The “Insanity” of AOCD

OCD can take a variety of forms, all of which create a disturbing sense of uncertainty. One such category of OCD that often makes the sufferer feel “insane” involves aggressive obsessions (AOCD): intrusive thoughts about unintentionally harming oneself or others, often in violent ways. AOCD often takes the form of indirect harm to others such as being responsible for burning down one’s home due to negligence. However, other forms of AOCD often leave client’s feeling “insane” due to obsessions surrounding more direct forms of aggressions such as running over pedestrians, stabbing one’s family member, hanging one’s self, or even pushing someone in front of a vehicle. Rituals often include retracing routes to determine whether I killed someone, avoiding sharp objects and machinery, and attempts to neutralize such thoughts by either replaying the event repeatedly in one’s mind until the distress subsidies or by attempting to suppress the thoughts. The common thread with AOCD is “ Is I am uncertain about whether or not I hurt someone and I may in the future.”

Like other forms of OCD, EX/RP is very necessary to decrease the distress associated with such thoughts. Similarly, a hierarchy of distressing situations surrounding AOCD is necessary in order to confront situations that trigger aggressive obsessions. One common example of an exposure in my own work with clients who struggle with AOCD includes driving in areas with a high probability of encountering pedestrians (such as an outdoor shopping center). Creating exposure statements to confront such beliefs is necessary. Some examples include “I think I just killed someone; the cops are coming at any moment; I will be on the news, my life is ruined.” This is often coupled with linguistic processing or “putting my feelings into words.” Statements such as, “I feel anxious because of the potential of killing someone” add significance to the exposure. Similarly, rituals must be prevented. Forbidding my client from glancing into the rearview mirror or watching pedestrians cross the road until they enter the store are rituals that must be eliminated. Ultimately, the client’s intolerance of uncertainty decreases and their thoughts become increasingly flexible through repeatedly confronting AOCD situations. In short, the client’s experience leads to changes in thoughts associated with killing someone; when the physiological arousal associated with such thoughts decrease, the obsessions associated with AOCD are no longer as distressing. EX/RP takes hard work but pays off in the end. You can do this.

Dr. Kevin Chapman

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