Problems in the Diagnosis of OCD

The criteria used to diagnose OCD give rise to a lot of confusion among sufferers and clinicians. Resistance: Resistance is certainly the hallmark of OCD. Obsessions often provoke the most ferocious resistance. However, not all OCD’ers resist their thoughts. Some just hate them and want them to go away. Also, when the illness gets bad, resistance is often gone and the thoughts just take over and resistance is impossible. Others choose not to resist. I talked to a female OCD’er with Harm OCD who said she didn’t want to fight off the thoughts because that would be “going against who I really am.” This is a case where the obsessions have taken over so badly that the person is starting to believe them. Unfortunately, this is quite common in the illness, and the sufferer often feels that the obsessions are completely real, because that is how they feel. Nevertheless, resistance is still an excellent marker for OCD. My feeling is, “If you try to stop it, it’s an obsession.” And that’s pretty much true. Resistance can turn into a cause of endless doubting and ruminations. I have talked to people who spend a good part of their time resisting and fighting off and trying to stop obsessions. Nevertheless, one of their worries was, “Am I really trying to stop the thoughts?” Anxiety: Certainly, anxiety is prominent in OCD. However, as OCD goes on, the anxiety often attenuates and the person does not feel so much anxiety anymore about the obsessions. For instance the Gay OCD’er feels that the gay thoughts do not cause anxiety anymore, so this means that they are gay. The pedophile OCD’er does not feel much anxiety about the pedo thoughts anymore, so that means they must be a pedophile. The Harm OCD’er finds that the violent thoughts do not cause much anxiety anymore, so they must be a murderer or a psychopath. It is uncertain why the anxiety goes down in OCD. Some think that the body simply tires of being anxious all the time and simply becomes attenuated to the anxiety. Feelings of numbness and lack of feelings: This is very common in OCD. Why this happens is not certain, but it may be because the anxiety has gone down.At any rate, numbness is very common. This often causes a lot of worry, particularly in Harm OCD, when the person feels that that they have lost their feelings and are turning into a psychopath. Lack of desire to carry out the actions: It is often said that the difference between someone with OCD and someone without it is the lack of desire to carry out the actions associated with the obsessions. “The person with OCD does not really want to do these things,” is how it is often phrased. However, this causes a lot of confusion because in many cases, the OCD will make the person feel that they want to carry out the acts. A person with Gay OCD will feel gay and feel like he wants to have gay sex, a person with pedophile OCD will feel like he wants to have sex with children, and a person with Harm OCD will feel like they want to attack or kill people. So this isn’t a very good barometer. However, in general, they do not want to have these feelings, and they fight them very hard. So you look at such things as unwantedness and resistance instead. Whether the person with OCD really wants to do these things is more of a philosophical question. They probably don’t, but OCD can make them feel like they do. Obsessions as repugnant: While it is probably true that the OCD’er finds their obsessions repugnant on a deep level, hence all the discomfort, anxiety and resistance, this can cause problems because when the illness is bad, the OCD will try to convince the person that they like the thoughts and don’t want to get rid of them. I have spoken to many OCD’ers who were panicked because they felt they were starting to enjoy the pedophile, gay or violent thoughts. This is just OCD trying to convince you that you like something that you really don’t. But the repugnant criteria can result in endless ruminations along the lines of, “Do I really find them repugnant?…Maybe I don’t…Maybe I like them…” Sometimes this leads to endless compulsions where the person tests themselves over and over again with the images to see if they are disgusted or not. A Gay OCD’er may look at gay images on the Net to see if they generate the proper amount of disgust. A pedo OCD’er may conjure up images of sex with children to see if they are properly disgusted by them. A Harm OCD’er conjures up images of crime scenes, homicides, or themselves committing a violent act over and over to see if they feel the proper amount of disgust and horror. I talked to one OCD’er who had an image of himself slitting his father’s throat in his head. He had to conjure up the image over and over until he “got it right” and had the proper feeling towards it. This compulsion could take some time and was accompanied by some interesting physical maneuvers in conjunction with it. “Am I really disgusted by the thoughts? Am I really horrified by them? Do they really bother me?