Contamination fears associated with OCD usually do not look like a very complicated subject. But when you take a close view about contamination it is quite a bit more complicated than what we all perceive compared to what a person with this issue feels and faces. When we say contamination OCD there are two things first is obsessions and second is compulsions. For contamination OCD sufferers it is not that simply limited to dirt, germs, and viruses. It may include like:

Some common obsessions in contamination OCD:

1.  Bodily excretions (urine, feces, semen): People with contamination OCD may experience intense anxiety and fear when they come into contact with bodily excretions. The fear may stem from concerns about germs, infections, or the idea of being "dirty." Ex: Any contact with another person’s semen is inherently dangerous, will result in disease or another health issue or Any other person’s contact with my semen may result in a health issue I will be responsible for having caused or impregnating someone with their semen.

2. Body fluids: sweat, saliva, mucus, and tears, ear wax: Contamination OCD sufferers often fear that contact with any bodily fluids, even those considered harmless, could lead to illness or contamination. For example, the thought of touching a surface with someone else's sweat or saliva might trigger extreme anxiety and compulsive cleaning rituals.

3. Blood and Blood Product: Fear of blood and blood products is a common obsession in contamination OCD. Individuals may worry about contracting diseases like HIV or hepatitis through contact with blood, even if the risk is minimal. This can lead to avoidance of medical settings or situations involving blood, such as donating blood or handling raw meat.

4. Garbage/ dustbin: Contamination OCD can also extend to concerns about garbage and trash bins. Individuals may fear touching or disposing of garbage due to the perception that it is packed with germs or pathogens. This fear can result in reluctance to take out the trash, excessive cleaning of garbage cans, or even hoarding garbage to avoid contact.

5. Used utensils: The fear of using used utensils is another manifestation of contamination OCD. People with this obsession may worry that using a fork, spoon, or plate that someone else has used, even if it's been thoroughly cleaned, will lead to contamination or illness. This can make dining out or sharing utensils with others extremely distressing for them.

6. Household chemicals: Contamination OCD may extend to fears of household chemicals. Individuals with this obsession might worry about toxic exposure, accidental ingestion, or chemical residues on surfaces. As a result, they may excessively clean and avoid using certain cleaning products, which can disrupt their daily life and household routines.

7. Radioactivity: Contamination OCD can lead to irrational fears of radioactivity, even in situations where there is no real risk. Individuals may become anxious or fearful about radiation exposure from common sources such as electronic devices, microwave ovens, or medical procedures involving X-rays.

8. Broken glass and Articles: People with contamination OCD may fear injury or contamination from broken glass or sharp objects. They might imagine that touching or being near these items will result in physical harm or contamination.

9. Sticky substances: Contamination OCD can also involve aversion to sticky substances, like glue, honey, or adhesive tapes. Individuals may worry about these substances adhering to their skin or belongings, leading to a fear of becoming "dirty" or contaminated.

10. People who look like unwell, unclean, or not maintained: They may worry about contracting illnesses or contamination through visual cues/ just by looking at them, even if there is no actual risk. This can lead to avoidance of social situations or excessive cleanliness rituals after social interactions.

11. Spoiled food/ waste food: Contamination OCD can manifest as a fear of spoiled or waste food. Individuals may worry about food poisoning or contamination from expired or discarded food items.

12. Liquid gel or soap: Some individuals with contamination OCD may have a heightened fear of liquid gel or soap dispensers. They might worry that these dispensers are contaminated with germs, and using them could lead to illness.

13. Pet animals: Contamination OCD may extend to concerns about pet animals. Individuals with this obsession might worry about the cleanliness of their pets or the potential for diseases for ex: diseases that can be transmitted between animals and humans.

14. Birds: Some individuals with contamination OCD may develop a fear of birds, particularly in situations where birds are in close proximity. They may fear being touched by birds or worry about bird droppings as potential sources of contamination.

15. Dead animal: Contamination OCD can also involve fears related to dead animals. Individuals might be anxious about coming into contact with deceased animals due to concerns about disease transmission or contamination.

16. Public utility places: Contamination OCD can lead to anxiety in public utility places such as public restrooms, public transportation, and shared facilities like gyms or swimming pools. Individuals with this obsession may fear germs or contamination in these environments  

17. Specific fragrance : Some individuals with contamination OCD may have heightened sensitivity to certain fragrances or scents. They may fear that these fragrances contain harmful chemicals or allergens that could lead to contamination or illness.

18. High sensitivity to body odour of specific body parts like palm, feet, and underarms:

19. Certain Thoughts and Believe : ontamination OCD may involve fears related to certain thoughts or beliefs. Individuals might obsess over irrational thoughts, beliefs, or ideas that they consider "contaminated" or morally wrong.

20. Particular words: In some cases, individuals with contamination OCD may have aversions to specific words or phrases. They might fear that saying or hearing these words will result in contamination or bring harm.

21. Specific  illnesses, disabilities, people who are ill, disabled, or who have died) : Contamination OCD can also involve fears related to specific illnesses, disabilities, or individuals who are ill, disabled, or who have died. Individuals may worry about contracting certain diseases or conditions or fear contamination from contact with people in these categories.

22. Places where bad things have happened: Contamination OCD can lead to irrational fears associated with places where individuals believe bad things have happened. These individuals might fear that negative events have left a "contaminated" or harmful energy in these locations.

23. Mental images: Some individuals with contamination OCD may experience distressing mental images or intrusive thoughts. They may fear that these mental images are contaminating their minds or causing harm to themselves or others.

24. Overweight : Contamination OCD can extend to concerns about body weight. Individuals may fear becoming overweight due to contamination from food or the environment. This can lead to restrictive eating patterns, excessive exercise, or other behaviors aimed at preventing weight gain.

25. Unattractive people: n some cases, individuals with contamination OCD may experience anxiety or fear around people they perceive as unattractive. They may worry about physical appearance-related contamination or fear that contact with such individuals will negatively affect their own appearance.

26. Colors: Contamination OCD can manifest as a fear of specific colors. Individuals may believe that certain colors are associated with contamination or harm and may avoid wearing or using items of those colors. This can be distressing when encountering these colors in everyday life.

27. Bad luck: Some individuals with contamination OCD may have superstitious fears related to bad luck. They might worry that certain actions, objects, or situations are "contaminated" with bad luck and may avoid them or engage in rituals to counteract the perceived bad luck.

Logic has little to do with these fears. The belief here is that certain names, images, concepts, or the characteristics of certain people can be magically transferred, simply by thinking about them or by coming into casual contact with them. They can be every bit as disabling as the items on the previous list. There is a further category that includes things that are more vague, for example, there are some sufferers who fear touching the floor, the ground, outdoors, or any public objects. When questioned about what it is they fear, they can only reply “I don’t really know, it just feels dirty to me or disgusted to me.” There are also cases where a sufferer will get the idea that another person is contaminated in some way, although they cannot exactly say why. It may be a total stranger or a member of their immediate family. Compulsions are the usual responses of sufferers to these fears. They may involve any protective act that an individual carries out to avoid becoming contaminated or to remove contamination that has somehow already occurred. Compulsions of this type may include:

1. Excessive and sometimes ritualized hand washing

2. Disinfecting or sterilizing things

3. Throwing things away

4. Frequent clothes changes

5. Creating clean areas off-limits to others

6.  Avoiding certain places or touching things

Another form of compulsion can include double-checking by a sufferer to make sure that they have not become contaminated or asking others for reassurance that this has not happened. Sufferers will sometimes repeatedly ask others to check parts of themselves they cannot reach or see, or things they cannot go near. Some will go as far as to make lists of things they believe may have happened in the past, so as not forget this vital information. In an attempt to keep clean and minimize compulsions, some sufferers will create two different worlds for themselves; one clean and one dirty. When contaminated they can move freely about their dirty world and touch and do anything, since everything in it is already contaminated. Nothing in it has to be cleaned or avoided. Clothes that are considered contaminated must be worn when living in this zone. This dirty world usually takes in most of the outside world, and can also include parts of their home or work areas. It may even extend to having a dirty car to be driven only when contaminated. They may also be able to live freely in their clean world as long as they themselves are clean when they enter it and also stay that way. The clean world is usually a much more restricted area than the dirty one, and is often limited to special places at home or at work. There may also be a clean car which can only be driven when clean. The two worlds may exist side-by-side like parallel universes that are never allowed to meet. For magical types of contamination the solution is often a magical decontamination ritual designed to remove or cancel out the problem, thought, name, image, or concept. Saying special words or prayers, thinking opposing or good thoughts to cancel out bad thoughts, and doing actions in reverse, are just some of the compulsions that can be seen. Sometimes the usual washing or showering may even be part of the magical ritual.  “Washers” as they are referred to are probably the most visible among those with contamination obsessions. It is not unusual for them to wash their hands fifty or more times per day. In more extreme cases, hands may be washed up to 200 times per day. Showers can take an hour or longer, and in severe situations can last as long as eight hours. Obviously, washers go through large amounts of soap and paper towels (used in preference to cloth towels which can only be used once and create laundry). Alcohol preps and disinfectant hand wipes are also popular. Their hands often become bright red and chapped with cracked and bleeding skin. Antibacterial soaps, peroxide, and disinfectants, such as Lysol, can be used to excess by some, causing further skin damage. I have even worked with several people who poured straight bleach on their hands and bodies, resulting in chemical burns.

Compulsive showering and washing are really quite futile, as the relief from anxiety only lasts until the washer contacts something else that is seen as contaminated. Washing may in some cases be strongly ritualized. It may have to be done according to exact rules, which if not followed force the sufferer to start all over again. Counting may also be part of a washing ritual to ensure that it has been done long enough period, or a certain number of times. In order to cut down on washing, sufferers sometimes resort to using paper towels, plastic bags, or disposable gloves to touch things.

In some cases, family members have been drawn into the sufferer’s compulsions. They are made to reassure, to clean things that cannot be approached, to check the sufferer or the environment for cleanliness, or to touch or use things that are thought to be contaminated. This type of help, of course, doesn’t really help, as it only locks the sufferer into the illness and increases helplessness. It also leads to resentment and fighting, as family members feel increasingly imposed upon and their lives become limited. This is especially true when a family member is seen as the source of contamination.

To further complicate our contamination picture, there is a variant that veers off into what is known as “hyper-responsibility.” This is where instead of being fearful of becoming contaminated, sufferers fear spreading contamination to others. The types of contamination that can be spread to others are about the same as those that trouble other sufferers. Generally speaking, so are the types of avoidance and decontamination compulsions. There is not only a fear of possibly harming others, but also a fear of having to live with the resulting guilt. There are also some that suffer from both types of fears at the same time.

The next question is what can be done about these problems? The answer is behavioral therapy.. Behavioral therapy would be in the form of Cognitive behavior therapy as cognitive restructuring and  Exposure and Response Prevention (ERP) to expose a person in such a systematic manner so that they can start learning gradually what they are fearing is not what is required to be fearful. . This remains the most widely used and accepted form of behavioral treatment for OCD. This type of therapy encourages patients to gradually encounter increasing exposure which is contaminated, while resisting washing, checking, avoiding, or conducting magical rituals.

Treatment is tailored to each particular person’s symptoms and is done at their own pace. If a feared situation is too difficult to confront in one whole step, it is approached more gradually. Some patients can only touch something that has touched a feared substance or object, and only later do they go on to touch directly what is feared. Family and friends are taught to not participate in rituals and to not give reassurance or answers to the same questions.

No one is ever forced to do anything, nor is anything sprung on them by surprise. It takes persistence and hard work, but through steady week-by-week work, the disorder is chipped away until recovery is eventually reached

Emotion of life is an online platform for providing specialized treatment for all types of OCD with Cognitive Behaviour Therapy since 2001, we have treated more than 7000 plus clients by now in the last 23 years who were suffering with OCD and other anxiety related disorders. We are working on recovery of OCD tirelessly and happy to share with thousands of OCD clients successful recovery with our holistic model of care. We are proud of all of our ocd recovery clients who have been struggling before joining our unique daily session recovery program and after completion of their ocd recovery program all of them are enjoying their life and contributing in their life and society. Our client ocd recovery success story you can read in our client review section, we invite all those who are struggling with their OCD to join our 100 days 100 days sessions 100% OCD recovery which complete in 4 months.      

