by Fred Penzel, PhD
This article was initially published in the Winter 2006 edition of the OCD Newsletter.
Make no mistake about it, obsessions, whatever the category, are nasty in content and very difficult to live with. If I were asked about which ones I think are among the most punishing to sufferers, I would have to say that my own selection as a therapist would be morbid thoughts, and of the many subtypes of morbid obsessive thoughts, wanting to harm your own children would probably get my vote. In actuality, all forms of OCD are unpleasant and torturous for sufferers, so perhaps this may be my own prejudice showing, being that I am a parent myself.
Any normal parent feels a strong protectiveness toward his or her offspring. When they are very young we feel concern for every aspect of their lives. Even after they have become adults, we worry about their well-being and happiness. Is it any wonder then, that when a parent suddenly begins to have thoughts about injuring, sexually molesting or murdering their beloved child (or children), this would strike fear in the deepest recesses of their instincts?
Some of the most anxious and depressed people I ever see in my practice fall within this group. I am not thinking here about parents who obsess about causing their children harm via forgetfulness or carelessness. I am not even referring to those who think of doing harm to other people’s children. These too, are all very difficult thoughts to have to endure. I am strictly speaking about those who experience ideas that they are going to actively stab, strangle, drown, suffocate, beat, sexually fondle, or rape their own children. I would also include here those who think they may have intentionally molested or injured their own child (or children) in the past.
I would ask all those neurotypicals (those of you with normally functioning brain structures and chemistry) who may be reading this to imagine for a moment what it is like to experience such unpleasant things being broadcast from within your own mind on a steady basis and not being able to change the channel. I would further ask you to imagine questioning yourself continually why you are having these thoughts and what their occurrence might mean in terms of your own motives and intentions. One of the most frequent questions I get asked by patients is, “Why would I think such things if I haven’t done them, or didn’t want to do them?”
Within this subcategory of morbid obsessions, there are further subcategories that would commonly include thoughts such as I will list for you below. Please note that I divide these thoughts by younger and older children. Also note that these categories are by no means exhaustive and there can be overlap between them.
Thoughts More Exclusively About Infants and Toddlers:
- Drowning, suffocating, choking or smothering them.
- Shaking them violently, or striking them.
- Dropping them out a window, off a balcony, a bridge, or other high place, or dropping them on their heads.
- Stabbing them.
- Poisoning them.
- Sexually molesting or raping them.
Thoughts More Exclusively About Older Children And Adolescents:
- Stabbing, punching or striking them with objects.
- Poisoning them.
- Sexually fondling them.
- Raping them.
- Suffocating them in their sleep or choking them.
Within this group of sufferers there are also three broad categories.
- Those whose thoughts take the form of severe doubts about the present or past.
- Those who experience sudden impulses to carry out these acts.
- Those who have both of the above.
Those in the first category worry that having these thoughts indicates they are crazy and dangerous and will be likely to act on their thoughts (or “Why else would I be thinking them?”). Their thoughts generally take the form of “How do I really know I won’t harm my children?” OCD could be summed up in two words: pathological doubt. It is doubt that just won’t quit and cannot be put off with simple answers. A complicating factor is that sufferers tend to mistakenly believe that the obsessive thoughts are their own real thoughts, and therefore must be important and paid attention to, rather than actually being irrelevant and the product of bad brain chemistry. This leads to the idea that thinking is the step before actually doing, and that these thoughts must be heeded and dealt with simply because they are occurring within their own minds. They tend to respond to them with compulsions.
Simply put, compulsions relieve the anxiety produced by obsession, if only for a short time. There is a compulsion for almost every obsession. The main compulsive strategies that morbid thinkers tend to use to cope with their thoughts include:
- Avoiding being around their children, or at least being alone with them.
- Checking their reactions when around their children to see how they really feel.
- Arguing with their thoughts to try to prove to themselves that they would never do these things.
- Analyzing their thoughts to see if they really do agree with them.
Another variation on this would be those who keep questioning themselves as to whether they might have already done some of these things either very recently or in the past. An example would be a sufferer who has older children but looks back in time wondering whether or not they may have inappropriately touched them in sexual ways or molested them when holding, hugging, dressing, playing with, or bathing them. They will continually re-analyze these events, relive them and try to fill in the missing details or clarify hazy memories. This activity can literally occupy hours of their lives. In some cases they may question those close to them either, directly or in subtle ways, hoping to utilize other people’s memories in order to fill in the blanks.
Those in the second category experience what I like to call ‘impulsions’ or mental calls to action that, for example, might sound like “Go ahead – stab them!” They might also get physical dysperceptions. By this I mean experiencing sensations that they:
- moved their hand in an almost imperceptible way as if to strike their child or to fondle them in an improper way,
- thrust their pelvis toward their child in a sexual way or leaned or brushed against sexual areas of their child’s body, or held them in their lap while moving in a sexual way,
- somehow pushed or shoved their child because they wanted to make them fall or injure themselves,
- somehow exposed a private area of their body to their child.
These are not just thoughts, but physical sensations in their bodies that seem very real and almost (but not quite) certain. There has always been a question as to whether or not symptoms of this type may fall into a gray area between OCD and the tics seen in Tourette’s Disorder. This has yet to be determined.