…” These are the sorts of endless ruminations that one encounters. “I am going to do X…”: It is actually fairly common for an OCD’er to think that they are going to carry out the unwanted act. For instance, a someone with pedophile OCD may think, “I am going to have sex with this child,” and someone with Harm OCD may think, “I am going to kill this person,” or, “I am going to shake the baby right now.” Often these more dramatic forms cause a lot of anxiety because the person worries that the thinking is too extreme to be OCD. However, this thinking is quite common in OCD. Confusion of voices with thoughts: The person with OCD often describes the thoughts as “voices,” but what they are describing is their inner voice only, not external hallucinations. Also the inner voice in the person with OCD often goes through a lot of changes in tone, etc. to where it seems there are different internal voices going on. Sometimes the obsessions seem to be in a voice other than one’s own, and this is very frightening. An internal voice is just a thought. Thoughts are internal voices. You hear them in your head, as the phrase “inner voice” implies. You can have one internal voice or many. It’s probably better to have as few as possible since otherwise you might find yourself confused. A hallucination is something you hear with your ears. It is external to the environment. Confusion of “fake hallucinations” with real hallucinations: In the form of OCD called Schiz OCD, the person worries that they are developing schizophrenia. They often worry that they are starting to hallucinate. They listen intently for all sorts of noises in the environment and start to either mistake them for voices or wonder if they are really voices. A person with true hallucinations will be quite clear that they are hallucinating. Usually careful questioning can ferret out the fake hallucinations from the real hallucinations. “Lack of empathy” in Harm OCD: In OCD, the obsessions often feel very real. So a person with Gay OCD feels 100 In Harm OCD, many times persons report a “lack of empathy.” Many Harm OCD’ers have told me this. “I feel like I don’t care anymore…I feel like I don’t love people anymore…I have lost the feeling of love…I feel like I don’t care about others’ lives or value them…I feel like I could take a life and not even care…” One told me, “You know, when my grandfather died, everyone around me was sad, but I felt like I didn’t even care. I felt like I wanted to laugh.” He was terrified as he told me this. On the surface, this looks like the lack of empathy associated with psychopathy and I have had OCD’ers tell me that their therapists told them that this sort of thing was not associated with OCD and was instead associated with psychopathy. This just caused them even more worry as they were already afraid they were psychopaths. Typically, this person had felt decent empathy for others before the onset of the Harm OCD. They are generally alarmed that they “seem to be losing their empathy” and see this as a sign that they “are turning into psychopaths.” They make desperate efforts to regain their empathy and feelings of love, but it often doesn’t work very well. This often turns into a form of a compulsion where the person can spend hours a day “practicing feeling love or empathy for others.” Presumably, a person with psychopathy or a true lack of empathy would not feel bad about it. The “lack of empathy” is probably a “false feeling” created by the OCD. Confusing obsessions with delusions: Unfortunately, many OCD’ers are still diagnosed with psychosis. I have had many of them come to me with a diagnosis of psychosis. In all cases, I felt the diagnosis was wrong. However, at times, obsessions take a very strange form in which the content looks like a delusion. In these cases, you look at how much the person believes in the thought, whether they are resisting it, etc. Confusion of checking with interest: I have talked to some pedophile OCD’ers who had looked at child porn or had masturbated to pedophilic imagery as a form of checking to see if they were interested in it or not. They were now terrified that they did not have OCD and instead they had pedophilia. They were not doing this because they were pedophiles. Instead they were they were checking to see if they were pedophiles or not. Concerns about escalation: It is quite common for OCD’ers to accept a diagnosis of OCD but to then feel it is “turning into something worse.” In other words, at first they had Harm OCD or Pedophile OCD, but now it is getting worse, and they are turning into pedophiles or psychopaths. Escalation is a strong worry in the form of OCD called Schiz OCD where the person worries that they have schizophrenia. Invariably these persons feel that they are developing schizophrenia. Realistically almost none of them are. I do not regard this as much of a worry. My feeling is, “Once it’s OCD, it’s always OCD.” “Is it really OCD?” This is not so much a matter of diagnostic confusion as it is a hallmark of the disorder. I cannot tell you how many OCD’ers I have talked to who ask me, “Is it really OCD?…I am worried it is not OCD…What if it isn’t OCD?” It is called the doubting disease after all. My feeling is that if you are asking yourself over and over, “Is it really OCD?” then in all probability it may well be OCD. Sometimes a person without OCD will wonder if they have it, but they are not usually so obsessive about it.