Religious/ Spiritual/ scrupulosity obsessive-compulsive disorder is a classic OCD sub-type characterized by ongoing Intrusive/ involuntary thoughts, images, urges, acts etc. Thoughts, actions around violating a religious, moral, or ethical belief. People with Religious/ Spiritual/ scrupulosity obsessive-compulsive disorder experience frequent worry, fears, and guilt about violating a religious or ethical code, system and what it means about them as a person for example “Did I allow myself to have an “impure” thought in church/temple. Does it mean that I’m a sinner and must be punish”. The guilt and anxiety drive these people to engage in various compulsions aimed to alleviate their distress (confessing to a religious figure).

Symptom of Religious/ Spiritual/ scrupulosity obsessive-compulsive disorder

OCD tends to fixate on what is most important to the individual, and when being moral or religiously devoted is central to a person’s identity. Spiritual OCD push and cause a person to have obsessions and compulsions centered around their core values, which makes the doubting thoughts more anxiety-provoking like Am I a “true believer” of my faith. Many religious people may be concerned whether they have sinned and want reassurance. However, with religious or scrupulosity OCD, the concern is never-ending, and these doubting thoughts can feel impossible to let go of despite extensive reassurance. Someone with this condition may have a thought come into their mind about eating a meal on a day when they are fasting. They might begin thinking: “Is it okay I thought about food right now? Am I fasting correctly? Have I sinned? Will I not have access to the afterlife?” This unrelenting anxiety and fear about committing a sin may cause a person to confess to their religious leader or to God. Yet, assurance about the fact that they haven’t sinned may only ease the anxiety temporarily. It’s only a matter of time before the thoughts kick back in, and they begin to think: “I didn’t confessed how I felt about breaking the fast when I saw a family barbecue at the beach. Maybe I should go back and confess this as well.” Regardless of the confirmation, the person’s OCD will come up with more and more fuel for their doubting thoughts.

• Did I pray correctly? Did I pray for the correct amount of time?
• I was or might have been distracted. Maybe I should do it again.
• I got a thought about my religious leader being ugly. Does this make me a bad person?
• During religious services, I found it hard to concentrate and thought about my to-do list for a few minutes. Is that a sin?
• At the supermarket, I accidentally picked up meat and immediately kept it down. Am I contaminated for having touched it? Should I confess?
• I wanted to laugh today during religious services. Does this mean I don’t take my religion seriously?
• I told someone I’ll call them at 5 p.m., but I called at 5:01 p.m. Did I lie? Am I a bad person?
• Did I displease my friend unintentionally during our conversation yesterday?
• Was the question I asked in class considered impolite? Have I accidentally insulted the teacher?
• Is it OK that my friend edited my essay? Does that count as cheating?
• I didn’t say ‘thank you’ to the person who held the door for me. I am a bad person.
• I told my spouse that I am great when they asked how I am. But the truth is I’m upset. Am I deceiving my partner? Do I deserve to be in this relationship?
• I told a prospective tenant that I ended up choosing someone else, but the truth is I let my cousin stay in the apartment. Am I a horrible person for “telling a white lie?”

Examples of Religious/ Spiritual/ scrupulosity OCD Common Compulsion

In response to their obsessive thoughts, a person with religious or scrupulosity OCD will engage in compulsive actions as an attempt to alleviate their anxiety. Here are some examples of what that might look like:

• Excessive prayer: People with religious OCD may pray extensively — longer than the standard for their particular faith, sometimes hundreds of times a day, in order to make sure their prayers have been performed perfectly. If there’s a mistake or hesitation, the person may repeat themselves until they believe the prayer is flawless.
• Excessive confession: People with religious OCD may repeatedly go to their religious leader/authority to ask about or confess sins they are worried about having committed. It could be minor questions, like, was it a sin when I found a woman attractive, even though I’m married? The person may return multiple times to confess about the same event, for fear that they haven’t communicated the sin properly and may still be guilty.
• Excessive rituals: People with religious OCD may develop excessive rituals to calm their obsessive thoughts. This may look like coming up with a number of minutes to pray, asking for God’s forgiveness a certain number of times, or performing established religious rituals a certain number of times.
• Reassurance seeking: People with religious and scrupulosity OCD may repeatedly turn to the people in their life for reassurance. They may ask family or friends if they’ve ever experienced the same thoughts they have, to affirm whether or not they are sinful. They may also spend hours in online forums asking strangers whether something they’ve done would be considered a sin. Someone with scrupulosity OCD may ask their teacher if it’s okay that a friend helped them with their homework, even if the teacher already clarified it is. They may ask a friend if they would consider this cheating.
• Mental checking: People may mentally review past experiences and try to evaluate whether they behaved in an immoral or sinful way. Someone who is concerned about having offended their friend might replay the face he made over and over, and think back to other times their friend has made this face. Is this the face he makes when he’s offended?
• Avoiding: Someone with religious OCD may avoid their place of worship for fear of behaving in a sinful way. They may avoid certain people who cause them to have thoughts they’ve determined are immoral or sinful.

Religious/ Spiritual/ scrupulosity OCD ERP therapy

The best course of treatment for religious OCD is ERP and ERP is considered the best standard for OCD treatment and has been found 90% + if recommended procedure is followed and adhere by client. The majority of patients experience and show the positive results within 30 sessions but complete recovery may take around 60 + session depends on severity and person ability to learn and practice new things relate with god.

As part of ERP therapy, you will track your obsessions and compulsions and also monitor the progress of therapy by your therapist, and make a list of how distressing each thought is. You’ll work with your therapist to slowly put yourself into situations that bring on your obsessions. This has to be carefully planned to ensure it’s effective, so that you are gradually building toward your goal rather than moving too quickly and getting completely overwhelmed. The idea behind ERP therapy is that exposure to these thoughts is the most effective way to treat OCD. When you continually reach out for the compulsions, it only strengthens your need to engage them. On the other hand, when you prevent yourself from engaging in your compulsions, you teach yourself a new way to respond and will very likely experience a noticeable reduction in your anxiety.

People with religious OCD may face particular challenges during ERP therapy because they may be convinced certain exposures will make them unfaithful to their religion. Working with a trained therapist who understands your faith and how important it is in your life will help you feel confident to begin the process of separating your faith from your OCD thoughts about it. As the nature of these OCD thoughts is to convince you that you aren’t devout, a therapist who’s familiar with religious OCD will be able to help you work through these thoughts in a way that isn’t overwhelming.

Example of Religious/ Spiritual/ scrupulosity OCD exposures

ERP therapy works to get you acquainted and comfortable with the unknown, since it’s the fear of the unknown and the need for certainty driving the obsessions and compulsions.

Let’s say you’re someone with scrupulosity OCD and excessively concerned about telling the truth. You’ve just told your spouse you’ll be home at 3 p.m., but you actually arrived at 3:30 pm. Each time this happens, you spiral into obsessive thoughts about being a liar, and the need to know if you’ve done something wrong, and sometimes ask your spouse for confirmation that this isn’t a serious lie and that you are still a good person.

In ERP therapy, the goal is to prevent yourself from acting on your compulsions. Instead of asking your spouse for reassurance, a therapist may have you think to yourself, “Maybe I am a liar. Maybe I’m not. It’s impossible to know for sure.” This teaches your brain a new response to your anxiety and begins to get you comfortable with the uncertainty fueling your obsessions and compulsions. In order to avoid becoming overwhelmed, you’ll work with a therapist to come up with a hierarchy of anxieties and related exposures and gradually work your way through them.

How to start your ERP for Religious/ Spiritual/ scrupulosity OCD?

Religious or scrupulosity OCD can be a tricky diagnosis to make because many of the behaviors can appear as concern about being faithful or ethical. A religious leader may tell you you’re simply overly concerned and have nothing to worry about, without knowing they are actually helping fill your need for reassurance. However, a mental health professional who specializes in OCD will be able to make an accurate diagnosis. If you’re interested in learning about religious or scrupulosity OCD and how it’s treated with ERP, you can get in touch with Emotion of life therapist to find out how this type of treatment work . our therapists specialize in OCD and receive ERP specific training and ongoing guidance from our OCD intervention team. our therapist understand have rich experience how things process and work in ERP. we offer live face-to-face video therapy sessions with OCD therapists and we have strong follow up system. Along with strategic relapse management system.

For any question write to us info@emotionoflife.in

Post Partum OCD: Obsessional fear of harming their child 

Post Partum OCD is a type of obsessive compulsive disorder that develop within first 2 to 3 months after delivery in women, men may also have some sign and symptoms as well in some cases. Post partum ocd impact approximately 3% of newly mothers. Post partum ocd is different from other subtypes of ocd. As its specifically focuses on the fear of causing purposeful harm or accidental harm to the new born baby. In most of the cases it will be limited to intrusive thoughts only not an intention. The fear usually start with compulsive checking to ensure baby safety, it may involved in compulsive praying or reassurance seeking from love one or other care givers in family. Post partum ocd create significant distress and impairment in day to day life of mother because of obsessional thought related with harming children. These thoughts are intrusive and make caring for your child very difficult. You don’t have the intention to harm your child, but you’re very much afraid that you will do so accidentally. This is to note during post partum ocd, mother do not desire to harm new born but they are having extreme fear of making mistake in child care with what if ? study have shown new father may also develop such child harming intrusive thoughts or negative thoughts about their new born baby. 

Main symptoms as obsession in post partum OCD

1. Fear & images of the newborn passing away in their sleep, choking, being unable to save them. 

2. Fear and images as flashback what if in any case they will dropping baby from height, baby may slip from hand, child get some disease just because of mother some mistake while caring child. 

3. Unwanted involuntary thoughts or impulse about harming the baby such as through, shaking them, drowning them, yelling at them, stabbing them, pressing child face with pillow.

4. Concerns about dirt and germs, Ensuring bottles are properly sterilized

5. Making sure not to make a mistake by mistake 

6. The urge to check and recheck that the baby monitor is working

7. Fear that you might harm the baby even when you don’t really want to. 

8. Avoiding certain activities with the baby  like bathing, using stairs, holding, diaper changing. 

9.  Needing to have a partner or helper nearby because of obsessional fear. 

10. Trouble sleeping because of obsessions and compulsive urges. 

11. Interference with taking care of the child

Main symptoms as compulsion in post partum OCD

1. Repeatedly checking on their baby to ensure they are safe/well

2. Praying repeatedly in the hope for ensuring the health and wellbeing of the baby  

3. Hiding or throwing out sharp objects.

4. Repeatedly reviewing daily tasks to ensure that no one has harmed the baby.

5. Avoidance in facing the child what if they may harm child. 

Why post partum OCD occurs

Medical definition may be differ from psychological perspective so as per huge data set analysis its being consider mother who have faced traumatic experience in their early childhood and adolescent age and might have phase difficult adulthood and had multiple failure in relationship and have skewed personality dynamic like high sensitivity, high apprehension, had history of anxiety spectrum issue in past, have different level of guild and unsatisfaction in life most likely to develop post partum OCD. 

How Is Postpartum OCD Diagnosed?

If you are having thoughts that overwhelm you and get in the way of your parenting, you should talk to your therapist. Many parents are dealing with similar worries, and you shouldn’t feel ashamed. Talking about your thoughts is the first step to getting correct management of your issue. Sharing them will not make you lose your child, though this is the main concern that keeps new mothers with postpartum OCD from talking to their therapist or psychologist.  

What treatment is best suitable for post partum OCD: 

Most effective treatment for post partum ocd is same as other sub type for OCD management which is cognitive behavior therapy (CBT) and Exposure response Prevention (ERP) so you can deal with this situation under cognitive restructuring process and need based systematic exposure. 

