally occurs to you that a massive tornado just hit you, but it somehow hit so fast or sneakily that you did not even realize it until after it was gone. You are standing there, dazed amidst the ruins, wondering what hit you. You look outside at the shadow of the human Trickster/Twister worming and shapeshifting its way towards the horizon.

“What the Hell was that?” you wonder.

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Psychopathy Is Hard To Diagnose

Justin writes:

How would you distinguish between someone with a massive chip on the shoulder and an annoying obsession with one idea, it can be any idea, as opposed to some sociopathic, or is it the same thing?

For instance, I told you all about the smart homophobic racist college graduate Trump supporter who, when being around him, you get the impression somebody molested him at some point, lol.

Psychopathy or sociopathy is one of the hardest conditions of all to diagnose, and I work in mental health. Even Hare says he has met sociopaths who he saw every day and it took him up to 6 months-1 year to figure out that they were psychopaths, and Hare is the world’s leading expert on the subject.

I asked my last therapist whether a good psychopath could fool him, and he said no. But then he thought a bit and said, “Some of them are pretty slick, let’s put it that way.” He then said then he often could not spot the right away, but given enough time, he could spot one for sure. He also said that he had dealt with many sociopaths in his career and that they were completely hopeless and incurable. He was a Clinical Psychologist with a 160 IQ, and he was one of the smartest men I have ever met. He was also a superb clinician.

I have been studying psychopaths for decades, and I still do not understand them. If you want to understand psychopaths, study the condition. Study it as much as you wish – the more the better. After a while, you may well meet a few people in real life who resemble the folks you have been studying.

In response to the question, the terms insufferable asshole, scumbag, piece of crap, lowlife, dirtbag, lousy person, amoral prick and even criminal are not the synonyms for the word psychopath. Sure, sociopaths are usually very lousy human beings who can typically be characterized as above, but not all lousy people and POS’s are sociopaths! A sociopath is a particular sort of scumbag, and they are a lot different than your ordinary dickwad.

There is also a difference between sociopathic behavior and being an actual sociopath. Many high positions in business and politics nearly require you to behave like a sociopath. However, the people forced to behave that way may or may not be sociopaths. I do not think Obama is a sociopath because, while of course he acts like one (you have to act like a psychopath to be President of the US), I get the feeling that he resents being forced to act like a dick, and he also feels guilty about it.

He also seems to be rebelling against a lot of the more sociopathic policies that his aides and agencies are always pushing him into. I feel the same way about Joe Biden. Biden actaully feels bad at being forced to act like a monster.

But John Kerry and Hillary Clinton really scare me. I have long thought that Kerry is sociopathic and I started thinking that about Hillary as well. Many of the new neoconservatives seem sociopathic and in fact, one can argue that neoconservatism in and of itself is a sociopathic philosophy.

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Leo Strauss and the Neoconservatives

Quite of a few of the most prominent neoconservatives struck me as as sociopathic. In fact, their hero, Leo Strauss, seemed like a psychopath himself to me. Strauss supported the Nazi regime until it started to go after the Jews. What most do not know is that many German Jews were incipient Nazis and they supported the Nazis until they went after their own kind.

Some of Strauss’ most famous works were written almost like crossword puzzles. They were supposedly analyses of Plato or other major philosophers, but they were written in this sort of “code” in which there was another, usually sinister, reading deep down inside. The Straussians were a cult of grad students and later professors who formed a Straussian “cult” whereby they were the “keepers of the Straussian flame” who had “access to the sacred Straussian texts,” and so were in a sense in on a big secret known only to themselves. Almost like Masons with their secret handshakes.

Strauss of course was a Jew, and many of the Straussians were Jews. Paul Wolfowitz was a prominent Straussian. Straussians are at heart nasty, fascist-like people who believe like Nazis that “the masses are asses,” are too stupid to govern themselves and therefore must be led by an aristocratic ruling class. Straussians are quite clear that the aristocrats must rule the peons (you, me and everyone not an aristocrat). Hannah Arendt, another much more humanistic Jewish philosopher, famously took Strauss to task over his views and more or less accused him of promoting fascism.

