Harm OCD sufferers spend a great deal of time trying to (dis)prove their “closeted lunacy.” As a group, they rely on a set of identical tactics that are equally ineffective in treating OCD. These tactics fall under the umbrella term of compulsions. Compulsions consist of repetitive behaviors that are used to ward off anxiety. The OCD sufferer performs them under the naive assumption that they will provide long-term relief. In reality, they provide intermittent relief while sustaining the OCD in the long haul.
The Psychobiological Explanation
The primitive parts of the brain responsible for basic learning interpret compulsions to be favorable behavior. Compulsions act as a form of negative reinforcement, wherein something unpleasant (the anxiety) is removed from the environment as a consequence of the behavior. Therefore, it becomes an automatic response to repeat the behavior in face of similar circumstances. This becomes a problem as the compulsions reinforce the obsessive thoughts. The brain sees that the thoughts trigger a response and concludes that they must be important. Therefore, they become more frequent and the obsessive-compulsive cycle repeats ad infinitum.
How Not To Approach Treatment (Compulsions)
Contamination OCDers repeatedly wash their hands to eliminate germs. Harm OCD sufferers try to “wash” their conscience by means of questioning or debating their thoughts, evoking neutralizing images, seeking reassurance and the like. The behaviors are different but the outcomes identical.
• Mental sword fighting – Oftentimes, suffers will engage their OCD in mental dialogue, presenting it with reasons why they shouldn’t push a pedestrian into oncoming traffic or trip someone in the street. For every objection made, the OCD counters with reasons to move forward. This mental chatter is highly draining and can leave you feeling detached from what is going on around you. This nasty side effect is known as derealization.
• Neutralizing images – Harm OCD can conjure some very disturbing images. It is common for sufferers to counter these depictions with images of happy times with loved ones, religious symbols, so on and so forth.
• Reassurance Seeking – Consists of researching, confessing, or evidence-seeking to disprove harm obsessions.
• Researching – may consist of reading forum threads about others’ experience with the condition. It may also entail reading about other mental health disorders like schizophrenia to ascertain whether or not the patient’s symptoms coincide with those of the said disorder. Reassurance seeking often helps the OCD fabricate new obsessions. The sufferer may become preoccupied with whether or not they have schizophrenia. They may even get new ideas for their Harm OCD theme.
• Confessing – Harm OCDers often confess their harm thoughts to family members. This is an area for concern as the confessions may very well startle those who know very little about the disorder. Confessions are a double edged sword – on one hand, the sufferer may feel guilty for internalizing these thoughts. They believe that by speaking up, they will prevent some disastrous outcome. On the flip side, they may feel guilty for confessing due to the negative reaction expected from family members.
• Evidence Seeking – We all have indiscretions that lurk in our past. However, isolated instances of poor decision making don’t dictate the trajectory of your future. A person who is in the reigns of Harm OCD may recall bad choices from the past and use them to justify their belief that what they have is not OCD. A person who fears violently attacking their pet may use memories of having crushed snails in preschool as evidence of their psychopathic nature. Another thing to note is that our memories become distorted with time. Just because you recall doing something doesn’t mean that it played out exactly as you remember. The more you spend analyzing an event from the past the more fictitious some details will become.
• Avoidance – In fear that they will act out on their thoughts, Harm OCD sufferers may intentionally isolate themselves from loved ones and avoid certain situations (i.e. driving) that trigger OCD thoughts.
• Touching, praying, physically restraining oneself, etc – These compulsions are associated with magical thinking (a cognitive distortion). The underlying belief is that the nonsensical behaviors will ward off harm to loved ones. Avoiding cracks in the sidewalk has no bearing on whether or not a family member will get cancer, for instance.
Reining in the Cycle
Getting a handle on Harm OCD involves eliminating the reinforcing effect of compulsions. This frequently proves challenging as sufferers often display an inflated sense of moral obligation to perform compulsions. This runs counter to the objective of Exposure and Response Prevention, (ERP) which is the core component of cognitive behavioral therapy for OCD. ERP is designed to desensitize the mind to obsessive thoughts through intentional yet gradual exposure to feared obsessions. If no compulsions are performed, the mind learns to disassociate the anxiety with the thoughts and they therefore become less frequent. Beating Harm OCD is about learning to separate your entire person – moral convictions and all – from the obsessive thoughts.