1. Learning that unwanted thoughts are normal and not dangerous 

2. Challenging how the person interprets their obsessional thoughts 

3. Gradually confronting situations and thoughts that have been avoided 

4. Reducing the use of compulsive rituals to deal with obsessional anxiety

So you learn the reality and can overcome your intrusive thought and compulsion and can lead stress free life with your love one new person in your family and you can enjoy motherhood all stages and can make your child a good citizen with excellent emotional health with parenting as wellness coaching, we are serving exclusively on post partum OCD client for decade with great success rate. Mindfulness and acceptance and commitment structure intervention bring time recovery from post partum OCD in 4 months timeline 

Effects of post partum OCD 

1. Depression, sadness, loss of interest in people and activities, sleep loss or excessive sleepiness. 

2. loss of appetite, suicidal thinking, hopelessness, helplessness, the lack of self-care

3. Problems with caring for the newborn because of fear and avoidance 

4. Problems bonding with the newborn because of avoidance 

5. Problems with one’s relationship (marriage or partnership) because of extreme anxiety

Checking and Rechecking OCD is a common form of OCD characterized by checking and Rechecking things multiple time compulsive behavior.People with Checking OCD fear that they will somehow cause something bad to happen to themselves or others, intentionally or not. This obsessive concern causes anxiety, which they respond to with checking rituals in an attempt to gain certainty that something terrible has not or will not happen.

Examples of Checking OCD

1. Riya  gets stuck trying to leave the apartment, checking for safety hazards. Riya is at risk of being embarrassingly late to work. Even she got up early, got ready in time, and could have easily made it to the office but she was once again stuck in her flat and stuck with intrusive thoughts like: 

: Did I remember to turn off the stove. 

: Did I really lock the windows and unplug the toaster. 

: What if a fire starts. 

: What if someone gets hurt.

: Couldn’t live with myself if it was my fault. 

2: Shyam turns his short commute into a long drive, checking for accidents. While driving to work, Shyam feels his anxiety rise to uncomfortable levels as the familiar unwanted thoughts start: 

: Did I look both ways before I made that last turn.  

: What was that bump I felt? Did I just hit someone. 

: There were a lot of pedestrians in that crosswalk. Did I see them all. 

: Did I break any traffic rule should I pay fine 

3 : Rahul after end of the call or reading a social media post get obsessional thoughts like

: Did I say something bad to the caller

: Did I ask an inappropriate question 

: Did I by mistake send adult content via a whatts up to other

: Did I post something vulgar on my social media comment 

: Did I comment on social media post something vulgar  

: Did I say something wrong to unknown 

: Did I use abusing language to my friend 

: Did I ask something sexually explicit to my friends

: Will my sexual fantasy my known will get to know, etc.  

Shyam worries that his carelessness will result in tragedy for someone else, a thought that feels unbearable. He feels the need to be 100% certain that nothing bad happened, so he starts his checking rituals. He ends up driving in circles, trying to retrace his route (sometimes several times). He excessively checks his rearview mirror to survey the stretch of road that he just traveled. At times he stops his truck, gets out, and walks all the way around it, checking for signs of a recent accident. What should be a short commute can take hours. 

As can be seen from these examples Shyam, Riya and Rahul both are struggling with something far beyond the “double-checking” that most people experience. Instead, they get stuck in a downward spiral of anxiety, doubt, and repetitive checking. The more they perform their compulsions, the more entrenched the cycle becomes.

Obsessive thoughts in Checking OCD tend to center on the possibility of something bad happening to ourselves or others. When it comes to others getting hurt, the fear is that it would be our fault. Common obsessive concerns in Checking OCD include: 

· Safety Concerns – fears about being responsible for a fire, flood, burglary, or any other threat to life or property.

· Health Concerns – fears of developing a serious illness.

· Mistake Concerns – fears of making errors of any sort.

· Inappropriate Behavior Concerns – fears of bad behavior (e.g., saying something hurtful in a conversation or accidentally writing racial slurs in a paper for school). 

These obsessive concerns lead to distress usually in the form of anxiety and for this sub type of OCD  checking is the compulsive behavior may be in range of 5 or 50 time utilized to reduce that anxiety. The purpose of the checking is to try to be certain that these feared outcomes have not, or will not happen. Common checking behaviors include: 

· Physical Inspection: Looking closely at things (sometimes taking photos for more lasting “proof”), or physically examining them.

· Avoidance: Avoiding responsibility can mean escaping the anxiety around uncertainty. Getting someone else to be the last to leave the house or a room takes the responsibility for checking locks, stoves, faucets, etc. off of the person with OCD. If the concern is about making mistakes, then avoiding the opportunities to make mistakes, (e.g., not sending emails or having interactions with others), can reduce anxiety.

· Reassurance: People with Checking OCD often seek reassurance. This reassurance can be from within, reminding oneself that they have done things correctly. It is also common to seek reassurance from others with questions such as “You saw me lock the door, right?” or “Does this mole look normal to you?”

· Mental Rituals: A lot of checking goes on inside the head. This can take the form of replaying events in one’s mind. For example, a person with Checking OCD can spend hours in bed going over and over conversations they had that day in order to be certain that they did not do anything hurtful or inappropriate. Safety concerns can result in “replaying the video” (in one’s head) of all of your actions before you left the house, in order to be certain that everything was done correctly.

Most common cause of checking and rechecking ocd are cognitive maladaptive practice, behavioral learning, environmental factors, low stress tolerance, bad experiences, too much strict or too much over protected parenting. We can be more confident in identifying what maintains the OCD. So all these factor need to be analyse during planning phase of therapeutic intervention. 

Compulsive behavior, like checking, is often temporarily effective because it reduces anxiety. Because of this, people with OCD are much more likely to do that checking behavior again the next time they find themselves feeling anxious about not being certain of something. That is how person becomes trapped with checking and rechecking OCD and then later never learn that there is another way out.

ERP again is best tool and approach in treatment for checking and rechecking OCD and is highly effective when done structurally.  It encourages people to face their fears about possibly causing harm or destruction by purposefully triggering these thoughts and then learning that they do not have to give in to their urges in order for everything to be okay. Let’s look at an example of how this might work: 

Example of ERP Therapy: 

Riya the woman from the first example, who was always late for work because she was repetitively checking her apartment for safety hazards. An ERP assignment might have Riya leave her apartment without doing the checking routine that she normally does. By avoiding her checking routine,Riya would learn that her compulsions are not necessary and that her anxiety will subside on its own. ERP would also teach Riya that she can handle uncertainty. 

People struggling with Checking OCD. first step is finding the right professional who have successfully work on the subject on this type of  OCD as  trained ERP provider. Exposure and Response Prevention therapy is most effective when the therapist conducting the treatment has experience with OCD and training in ERP. At Emotion of life all the therapists specialize in OCD and receive ERP specific training. 

  For any question write to us info@emotionoflife.in 

OCD is a condition in which a person experiences persistent thoughts, images, and ideas that are unwarranted, upsetting, anxiety-provoking, and troublesome. OCD can manifest in a wide array of sub-types, including sexually-based thoughts, in which the person experiences obsessive thoughts about sexual themes that can range from mild to violent. While the human mind may daydream about sex on a daily basis, these thoughts or impulses come without any desire to think in a sexual manner and are highly disturbing to the individual experiencing them.

SYMPTOMS OF SEXUAL OCD: 

Some common obsessions that are associated with sexual OCD are:

· Extreme fear of being attracted to a family member, animal, dead figure or children

· Intense fear of committing a sexually heinous act

· Extreme fear of becoming violent during sex

· Intrusive thoughts or images about distressing sexual acts with children or animals

As individuals experience these types of obsessions, they begin to develop compulsions or behaviors that are employed in order to cope with the anxiety caused by their sexual intrusive thoughts. Some common compulsions of Sexual OCD are:

· Avoiding situations where they may interact or encounter a subject of their intrusive thoughts

· Performing mental rituals to replace unacceptable sexual thoughts with acceptable sexual thoughts

· Avoiding sex so they do not harm their partner

· Mentally reviewing past sexual behaviors for signs of perversion or depravity

· Checking for genital arousal when encountering or interacting with the subject of their obsessions

People suffering from Sexual OCD are encouraged to seek treatment from a mental health professional specially therapist or Psychologist that specializes in the treatment of OCD.  OCD specialists are equipped and prepared to treat a wide array of OCD subtypes, including Sexual OCD. Like all types of OCD, Sexual OCD is being treated with  CBT, specifically with treatment approaches called ERP and Mindfulness based Cognitive Behavior Therapy .

Mindful-Based CBT teaches patients that everyone experiences intrusive thoughts. Individuals will also learn that intrusive thoughts have no power over them and that by responding to their thoughts through compulsive behaviors, their thoughts are given more strength and credibility and their fears and obsessions are strengthened and reinforced. Mindfulness-Based CBT is a very effective OCD treatment , especially when combined with ERP.

ERP exposes patients to situations related to their intrusive thoughts that cause them anxiety. The goal of this treatment is for the patient to prevent himself or herself from completing their compulsive behaviors when triggered by intrusive thoughts. The situations that are confronted will intensify over time, until the patient can face and overcome their most feared scenario. Once they are able to stop themselves from responding to their intrusive thoughts with compulsive behaviors, they can experience tremendous relief from the symptoms of OCD, OCD symptom's if not treated on time usually worsen over time and can take over a person’s life, so it is very important to seek OCD treatment as soon as possible with a skilled and dedicated OCD specialist who can provide expertise and support during person OCD recovery  journey from sexual intrusive thoughts or OCD .

 For any question write to us info@emotionoflife.in 

Harm OCD is a type of OCD,  in Harm OCD individual experiences constant intrusive thoughts of engaging in harmful behavior toward themselves or others. Harm OCD is often accompanied by compulsive behaviors to decrease the anxiety associated with those disturbing thoughts. without customized psychotherapeutic intervention harm OCD can increase over time.

OCD is specific to a fear of harming oneself or others and subsequent checking compulsions. For example, your harm OCD could manifest as a fear of running someone over with your vehicle; the compulsion would be checking to make sure you haven’t.

People can typically discern fleeting thoughts from a desire to cause harm, but with harm OCD, you may interpret the thought to mean you will act on it. Or, you will need reassurance that you’re a good person, and then engage in compulsive behaviors to reduce anxiety and protect yourself against these feared behaviors.

Symtoms of Harm OCD 

· Fear of causing harm to self or others

· Intrusive thoughts of engaging in violence against self or others

· Self-doubt regarding whether you will act on obsessive thoughts

· Avoidance behaviors to prevent violence against self or others

Harm OCD can occur at any age but most common in late adolescent but can be in adulthood too. Common example. What if I accidentally cut myself with a knife or What if I kill my parents in their sleep.  In harm OCD person may fear driving into a tree, hitting to their boss/ family members,  dropping their baby from a balcony or can be thought of killing their baby. Children generally seek out reassurance from their parents that they won’t engage in harmful behavior. In late adolescence and Adult may engage in compulsive reassurance or checking behaviors.

Causes of Harm OCD 

· Early childhood physical and emotional abuse.

· Close family history of OCD with in family

· Stressful or traumatic life events as a child or in early adulthood.

· Co-occurring mental health disorders

· Learned behaviors/Imitation

· Poor parenting

· Low stress tolerance

· Weak personality dynamic

· Too much engagement in criminal content/ fiction movies

CBT  is the most commonly used to treat harm OCD along with psychoanalytic approach. When individuals seek out therapists not designed to address OCD, their condition can be made worse by reinforcing unhelpful obsessions. Harm OCD must be treated by a therapist who is specializes in OCD and is trained to utilize CBT. There are three specific techniques commonly used to manage harm OCD and traditional OCD. They are CBT ( cognitive restructuring) and systematic exposure and response prevention.

Mindfulness is designed to teach an observational vs. judgmental stance regarding thoughts, feelings, urges, and physical sensations. Those with harm OCD learn that the mere existence of a disturbing thought is not indicative of their character and doesn’t point to an intent to cause harm to self or others.

Cognitive Restructuring : People with harm OCD may struggle with cognitive distortions, including all-or-nothing thinking, catastrophizing, and perectionism. Cognitive restructuring helps you to identify and challenge those thoughts with more rational, objective, evidence-based thinking. The goal is for automatic thoughts to become rational and less distorted.

