-Steve, thanks for joining us. Today, we’d like to learn more
about intrusive thoughts. It’d be great to start with your background,
your specialty, and a little bit about your inspiration through
how you got involved. -Great.
I got involved in psychology for no other reason than to honor
my father who passed away when I was two. He was a clinical psychologist.
I’m a bit of a traditionalist, so I grew up really only wanting
to do two things. First, to be a dentist
because I actually like my dentist. Then when I got to high school, I decided
I would pursue a career in psychology. I was a psychology major
at Lynchburg College in Virginia. Then I got a masters degree
at Towson State University in Clinical Psychology where I did
a year-long internship at Johns Hopkins Hospital.
At that point, Johns Hopkins taught me how to be a scientist.
They are a very behaviorally oriented institution, very topnotch people,
who really took a analytical approach in a very scientific behavioral way.
I learned about how human behavior can be measured.
I learned about what influences human behavior, what changes it.
Then I got into a PhD program at Hofstra University in Clinical Psychology
and School Psychology. When I did my first internship from Hofstra,
I did it at the Institute for Behavioral Therapy.
There was a senior staff psychologist at the institute, who was a specialist
with OCD, I’d say at that time. His name is Dr. Gordon Ball.
He’d probably be rated as the top psychologist in the New York area.
He was someone that I admired so I asked him whether he might refer
to me some of his patients that couldn’t afford him.
At that point, I was at the lowest rank on their training net.
He gave me some patients and he supervised me on the cases.
Then one of my patients, one day, asked me if there was a group for OCD sufferers
in the NY area. I looked into it and I found surprisingly, at
that point, that there weren’t any OCD groups. So, I went to my mentor and I asked him
whether we might combine our case load and start the first OCD group
for behavioral therapy. He agreed to that.
When I would sit in the room, and I would listen to people talk about
these very upsetting intrusive thoughts or to be engaging in behavior
that seemed so irrational to me. These were very, very intelligent people.
These were very logically, reasonably minded people, and yet
they were acting in such a bizarre way and expressing fear over thoughts
that I had myself, similar ones. Yet they were reacting to these thoughts
as if there was something terribly wrong. It didn’t make any sense to me why
these level-headed, rational, intelligent people would be engaging in such irrational
responses to these intrusive thoughts. Using my history from Johns Hopkins,
at looking at things in a behavioral way and also from my training in neuroanatomy,
I started looking into what must be going on here if these people are having
such strong reactions to things that even they realized were irrational
and unnecessarily burdensome. At that point, there was a woman
in Philadelphia named Edna Foa, who was doing really good work using behavioral
approaches with persons with OCD, at a subset of OCD where these behavioral
rituals were more observable like handwashing, checking the faucet,
checking lamps just to make sure there wouldn’t be fires or flood.
She was using a very aggressive exposure treatment in which she would have people
come into contact with things that were at various degrees of dirtiness
or contamination or have people leave lights on in their apartments
and take the risk for fires. For a subset of people with OCD,
to me at that point, existed almost equally as prevalent were persons who had
intrusive thoughts. People such as a new mother
might have an intrusive thought of suffocating her own child.
It wasn’t a temptation or a desire on her part, but it was just a thought
that her brain produced. Then she would have a very strong
emotional reaction of terror to the possibility that this
might implicate either that the baby might be in danger or might say
something about her character. Persons had intrusive thoughts
about possibly not believing in God, possibly being homosexual.
These types of OCD is a subset I looked into and then at that point,
the treatments that had been designed at that point seemed very primitive to me.
Persons were asked to snap a rubber band on their wrist if they had an intrusive
thought, or persons were asked to shout out the word stop whether out loud
or in their own mind as a means of getting their brain to behave itself.
That form of therapy just did not seem that eloquent to me.
It didn’t seem like you needed a PhD to design something like that.
Using my background in neuropsychology and training from Hopkins, I started looking
at this subset of OCD and trying to devise a treatment using some of the same
principles that Edna Foa had used in terms of aggressive exposure work.
