online conference transcript
Dr. Michael Jenike talks about one of the most difficult aspects of Obsessive Compulsive Disorder (OCD), obsessions, including obsessive thoughts, intrusive thoughts, disgusting thoughts and what to do about them. We also discussed medication for treating OCD, Cognitive Behavioral Therapy, and treatment resistant OCD.
David Roberts is the HealthyPlace.com moderator.
The people in blue are audience members.
David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com.
Our topic tonight is "What To Do About The Obsessions Part Of OCD." Our guest is Dr. Michael Jenike.
Understanding that everyone in the audience might have a different level of knowledge, here's some basic information about Obsessive-Compulsive Disorder.There's even an OCD screening test on our site.
Just so everyone knows, obsessions are unwanted, recurrent, and disturbing thoughts that the person cannot express and that cause overwhelming anxiety. (i.e. fear of germs or toxic substances, did I unplug the coffee pot?, etc.)
Our guest tonight is Michael Jenike, M.D. Dr. Jenike is a psychiatrist at Massachusetts General Hospital, a Harvard Medical School professor and his primary research interest is in obsessive-compulsive disorders. He has written numerous articles for scholarly journals on the topic, authored a book entitled "Obsessive-Compulsive Disorders: Practical Management," and he is a member of the board of directors of the Obsessive Compulsive Foundation.
Good evening, Dr. Jenike, and welcome to HealthyPlace.com. We appreciate you being our guest tonight. What is it that causes certain individuals to have obsessive thoughts?
Dr. Jenike:Thanks. Everyone has intrusive thoughts, but people with OCD give them special significance and they get stuck in their minds. We really do not know what causes Obessive-Compulsive Disorder in most patients, occasionally, it can occur after strep infections or head injury, but this type of cause is very unusual.
David: How do the obsessions get started?
Dr. Jenike: Patients often report that they have a sudden onset of some thought that upsets them, for example, that they did something hurtful to someone else, said something inappropriate, or some sexual thought that is repulsive to them, like wanting to molest their children or parents. We don't know why some people get these types of thoughts stuck in their heads. For those without OCD, we're able to chalk those off to "passing thoughts". What is that makes a person with OCD obsess about them? I wish I knew, but I don't. If I get a thought that seems bizarre, I just let it pass. If I had Obsessive Compulsive Disorder, I would try to find some significance in the thought and somehow determine that I was a bad person, etc.
Interestingly, the more one tries to get rid of such a thought, the more it intrudes. The classical example is telling someone without OCD not to think of a white bear for the next 5 minutes. In careful studies, this has been shown to cause the thought to come much more often, so telling OCD patients to force the thoughts out of their heads, just makes things worse.
David: So what is the answer to ridding yourself of these obsessions?
Dr. Jenike: Good question. We know what not to do.
The first thing to do is to educate the person. once they know that we all (except me, of course) have such thoughts and that they are normal, that often helps a lot just by itself.
Next, tell them not to try to force the thoughts out of their heads, but just let them pass naturally. Don't try to read any significance into the thoughts. If you are obsessing about wanting to have sex with your baby, don't interpret this as you being a bad mother, the thoughts, have nothing to do with the character or motivation of the person. They are produced naturally by the brain, and if you have OCD, your normal filtering mechanism does not work so they get stuck.
There are medications that may lessen considerably the thoughts, and even lighten your interpretation of them. In some patients, we use what are called "loop tapes." These are tapes on which a person records, in their own voice, the disgusting thoughts and plays them back for a couple of hours per day, until they essentially become boring. This lessens, greatly, the hold that the thoughts have on the person.
One final thing, Dr. Lee Baer has a great new book coming out called: The Imp of The Mind, due out in January 2001. I don't get any royalties, but after tonight maybe I can make a deal with him!
David: I want to touch on one thing you said before we get to some audience questions. Earlier, you mentioned that we should let the obsessive thoughts pass naturally. Of course, people with OCD have great trouble with that. Is that something that can be taught in therapy?
Dr. Jenike: The main thing that can be taught, is that these thoughts come into everyone's minds and are normal. This helps a lot.
So, the problem is not that OCD patients have abnormal thoughts (we all do); it is their interpretation of the thoughts and their holding onto them, as if they have some intrinsic value.