1. Flexible routines: Learning to be less rigid about daily routines can help improve relationships and encourage a willingness to try new things.

2. Resist avoidance: Avoidance may sometimes seem logical, but it perpetuates the OCD cycle by intensifying the desire to avoid.

3. Set realistic expectations: One way to manage self-doubt and frustration is by being realistic about goals and expectations. You and your team can discuss what treatment will achieve and how long that may take to accomplish. For many cases, the goal is a reduction in symptoms and not the total elimination of them.

4. Manage stress: Stress has the potential to worsen symptoms, so learning new ways to reduce it is important.

5. Social interaction: Social interactions can have a positive impact on our physical and mental health. They reduce stress and increase an overall sense of well-being.

6. Mindfulness & meditation: Practicing mindfulness and meditation can assist those with harm OCD to shift focus from over-thinking to a less judgmental stance.

Beyond that above you definatly might be in need of customize therapy session based on your needs assessment. 

  For any question write to us info@emotionoflife.in 

What is Pure Obsessional OCD (Pure O):

“Pure O,”  is characterized by distressing and intrusive and Involuntary  thoughts that are not accompanied by overt, observable, or physical compulsions, although mental compulsions and those of a more covert nature do take place. Many people mistakenly assume that “Pure O” implies that no compulsions occur; rather, compulsions are most certainly present but are more likely to occur within one’s own mind and are less likely to be visible to others.

Common Obsessions of Pure Obsessional OCD

The obsessions that occur within “Pure O” can vary substantially from one person to the next, but generally can cause you to believe that you are flawed or a bad person and will plague your mind with fear, doubt, shame, and anxiety. For example, a mother with “Pure O” may have intrusive thoughts of harming her child that cause her to feel like a terrible mother and to experience crippling doubt about whether she would ever want to harm her baby.

Some types of obsessions that may occur within “Pure O” include:

· Hateful sexual acts

· Doubt about your sexual orientation

· Doubt in your romantic partner

· Sacrilegious thoughts

· Thinking about somatic function (breathing, blinking, or swallowing)

· Doubt on own existence 

· Fear about being selfish

· Doubt of being not intelligent 

· Doubt on own potential 

· Compare thing more with others at thought level

· Constant fear with god and super natural figures 

Common Compulsions in Pure Obsession: 

The compulsions that are enacted when a person experiences “Pure O” OCD are often driven by the mental analysis of one’s obsessions, attempting to eliminate doubt caused by obsessions and find certainty, and trying desperately to find the answer behind unwanted, Intrusive Thoughts.

Common compulsions of “Pure O” include:

· Mentally reviewing memories, experiences, and past events to try to find certainty

· Mentally trying to ascertain what one’s intentions were in a given situation

· Using logic and rationale to try to neutralize the doubt created by obsessions

· Reassuring one’s self about motives and behavior

· Avoiding situations that may trigger your obsessions

· Performing superstitious rituals in order to lower your anxiety

· Seeking reassurance from others

People suffering from OCD are encouraged to seek treatment from a mental health treatment provider that specializes in the treatment of OCD. OCD specialists are equipped and prepared to treat a wide array of OCD subtypes, including OCD that presents as “Pure O.” Like all types of OCD, this form of OCD can be treated with CBT , REBT and ERP  

.

ERP exposes patients to situations related to their intrusive thoughts that cause them anxiety. The goal of this treatment is for the patient to prevent himself or herself from completing their compulsive behaviors when triggered by intrusive thoughts. The situations that are confronted will intensify over time, until the patient can face and overcome their most feared scenario. Once they are able to stop themselves from responding to their intrusive thoughts with compulsive behaviors, they can experience tremendous relief from the symtoms of ocd.

 For any question write to us info@emotionoflife.in 

One of the interesting and invariably frustrating parts of OCD is its ability to take things that are common place in our daily lives like Hand washing, checking door lock, and twist them into maddening rituals that just never seem to satisfy OCD’s impossible demands, no matter how hard a person tries. 

Have you ever knocked on wood? Made a wish then blown out birthday candles.Most, if not all, of us have engaged in some superstitious thoughts or actions such as these at some point in our lives. If you were to imagine superstitions, you would end up with Magical Thinking OCD. 

Magical thinking happens when you believe your thoughts, ideas, wishes or actions directly influence events in the physical world. Importantly, this belief occurs in the absence of concrete evidence demonstrating a link between you and any such events in other words, there’s no actual evidence that anything you’ve thought actually has an impact in the real world. That’s the “magic” part of magical thinking.

Magical thinking can be a type of cognitive distortion, or thought error, that you give into here and there without much consequence. when such obsession is the foundation of all or most of your OCD, we can refer to your experience as Magical Thinking OCD. 

Things or events you might be attempting to influence could be seen as two sides of the same superstitious coin: preventing “bad” outcomes and/or generating “good” outcomes. Either way, you are driven to do everything you think is in your power to control those outcomes.

For someone without OCD, if they feel the urge to knock on wood yet are nowhere near wood, they will settle for knocking on plastic or metal, or they may just say the phrase without knocking on anything at all. The superstitious ritual is something they can adjust or live without, something they trust probably isn’t going to change the outcome of things one way or another

For someone with OCD, there is no flexibility. Knocking on wood means you find wood and knock on it. If you don’t do the ritual correctly, your OCD tells you, you risk the bad thing happening or the good thing not happening. Your words, your actions and your thoughts all must be done exactly in accordance with the rules of your Magical Thinking OCD. 

There are actually three main types of magical thinking.

· Thought-Action Fusion: the belief that a thought can cause a particular event to occur or means an event has already occurred

· Example: If you think about a plane crash, a plane will crash.

· Thought-Event Fusion: the belief that thoughts, feelings and impulses have the power to cause one to commit unwanted and undesirable actions

· Example: If you think a violent harm thought, you will lose control and act it out.

· Thought-Object Fusion: the belief that thoughts and/or feelings can be transferred into objects, making them “contaminated.” For some, this could also “contaminate” others.

· Example: If you have an intrusive sexual thought while holding a pen, the pen becomes “dirty” & anyone who touches the pen will also be “dirty.”  

Other common obsessions and compulsions related to magical thinking.

· Fear that failing to think or say certain words, phrases, sounds or numbers a specific number of times will cause harm to oneself or others

· Fear that failing to do certain things in a specific way will cause something bad to happen to oneself or others

· Belief that one must cancel out or neutralize “bad thoughts” or “bad memories” by thinking of or saying “good thoughts” or “good memories” to prevent negative consequences

· Repeating certain words, phrases, sounds, numbers or names

· Following specific routines or rituals. It is not uncommon for an individual to feel it necessary to repeat these rituals or routines multiple times until their OCD is satisfied (i.e., anxiety dissipates). Similarly, it is not uncommon for individuals to perform these rituals or routines at specific times of the day or days of the week.

· Engaging in superstitious behaviors, such as avoiding cracks on the sidewalk when walking or knocking on wood

· Picking up and putting down items a specific way

· Arranging items in a specific order

· Avoiding unlucky numbers, colors, words, places and items

· Tracing one’s steps or performing specific physical actions in reverse

· Counting in a certain way to a specific number or type of number

· Moving one’s body or completing a specific gesture in a certain way

· Touching items a certain way or for a specific number of times

Best treatment for Magical Thinking OCD is actually the same for any type of OCD ERP a type of cognitive behavioral therapy, both of which are considered evidence-based best practices.

Both parts of ERP are critical for success. Exposure is simply exposing you to your fears, also known as your triggers. Unlike OCD, where you would almost instantly give into compulsions, in the Response Prevention part you delay and resist compulsions, leading to the learning that anxiety dissipates with the passing of time.You also get the bonus learning that not doing your compulsions has no outcome on your feared consequences, because they were never connected in the first place when it comes to magical thinking!

In ERP, Therapist approach should be graduated desensitization, which means starting off with triggers and compulsions that are considered lower-risk than others you may also hold. For instance, setting an alarm clock or the volume on the TV at an unlucky number, then working up to something scarier, like not texting your parents goodbye when you board an airplane (assuming those texts have presumably guaranteed all previous safe flights).

Remember, OCD thrives on your choice to seek short-term relief through compulsions at the expense of long-term discomfort & distress. In ERP, we flip the script, exchanging short-term discomfort for long-term relief. we can surly say ERP is 90%+  effective if your therapist and you both have patience and your therapist approach is customize based on your personality and learning approach.

If you’re struggling with Magical Thinking OCD, schedule a preliminary discussion call with Emotion of life therapist as consultation session. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP. We have experience therapist more than 25, years of 20 years and 16 years of experiences in OCD  intervention.

 For any question write to us info@emotionoflife.in 

Perfection is helpful and needed but it's not a whole life: Just Right is a subcategory of OCD in this type of OCD person often experiences an overpowering internal sense that the balance, order, place, frequency or position of something is disturbed and must be corrected. It may include the spoken or written words, related to senses like touch, feel, sound, smell, and alignment of some object that is not ‘just right.’ The individual with ‘just right’ OCD often performs endless repetitions of ordinary tasks because of anxiety/ frustration that they are not ‘perfect’ or ‘just right.’ Touching and tapping, symmetry, ordering, and arranging, perfectionism and counting can all be part of the rituals related to ‘just right’ OCD. When things are not in proper way person feel discomfort and start putting things in write way based on their understanding and belive that other will be able to avoid or not think in day to day life. People with not just right OCD experience subjective feelings that something is wrong. Most of the people within Not Just right OCD, the feeling is not accompanied with any specific fear but rather difficulty tolerating feelings of discomfort/tension that are associated with skipping rituals. People with not just right approach as obsession under supervision exposures may look more similar to habit reversal training with emphasis on the practice of tolerating difficult sensations and course correction in beliefs and priority. People with not just right obsession may have associated beliefs that feeling less than just right will lead them to underperform in work, society, family and personal functioning particularly with upcoming task or events, high-performance situations. CBT process evaluate perfectionist beliefs and values and assign therapist work with client correcting the overvalued aspect related with not just right OCD. People with not just right feelings accompanied by distressing intrusive thoughts for example thoughts of something bad will happen to self or loved ones or work setup, others will consider them inefficient that increase the need to achieve a just right feeling through compulsions to prevent intrusive thought from coming true. On the other side person with just right obsession partially understand logically that their believe are not correct and connected with reality what they presume as negative outcome. Common feelings associated with just right OCD include:

• Feelings in Just Right OCD: Person feel set off visual, tactile experience, and auditory cues in the environment
• Superstitious in Just Right OCD: Person try to find meaning for why this happens,  some people interpret just right OCD in the way we develop superstitions. Behaviors considering it as lucky may be performed due to an unlucky feeling. People also say they feel responsible for doing something that will prevent a bad  thing from happening.
• Guilt in Just Right OCD: Guilt may be be associated in may cases in just right OCD, People feel a sense of responsibility to ensure things are safe and are driven to perform compulsive behaviors. These can be physical acts like tapping article or body part, repeating the behavior in the moment of being triggered and visual or reviewing like praying, seeking reassurance, mentally reviewing the sequence of actions prior to the trigger.
• The feeling of having forgotten something
• Physiological  feeling that you can’t explain
• The feeling that something hasn’t been done perfectly enough
• The feeling that something is unsafe or vulnerable for no recognizable reason
• Feeling that objects aren’t arranged in just the right way

Common Just Right Obsessions: People with just right OCD may or may not identify a specific obsessive thought that is causing their distress in routine but it can be many things simultaneously, they feel sensation of incompleteness that provoke sense of harm or danger for which they feel responsible in real world which is not discomforting for others Obsessions in Just right OCD can be related with to feelings of:

• Impending doom: A sense of intense feeling that something life threatening or tragic is about to occur, despite no apparent danger
• Causing harm to others because of person unintended action
• Being harmed by others without any reason based on their beliefs
• Bad luck
• Something wrong without any significant identifiers
• Being negligent, selfish, uncaring if they do not perform compulsions

• Ordering
• Arranging
• Washing
• Being  stuck in place
• Counting
• Mental reviewing
• Cleaning
• Calling others
• Sending email
• texting to others to make sure everything is OK

Just Right OCD can make day-to-day life difficult to live. This can become hard to leave the house on time due to intrusive thoughts which can delay you if you need to do more rituals and cross check to cope. It can take time to make something feel complete even when you know you are doing compulsions and it does not need to do as necessary. It can also pose challenges in relationships as a partner or parents or caregiver may feel overly watched or monitored.