I wrote a first article that got national distribution in an OCD newsletter
called Thinking the Unthinkable. I coined the term Pure O which meant
that these people engaged in more of a purely obsessional form of OCD, their intrusive
thoughts existed in their own mind and their rituals often existed
in the form of thinking. Persons that might have an intrusive
thought about a relative might pray to God to find forgiveness, or they might engage
in a thought of trying to use reason to prove they weren’t capable of acting in such a way.
The article coined the term Pure O which gained a lot of popularity
amongst sufferers of this subset because many people who contacted me really
were complaining that many psychologists they were seeing at that time were telling
them they didn’t even have OCD because they weren’t washing their hands
or they weren’t checking faucets and lights. So many colleagues at that point
were really not very knowledgeable at all about this particular subset.
Many of my patients back in the late ’80s were even misdiagnosed as being delusional.
They were often mistaken for subset of psychosis because they had
these very imaginative thoughts and they were reacting to them
with a strong sense of belief in the thoughts because they were acting as if
these thoughts were legitimate. You could understand, if you’re not
really well-trained, that this looks like someone who has
a delusion, a form of psychosis,
rather than just an anxiety disorder. -You said you, yourself, have
intrusive thoughts. -True.
-A lot of people have intrusive thoughts. -Yes
-Can you define intrusive thoughts for us and what that might mean
in context to someone with OCD? -Yes, it’s funny because I prefer using
the term creative association. As I said, I give my brain a lot of license
to generate these associations that are no different from the associations
that my patients come in with. The difference is that when my patients
have these associations, their brain reacts to them as if there
is a crisis going on. There’s a very strong emotional component
for persons with OCD compared to the population that also readily admits
to having these exact same types of thoughts. The population with OCD, when they have these
thoughts, are so overwhelming terrorized by them that it creates an infusion
of authenticity and legitimacy that there’s really a problem going on,
that these thoughts are not okay, that they really warrant some effort
to prove their lack of danger. That’s called a ritual.
When I have an intrusive thought or a creative association,
I literally just thank my brain for sharing the experience
of the heebie-jeebies lasting no more than two seconds
and I just go on with my day. Persons with OCD have this avalanche
of distress that in their efforts to seek relief from, it actually creates a vicious
cycle that reinforces to the brain the idea that there is something actually wrong,
there actually is a crisis going on and so the brain becomes even more alarmed
the more a person tries to escape or to rationalize away or to ritualize away
the potential danger that comes along with the thought.
For people with OCD, it turns into a life altering,
very handicapping condition. -What is the difference between Pure O
and our traditional understanding of OCD? -I think I’d mentioned a number of patients,
came in believing that they had OCD, but they didn’t engage in any observable
rituals like handwashing or checking the stove or light switches.
They had these intrusive thoughts that created the same amount of terror
as someone with an observable ritual, but their rituals just involved mental
escapes, reassurances in their own mind to try to prove that they weren’t guilty
of the associations or that the associations
weren’t legitimate. Instead of handwashing, their undoing
response was, in their own mind, to use logic and reason to try to extricate
themselves from their brains presented possible emergency
or the risks as it were. -Is Pure O a real diagnosis or is it a nickname?
-Actually, most of my colleagues are not happy with the term because the term Pure O
is not derived in a scientific way. The technical term is actually called
non-observable ritualizers and that’s the scientific expression.
For my patients’ sake, they really liked the idea of having this term that
distinguished them from at that point in the late ’80s, early ’90s, all of media that
talked about OCD only talked about people who had these observable rituals.
It made for great television to show someone washing their hands like a surgeon
for just having touched a doorknob. You really can’t see a person ritualizing
in an entertaining way so the subset of Pure O was really ignored.
It’s just a term that I developed because I believed that my patients
would want to have a term that distinguished them from this other type of OCD that
had gotten a lot of publicity. -In my own experience, I think
the phrase Pure O is extremely important on getting on the right path to treatment
because of what is understood about OCD in mainstream media, there seems to be,
generically speaking, a cause and effect. If I’m afraid of germs, I wash my hands
or I don’t shake your hand. If it’s an intrusive thought like
I’m afraid of murdering my wife, I don’t go in and murder my wife.
