Don’t feed the reassurance monster…and other quick tips to help your child fight OCD

Posted by Steven J. Seay, Ph.D. in Obsessive-compulsive disorder (OCD) Many excellent parents struggle with how to appropriately parent their child with obsessive-compulsive disorder (OCD). Unfortunately, this process is rarely straightforward and is often counter-intuitive, which leaves many parents feeling anxious and confused. As a psychologist in Palm Beach, Florida, I work closely with kids, teens, and parents throughout the greater Palm Beach, Fort Lauderdale, and Miami areas on strategies for recovering from OCD. Consider the following set of ground rules for parenting your child with OCD.  The strategies you adopt as a parent can mean the difference between reducing your child’s symptoms or giving these symptoms room to grow. 1. Remind yourself that OCD is based on emotion rather than logic. Many parents get tripped up and frustrated by the many illogical forms that OCD takes. If you consider OCD to be a logical process, you’ll inevitably become vulnerable to using lecturing and/or chastising as your primary intervention. However, if you correctly recognize and label OCD as illogical, it is much easier to implement behavioral strategies that are exposure-based, and will decrease symptoms over time.  One example of an exposure-based strategy might be eating dinner while intentionally making statements related to contamination.  These might include, “Pass me the germy mashed potatoes” or “I hope the roast beef has extra e.coli tonight.”  Although many people (with or without OCD) might be uncomfortable thinking about germs while eating, this strategy allows us to directly challenge OCD-related cognitions. 2. All primary caregivers (and all household members, if possible), should adopt consistent policies for responding to OCD. In two-parent households, parents must agree on how OCD-related situations will be addressed. If a child splits time among multiple households, it is critical that all primary caregivers implement similar strategies. Failure to adopt a consistent plan will likely increase your child’s anxiety, increase household conflict, and lead to splitting among caregivers. 3. Don’t “Feed the Reassurance Monster.” In most cases, regardless of the form it takes, OCD is about wanting certainty in situations that are fundamentally uncertain. When a child washes his or her hands repeatedly, he or she is trying to be certain that all potential germs have been eliminated. When a child repeatedly checks locks, he or she is trying to be absolutely certain about issues of safety. When we, as parents, repeatedly provide reassurance, we make it more difficult for our children to learn to be content in an uncertain world. Examples of “Feeding...
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Pets & OCD: Contamination

Posted by Steven J. Seay, Ph.D. in Contamination/Health-Related Symptoms, Obsessive-compulsive disorder (OCD), OCD Obsessions focusing on pets and animals incorporate all the common themes: contamination, checking, harm, scrupulosity, and sex. In this 3-part blog series, I discuss some of the common ways OCD obsessions may target our lovable, snuggable friends. This article, Part 2, will focus on contamination obsession associated with pets and animals. Part 1 covered harm and violent obsessions related to pets. Part 3 will address sexual obsessions and scrupulosity, as they pertain to pets and animals. Most everybody loves that shower fresh feeling, right? Not only does it feel good, but it’s probably good for us too. Throughout history, cleanliness and good hygiene practices have been instrumental to reducing our vulnerability to germs, disease, and illness. For survival’s sake, to a certain extent, we’re probably biologically-programmed to prefer clean, hygienic environments, over dirty, disgusting ones. Yet, at the same time, our human weakness for all things cute and cuddly leads many of us to choose to co-habitate with wild — or rather, domesticated — animals. This choice brings with it all sorts of opportunities for OCD to stir up contamination worries. Dogs and cats walk around barefoot outside or in litter boxes, and they tend not to wash their paws or bottoms very often (and when they do, it’s only with our assistance). Moreover, dogs have a predilection for both sniffing other dogs’ rear ends and licking themselves in inappropriate places… Naturally, this licking always tends to happen right before they decide to run up to us and lick us on the face. YUCK! So yes, animals can be gross sometimes. But fortunately, most of OCD’s error messages about how dirty, disgusting, dangerous, and unacceptable this is, tend to be overblown. OCD contamination obsessions about pets and animals come in a couple different varieties. Today, we’ll focus on identifying obsessions related to the fear of contaminating your pet, as well as the fear of being contaminated by your pet. Pet Obsessions – Fear of Contaminating Your Pet These pet obsessions involve accidentally contaminating your pet or making it sick. What if I make my pet sick by accidentally feeding it food contaminated with household chemicals or cleaning products? What if the air freshener I spray gets in my cat’s lungs and makes him sick? What if I accidentally feed my dog tainted or spoiled food? What if bugs accidentally got into my kitten’s food? What if I accidentally spread...
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OCD & Checking: Part 2 (Mental Checking)

