Phil

OCD is a mental health disorder, Obsessive compulsive personality disorder is, obviously, a personality-disorder. Different criteria. Very unusual that OCD overlaps (is a symptoms of) OCPD. Different therapies used. Look up DSM-5 or ICD-10 online if you wish. Regards Phil

Just my thoughts, but anyone who doesn't have those types of thoughts at some time is, in my view, not human. Most, just pass them off, but it depends on a persons mood or stress, whether they are angry or other emotions we feel. Another hour, day etc you would probably think more empathically, but just because you think things like that doesn't mean you have no morals or goodness, its just fleeting thoughts we all have. Sometimes it makes us feel a bit better, that's life. it appears you are testing your morals, this is not helpful. Its not as if you wish someone harm and then go out of your way to action it. Its just human thinking. When you say you don't know right from wrong, if that was the case you would not be writing the post. Thinking something is NOT doing it. When we are in a low mood, we sometimes get apathetic (flat-affect), and a bit emotionally numb. its the brain just wanting to hunker down for a bit. And a way of reducing/ blocking out stressful/anxiety provoking stimuli. Another hour, day, week, etc, different mood and we are ok again. What's the betting if you see a toddler accidently walking into a busy road you would react like your true self and try to save him/her. that the difference between thinking and doing. obviously therapy/medication is likely to help, but my humble suggestion is give yourself a break. What seems to be happening is that you are focusing on good and bad, and constantly testing yourself, instead of focusing on being human. Our mood changes the emotion behind the thoughts. if i was in a positive mood and I had a fleeting thought that i don't care if someone would die or not, it wouldn't tag onto my negative emotional system and I probably wouldn't even recall it, I'd say that we all have the thoughts similar to the thoughts you describe, sometimes, but we don't recall them because they are so transient. They are significant/meaningful to you because you are thinking overly about them and testing them mentally. but many would just pass them off as harmless. Hope this helps a bit Regards Phil

Hi, reduce/limit/stop your reassurance seeking and certainty chasing. It won't work when you are anxious because there will be more questions than answers, and you will never be satisfied (certain), am I right? ( transient relief and then it (the what-if's start again). Focus on 'what is' rather than 'what if'. negative rumination is a slippery slope, we do it, mostly, to problem solve, but we always use emotional reasoning bias and this is not helpful. If you restrict your compulsions with media etc, guess what, you are starting to do ERP. A thought might be 'I'll just go and look up ????????', delay that action, even for 10 minutes, then 15 , 20 etc. Ironically, looking at posts can be termed as a compulsion. But only YOU know whether its problem-solving/ for information/ support etc or a compulsion. If that anxiety spikes then reduces and you are able to tolerate reducing/stopping compulsions, then its starting to work. What's happening outside your head now,? use your five senses if you want, like mindfulness. , what going on about you that is interesting, entertaining, and gets you in the flow/zone. Distraction is not ideal in the long term, but to get you started its ok, helps to direct attention to a nicer activity. Does than road/countryside outside where you live need walking, what about going for a newspaper, etc, anything. look out at the Christmas lights, talking to a friend (not about OCD). Count down from 3 2 1 and Just do it, NOW Just suggestions Regards Phil

In the UK, only a registered clinical psychologist/psychiatrist can FORMALLY diagnose with a mental health/personality disorder. GP/Other mental health practitioners/clinicians etc can give problem /symptom descriptors and work with them as a working 'diagnosis'. If a GP says I am suffering from anxiety/ depression etc, this is a professional opinion, it is not a formal diagnosis. Unless they are also a psychologist/psychiatrist and professionally working as such. A therapist/clinician will probably include an assessment/interview and self-report questionnaires/measures. Also possibly give screening measures as OCD can overlap/co-occur with other disorders. It is not necessary to have a 'formal' diagnosis of OCD in the UK to receive psychotherapy. Regards Phil

I'm afraid a therapist/GP is unable to formally diagnose in the Uk. It is only a registered clinical psychologist/psychiatrist. However, a therapist will do an assessment then work with you on your problem symptoms and probably do some self report measures . One doesn't need a formal diagnosis to have therapy. The usual route is through GP, but some areas have self referrals to local NHS/ IAPT services. CBT therapy is the gold standard at present for OCD.