I do everything that I can not to that. For a sufferer, it’s
a very important association. However, I think ultimately,
from a purely clinical perspective, I understand that the ritual is to put
the knife away or to hide the knife or to do things of that nature.
-Or to tell yourself, “I love my husband. I love my child.
I would never hurt my child.” That’s the undoing or the escape
within one’s own mind. Yes, technically, scientifically speaking,
there’s no such thing as Pure O because all OCD has the intrusive thought
and then the escape which is the ritual portion of it.
I’ve known since I started that the term actually wasn’t
a scientifically-derived one. It was more just defining a subset
for people whose rituals were just within their own mind.
-I think I could confidently say on behalf of the OCD community that that was
a very important and valuable contribution to create that nickname because that
provided an avenue for understanding, especially when you’re up against
a mainstream media that’s telling you something very different
as to what OCD is. With respect to that,
there are a lot of subtypes it seems. If you go online and you read the pages,
I’m sure each individual sufferer has a lot of different subtypes of OCD.
Maybe you can walk us through those? Any perspectives and insights
on the subtype? -The big three in OCD are about violence,
the idea that we might act in a way harmful to others or ourselves
and some loss of control. Some people think that they’ve committed
some violent act and they spend a great deal of time researching or contemplating
whether or not that moment might have happened.
While other people think that they might be capable of committing a violent act
and so they might stay away from knives or sharp objectives.
The second most popular theme is related to sex.
Persons will often have thoughts that they might find underage children
sexual and such to the effect that they might actually have a physiological
reaction in their growing that gives them this kind of feedback
that something unnatural, unhealthy and illegal might be taking place
in terms of seeing a young child. These people, like all persons with OCD,
have no more inclination toward being a pedophile than any other person.
It’s just that their brain is reacting with the idea that there may be
a danger here. I heard you say earlier the idea
that your brain is messing with you, almost as if your brain
is tormenting you with associations. I often try to correct persons
who say that to really be a lot more forgiving and to understand that a person’s brain
is just really generating a warning about the association to say,
“Hey, is this Okay?” Its an offering of the potential for danger.
It’s not really trying to evoke a self-defeating response.
The third subset theme within Pure O subset of OCD is religion.
Persons might have thoughts that they might say something negative
about God or something negative about Jesus or Mary and then they feel an overwhelming
sense of guilt or anxiety that they might be in danger of being reacted to by God
in a negative way. Pure O persons might, while saying a prayer,
have an intrusive thought in the middle of it and then have to restart the prayer
if they try to have a prayer from beginning to end with it being a clean slate as it were.
They might have a thought that they didn’t say the prayer with sufficient
authenticity or sincerity. It’s interesting, certain subsets of OCD imply
certain personality characteristics. Persons who have intrusive thoughts,
they might be gay for instance. There is an incredible cluster
of persons who are perfectionistic or have, technically speaking, obsessive
compulsive personality disorder. It’s not that a person who has
intrusive thoughts about being gay might be homophobic, which when I first
started working with OCD, was more of the case that persons thought, “Being gay would be bad
so I need to make sure that I’m not.” I’m happy to say that since the mid-’90s,
the spike about being gay is more, “It would be fine if I were,
but I really should know for my girlfriend’s sake or boyfriend’s sake or for who
I choose to date next.” It becomes more of a sleuth to solve
than it is a burden to extricate oneself from. -What is that experience that someone’s
having if they’re in a heterosexual relationship, they love their partner,
what is this spike telling them about their sexuality?
-It’s telling them that they might have a strong sexual desire for persons
of the same sex. That’s what their brain is telling them.
Once again, because it’s paired with terror, the person becomes desperate to figure out
whether that question is a legitimate one. They feel compelled to prove that they are
attracted to persons of the opposite sex. It’s interesting, I actually had a patient who
was gay, and he had an intrusive thought that he might have been straight.
It’s just the idea that coming to one’s acceptance and understanding
of what one’s sexual orientation is becomes questioned.
The French refer to OCD as the “doubting disease”.
It’s like all things that we believe that we have a secure answer to become up
for grabs because there’s an emotional distress that maybe it’s not so.
-What would you say is the difference between someone who experiences pedophile
OCD and they’re bombarded with essentially meaningless thoughts versus
an actual pedophile? What’s different about that?