Along the same lines, Straussianism can be summed up as “the strong must rule the weak,” because the masses, in addition to being idiots, are also weak people. Society can only be ruled by the strong and not by the weak. If the weak rule, moral rot sets in along with cultural decay and what Straussians would call “too much democracy,” which is synonymous with the lack of aristocratic rule.

Straussians actually believe that the aristocratic rulers of society must start wars every now and then in order to keep the people strong-minded and to keep weakness and moral rot from setting in. They also believe that the people must be distracted with “bread and circuses” which the masses, being weak-minded idiots, will of course fall for, which will leave the aristocratic rulers of society to do as they please. In these senses, especially in the democracy causing weakness and moral rot and the need to start wars now and again to prevent this, Strauss resembles modern European philosophers like Kojeve.

Straussians also believe in “the necessity of the lie.” This is dressed up in moral clothing by calling it “the necessity of the noble lie,” but if you see the sort of things that Straussians push for, it’s clear that a lot of the lies that they tell are not so noble. Aristocrats love to dress up their self-serving and anti-Democratic policies in moral language because it makes them feel better about what they are doing, and it makes their program go down easier with the masses.

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Psychopathy/Sociopathy

Enoch writes:

Robert, you seem to be very knowledgeable on sociopathy/psychopathy.

While most people would turn crazy if they are isolated from people during a long period of time, do you think a psychopath would not (since he see peoples as objects)?

What famous people (excluding serial killers) do you think are true psychopaths?

Do you met people you think were psychopaths in real life ?

Would you consider yourself above or below average in psychopathy?

One by one.

While most people would turn crazy if they are isolated from people during a long period of time, do you think a psychopath would not (since he see peoples as objects)?

Hard to say, but I suppose they would be ok with it.

What famous people (excluding serial killers) do you think are true psychopaths?

See separate post. Clinicians now agree that Hitler was definitely a diagnosed sociopath. George Bush? I almost think most major politicians are, or at least they act like sociopaths. You have to behave like a sociopath in order to hold high office in many countries. If you don’t act that way, you can’t do the job. Lately I think Hillary Clinton and John Kerry are acting very sociopathic. Kerry especially worries me with his Vietnam record. Kerry definitely acts like a psychopath, but everyone who is a Secretary of State for the US has to act like one. It goes with the territory.

Do you met people you think were psychopaths in real life?

I am not sure. I met a fellow recently who was the most sociopathic person I have ever known, let’s put it that way. He was so sociopathic that I was actually stunned because I had never seen one that bad before. Sociopathy is a continuum ranging from 0-40 on a Psychopathy Scale, and this fellow was pretty sociopathic. Whether he was an actual sociopath (whatever that means) I do not know, but he may well have been. He’s a gang member. I used to let him into my house. I turned my back on him, and he stole an Indian knife from Guatemala from my home. It was worth $175. He is Cuban, part Black, sort of a mulatto.

I met a local Black man who was a pimp a few years back. One of the smarmiest people I have ever met. I definitely got a sociopathic vibe off of him.

My brother’s best friend had a girlfriend who seemed like a sociopathic female, but I do not understand sociopathic women at all. They definitely don’t make sense.

There was another longtime friend who was pretty high in sociopathy. He is out of my life finally, and I am so grateful.

I know a lot of people who act bad and are basically ratfucks, scumbags and lowlifes, but whether they are actually sociopathic or not, I have no idea. The idea that every ratfuck bastard out there is a sociopath strikes me as wrong. There is so much more to it than that.

I do not understand these people, and I do not know how to identify them either. It’s so hard to tell who they are. I wish I could know who they were so I could identify them and study them. The disorder frankly makes no sense to me. I have been studying them for years now and they still don’t make sense. I simply cannot understand how anyone could think that way. I honestly don’t get it. I think the only way you can understand them is maybe to be one.

Would you consider yourself above or below average in psychopathy?