We all have intrusions, but to most the meaning behind the intrusions isn't significant/meaningful and does not affect the emotional system, that's why they bounce off, and are fleeting. The head and the body are connected (dual system). What's the betting that if i think about having cramps all day (obsessions), I WILL get cramps, same with groinal experience/ call it what you like psychosomatic, physiological etc, but its the misinterpretation of the bodily sensation that we obsess about. its a feedback system. Do we get panic if we have NO somatic sensations in our body, no. The anxiety causes the bodily sensations, we misinterpret the sensations and the panic thoughts arise. Then more sensations and guess what, panic attack. When we have a groinal sensation, our thoughts fasten onto it and obsess, and guess what, it perpetuates. then the 'it must mean I'm a monster' thought pops in and we get entangled in that. We are constantly selectively attending to the obsession/threat. If we tolerate them and habituate to the thoughts and accept them just as a physical sensation, the brain gets used to them without trying to neutralise them, the emotional spike lessens then becomes extinct. Classic ERP.

Whoever brushed you off is an idiot, and are not professionally experienced/trained/qualified. I only ask about diagnosis because a reputable therapist will work on your negative symptoms with you as a person. Working in the NHS as a high intensity therapist (retired now), very few of my patients had formal diagnoses. We worked in a therapeutic collaboration to improve their symptoms. OCD or OCD pure-o is everyday work to a CBT professional. You probably know CBT /ERP is the recommended therapy in the NHS here in the UK , but CBT can be individualised. A professional (CBT) will undoubtedly help, but CBT is collaborative and a client has to be prepared to be committed, engaged and motivated. A therapist can give initial relaxation/stress management techniques before doing the protocol, but the therapy is a 50/50 collaboration between you and the therapist. Usually with OCD, no background/history of problems is raised. however, if their is a 'significant' backstory then this needs to be discussed. Some of my patients disclosed and we worked just cognitively and they recovered without ERP. CBT is a relatively short therapy ( we in the NHS were allowed up to 20, 1 hour sessions, and that was stretching it). Please bear in mind that if you see a therapist (CBT), they can only focus on, say OCD, at once. They, and yourself are focusing on your MAIN mental health problems. At the end of this long post, the goal is to be in therapy, and with a therapist you can have a therapeutic relationship with (trust). If you feel you require a formal diagnosis, then that's ok, I'm just giving my view on how therapy can help without one. Regards Phil

In the UK, only a registered clinical psychologist/psychiatrist can formally diagnose. Can I ask, why do you need a formal diagnosis?

Be honest and open, the therapist is there to help you help yourself. CBT is not passive, it is a therapeutic relationship, that means you are an active, committed and involved client. You both work as a team. An assessment / interview /confidentiality and risk discussions may be included, and some psychoeducation will probably be done, with some symptoms/screening self-report questionnaires/measures. The therapist will help you along with all these. The therapist may also give you some relaxation/stress management exercises if needed. Ask as many questions as you like, the therapist will give you ample opportunity. There will be between session work and probably further symptom measures and worksheets to complete as you go through the sessions. The therapist may/usually make out a formulation ( plan of your problems) with you. Exposure Response Prevention (ERP) is the usual therapy protocol, but both of you must agree on the formulation, then focus in therapy on what you are targeting it on ,everybody is individual. Please, if the therapist explains something and you don't understand , say so, especially to do with the ERP etc. Please don't be embarrassed. No-matter what type of intrusions/compulsions you have. OCD therapy for a professional therapist, including pure-o thoughts, is their everyday work. I know it might be difficult, but you must be committed and give it your best. This is only a general guide from a retired NHS high-intensity therapist, but other therapists may work differently.

Hi, only one humble suggestion. The media (TV etc) is saturated with Covid related stories/back stories at present. Might be a suggestion to work together and agree to lessen /limit the exposure at this time. Ironic that CBT employs some sort of exposure therapy, but, reading your post, i think its too early for that. Stress reduction/coping is a must at these times and the media exposure only serve, at present, to induce more anxiety, especially with contamination OCD sufferers, just a thought, Phil

Hi again. When you said 'i was once on the phone, to someone, a group walked by and asked what time it was, i gave them the time, 2 minutes later, i said to the person on the phone what time is it?', you have just remembered it. Not trying to be a clever dick, but you must have processed that in your short term memory to consolidate it in your long term memory. I think, that its still attention, probably maintained by high anxiety/stress. The more we worry/obsess about it the worse it gets, We have a cognitive filtering system and when we are anxious this is not as efficient, especially when what we are thinking/talking about something meaningful/significant and hits our emotional system. We also tend to pick up the things that we negatively select to and are threatening, and not the many things that's ok with us, then when we focus on the negative stuff and this just magnifies it. We then end up just focusing on this and are forever testing it in some way or other, which again can become obsessive. Its funny, when we are in the 'zone' or 'flow' ( say playing a computer game) and really focusing, then someone brings in , say a cup of coffee, for us, what's the betting that we don't remember them even coming in, and our coffee goes cold. We are just selectively attending to something we are interested in, its not memory issues, its us being human. I can honestly say that during my NHS CBT therapist career, I have never known any of my anxiety patients (hundreds) to have any memory issues, although some thought they did, until after therapy recovery regards Phil