-[chuckles] I’m actually asked that question routinely by my pedophile spikers.
I may also ask the question, “What’s the difference between
my having intrusive thoughts about stabbing someone and so on
who might actually act on it?” I often tell the patients that my answer
to them will not help them in any way because, once again, the basis of the disorder
is a biological malfunctioning of a machine that has no language skills, so to say
than that a pedophile excitedly plots the potential to have sex with a child.
Pedophile will think of scenarios in which they can get closer to the children
so that they can basically have their way and achieve sexual gratification
through children. Someone who spikes about being a pedophile
has exactly the opposite reaction. They are terrified to be around children.
They are terrified to even have thoughts about children.
They constantly seek reassurance that it’s not them.
They are looking desperately to prove their innocence, whereas a pedophile
secretly and excitedly looks forward to the opportunity
to sexually exploit a child. They are actually on opposite ends
of the continuum. -Due to the nature of intrusive thoughts,
types of thoughts, do they speak to someone’s character?
-Tragically, this is probably one of the greatest misnomer about OCD,
is that people are so tempted to look at at the content of these thoughts
and react as if they have some meaning about a person’s inner character,
yet, nothing could be further from the truth. If a patient came in with spiking
about being attracted to children sexually, the pedophile spiking subset, I often tell
them, that I’d be happy to leave them in a room with either of my two children for a week.
I say to them at the end of that week, you’d be in a lot more danger
than my children would be because it’s generally almost the exact
opposite in terms of a person’s character that they have these thoughts.
The brain is just testing the potential danger of the thought.
It’s not actually creating a sexual response or an excited response.
It’s creating a danger response. The people who would be
the least likely to harm a child or the least likely to be violent
are actually the ones whose brain is testing these ideas in a way the more importance
we place on something not occurring often is the topic that the brain will choose.
It’s kind of like the white elephant effect. If we say, “Oh, I don’t want to think
about a white elephant.” The brain will keep testing,
“Am I thinking about a white elephant or has the white elephant
topic gone off the radar?” Even in asking that question,
obviously it brings up the white elephant. -It’s meaningless?
-It’s absolutely meaningless. -Even as you talk about this,
it’s very overwhelming for me, because in my my personal experiences.
How is it that highly intelligent
switched on people are experiencing such a level of trauma and fear?
What is the science behind OCD? -There are systems in our brain that
are designed to prepare us for an emergency. The system that I focus most on is called
the amygdala and it’s located in the very back and lower
portion of the brain. The significance of that is that,
that portion of our brain doesn’t contain a lot of thinking.
That portion of the brain, that location, is responsible for a lot of very basic
functioning; hunger, sleep cycles and also emergency systems, if we’re in danger.
My belief is that this portion of the brain has a malfunctioning misfiring
mechanism going on. It sends this thoughtless signal
of terror to our outer portion of the brain which is where our thoughts really exist.
I think that the brain doesn’t like to feel like we are about to die, without
having an association as to where from. The brain spontaneously pairs
this emergency signal with these thoughts and it infuses a completely
authentic experience of danger. If there was a poisonous snake
running around the floor, you and I would have a very natural
physiological reaction of terror to the idea that our life is in danger.
We would see that snake as the source of that danger and we would think,
get rid of the snake and we’ll calm down. With OCD, the brain is just very
mechanistically pairing this emergency signal with these thoughts,
and sufferers then react in the most basic and instinctual way which
is get rid of the danger. That might involve for the classic subset
of OCD, if I touch a doorknob that might have AIDS on it, washing. For the Pure O to prove that
I’m not capable of harming someone. To try to maybe ask other people
whether or not they see me as dangerous, to look up online what are the qualities
of a murderer, what are the qualities for someone
who is dangerous. The internet provides an endless black hole
of reassurance seeking, and unfortunately, most often, the more people research
their spike theme, the deeper into the hole they go.
I use the word spike. Spike is what I refer to as the intrusive
thought that the mind generates. After time, it’s not really clear
whether the anxiety comes first and then the thought follows, or whether the
thought comes first and then that proceeds by triggering the anxiety response.