Just right OCD results from a imitation as a learning in early adolescent age from parents or via elder siblings or it can be outcome of high standard from family or from teachers also in exceptional case or it can be imitation from you’re your own role model and someone who are successful. Usually the sense doing things better way so people can acknowledge and they can be in good of others as following good things in early stage than later it take the form of compulsions.

Just right OCD is treated well with CBT and ERP and REBT models of care as intervention but in customized manner based of the development of these ritual and belief system that need to restructure in cognitive restructuring process. it need to understand as moment by-moment basis.Experience of the obsession or compulsion for example what are the emotions, thoughts, beliefs before, during and after the event or situation based on client opinion and then what is the consequence if person do not do what they force to do whether its right or not, or needed or not need as mandatory aspect of life. Some client may have assumption based situations and outcome that can trigger the feeling for example while reading, writing, playing, watching movies. Most crucial time in just right OCD is the beginning phase of behavioral change, with consistent practice person develops the ability to keep moving and is better able to focus on the task and activity needed for balancing life rather than the feeling of incompletness.

Behaviors related to just right OCD can be challenging to control but with consistent practice people can accept and get used to the feeling as part of their daily experience. Once the feeling is accepted, people surrender the need to fix it instead of fighting with this state of mind and thought process as beliefs.

For getting rid from Just right OCD we have customized intervention and CBT and ERP session which can make this possible you live your life without this OCD.

Write to us: info@emotionoflife.in

Sensory Motor OCD is one of type of OCD. Clients report distressing preoccupations with bodily sensations like obsessive swallowing, obsessive blinking, conscious breathing, Compulsive Staring  these problems under sensory motor obsessions. Sensorimotor obsessions as defined involve either a focus on automatic bodily processes or physical sensations.  Any bodily process or sensation to which one selectively attends can form the foundation of this sensory or sensorimotor obsession.  In a typical scenario, individuals begin to selectively attend to their swallowing, for example, and become anxious that they will become unable to stop thinking about their swallowing.  Attempts to distract themselves fail, leading to higher levels of anxiety.  This anxiety perpetuates the focus on swallowing, leaving them preoccupied and frustrated by their unsuccessful attempts to shift attention elsewhere.

Examples of Common Sensorimotor Obsessions : often involve one or more of the following:

1. Breathing: whether breathing is shallow or deep, or the focus is on some other sensation of breathing. 

2. Blinking how often one blinks or the physical requirement to blink.

3. Swallowing/salivation (how frequently one swallows, the amount of salivation produced, or the sensation of swallowing itself.

4. Movement of the mouth and/or tongue during speech.

5. Pulse/heartbeat (awareness of pulse or heartbeat, particularly at night while trying to fall asleep or specially in public place or with stranger or while performing some technical task. 

6. Eye contact (Staring): unlike social anxiety-based concerns, this form involves awareness of the eye contact itself or which eye one is looking at when staring into the eyes of another person (Compulsive staring).

7. Visual distactions: paying attention to “floaters”, the particulate matter that is drifting within the eye that is most visible when staring at a blank wall or awareness of subtle movements of the eyes.

Awareness of specific body parts: Perception of the side of one’s nose while trying to read or as in the cases of a young boy and older man, a hyper-awareness of particular body parts such as their feet, arm, or fingers.

Sensorimotor obsessions fears center mainly on the concern that automatic bodily processes or physical sensations will fail to return to their previous unconscious state. Such fears are frequently accompanied by the broader concern that the obsession itself will be unending, termed as “obsessing about obsessing”.  Sensorimotor obsessions are infrequently accompanied by perfectionistic attitudes or beliefs. However they do occasionally play a role, as in the case of a perfectionistic patient who was constantly preoccupied by smudges on his glasses and by other imperfections in his sensory environment.  By definition sufferers report significant levels of distress, particularly as a result of impairments in concentration at work, when socializing, or when attempting to fall asleep.  Compulsions in response to sensorimotor obsessions are usually limited to repeated attempts to use distraction to interrupt the fixation on sensory phenomena. Most people at some point in their lives have experienced transient problems with this sort of sensory hyper-awareness.  Stuffy noses, irritated eyes, rashes, coughing and the like represent the normal sensory annoyances that can come to preoccupy individuals for short periods of time.  For some less fortunate individuals, their chronic allergies, pain syndromes, and other medical problems cause sustained interruptions to selective attention. However, for a minority of sufferers, their awareness of sensorimotor phenomena elicits anxiety and preoccupation severe enough to warrant a clinical diagnosis of obsessive-compulsive disorder or an obsessive-compulsive spectrum condition.

Relationship of Sensorimotor Obsessions to OCD Spectrum Conditions:

Evidence suggests that sufferers diagnosed with this type of sensorimotor OCD are also more likely to have current or past difficulties with other issues more common are obsessive-compulsive disorder, generalized anxiety disorder, panic disorder.  This reflects the fact that problems with sensory hyper-awareness are not confined to a particular diagnostic entity (such as OCD), but cut across a number of obsessive-compulsive spectrum conditions.  For example, individuals with bowel or bladder preoccupations, hypochondriasis (health anxiety), and panic disorder report not only sensory hyper-awareness (such as fullness of the bladder, acute physical symptoms, or rapid heart rate) but also cognitive dysfunction that involve specific, catastrophic fears. Currently, individuals who suffer from the relatively unelaborated sensorimotor preoccupations as described are routinely diagnosed with obsessive-compulsive disorder.  Individuals who suffer from elaborated catastrophic fears associated with their sensorimotor preoccupations tend to be diagnosed according to the content of those fears.

Treatment of Sensorimotor Obsessions

Sensorimotor obsessions can be treated quite successfully by segregating any sensory awareness with reactive anxiety.  Sufferers must ultimately experience their sensory hyperawareness without any resulting anxiety. Anxiety, as is the case in other forms of obsessive-compulsive disorder, serves as the glue that binds particular thoughts to conscious awareness.  Once a thought is linked with anxiety, the conscious mind keeps it ever present.  This occurs because anxiety is part of life. The mind clearly does not want us to forget about any danger that may be present around.  If a particular idea scares us, we tend to think about it over and over.  In sensorimotor obsessions, sufferers repeatedly attempt to shift their attention for fear that their sensory focus will become stuck and they will not be able to concentrate fully on the task at hand.  Here, the thought that “I’m never going to stop thinking about this” leads to immediate fears of impaired functioning.  As a result of the pairing between this thought and a feared outcome, the mind holds on tightly to the very awareness that the sufferer is attempting to rid.  In many ways this is much like psychological process whereby deliberate attempts to suppress certain thoughts make them more likely to surface (white bear syndrome) where attempts by individuals to think about anything other than a white bear lead to many more thoughts of white bear. In order to recover from sensorimotor obsessions, sufferers must learn “the art of self-awareness.”  Sufferers must learn how to invite in the sensory awareness with a relaxed and accepting posture. 

Psycho education: 

The first stage of treatment focuses on teaching client that selective attention to previously automatic or unconscious bodily processes or sensations is not dangerous in and of itself.  Patients are reassured that once their anxiety disappear, the sensory awareness will shift.  This reassurance often sets the stage for “inviting in” the sensations as a means of reducing anxiety.

Exposure and Response Prevention

In short, sensorimotor obsessions can be outsmarted by voluntarily paying attention to the relevant bodily process or sensation. Client are instructed to allow the sensation to be present and to invite in any such awareness (exposure) with a casual, dispassionate focus.  By purposely focusing on the sensations (exposure), patients stop relying on distraction (response prevention) as the tool for reducing anxiety. Repeated voluntary exposure to the sensations leads to diminished anxiety as patients grow accustomed to embracing any awareness without attempts to avoid or escape it.  Imaginal exposure to particular feared outcomes (e.g. “my life will be ruined,” “I’ll never have peace of mind,” “I’ll never be able to get rid of this problem,” or “this obsession will never go way”) may be employed to enhance exposure.  Additionally client may be asked to invite in the sensations and accompanying fears throughout the day.  This is accomplished by having client place reminders at home, in the car, and at work.  These reminders help to cue client to engage in repeated exposures throughout the day, thus increasing the likelihood of successful habituation.

Body Scan Meditation 

Client are frequently unaware of the changes in perception that occur when selectively attending to their bodies. These changes in awareness can be frightening, as they may represent an uncomfortable level of awareness to previously unconscious bodily processes. Client tend to believe that they must purposely shift attention away from these unusual or previously unnoticed sensations in order to restore them to their unconscious state. Participation in a body scan can help client fluidly move in and out of their awareness of these sensations without resorting to forced attempts. A body scan involves shifting attention to various bodily processes or sensations for prescribed periods of time.  Patients are instructed to close their eyes and selectively attend to their feet, for example, until they acquire full sensory awareness.  Once this occurs, they can next move to their calves, stomach, upper body, arms, head, or any particular sensorimotor process (such as breathing).  Patients learn that they can move gently from one sensation to another without getting “stuck” by focusing and refocusing in the absence of anxiety, apprehension, or active attempts to force a shifting in awareness.

Mindfulness 

The art of paying close attention to an experience in the absence of criticism, judgment, or defensiveness, can also play an important role.  Mindfulness often involve choosing certain bodily processes to be the focus of meditative practice (e.g. breathing, the rise and fall of the chest or stomach, sensations of air through the nostrils).  Client is instructed to allow their particular sensory preoccupation to become their meditative focus; they are to accept all sensations without criticism or judgment, and observe any sensations with curiosity and interest.  Over time client begin to experience a fading of sensory awareness (or much greater tolerance of it) as their anxiety diminishes and their willingness to invite in the sensations grows.

Sensorimotor obsessions are best dealt with within a cognitive-behavioral framework.  Psycho education, cognitive restructuring, reassurance, exposure and response prevention, certain mindfulness and acceptance techniques can all play important roles in diminishing the frustration and distress associated with this sensorimotor OCD.

 For any question write to us info@emotionoflife.in 

People with POCD typically fear that they are sexually attracted to children, including their own, if they have any. Some may also fear that they will commit sexual crimes against children, either consciously or unconsciously. Essentially, clients with POCD suffer from recurring mental thoughts and images of children in sexualized contexts, which often raises doubts about whether they will engage in acts of sexual violation toward them. However, unlike pedophilic disorder. the thoughts in POCD are unwanted and cause severe shame, disgust, and anxiety in sufferers. Where as clients who have pedophilic disorder enjoy and are aroused by sexuality thoughts and images of children, clients with POCD fear that they may actually enjoy or find pleasure in these images. As a result, clients with POCD can spend several hours throughout the day worrying about the possibility of being or becoming pedophilic. People with POCD tend to have great difficulty carrying out professional, academic, and social/interpersonal routines because of the amount of time and mental resources they devote to their pedophilia-themed worries.