New mothers make up another distinctive subgroup where thoughts of harming one’s child are frequently seen. Post-partum OCD is a well-known phenomenon which may have links to post-partum depression. It can result in the sudden appearance of OCD where no symptoms were previously seen, or else may involve the worsening of mild OCD or OCD that was previously under control. I have encountered a number of cases of women with or without prior histories of OCD who, within a short time after giving birth, began to think of ways in which they might be able to harm their newborns. In one particular case, a patient of mine, a new mother, shared these thoughts with an obstetrics nurse and was then denied contact with her baby by hospital administrators who feared an act of violence might occur. Only an intervention on my part with the hospital’s department of psychiatry set the situation right after I convinced them that my patient, a known OCD sufferer, was being obsessional and was absolutely not capable of such behavior.
One potentially difficult situation for parents who suffer from morbid thoughts is feeling anger, as in their minds this could surely lead to acting their thoughts out. We all lose our tempers with our children now and then. None of us are saints, and it is a rather normal occurrence – except when you then move on to experiencing thoughts about how you might now want to kill your child. In such cases, ordinary parental anger over everyday occurrences quickly turns to fear. Parents with this form of OCD tend to work extra hard to never lose their temper or to squelch their rising emotions. This leads to constant fears of emotion, and a great deal of over control when around their children.
So, having reviewed the various forms of this insidious form of OCD, the question remains, “What to do about it?” I think that in tackling OCD, it is crucial to have an understanding of what it is you need to do. The first thing to understand is that OCD is chronic; that is, you cannot be cured but you can recover and live a normal life like everyone else. It won’t simply go away, but with work, you can get it under control and keep it under control. Secondly, when it comes to controlling OCD, I think the single most important thing to understand is this: “The problem is not the anxiety – the problem is the compulsions.” If you think that the problem is the anxiety, then you will most likely keep doing compulsions as a way of relieving it. This is of course wrong, as the compulsions only keep things going and convince sufferers that the thoughts really are important and should be acted upon. In actuality, when you stop doing the compulsions the anxiety eventually subsides when nothing bad occurs. It is also important to realize and accept that you cannot block the thoughts out, switch to a different set of thoughts, argue with them, or reason them away. You need to see that when it comes to escaping the thoughts, you have lost this particular battle and that it is one you will never win. Once you understand this, you can then get down to the business of confronting and overcoming your frightening thoughts.
This is obviously a bit of an oversimplification. Learning to not do compulsions has to be done gradually, takes time, and along with it you have to learn to stay in the presence of what you fear – not run away or avoid it. In this way you build up tolerance to what you fear and at the same time discover the truth of the situation. That is, you learn to test your theories of what may happen to you or others if you don’t avoid things or perform compulsions. As I mentioned earlier, nothing ever happens. It is really a lot like being a scientist.
All this is best done within a program of behavioral therapy – that is, Exposure and Response Prevention. Within such a program, patients learn to gradually expose themselves to what they fear, be it thoughts or situations, and at the same time resist performing the compulsions they usually do to relieve their anxiety. In this way as I have said they learn the truth. As part of my own approach to treatment we first make a listing (called a hierarchy) of all possible situations and thoughts relating to the problem which can cause any noticeable anxiety, and assign number values to them from 0 to 100. From this list, patients are given weekly homework assignments to help them do these things, and which they themselves are responsible for carrying out between visits. Some typical assignments might include the following (and I list these in no particular order of difficulty as this can be different for each sufferer):
- Agreeing with thoughts of harming the child (or children) in question instead of analyzing or studying them.
- Resisting the reviewing of past events in detail to determine if they actually did something harmful or unacceptable.
- Not questioning others directly or indirectly to determine if they might have done something wrong in the past or will do something in the future.
- Writing, taping, and then listening repetitively to compositions about how they really want to do (or really did) the unacceptable things they are thinking about.
- Holding their young child near a window balcony or other high point.
- Becoming more physical in playing with their child (if they are avoiding this) and creating more opportunities to hold, hug, massage, cuddle, etc.
- Reading news articles or books about parents who have injured, killed, or molested their children.
- Being around their child while holding sharp or pointed objects, or other weapon-like things.
- Visiting websites concerned with child molesters and murderers.
A sufferer might look at such a list and say, “You are asking me to do these scary things as if you think they’re easy!” My answer is that I would never tell anyone that these assignments are easy, but then having unrelenting OCD isn’t easy either. No one usually argues that point. When correctly educated, the overwhelming majority of patients are able to successfully carry out these assignments. Some have suggested that having people carry out such therapy work is cruel or mean in some way, but thirty-five years of research contradicts this. It is a complete misrepresentation of behavioral therapy. If the therapy ultimately relieves people of their suffering in the quickest and most efficient way, and enables them to function as parents again, I would label it as kind. Besides, as I tell my patients, “You know what I would really do if I wanted to be mean? I’d leave you the way you are.”
Fred Penzel, PhD, is a licensed psychologist who has specialized in the treatment of OCD and related disorders since 1982. He is the executive director of Western Suffolk Psychological Services in Huntington, Long Island, New York, a private treatment group specializing in OCD and OC- related problems.
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