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30 thoughts on “Problems in the Diagnosis of OCD”

  1. Hi there Mr Lindsay I came across your site and this post while searching. I was wondering if you had an opinion on Dr Jonathan Grayson’s approach as outlined in his book “Freedom from Obsessive Compulsive Disorders”. I am referring to pure OCD. Would be nice if you can comment on it.

  2. two people told me that one of them had ” HOCD symptoms ” and discovered they were bisexual or gay. What is the difference. PLease answer and help me mister lindsay

        1. I was watching CNN the other day…….
          and both Tapper and Blitzer were on the same time…… Tapper was stumbling over what he was saying, and while doing it placed the back of his hand on Wolf’s chest, and kept it there.
          Is this some thing where fellow Jews are extremely comfortable with each other?
          I ask not out of anti-Semitism but genuine curiosity.

        2. Kevin MacDonald…………
          talk about “pseudo science”;
          EGIs are more cultural than genetic (i.e. can you automatically identify someone who has your genome- no. Only in extreme cases like race), so Jews really wouldn’t have an inherent desire to try to do whatever (there WOULD need to be a conspiracy).
          Jews killing Whites? Jews, at least in the United States are strongly genetically European, and culturally so.
          No compelling evidence is presented anyway (I argued with this lady on peepee’s blog, her sole “proof” of Jews wanting to “kill Whites” is that 21% of them are in favor of illegal immigration, as opposed to 15% of other races. “Proof” 🙂 )
          Do you have a desire to kill Whites?

        3. Now, it is true that Jews have highly disproportionate power. BUT, for the most part is a mutualistic relationship.
          The Jews help us, but the Jews would not thrive without us (less impressive performance IQs). They’ve stood on all sides of economic issues (representing 53% of Nobel prize winners in Economics), they helped.
          Even neo-conservatism was not universal.
          Did you know John Kerry, who worked a lot on the Iran Nuclear Deal for Obama, is half-Jewish. His Paternal Grandparents were Ashkenazis from Austria named “Kohn”.
          Obama also won the 2012 Jewish vote against Netanyahu’s ads in Florida for Romney.

        4. I know all about John Kerry. I’m a Boston girl don’t you forget. His daughter married an Iranian Muslim, and I hope to do the same!

        5. I know you’re more skeptical Bibi Gun Netanyahu (less pro-Israel, hence more open to the idea that Iranians aren’t inherently evil Nazi ‘Murica haters).
          But… I take it all family does not feel the same way?

        6. Haha that’s the whole point.
          My parents spent a ton of money to belong to a religious cult, send my siblings to Yeshiva, donations to numerous organizations it put an enormous strain on their resources. I really couldn’t ask for anything growing up. I went to one of the cheapest state universities in a really shitty area. And I was never able to ask for supplemental salary, and working has always been difficult. Coordination problems made it impossible to wait tables FFS. But I could never ask for any kind of supplemental salary because all daddy’s money was going to a slew of Yeshivas. Under these circumstances, it be natural to want to antagonize your family. Wouldn’t you?

        7. I do think it sounds bad, I mean, if it was at the expense of both your social life, later job prospects (going to the crappy school), etc. that’s not exactly the right priorities.

        8. Funny story about Yeshiva. My dad’s cousin, who got away from Communism by going to study Biochemistry in France, did go onto get his pHD there (he went from Freshman to pHD all in France), and then brought with him a French lady.
          Then he came home and got a job at Yeshiva, had a daughter, etc.
          I only met his wife once, I had no idea what her surname was. I was less Jewarthic then, so I didn’t realize until later, when I saw her on facebook (they have since divorced, he got a job in Hungary, she moved back to France) that she was actually Jewish! I suppose that’s why he got a job there, maybe. LOL!