Difference Between Pedophilic Disorder and POCD

Pedophilic Disorder                                                                                         P-OCD

1. Sexual attraction to children                                                   Fear of sexual attraction toward children

2. Prefers the company of children                                           Avoids or minimizes contact with children 

& desires to be intimately close with them                                        reminders due to feared thoughts

3. Performs grooming behaviors toward                                 Avoids or minimizes contact with children 

children for sexual contact                                                                   or reminders due to feared thoughts

4. Experiences sexual gratification                                               Experiences extreme distress and                      

from sexual contact with children                                        possible suicidality with feared thoughts or reminders

Clients who suffer from POCD tend to engage in many types of repetitive rituals, whether overt or covert. Mental compulsions or rituals are very common. These often include excessive mental review of one’s interactions with children. The mental review process may involve mentally replaying past scenarios or situations in which children were present, in order to check for any sexually inappropriate thoughts or actions during one’s interactions with or around children. Clients with POCD who engage in mental review may ask themselves questions such as, “When I was talking to that little boy, did I think about or look at his genitals?” or “When I was changing my daughter’s diaper, did I look or touch her vagina longer than necessary?” Mental review of interactions with children can haunt clients with POCD as they attempt, to ascertain whether or not they have violated the children sexually. Rumination is very common in POCD. Rumination appears to be linked to the use of mental review in an attempt to achieve some form of resolution of the uncertainty, or some of confirmation that no sexually inappropriate or perverse actions occurred when interactions with children. Other mental compulsions may involve repeating certain words, phrases, or visual images multiple times, in an effort to soothe or distract oneself from triggering situations and events. For example, in one client, if an intrusive sexual image of her daughter came to mind, she would attempt to replace that with a ‘safe image’ of her daughter sitting in a chair smiling. She would also sometimes try to replace any intrusive sexual image of her daughter with a comforting image of her husband’s face. Clients with POCD may specifically check their body for signs of sexual arousal or attraction to children. In this checking process, any physical sensation or movement experienced in the genital region in the presence of children and/or during pedophilia-themed obsessions may be misinterpreted as a sign of sexual arousal or attraction.

Reassurance-seeking can take many forms, including constantly reassuring the self, persistently seeking reassurance from others, confessing to others, or compulsively searching the internet and/or scrutinizing relevant reading materials for explanations for one’s obsessions

Detailed case history of development of PCOD and Psychoanalytic framework for therapeutic planning need to be carried out during management & planning of treatment for PCOD along with strategic CBT & ERP intervention along with family therapy based on client age and impact PCOD in life 

 For any question write to us info@emotionoflife.in 

The act of picking at one's skin may seem like a harmless habit for some, but for others, it's a compulsive behavior that can lead to significant physical and psychological distress. Known as Dermatillomania or Excoriation Disorder, skin picking is more than just a fleeting impulse for many. Skin picking, clinically known as Excoriation Disorder or Dermatillomania, is a Type of OCD characterized by repeated and compulsive picking of the skin, leading to skin lesions. This behavior may be a way of dealing with negative emotions or stress. While many people might pick at their skin from time to time, those with Dermatillomania do it habitually, often without realizing & find it challenging to stop, even if they want to.

Why People Pick Their Skin: Combination of factors is believed to contribute:

A. Family history of Obsessive Compulsive Disorder (OCD) might increase the likelihood of skin picking.

B. Many individuals pick their skin as a way to cope with anxiety, stress, or other emotions.

C. Sensory Stimulation: Some people find the act of skin picking to be satisfying or pleasurable.

The Impact of Skin picking: While the physical effects, such as scars or infections, are visible, the emotional toll can be even more profound:

A. Isolation: Due to feelings of embarrassment or shame, many hide their condition.

B. Decreased Self-Esteem: Visible marks and scars can lead to self-consciousness and a decline in self-worth.

C. Anxiety & Depression: Continual skin picking and the consequences thereof can exacerbate feelings of anxiety and depression.

Symptoms: Symptoms of Dermatillomania include:

· Regularly picking at skin, often to the point of causing damage or scars.

· Repeated attempts to stop or decrease skin picking.

· Picking in response to feelings of anxiety, boredom, or tension.

· Feeling a sense of relief or satisfaction after skin picking.

· Hiding or being embarrassed about the skin-picking behaviour.

· Having noticeable skin damage, such as scars, open sores, or discoloration.

· Spending a significant amount of time picking at the skin or dealing with its consequences.

· Interference with daily life due to skin picking (Avoiding social situations and social interaction)

Psychological Interventions Suitable for skin picking

Skin picking might seem as a mere skin allergy which they would often not consider significant but to those who experience it as a compulsion it takes a major toll on different areas of their lives and most of the times such people aren’t fully aware of what triggers lead to skin picking in them. Before it gets worse, people who have skin picking as a compulsion must reach out to a Psychotherapist in order to receive the best treatment possible. Some of the major psychotherapies/ psychological approaches that have been result oriented/ have given the best results for skin picking are

Cognitive Behavioural Therapy (CBT): CBT can help individuals recognize the triggers for their skin-picking behaviour and develop healthier coping mechanisms. A specific form of CBT called Habit Reversal Training (HRT) has been particularly effective for it. HRT helps individuals become more aware of their picking and the situations in which they pick, and then teaches them to engage in a competing response when they feel the urge to pick.

Acceptance and Commitment Therapy (ACT): This form of therapy can help individuals accept their urges without acting on them and commit to making behavioural changes based on personal values.

Mindfulness and Meditation: Focusing on the present and developing greater self-awareness can help individuals resist the urge to pick and recognize when they're doing it.

Exposure and Response Prevention (ERP): This is a technique derived from CBT and used primarily for OCD. It exposes individuals to the situation that triggers their urge to pick but prevents them from engaging in the picking behaviour.

Dialectical Behaviour Therapy (DBT): Originally developed for individuals with borderline personality disorder, DBT can also help those with skin picking. It teaches coping skills to deal with stress and regulate emotions, which can reduce the urge to pick.

In conclusion, Skin picking is a challenging condition, but with awareness, support, and appropriate intervention, many individuals can reduce or manage their skin-picking behaviors and improve their overall well-being.

A Case study on Skin picking:  Reshu,  27 Years

Background: Reshu is a 27-year-old software engineer who works at a reputable technology company. She's lived in a city apartment for five years, is single, and has a close group of friends. Despite her achievements, Emily has been dealing with an uncontrollable urge to pick at her skin for the past 10 years.

Presenting Problem: Emily seeks therapy due to increasing distress over her skin-picking habits. She has noticeable scabs and scars on her arms, legs, and face. She confides that her picking sessions can last anywhere from minutes to hours, especially during high-stress periods.

History: Emily first remembers picking her skin during her teenage years, particularly during exam times. Initially, it was an unconscious act, but over the years, it has become a way for her to cope with stress, anxiety, and boredom.

Impact on Daily Life: The condition has impacted Emily's quality of life:

Social Impact: Emily avoids social situations where her skin would be exposed, like pool parties or beach outings. She has started wearing long sleeves and pants even in hot weather to cover up the scars.

Professional Impact: She finds herself picking during virtual meetings when her video is off. Emily sometimes takes longer to complete tasks because she gets lost in a picking session during work hours.

Emotional Impact: Emily feels a mix of relief and intense guilt after picking. She's increasingly self-conscious about her appearance and fears judgment from others.

Assessment and Diagnosis: After thorough assessment, the therapist diagnoses Emily with Skin Picking Disorder (Dermatillomania), a type of OCD 

Treatment Plan:

Cognitive Behavioural Therapy (CBT): Emily starts attending weekly CBT sessions. Here, she learns to identify triggers that cause her to pick, such as feelings of anxiety or the texture of a scab. She's introduced to healthier coping mechanisms like deep breathing exercises or using a fidget toy.

Habit Reversal Training (HRT): This involves becoming more aware of the habit and replacing the skin-picking behaviour with another action, such as clenching her fists or playing with a stress ball.

Skin Care: A dermatologist helps Emily with a skincare routine to heal her skin and reduce the temptation to pick at imperfections.

Hair pulling, often medically termed as "Trichotillomania" (TTM), is a psychological disorder that's more than just a mere habit. It falls under the umbrella of Body-Focused Repetitive Behaviors (BFRBs), where individuals often pull, twist, or break their hair, causing hair loss and emotional distress. Let's dive deeper to understand this compulsive behavior and its nuances. Trichotillomania is a disorder characterized by the recurrent and irresistible urge to pull out hair from the scalp, eyebrows, or other parts of the body, despite trying to stop. While it may appear as a mere habit or a coping mechanism for stress, TTM is a recognized mental health disorder, with roots in both neurological and psychological factors.

Why do people pull their hair?

The reasons can vary widely. Some of the most common triggers and reasons include:

A. Stress and Anxiety: For many, hair pulling is a way to deal with negative emotions such as anxiety, tension, or stress.

B. Pleasure or Relief: Oddly enough, some individuals experience relief or pleasure after pulling their hair.

C. Boredom: It can also emerge as an activity during periods of boredom or inactivity.

D. Perfectionism: Trying to pull out 'imperfect' or 'wrong-feeling' hairs can be a trigger for some.

Physical and Emotional Consequences

Beyond the visible hair loss, individuals with TTM often face:

A. Skin damage: Continuous hair pulling can lead to infections, scars, or even permanent damage to hair follicles.

B. Emotional distress: The realization of the hair loss can lead to emotional turmoil, feelings of shame, and avoidance of social situations.

C. Co-existing disorders: Many with TTM also suffer from anxiety disorders, depression, or Obsessive-Compulsive Disorder (OCD).

Breaking the Myths

A. It's not just "a bad habit." TTM is a recognized mental health disorder and isn't something one can "just stop."

B. It's not about vanity. People don't pull their hair because they are overly concerned about their appearance.

C. It's not uncommon. Millions worldwide suffer from TTM, but many hide their condition due to embarrassment or fear of judgment.

Characteristics and Symptoms:

A. Recurrent Hair Pulling: Individuals with trichotillomania have an irresistible urge to pull out hair from the scalp, eyebrows, eyelashes, and other parts of the body.

B. Resultant Hair Loss:Constant hair pulling leads to bald patches and uneven hair growth.

C. Increasing Tension Before Pulling: Prior to the act, the person often feels an increasing sense of tension or anxiety.

D. Relief After Pulling: The act of pulling is typically followed by a feeling of relief or pleasure.

E. Attempts to Stop: Despite wanting to stop the behaviour and understanding its consequences, the individual struggles to control the urge.

F.  Impact on Social Functioning: People with this condition may avoid social situations due to embarrassment about their hair loss.

Causes of Hair pulling OCD :

A. Ongoing continuous stress 

B. Traumatic life event in past 

C. Bulling in early childhood or adolescent age

D. Low emotional health and self esteem 

E. Poor Parenting: lot of instruction, unrealistic parental demand in academic, high set standard for children

F. Poor coping mechanism 

G. Anxiety prone personality and high apprehension

H. Comparison within family and external environment like in friends circle, school. 

Psychological Treatment: 

There's hope! There exist a number of Psychological treatments that helps those with hair pulling rituals get out of the distressing loop. 

1. Cognitive-Behavioral Therapy (CBT): The most widely used treatment, CBT helps individuals recognize their negative behavior patterns and triggers. A key component for trichotillomania is Habit Reversal Training (HRT), where individuals learn to recognize the urge to pull and substitute a less harmful behavior.

2. Acceptance and Commitment Therapy (ACT): ACT helps individuals accept their hair-pulling urges without acting on them. It teaches mindfulness skills to deal with these urges more effectively.

3. Mindfulness and Meditation: Engaging in mindfulness practices can help individuals become more aware of their hair-pulling triggers and reduce impulsivity.

4. Family Therapy: Family members can play a crucial role in the recovery process. This therapy educates families about the disorder and how they can support their loved one.

Understanding and awareness are crucial. The next time we encounter someone with inconsistent patches of hair or bald spots, let's refrain from judgment. Compassion, understanding, and open conversation are steps forward in helping those who grapple with this disorder. If you or someone you know struggles with hair pulling, consider seeking psychotherapeutic intervention to get rid from this type of OCD.

Sheena, india, 28, Software engineer

Sheena has sought therapy due to a noticeable decline in her self-esteem and social avoidance. Upon examination, the therapist observes bald patches on her scalp and a lack of eyebrows. Sheena admits to pulling out her hair compulsively, often while reading or watching TV. She has tried to stop multiple times but finds the urge too overwhelming. She's begun to wear hats and uses eyebrow pencils to camouflage the missing hair.

History: Sheena first noticed her urge to pull her hair during her teenage years, around age 15, during times of increased stress and studying for exams. Her parents dismissed it as a "phase.", By the age of 24, the behavior intensified after a significant breakup. She's attempted various remedies, such as wearing gloves, keeping her hair tied up, and using fidget toys but has seen minimal improvement.

