It has been really crazy lately. Loads of emails to reply to (I will reply to everyone when possible), busy at home and extremely busy at work.I have been going through some old OCD notes in preparation for the final draft of the rOCD book and found something really good that I just had to share. These notes are taken from one of the best OCD books that I ever read. The book is called “The Imp of the Mind” – you can find it on Amazon here.
Here are some of the notes:
What is the imp
The word “Imp” is taken from a title of a poem from Edgar Alan Poe “The imp of the perverse”. It describes the natural tendency that our brains have to think and being attracted to evil. Pierre Janet called this “association by contrast” whereas patients feel driven to do the exact opposite of what they want to do.
Bad thoughts happen to everyone. Some people just seem to cling to these more strongly thus in time developing obsessions. These bad thoughts tend to be the most inappropriate things to think at the most inappropriate times. What you consider the most awful or shameful thing to do is normally the subject of these thoughts.
Thought suppression and Rebound effect
The more you try to get rid of something, the more you are aware of it. That is why thought suppression is not a very effective technique. Fighting or avoiding situations where these thoughts might occur is only likely to increase the intensity and frequency of these thoughts. A rebound effect might also occur after we give up on suppressing thoughts i.e. thoughts come to the mind at a higher frequency than before suppressing them. After we abandon control of these thoughts, they become less bothersome and are less noticed.The more you try to avoid situations that trigger unwanted thoughts, the worse your problem will become.
OCD and depression
It appears that depression impairs the normal functioning of the brain and this results in the patients being more vulnerable to bad thoughts. Interpreting these bad thoughts in a wrong way can also lead to further depression. It also appears that people with depression are more 5-6x more likely to have bad thoughts than people without depression (based on a study done on post-partum patients). When we are depressed we tend to think the worst of ourselves.
Some patients with bad thoughts seem to report that these started when everything in life started to go well and happiness was “reached”. Almost like the mind has come up with something to worry about and ruin things.
One of the biggest fears seem to be that of loss of control. That you would snap and do something that you would not normally do.
Sexual obsessions seem to be present in more than 1/4 of people with OCD. Self-medication sometimes occurs in the form of alcohol and drugs to try and deaden the obsessions.
Absolute certainty vs. enough certainty
There seems to be a need to feel certainty absolutely before being able to move on.The slightest doubt is a tormentor. The very act of trying to attain perfect certainty is often the worst source of distress. This is why the French call OCD the “doubting disease”. Part of the success consists in stop checking for reassurances.
What is like to feel absolute certainty and how will you know you have achieved it? Nobody knows and even if you could, your brain will tell you that it is not because it is too good to be true. Hence people are tormented by doubt caused by a need of feeling certain.
There is no such thing as absolute certainty, but there is assurance sufficient for the purposes of human life.
John Stuart Mill
Common cognitive error for people with OCD:
- attributing too much importance to thoughts
- thinking that they need to be able to control thoughts (or are capable of doing so!)
- exaggerating the danger of a situation
- intolerance of uncertainty
- excessive responsibility