I think over time it really becomes the chicken and the egg question. -If you’re a sufferer of OCD,
what is the right path to treatment? -I think doing research on what OCD is,
so that a sufferer can not personalize the condition,
so that they can learn that they are not different from any other person
on the planet, other than that their brain is malfunctioning in a way that just
creates an anxiety response over something that’s meaningless,
and to really seek a qualified specialist. A lot of my colleagues refer to themselves
as generalists. They treat quite a variety
of different conditions and at the center that I am the director at,
we really treat this condition from a place of it being a specialty.
We really don’t want to have sufferers get a therapist that doesn’t really have
the greatest depth of knowledge about treatment and understanding
of the condition. I recommend that people really extensively
interview a prospective therapist. Therapists often will say,
“Oh yes, I’ve treated some people with OCD.” I think that’s kind of a red flag, because,
for a specialist, OCD is really literally 80% of my case load and it’s been that way
for the past 25 years. For people who have gotten specific
training in the very specific types of treatment that we use for OCD,
I think is very essential. -What is Exposure Response
Prevention therapy? -Exposure Response Prevention is the skills
for a patient to acquire to teach their brain of the irrelevance of their associations.
A person who might have a violent thought can purposely create these associations
voluntarily and to do that repeatedly through the day.
To show the brain that they’re not not just going to be cautious in waiting
or hoping that the brain doesn’t deliver these associations, but by evoking them
purposefully and voluntarily, they show the brain that these associations
are not only okay, but they are willing to be created
repeatedly. That demonstrates to the brain
a mechanism that’s called habituation. The human brain is wired
to stop paying attention to things that are basically ever present.
A constant noise, or even the traffic noise outside your apartment.
Probably, you lose awareness of because you give it permission to be there,
it happens on a regular basis so the brain stops holding onto it
as something that is relevant, or something that you need to be informed of.
In ERP, by having the person repeatedly and voluntarily create the association,
it shows the brain that the associations are meaningless.
Then the brain literally over time, let’s go of the conditioned anxiety
and terror response. -I imagine that each therapeutic approach
would be very customized to the individual. Could you speak broadly to a couple examples;
maybe someone with Harm OCD someone with Pedophilia OCD.
What is that ERP experience like? -Sure, what we might do is get a catalog
of children in bathing suits and have a person literally carry it
around on their cellphone a picture of a child in a bathing suit
and have the person bring up that image about 10 times a day and look at it
and say to their brain “Okay, look at this sexy kid.
Oh boy, Let’s have a really strong sexual response now.”
To encourage the brain purposefully, shows the brain, once again,
the irrelevance of the association. A person with a violent thought
might carry around a knife in their pocket. They might be at a subway platform
and purposefully evoke the thought, “Hey, that person over there looks
really vulnerable. I think I’m going to go over and push him
in front of the train now.” To do it, once again, redundantly
is really the essential part of ERP because it’s the redundancy that
shows the brain that these associations are meaningless and need not
be warned about. -Your patients, in proper ERP therapy,
would have a desensitization experience over time that lessens the anxiety?
-That’s correct, yes. Generally speaking, we find, as behavioral
psychologists, that it’s the in-between work of the patient that really produces
the outcome in treatment. It’s not really what happens
during the session. Although, oftentimes, during a session, when
we take the exposure item to the next level, we develop a hierarchy.
Start with associations that produce a minimal anxiety response,
and then gradually build up to the highest level of stress.
We’ll start in the office by creating the association and just testing
the patient’s response to it to make sure that it doesn’t overwhelm them or doesn’t
actually produce a non-emotional response. We’ll gauge it within the office
and then send the patient home to do these exposure response prevention
exercises through the day. I often suggest that they have their
cellphone just set on reminder for once an hour to evoke the associations. -Why is it important to find
the right therapist? -It’s important to understand that the term
psychologist is not a universal xerox of one another.
In the world of clinical psychology where we treat patients,
there are different orientations. Those orientations are really important
to be understood as being related to different goals.
In the treatment of an anxiety disorder, it’s very, very important to see
a behavioral psychologist, someone that is trained to engage
in exposure therapy. A very popular term now in treatment
is called cognitive therapy. Unfortunately, for treating an anxiety
disorder, seeing a cognitive therapist might not be in one’s best interest.