The therapist conducts a thorough assessment to rule out other disorders and confirm the diagnosis of Trichotillomania. This includes:

1. Clinical Interview: Delving deep into the onset, frequency, triggers, and consequences of her hair-pulling behaviors.

2. Psychological Assessment: Using standardized scales to gauge anxiety, depression, and compulsive behaviors.

3. Physical Examination: To ensure the hair loss isn’t due to a medical condition.

Diagnosis:

Trichotillomania (Hair Pulling Disorder), as per DSM-5 criteria.

Treatment: Sheena will undergo a series of CBT sessions focused on Habit reversal training (HRT):Sheena will be trained to recognize situations where she's likely to pull her hair and substitute a different behaviour, stimulus control this involves making changes to her environment to help prevent the hair-pulling. For example, she might start wearing a tight hat or bandana when at home to make it harder to pull out the scalp hair.

Outcome: After six months of therapy, Sheena reports a significant decrease in her hair-pulling urges. She's regrown some of her eyebrows and the bald patches on her scalp are less noticeable. She's also more socially active

  OCPD is a type of “personality disorder” with these characteristics:

• Rigid adherence to rules and regulations

• An overwhelming need for order

• Unwillingness to yield or give responsibilities to others

• A sense of righteousness about the way things “should be done”

What are the symptoms of OCPD?

• Excessive devotion to work that impairs social and family activities

• Excessive fixation with lists, rules and minor details

• Perfectionism that interferes with finishing tasks

• Rigid following of moral and ethical codes

• Unwillingness to assign tasks unless others perform exactly as asked

• Lack of generosity; extreme frugality without reason

• Hoarding behaviors

The diagnosis of OCPD is made when these traits result in a significant impairment in social, work and/or family functioning. A person does not need to have all of these symptoms to have the personality disorder.

What is the difference between OCPD and OCD?

• People with OCD have insight, meaning they are aware that their unwanted thoughts are unreasonable. People with OCPD think their way is the “right and best way” and usually feel comfortable with such self-imposed systems of rules.

• The thoughts, behaviors and feared consequences common to OCD are typically not relevant to real-life concerns; people with OCPD are fixated with following procedures to manage daily tasks.

• Often OCD interferes in several areas in the person’s life including work, social and/or family life. OCPD usually interferes with interpersonal relationships, but makes work functioning more efficient. It is not the job itself that is hurt by OCPD traits, but the relationships with co-workers, or even employers can be strained.

• Typically, people with OCPD don’t believe they require treatment. They believe that if everyone else conformed to their strict rules, things would be fine! The threat of losing a job or a relationship due to interpersonal conflict may be the motivator for therapy. This is in contrast to people with OCD who feel tortured by their unwanted thoughts and rituals, and are more aware of the unreasonable demands that the symptoms place on others, often feeling guilty because of this.

• Family members of people with OCPD often feel extremely criticized and controlled by people with OCPD. Similar to living with someone with OCD, being ruled under OCPD demands can be very frustrating and upsetting, often leading to conflict.

How many people have OCPD?

• About 1 in 100 people is estimated to have OCPD

• OCPD is diagnosed in twice as many men as women

• Many people have OCPD traits without having the fully diagnosed personality disorder.

What causes OCPD?

• There is no single, specific “cause” identified

• Several theories suggest that people with OCPD may have been raised by parents who were unavailable and either overly controlling or overly protective. Also, as children they may have been harshly punished. The OCPD traits may have developed as a sort of coping mechanism to avoid punishment, in an effort to be “perfect” and obedient.

• Genetics may play a role, but this has not been well-studied.

• Cultural factors may play a role. Societies or religions that are very authoritarian and bound by strict rules may impact early childhood development that affects personality expression. A word of caution: not all rule-bound societies are dysfunctional and OCPD traits may in fact be rewarded within that specific cultural or religious context

What are the treatments of OCPD ?

• Psychotherapy – cognitive behavioral therapy (CBT) and techniques that improve a person’s insight (for example, psychodynamic therapy) can be helpful for some people. The goal is to lessen rigid expectations and learn how to value close relationships, recreation, and fun with less emphasis on work and productivity.

• Relaxation – specific breathing and relaxation techniques may be useful to reduce a sense of urgency and stress that are experienced with OCPD.

People with ROCD struggle with obsessions and compulsions about their relationships and their feelings about them. As with all subtype of OCD, uncertainty leads to intense fear and subsequently, compulsions, such as seeking reassurance to alleviate the fear.  If you have ROCD, the fears you have typically fall into two categories:

· relationship-centered, where you are concerned about your feelings toward your partner and if the relationship is right

· partner-focused, where you obsess over your partner’s characteristics

Another fear variant is obsessional jealousy, where you may experience intrusive thoughts about your partner thinking about or cheating with someone else.

Having obsessive-compulsive cycles related to your relationship can take a toll on your mental health and the well-being of your relationship. Fortunately, ROCD can be treated through a form of cognitive behavioral therapy called Exposure and Response Prevention ERP. 

ERP therapy is considered the gold-standard treatment for all types of OCD, and all NOCD therapists receive ERP-specific training to offer you the most effective treatment. During ERP, your therapist will collaboratively work with you to expose you to the things that trigger your obsessions and guide you through them in order to help you resist enacting your compulsions. Over time, you will learn to let the intrusive thoughts simply exist without causing you an overload of distress or rushing to engage in compulsions.

ROCD exposures allow you to lean into your unwanted thoughts and subsequent uncomfortable feelings and learn how to tolerate uncertainty. A common type of exposure used for people with ROCD is imaginal exposure. These are exposures that cannot be done in real life, but rather are done using the imagination. 

For example, if you are concerned about being with the wrong person, your therapist may ask you to write exposure scripts about being with the wrong person or, even better, about never knowing or never being sure if you are with the right person. By writing this exposure script, reading it and not engaging in your compulsions, you can learn how to better endure your relationship fears.

Another variant of this would be to write an exposure script or vocalize exposure statements that you might never find the right person or that you might be stuck in a loveless relationship forever. This lets the uncertainty bubble to the surface so you can learn how to lean into it without enacting compulsions. 

An exposure script may look like this: 

“I can never know if Bob is the right person for me. We have been together for four years and there still might be another person out there that is a better fit for me than Bob. Even though I enjoy his sense of humor and find that our values and plans for the future match, I might be making a horrible mistake. I may never know if I am settling or making the right choice.”

This can be overwhelming to write and read, but your therapist will be alongside you the whole time to help you work through the fear and anxiety these exposures cause without giving in to your compulsions.

Other examples of ROCD exposures can include (but are certainly not limited to): 

· looking at unflattering pictures of your partner

· having your partner do irritating things and resisting compulsions

· resisting compulsions such as looking at articles about relationships or asking reassurance-seeking questions

· imagining your partner having intercourse with someone else

· thinking about your partner’s former lovers

ERP therapy isn’t just about exposures — response prevention is key. Resisting compulsions is imperative to treating your OCD and is what will ultimately lead you to a healthier relationship and mental state. If you do an imaginal exposure only to leave the exposure session and ask your partner reassurance-seeking questions all night or research relationship articles online, your obsessive-compulsive cycles will likely persist.
It may feel impossible to resist your compulsions, but as you continue to work with your therapist, it will get easier. 

Health Obsessive-Compulsive Disorder (Health OCD) is a subtype of Obsessive-Compulsive Disorder (OCD) where an individual's obsessions and compulsions center around the fear of having or contracting a serious medical condition or disease.

Features of Health OCD include:

Obsessions: Persistent, intrusive thoughts or fears about having or acquiring a serious health condition. For instance, a person might constantly worry that their headache is a sign of a brain tumor.

Compulsions: These are repetitive behaviors or mental acts that someone feels driven to perform in response to the obsession. With Health OCD, this might involve repeatedly checking the body for signs of illness, constantly seeking reassurance from doctors or loved ones, or excessively researching symptoms online.

Resistance and Distress: Individuals with Health OCD typically recognize that their fears and behaviors are excessive or irrational, but they feel compelled to engage in these behaviors anyway. The obsessions and compulsions cause significant distress and can interfere with daily life.

Symptoms:

Health OCD manifests through a range of psychological symptoms tied to obsessions and compulsions. These symptoms are usually focused around health-related fears, such as developing or having a serious medical condition.

Obsessions:

· Intrusive Thoughts: Persistent thoughts about having or contracting a serious illness, often disproportionate to any actual medical symptoms or risk factors.

· Preoccupation with Body Sensations: Over-attention and misinterpretation of normal or benign body sensations (e.g., a headache or muscle twitch) as signs of serious illness.

· Fear of Contamination: Worry about encountering people, places, or things that could lead to a serious illness, beyond standard hygiene practices.

· Hyperawareness: An exaggerated sense of attentiveness to the body, leading to heightened perception of minor symptoms.

Compulsions:

· Excessive Body Checks: Constantly examining oneself for signs of illness, such as feeling for lumps, scrutinizing skin changes, or taking one's temperature repeatedly.

· Reassurance Seeking: Frequently asking family, friends, or medical professionals for reassurance that symptoms are not indicative of a severe disease.

· Information Seeking or Avoidance: Either excessively researching symptoms and diseases online or avoiding medical information altogether out of fear it will trigger anxiety.

· Frequent Medical Visits or Avoidance: Making frequent doctor appointments for reassurance or, conversely, avoiding medical professionals altogether for fear of receiving bad news.

· Ritualistic Behaviors: Engaging in specific behaviors believed to "ward off" illness, even when there is no logical connection between the action and health.

Emotional and Behavioral Effects:

· Anxiety and Distress: Intense, often debilitating anxiety specifically focused on health-related fears.

· Interference with Daily Life: The time and energy spent on obsessive thoughts and compulsive behaviors can significantly interfere with personal relationships, work, or other aspects of daily living.

· Low Tolerance for Uncertainty: A tendency to perceive any level of uncertainty about health as unbearable, leading to more compulsive behaviors to seek certainty or relief.

Treatment:

Health OCD, like other forms of Obsessive-Compulsive Disorder (OCD), can be effectively managed with various psychological therapies. Here's an overview of the primary psychological treatments for Health OCD:

· Cognitive Behavioral Therapy (CBT): This is the most commonly recommended treatment for OCD, including Health OCD.

· Exposure and Response Prevention (ERP): A specialized form of CBT, ERP involves gradually exposing patients to their obsessive thoughts and training them to resist performing the compulsions that usually follow. Over time, this can reduce the intensity of the obsession and the urge to carry out the compulsion.

· Cognitive Therapy: This component of CBT targets catastrophic and overly negative beliefs about health and teaches strategies to challenge and modify these beliefs.

· Acceptance and Commitment Therapy (ACT): ACT helps individuals recognize and accept their obsessions without acting on them. It focuses on being present, opening up to unpleasant feelings, and doing what you value.

· Mindfulness-Based Cognitive Therapy (MBCT): This integrates traditional cognitive behavioral approaches with mindfulness strategies. It teaches patients to pay attention to their thoughts and feelings without judgment, helping them become more aware of their obsessions and decreasing the need to act on them.  

· Dialectical Behavior Therapy (DBT): Originally developed for borderline personality disorder, DBT can also be adapted for OCD. It emphasizes skills like emotion regulation, distress tolerance, mindfulness, and interpersonal effectiveness.

· Group Therapy: Sometimes, people with Health OCD benefit from therapy sessions with others who share similar challenges. Group settings can provide a supportive environment where participants can share experiences, coping techniques, and encouragement.  

· Psychoeducation: This isn't a therapy per se, but educating individuals about the nature of OCD and its mechanisms can be a crucial part of the therapeutic process.

· Family Therapy: OCD affects not just the individual but their families too. Family therapy can help relatives understand the condition and learn supportive techniques while addressing any familial dynamics that might exacerbate the condition.

Case Study: Rohit's Battle with Health OCD

Background:

Rohit Sharma, a 28-year-old software engineer from Bangalore, India, first began to experience troubling thoughts about his health shortly after a minor bike accident. Though he suffered only a few cuts and bruises, he became overwhelmingly anxious about potential internal injuries.

Symptoms:

Over the next few months, Rohit's concerns grew. He frequently checked his pulse, believing he might have a heart issue. Every minor ache or pain sent him into a spiral of catastrophic thinking: a headache became a feared brain tumor, and stomach discomfort was perceived as potential cancer.