My suggestion is that it is not a memory (short term) problem, it is a an attention issue. If we are not attending (taking in) something we cannot cognitively process it and it doesn't enter our memory system. People who are in autopilot and thinking about other things (selective attention) tend to have attention difficulties. Its very common with people with anxiety. Take a look on YouTube about selective attention below. You may be surprised, let me know if you have any questions etc ?

Spot on, Well said

Good luck, A caveat though, when I'm talking about negative metacognition I am NOT talking about Adrian Wells Metacognition therapy, this is DIFFERENT, take care -Phil

Without sounding ruddy obvious, a professional is your best bet. Us humans almost always need certainty ( i.e., what is it?), but occasionally different mental health issues can heavily overlap and jockey for position, depending on circumstances. Some are what is called transdiagnostic and exclusively relevant to the individual. Sounds like a type of negative metacognition has developed, but needs a therapist to work with you and make out a formulation ( conceptualizations) a blue-print of your problems and something to work on with the therapist. with you to target the exact problem/s that distress you ( I am assuming they are distressing). When you say 'constantly' , can you find anytime they are not constant, say when you are in the 'flow' with something/someone. If you can then its not constant, do you think. same with 'You'll never be able to stop thinking about thinking' If you can dispute this and prove it wrong, just once, then that thought has been debunked. Its focusing outside your head rather than introspection/ self - focusing/analysing, that may help. Alongside this, is the rumination, this is usually thinking about the past. ( rumination is a term that comes from cows ruminating with food), the more we negatively ruminate the more we will do it, it becomes habitual/automatic, and we become on autopilot to this. We ruminate to try to problem solve, but it don't work because we are always using emotional reasoning bias, and it develops more questions than answers, which obviously increases intolerance to uncertainty/frustration/obsession etc. Post event processing is the same but usually associated with people with social anxiety and maintains the social anxiety. This is mentally doing a 'post mortem' on a recent/ past social interaction and focusing on the negatives. Not much help i suppose. regards Phil

Sorry, but can i ask is it OCD or a type of GAD/worry /'what if' thoughts. You say you have no compulsions/even mental compulsions and the sleep issue certainty relates to worry, but what do you think? Phil

You probably know that all of us have intrusions of one sort or another. The difference is that many people don't recognise/be aware of them because they don't hit the emotional system and pop back up feeling scared/guilty shame etc. you wouldn't be scared unless they weren't distressing you and that is because they are unwanted/unbidden. When I worked with many OCD sufferers in my job as a NHS therapist (retired now), I never had a patient who acted on their intrusions, it was not their personality/morality. I also found that, especially with patients with OCD, they were the most dignified, respectable and responsible people I have worked with. Your not 'letting them' get to you, they just pop in, and probably due to other triggers and /or stress. Obviously therapy will probably help, and the good news is that you were free for a long time, this shows you can beat it. As I said, psychological stress is a big trigger, especially prolonged stress. Letting them come and go and not attending to them is a good start, but easier said than done, because the intrusions are significant to you. I'm going to be a bit silly here, but if you were having intrusions about killing a kangaroo, what's the betting it would not be half as distressing. Silly, i know, but that's the difference. In my work over 20% had was is termed pure-o ocd, but that term is a bit outdated now because this does have compulsions, but mainly mental compulsions. people with them usually avoid situations/object, in the short term this is ok, but a therapist would help you to tolerate them. Distraction, deep breathing exercises etc for the time being helps, being focused on something interesting and being in the 'flow'. with hobbies/work etc is good. Going out and physical exercising also helps, those thoughts will come and go, not to ignore them, but just 'accept' what they are, thoughts. Obviously, if you are taking steps to get professional help then that's a good thing, and support from loved ones. You have coped well before and there is no reason you can do it again. the intrusive thoughts will flop about a bit, and that's ok, the meanings of the intrusions will change and get lighter, then they won't bother you and fade away, its the emotional spike from these intrusions that's maintaining them. hope this helps a bit, but perhaps some close support/cbt therapist may help better. Phil