It might actually be detrimental. Cognitive therapy is the subset
of psychology, which I’m actually very trained in and practice,
for other types of conditions where a person is asked to be analytical of thoughts that
their brain delivers in an irrational way, and then to dispute those thoughts
to work to have one’s final belief systems be predicated on reason
and rational thinking. With OCD, it looks like that would be
amenable to cognitive therapy because people with OCD are having these
very irrational, very illogical thoughts. They’re not engaging in a ritual
because of a faulty belief system, they’re engaging in rituals
because of a faulty anxiety alarm system. Anxiety has no verbal component
to it that’s why I could tell someone, “Hey, that doorknob doesn’t have AIDS on it,
they’re safe,” but anxiety will not respond
to that rational reminder. Anxiety response to repeated exposure
to that doorknob and then eating, let’s say, finger food after touching
the doorknob to demonstrate, not that “It was safe,” but that the warning in the first
place was unreasonable or irrelevant. A very dangerous form of therapy would be
to go to see someone who does analysis, someone who looks more
at the thoughts and looks at the underlying meaning of the thoughts.
They do a lot of deep personality deconstruction to get a sense
as to the origins of the thoughts. That’s exactly the opposite of what would be
an effective treatment. -This is why exposure response prevention
is the gold standard in therapy? -That’s correct.
-If you are trying to find the right therapist, and you’re looking for
is it a clinical psychologist? You’re looking for someone
with a specialization in OCD and, in particular, someone who is expert
in exposure response prevention therapy? -That’s correct.
-How do you find that if that’s not available in your town, in your area,
where you’re growing up or where you live? -For people who live in more remote areas or
who have tried some of the local clinicians who have not been adequately trained,
there are locations where Skype therapy might be offered.
The Center for Cognitive Behavioral Psychotherapy, we’ve been doing phone
therapies since my first article came out and got national distribution.
Now, thankfully, we’re able to do Skype therapy. It’s funny because I’m often asked,
“How effective?” Or how much less effective might that be to work with a patient
over the phone or work with a patient face-to-face through Skype.
Funnily enough, since I’ve been working with patients remotely, I’ve actually found
the percentage of success to be about 15% higher for patients that I speak to
in remote areas than people who come in to my office and sit across the table from me.
I don’t have specific research on that, but I hypothesize that people who contact me
from remote areas are often people who’ve done a lot of research.
They’ve had treatment failure locally and so they’re highly invested in coming
right out of the gate and being very invested in being cooperative and compliant
to the treatment guidelines. I’m not suggesting if there is a local expert
that you work with them over Skype, because I certainly do prefer working
with patients face-to-face, but I think that it’s a self-selected group
of people who reach out and do Skype therapy or over the phone are people
who are generally more ready to start treatment and to do it with a lot
less meandering in the treatment process. -You mentioned that you might be getting
the wrong type of therapy. If there are any viewers out there
watching this video, who maybe they’re young, maybe they live with their parents,
how do they go about telling their parents that the therapy they’re getting
is not actually right? -When you look into what is proper therapy,
you’ll see that it’s a very home-based approach. I think, for a teenager to inform their
parents that the therapist is spending time looking into the thoughts or just
talking about week-to-week activities that are taking place, we call that talk
therapy, it’s important to bring that information to one’s parents
to let them know that the active component of exposure therapy is not being engaged in.
-That basic principle that there is a spike, it’s a fight-or-flight response,
it’s a meaningless thought. If you’re getting professional care
where someone is trying to assign meaning, you’re not getting the right type of care,
and that there are opportunities, with technology today, to work
with professionals like yourself through Skype or screen-sharing
or all kinds of different things and that that’s an effective means of therapy.
-that’s right. -Can people with OCD benefit
from mindfulness practice? -I think that mindfulness can be a very
powerful adjunct to the treatment of OCD because it allows us to engage
in the discipline of watching our brain speak to us in a way that’s non-judgmental
and, hopefully, non-reactive. It’s common that people will say,
“My brain is messing with me,” “My brain is disruptive to me,”
as opposed to being able to look at it and say, “My brain is sharing this thought,”
which is an indication of a mindfulness practice.