His family noticed he would often spend hours online, researching diseases and correlating them with any minor symptoms he felt. He made repeated visits to various doctors, undergoing numerous tests, all of which came back normal. Despite medical reassurances, Rohit's anxiety persisted.

The symptoms of his Health OCD began to interfere with his daily life. He took several days off work, fearing he might collapse there. Social outings dwindled as Rohit was either busy with doctor's appointments or too anxious to step out, worrying he might catch a severe illness from someone else.

Intervention:

Rohit's sister, Priyanka, grew increasingly concerned after witnessing one of his panic attacks. She persuaded him to see a psychologist.

Upon assessment, the psychologist diagnosed Rohit with Health OCD. His treatment plan included:

- Cognitive Behavioral Therapy (CBT): This helped Rohit identify and challenge his irrational health-related beliefs.

- Exposure and Response Prevention (ERP): Rohit was gradually exposed to his health fears without resorting to compulsions (like checking his pulse). Over time, this reduced his anxiety levels.

- Mindfulness Techniques: To help Rohit manage his anxiety and remain present.

- Family Counseling: Educating the Sharma family about Health OCD and teaching them how to support Rohit without reinforcing his compulsive behaviors.

Outcome:

After several months of therapy, Rohit began to regain control over his life. He learned to manage his anxiety and to distinguish between irrational fears and genuine health concerns. With the continued support of his therapist and family, Rohit returned to work, rekindled his social connections, and started enjoying his hobbies once more. 

Existential OCD (Obsessive-Compulsive Disorder) is a subtype of OCD wherein individuals are consumed by intrusive and distressing thoughts centred around existential themes. These can include concerns about the meaning of life, the nature of reality, or the concept of free will. Rather than being driven by external compulsions, the sufferer is often trapped in endless internal ruminations.  

Obsessions and Compulsions around it:
Individuals with Existential OCD often grapple with a series of obsessive thoughts and mental compulsions:

• Obsessive Thoughts: These can include ruminations about the purpose of existence, the nature of self-awareness, the reality of one’s experiences, or the concept of death and what follows it.
• Mental Compulsions: In an attempt to alleviate the distress caused by these thoughts, sufferers might repeatedly analyze or seek reassurance for these philosophical questions, delve into philosophical books or discussions, or mentally review past experiences to ensure they were "real."

Symptoms:

Some of the symptoms associated with Existential OCD include:

· Persistent and intrusive existential thoughts that cause significant distress.

· A sense of being "stuck" in deep philosophical ruminations.

· An urgent need to find answers, even when recognizing that definitive answers might be elusive.

· Overwhelming feelings of detachment or unreality.

· Anxiety or distress when confronted with discussions or reminders of existential themes.

Impacts on the Lives of People:

The constant quest for meaning and reality can significantly affect an individual's daily life:

· Social Withdrawal: Engaging in everyday conversations might become challenging, leading to social isolation.

· Career Disruptions: Persistent ruminations can hamper focus and productivity at work.

· Relationship Strains: Loved ones might struggle to understand or provide the reassurance that the sufferer seeks.

· Mental Exhaustion: The constant internal debate and analysis can be mentally draining, leading to fatigue, irritability, and even depression.

Psychotherapies useful for it:

Several therapeutic approaches can benefit those with Existential OCD:

· Cognitive-Behavioral Therapy (CBT): This is the gold standard for treating many types of OCD, including existential OCD. CBT teaches individuals to recognize and challenge their distressing thoughts and change their maladaptive behaviors.

· Exposure and Response Prevention (ERP): ERP is a subtype of CBT and is the most recommended treatment for OCD. In this therapy, individuals are exposed to their obsessive thoughts and then prevented (or resist) from performing their usual compulsions. Over time, this can help reduce the anxiety triggered by the obsessive thoughts.

· Mindfulness-Based Cognitive Therapy (MBCT): Given that existential OCD often revolves around deep and introspective thoughts, mindfulness can be especially beneficial. It teaches patients to observe their thoughts without judgment, thereby creating some distance from distressing existential ruminations.

· Acceptance and Commitment Therapy (ACT): ACT can be beneficial for existential OCD as it encourages individuals to accept their thoughts and feelings rather than battling against them. The therapy emphasizes committing to actions that are consistent with one's values, even in the presence of distressing thoughts.

· Existential Therapy: Interestingly, existential psychotherapy, which focuses on exploring issues of existence, freedom, isolation, and meaning, may be beneficial for some with existential OCD. It might allow individuals to explore their profound questions in a therapeutic context, potentially leading to greater acceptance and less distress about unanswered questions.

Hit and Run OCD, also known as Vehophobia, is a specific subtype of Obsessive-Compulsive Disorder (OCD) characterized by persistent and distressing thoughts and behaviors related to causing harm while driving or walking. This condition can significantly disrupt a person's life, causing distress and anxiety.

Obsessions and Compulsions:

People with Hit and Run OCD experience obsessions related to causing harm to others while on the road. These obsessions often revolve around fears of hitting pedestrians, cyclists, or other vehicles. These intrusive thoughts can be graphic and distressing, leading to intense anxiety and guilt. To relieve this anxiety, individuals with Hit and Run OCD engage in compulsive behaviors, such as checking and rechecking their surroundings, reviewing their driving route multiple times, or avoiding specific routes altogether.

Symptoms:

1. Intrusive Thoughts: Persistent, unwanted thoughts of causing harm to others while driving or walking.

2. Anxiety and Guilt: Overwhelming feelings of anxiety, guilt, or fear associated with these thoughts.

3. Compulsive Behaviors: Repeated checking, excessive reviewing of actions, or avoiding specific situations to prevent harm.

4. Impaired Daily Functioning: Difficulty concentrating on tasks, social withdrawal, and avoidance of activities that trigger obsessions.

5. Time-consuming Rituals: Spending excessive time on compulsive behaviors, which can interfere with daily routines and responsibilities.

Impacts on the Lives of People:

Hit and Run OCD can have profound effects on individuals' lives, causing distress and impairment in various areas:

1. Relationships: Constant preoccupation with obsessions and compulsions can strain relationships as loved ones may struggle to understand and support the individual.

2. Occupational Functioning: Concentration difficulties and time-consuming rituals may hinder work or academic performance.

3. Emotional Well-being: Persistent anxiety and guilt can lead to depression and reduced overall life satisfaction.

4. Social Isolation: Avoidance behaviors may result in social withdrawal and isolation.

5. Physical Health: The stress associated with Hit and Run OCD can impact physical health, including sleep disturbances and increased blood pressure.

Psychotherapies for Hit and Run OCD:

1. Cognitive-Behavioral Therapy (CBT): CBT helps individuals identify and challenge irrational thoughts and develop healthier coping strategies. Exposure and response prevention (ERP) is a specific CBT technique used to gradually expose individuals to their fears and reduce compulsive behaviors.

2. Mindfulness-Based Cognitive Therapy (MBCT): MBCT incorporates mindfulness techniques to help individuals manage anxiety and intrusive thoughts.

3. Support Groups: Joining support groups can provide a sense of community and understanding, reducing feelings of isolation.

Staring OCD is another sub-type of OCD. This specific subtype of OCD revolves around the compulsive need to gaze at specific objects or individuals, often causing significant distress to the individual experiencing it. It involves a preoccupation with staring or fixating on certain objects or people.

Obsessions and Compulsions around It:

People with Staring OCD typically experience intrusive and distressing thoughts or obsessions related to staring. These obsessions can take various forms, such as fearing that not looking at something or someone will lead to negative consequences or that they will miss something important. To relieve these anxieties, individuals with Staring OCD engage in compulsive behaviors like compulsively staring at the object or person in question.

Symptoms:

Symptoms of Staring OCD can vary from person to person but may include:

1. Intrusive Thoughts: Persistent and distressing thoughts about the need to stare at something or someone.

2. Compulsive Staring: Repeatedly and excessively gazing at objects, people, or specific body parts, often for extended periods.

3. Anxiety and Distress: Feelings of intense anxiety, guilt, or discomfort when unable to satisfy the compulsive urge to stare.

4. Time-Consuming: Spending a significant amount of time staring, which can interfere with daily activities and responsibilities.

5. Avoidance: Avoiding situations where staring obsessions may be triggered or avoiding eye contact with individuals to prevent staring at them.

6. Impaired Functioning: Difficulty concentrating on other tasks or maintaining healthy relationships due to the preoccupation with staring.

Impact on Lives:

Staring OCD can have a profound impact on individuals' lives. It may lead to social isolation, strained relationships, and difficulties in work or school. The constant need to engage in staring behaviors can be time-consuming and mentally exhausting, making it challenging for those affected to enjoy a fulfilling life.

Psychological Therapies Available for It:

Several psychological therapies can be effective in managing Staring OCD:

1. Cognitive-Behavioral Therapy (CBT): CBT, particularly Exposure and Response Prevention (ERP), is a common treatment for OCD subtypes like Staring OCD. It helps individuals confront their obsessions and gradually reduce compulsive behaviors.

2. Mindfulness-Based Therapies:Techniques like mindfulness meditation can help individuals with Staring OCD learn to tolerate their obsessions and compulsions without reacting to them.

3. Support Groups: Joining support groups or therapy groups can provide individuals with a sense of community and understanding, making it easier to cope with their condition.

4. Self-Help Strategies: Learning self-help strategies, such as stress management and relaxation techniques, can complement therapy and reduce the impact of Staring OCD on daily life.

Staring OCD is a challenging condition characterized by intrusive thoughts and compulsive staring behaviors. It can significantly disrupt the lives of those affected, but with the right psychological therapies and support, individuals can learn to manage their symptoms and regain control over their lives. 

Obsessive-Compulsive Disorder (OCD) involving violent or aggressive thoughts is a specific subtype of OCD characterized by intrusive and distressing thoughts related to causing harm to oneself or others. These thoughts are often graphic, vivid, and highly distressing, and individuals with this form of OCD may find them deeply unsettling. The obsessions may revolve around scenarios such as accidentally hurting a loved one, engaging in aggressive behavior, or even committing acts of violence.

To alleviate the anxiety caused by these thoughts, individuals with this form of OCD may develop compulsions or rituals. These compulsions often involve mental acts, such as counting or repeating specific phrases to neutralize the violent thoughts. They may also engage in physical actions like avoidance behaviors, such as steering clear of certain people or situations that trigger their thoughts.

Symptoms:

The hallmark symptom of OCD related to violent thoughts is the distressing and persistent nature of these thoughts. Individuals often recognize that these thoughts are irrational and inconsistent with their true character, causing them considerable distress. The anxiety and fear associated with these thoughts can be overwhelming, leading to a significant impact on their daily lives.

Impacts on the Lives of People:

Living with OCD related to violent thoughts can be incredibly challenging. These intrusive thoughts can lead to increased stress and anxiety, affecting one's ability to concentrate, work, and maintain healthy relationships. People may become isolated, avoiding social interactions and situations that trigger their obsessions. This can lead to a diminished quality of life and hinder personal growth and development.

Psychotherapies Available for It:

Fortunately, there are effective psychotherapies available for individuals struggling with OCD related to violent thoughts. One widely recognized approach is Cognitive Behavioral Therapy (CBT). In CBT, individuals work with a therapist to identify and challenge irrational thought patterns. They learn to cope with anxiety without resorting to compulsions.

Exposure and Response Prevention (ERP) is another beneficial therapy. ERP involves gradual exposure to situations that trigger violent thoughts while refraining from performing the associated compulsions. Over time, individuals learn to tolerate the discomfort and anxiety, reducing the power of these thoughts.

Mindfulness-based therapies and support groups can also be helpful in managing OCD-related symptoms. These approaches emphasize self-acceptance, non-judgment, and developing mindfulness skills to better cope with distressing thoughts.

In conclusion, OCD related to violent thoughts is a challenging mental health condition that can significantly impact an individual's life. However, with the right therapy and support, people can learn to manage these intrusive thoughts and regain control over their lives. The key is to seek professional help and remain committed to the therapy process, allowing for gradual improvement in mental well-being.