Posted by Steven J. Seay, Ph.D. in Obsessive-compulsive disorder (OCD) Behavioral Checking (Overt Checking) Many examples of compulsive checking rituals in OCD involve direct inspection of a target stimulus by sight, sound, or feel. Common OCD checking behaviors include relocking doors, visually examining the position of one’s parking brake, or holding one’s hands above stove burners in order to detect warmth. Behavioral checking is often accompanied by the thought, “Did I do it the right way?” These checking behaviors are often referred to as behavioral checks, manual checks, or overt checks. Overt rituals (by definition) are visible behaviors that can be perceived by external observers. However, in some cases, overt rituals may be subtle or purposefully hidden in order to avoid embarrassment. Mental Checking (Covert Checking) In contrast, other compulsive checking rituals can only be perceived by the individual engaging in the behavior. These types of OCD rituals are thought-based and are sometimes referred to as mental checking or covert checking rituals. Mental checks are often accompanied by thoughts such as, “Did I do it the right way?”, “Am I feeling the right way?”, or “Did I do this for the right reason?” Mental checking is the cognitive counterpart of behavioral checking, and many covert checking rituals overlap extensively with the mental rituals that characterize Pure-O OCD. Whereas overt checking involves obtaining evidence directly from the current physical environment (i.e., obtaining visual, auditory, or tactile feedback from physical objects or behaviors), mental checking typically involves an evaluation (or reevaluation) of information already obtained. This information may exist in the form of memories, feelings, motivations, or other internal states of being. Mental checks can occur both in the presence and absence of a given target stimulus. Individuals may engage in mental checking rituals shortly after an event, but covert checking is not bound by time or space. Some people with OCD continue to check hours, days, or even years after the original event. For example, some individuals may review or check the content of conversations that occurred many years ago. Let’s identify some examples of mental checking. This list is not exhaustive but is intended to illustrate the diversity of situations in which mental checking might be present. Examples of Mental Checking 1. Memory Checking Rituals – Reviewing one’s memory to “make sure” or verify that a behavior was completed properly. Did I lock the door?  Was the stove really off? Was the “H” on the faucet handle facing the...
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Body Dysmorphic Disorder (BDD)

Posted by Steven J. Seay, Ph.D. in Body Dysmorphic Disorder (BDD) What is Body Dysmorphic Disorder (BDD)? Body dysmorphic disorder (BDD) is not formally classified as an anxiety disorder; however, it shares many overlapping features with anxiety disorders like obsessive-compulsive disorder (OCD). In contrast to OCD which typically focuses on specific external feared outcomes, body dysmorphic disorder involves hyper-attention to one or more perceived bodily defects, imperfections, or flaws.  BDD “flaws” are experienced as distressing and intolerable. In some cases, the imperfections that bother individuals with body dysmorphic disorder can be perceived by other people, but BDD magnifies and distorts these imperfections in the eyes of the sufferer.  In other cases, individuals with BDD notice and attend to “flaws” that cannot be readily perceived by others.  Regardless of the form of one’s symptoms, body dysmorphic disorder is associated with extreme distress and shame.  Moreover, because BDD-related “flaws” are often perceived as being permanent, inescapable, or un-fixable, many individuals with body dysmorphic disorder experience hopelessness, depression, self-loathing, and suicidal thoughts. Due to shame about their appearance, many people with BDD go to great lengths to keep their symptoms a secret. Individuals with body dysmorphic disorder often use mirrors to check or scrutinize their appearance.  They also engage in a variety of avoidance behaviors in order to mask or hide their perceived defect(s) from others.  They often avoid going out in public (e.g., skipping class or work), limit involvement in situations in which they might be the center of attention (e.g., dating), or spend excessive time trying to camouflage, disguise, or alter their appearance.  Preparation for leaving the house may involve elaborate grooming behaviors that span hours every day. Although many people have sensitivities about certain aspects of their appearance, typical sensitivities do not reflect BDD.  By comparison, symptoms of body dysmorphic disorder are extremely distressing and potentially disabling. The checking and grooming rituals that characterize body dysmorphic disorder resemble the compulsive behaviors found in obsessive-compulsive disorder.  However, there are some notable distinguishing features between individuals with OCD and BDD.  One of the major differences between OCD and BDD is the degree to which one recognizes his/her rituals as excessive or unreasonable.  Although individuals with OCD experience extreme anxiety about their particular feared outcome (e.g., fear of getting sick, fear of hitting someone with their car), they often recognize that their rituals are excessive.  This is particularly true when the individual is not actively exposed to a symptom trigger. In contrast, body dysmorphic disorder tends to...
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Scrupulosity & OCD: Religious/Moral Symptoms

Posted by Steven J. Seay, Ph.D. in ERP, Obsessive-compulsive disorder (OCD) Question: I have scrupulosity (religious/moral obsessive-compulsive disorder), and I am triggered by religious posts on Facebook. When I see a religious post, I feel like I have to repost it or God will be mad at me. I also worry about what other people think about these reposts, which then leads me to fear that God will judge me for worrying. Any suggestions for treating scrupulosity (religious OCD)? Religious Scrupulosity/OCD For many people with OCD/scrupulosity, treatment can be especially confusing at first. Every action or inaction can feel potentially dangerous, which is why scrupulosity often goes untreated for so long. The very fact that you recognize that this is related to obsessive-compulsive disorder is excellent. It also sounds like you have insight about your OCD symptoms and the OCD positive feedback loop. Many people with religious obsessions don’t realize that obsessions can target religious/moral topics. Their OCD tells them that it’s impossible to engage in religious practices “too much” or “too frequently.” Scrupulosity/OCD Belief Clarification The first step in your recovery is to clarify your religious beliefs. If you don’t do this, exposure and response prevention for your scrupulosity will likely be unhelpful. The types of questions you should ask yourself are: Does God expect me to be perfect? If I make a mistake or commit a sin, does my religion have procedures for obtaining forgiveness? Would God want my behaviors to be largely driven by obsessive-compulsive disorder? Would God want my relationship to my religion to be OCD-based or faith-based? Would God understand what’s going on in my head and want me to fight my OCD? If my treatment involves doing things that might be considered potentially sinful, would God understand? Although you cannot have complete confidence when answering many of these questions, your answers to these questions will help frame your treatment efforts. For those whose symptoms distort their view of God, these questions can be especially tricky. These individuals sometimes base their answers on how they would like to think about God. When I treat people who have religious scrupulosity in my South Florida (Palm Beach County) psychological practice, my intention is not to change their religion or create more guilt for them…but rather to help them determine if there are aspects of their current relationship to God/religion that are dysfunctional. If this is the case, it’s not the person’s fault; this simply reflects a common...
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