To allow our brain to generate all kinds of experiences and sensations
and also thoughts in a way that is very permission-giving.
Definitely, the practice of ERP can definitely benefit from
the integration of mindfulness practices. -Types of mindfulness practices
that would be valuable would be what? -To practice mindfulness, you can take
about 10 minutes, maybe twice a day, and just meditate, just spend that time
watching what the brain is saying or being aware of our own experiences
in a way that’s non-altering. To say, “Okay, my brain is aware
of this current thought,” “I’m aware of the breeze on my face,”
or “I’m aware of my brain telling me that my head has an itch,”
those are some practices of mindfulness. -That’s helpful.
In doing a lot of keyword research on this project and just understanding
what are people looking for online, there’s a lot of search around OCD
in children, OCD in adults. Can you speak to what you think
those searchers might be looking for? -If a person has OCD and they’ve done
research, they’re going to become informed that there is a genetic component to OCD.
If one parent has OCD, the statistical chances of a child having OCD
is between 15% and 20%. I’ll tell patients who speak to me
about their concerns and their children having OCD that at around age nine
that they can ask children whether they’re having intrusive thoughts.
They can talk about the idea of what anxiety feels like and keep their child informed
and keep an open dialogue for the child to be able to bring any
of these concerns to their parent. For most children, they actually
have more of a Pure O form of OCD than a observable ritualizing subset
because children experience so much shame in school, and so the expression of OCD
comes out in more of intrusive thought form. It’s very likely that parents would never
even notice that their child has OCD other than a child might ask, “Oh, is it okay
if I have thoughts that I might hate God? Is it okay if I have thoughts that you might
not come home when you go to work?” Children, basically, from age three to age
seven often exhibit a lot of behavior that looks like OCD, but actually is just
quirky childhood efforts to keep their world organized and secure.
Really, we don’t give children below the age of eight a diagnosis of OCD
because oftentimes children just grow out of it.
-Even when as a sufferer you might withdraw and take a lot of that internally,
you should invest in community? -I would suggest that whether
joining an OCD group, which there are many of now, and sharing
that with comrades to have support in the treatment can be very, very effective.
To not keep it to yourself and to share with others the information that’s
available in terms of defining the condition is something that’s
very natural, it’s not deviant, it’s not something to be afraid of.
-What would you say to the industry at whole; the practitioners, the media, with respect
to where you’d like to see the conversation about OCD in 5 or 10 years?
-I’d like people to be aware that OCD is just an anxiety disorder,
I’d like people to be aware that it’s it’s a very treatable condition,
and I’d like people to stop confusing it with perfectionism.
Movies like As Good as It Gets, portray this person who has tremendous
anger issues and control issues, who’s extraordinarily judgmental.
They towered it as an OCD movie, when, in fact, it’s more about
perfectionism than OCD. OCD is derived from malfunctioning anxiety
signals rather than a person who has a personality inclination
to being very rigid or angry. I’d like people to be aware of the treatment
for OCD is ERP, it’s not cognitive therapy, it’s not deep analysis.
I’d like people to be aware that our brain, the machine, is a very separate entity
from our own unique identity. Our brain, the machine, is capable of
regulating acid supply when we digest food, it’s capable of regulating our body
temperature, and it’s capable of sending us thoughts that are not about our autonomous,
independent volitional choice. -That’s great.
Any particular top line takeaways for our audience?
What should they be thinking about if they’re a sufferer
or their loved one is a sufferer? -That treatment is available,
that being informed about the condition can go a long way in their first step
in symptom relief, and to take away the shame and the mystery
of the condition, I think, is so important. I think, to be able to share it
with other OCD sufferers, there are a lot of forums online for people
to share their spike themes. Often, those forms are turned
into reassurance vehicles, which I don’t necessarily recommend,
but to develop a sense of camaraderie and the idea that they’re not alone,
I think that’s one of the most detrimental aspects of most forms of psychological
challenges, is the idea about the uniqueness of it.
By gaining education, you see that it’s a condition that’s shared
by hundreds of thousands of people.