        9. Actually…
          I suppose he was an associate professor. He actually stayed in France a little after he got his pHD, and was an Assistant professor there. His daughter was 3 when they came, and he would have been 29 when she was born. I suppose he got his pHD at 26?
          But, anyway, he was one of those didn’t actually teach. He was doing work on muscle regeneration in rats.

        10. As shit hit the fan with his wife (two years after the only time I met them), he got a job offer at Harvard. Now, his wife was moving back to France, so he instead took a job in Hungary to be closer to her.
          He could have been a Harvard man!
          I tend to think that the second his Jewish wife left him, the Jews at Harvard took him off the “good goy” list 😉

        11. closer to his daughter, I mean.
          His wife’s dad was apparently loaded. The wife looked typical Frenchwoman, the daughter had curly blonde hair.
          He looked like the most stereotypical douche Italian motorcycle guy.
          They must have been Ashkenazi.

        12. The worst part is they don’t understand why I could possibly be angry. Everyone else validates my grievances even among the community.
          I went to public school and spent more time observing than other people. I could understand that the “special relationship” was detrimental even before 9/11. I discovered that from reading blogs and shit. It’s hopeless to try to talk to relatives about it because they’ve been conditioned from birth so I can’t blame them, but I can blame him for devoting 90% of his resources toward a goddamn religious cult, though it is not recognized as such simply because they don’t self immolate, or marry off preteen girls. But they are world class swindlers.

        13. Spirituality and “feel good” advancement of ones’ “people” is the only way to cope, even with everyday life for some people.
          I suppose that they were focusing more on their beliefs than everyday life of their family, which does hence become an issue.
          So will the relationship with the Muslim guy work out if it’s all for this purpose? That’s one thing to think about.

        14. My dad lost a family business that he had devoted much of his life to, it went bankrupt due to the shortsightedness of his uncle, so he sought solace in the shul and religious community. But having lost millions and then continuing to all too willingly get swindled. Complete dupe. Shakes head.
          Nah, I only said that in jest of out of sheer frustration. I’m not looking for a Muslim boyfriend, and certainly not a practicing Muslim. I’m not willing to conform to their lifestyle, I won’t allow myself to get swindled like my old man. I could probably find a Jewish Gaza Groupie who would anger my family even more than a hypothetical marriage to an Iranian 🙂

        15. They’re pro-Israel as well? Should have figured, I suppose.
          Andrew Cuomos’
          “evil goy” hate list (those protesting to free Palestine) had a surprising number of Jews, so they are out there.

        16. Nah. I don’t want a left wing Jewish guy, I’m very moderate. I’ll probably wind up with a Chinese guy. There’s an abundance of single Chinese in the motherland due to selective abortions, and Chinese women prefer white guys anyway.

        17. I’ve always heard NE Asians have low rates of psychosis type mental illness (they are less schizoid and more autistic/neurotic, in general).
          That’s something I’d like to breed out. I think an Asian would be best genetically for me (the Japanese do appear generally more “zany” in their culture, and Koreans are largely ethnically the same, so Chinese is the way to go, for me).
          But being the massive cuck that I am, I feel the same way some Black HBDers feel about dating a person from a higher average IQ race, it would be wrong, because of regression to the mean, etc.

        18. I hope they’re not prejudiced against me just because I’m a white woman. They don’t have much option as all their women marry out, at least in the diaspora.

        19. Overseas Chinese should knock up a lot of women. They’d be doing more to help by imparting their smart gene than developing any kind of societal infrastructure (which will get snatched up by a dictator) I’m sorry to say.

  3. Excellent article, I can certainly relate, I been suffering though Severe Homosexual OCD on and off for over 12 years, I’ve reached a state where I am completely uncertain about my sexuality. I’ve tried to explore numerous times however OCD and Anxiety always gets in the way which makes things incredibly difficult to figure out.

    Sorry to be blunt, however I have watched both Lesbian and Gay pornography, i found both to be arousing, so I assumed I was bi sexual, and even came out however the thoughts, urges and doubts didn’t end, only became worse.

    I have been in intense ERP Therapy for over a year however symptoms only slightly decreased, OCD still incredibly strong and always comes around in different ways with the same theme.

    I feel like I have lost my identity and don’t know who I am, cannot do anything without OCD getting its way first.

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