I would think I am below average, or I would hope I was anyway. I have often worried that I was one, but of course no true sociopath would ever worry about such a thing. I surely had not developed signs of it by age ~18, and if you don’t have it by then, you will probably never get it. Psychopathy is one of those early-onset conditions that nearly always appears first in childhood. If you make it to age 18 and do not have it, you will probably never develop it.

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List of Famous Sociopaths

Enoch writes:

Robert, you seem to be very knowledgeable on sociopathy/psychopathy.

What famous people (excluding serial killers) do you think are true psychopaths?

Are or were?

Here is my list. Feel free to comment.

  1. Hitler (diagnosed)
  2. LBJ
  3. Max Hardcore (surely)
  4. Kenneth Lay (definitely)
  5. Tom Cruise (also very narcissistic)
  6. Robert Blake
  7. Suge Knight
  8. Bris Brown
  9. 50 Cent
  10. Harvey Weinstein
  11. Phil Spector
  12. Christian Bale
  13. Courtney Love (also a narcissist with Borderline Personality Disorder)
  14. Khan Tusion
  15. Steve Jobs
  16. Ted Cruz
  17. Ray Sharkey
  18. Naomi Campbell
  19. Saddam Hussein
  20. Dick Cheney
  21. Rupert Murdoch
  22. Ayn Rand
  23. L. Ron Hubbard
  24. Fred Phelps
  25. Mitch McConnell
  26. Grover Norquist
  27. Rush Limbaugh (also a narcissist)
  28. Bill O’Reilly (also narcissist)
  29. Dick Fuld
  30. Chris Brown
  31. Mitt Romney
  32. Bernie Madoff (certainly)
  33. Jeff Skilling
  34. Aretha Franklin
  35. Joe Jackson
  36. Eddie Nash
  37. Alan Dershowitz
  38. Mark Wahlberg
  39. Jimmy Saville (very much so)
  40. Al Dunlap (surely)

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Sly and the Family Stone, “Everybody Is a Star”

That’s Sly and his brother and sister Freddy and Rose along with Larry Graham on vocals. Cynthia Robinson was playing trumpet. She’s one of the greatest female trumpeters ever. She died only 6 weeks ago on November 23, 2015. You will be missed Cynthia!

Everybody is a star.
Who could rain chases the dust away.
Everybody wants to shine.
Who will come out on a cloudy day?

‘Tis the sun that loves you ’round.
When the system tries to bring you down.
Every had to shine at night.
You don’t need darkness to do what you think is right.

Everybody is a star.
I can feel it when you shine on me.
I love you for who you are.
Not the one you feel you need to be.

Ever catch a falling star?
Ain’t no stopping ’til it’s in the ground.
Everybody is a star.
One big circle goin’ round and round.

Shine, shine, shine, shine.

We are all narcissists now!

Honestly, I think Sly was onto something here. Narcissism is present in most every single human being. It’s just a question of degree – of how narcissistic you are. There are normal healthy levels of narcissism, and then as it gets more extreme, narcissism gets more and more unhealthy. At the far end of the spectrum, it merges with sociopathy in malignant narcissism to the point where it is hard to tell the narcissist from the sociopath. Now we are at the monsters like Ted Bundy, one of the most famous malignant narcissists of all time.

But unhealthy levels of narcissism are all tied up with sociopathy anyway, as the two conditions have a lot in common and are somewhat similar. All of the Cluster B personalities tend to merge and overlap into something like “Total Asshole Disorder”, “Complete Psycho Disorder”, “Get the Hell Away from Me, You Monster Disorder”, etc.

These Cluster B types have what is known as “high conflict personalities.” Everywhere they go in life, they leave a tornado-like swath of chaos and destruction to varying degrees. Why? Because that’s what they do. That’s what Cluster B people are like – this is their basic style of living.

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Harm OCD Versus Other Conditions: Differential Diagnosis

This is a repost of a very popular post of mine on psychology. It just received a massive update and major changes have been made. It is offered here in case you did not read it the first time and are interested in the subject.

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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