Academic journal article Journal of Cognitive Psychotherapy

The Menace Within: Obsessions and the Self

Academic journal article Journal of Cognitive Psychotherapy

The Menace Within: Obsessions and the Self

Article excerpt

The current article attempts to provide a theoretical account of obsessions about blasphemy, sexuality, and aggression from an inference-based perspective. It is argued that self-evaluative and self-representational dimensions in obsessions need to be taken into account to allow for the misrepresentation of mental states. A persuasive narrative containing rhetorical devices informs the misrepresentation of mental states and gives credibility to the obsession. These narrative devices seem to originate from a distrust of the self where the person overinvests in a sense of self-as-could-be rather than a sense of self-as-is, which consequently gives rise to a discordance between the person and the obsession (i.e., egodystonicity). The article concludes with some theoretical and clinical implications for cognitive models of obsessive-compulsive disorder.

Keywords: obsessive-compulsive-disorder; self; reasoning; inference-based approach

My conscience hath a thousand several tongues, And every tongue brings in a several tale, And every tale condemns me for a villain.

-William Shakespeare, Richard III, Act 5, Scene iii.

While common usage of the term obsession generally refers to an excessive preoccupation with a particular idea or activity (e.g., obsessed with work, obsessed with sex), the clinical use of the term is reserved for obsessive-compulsive disorder (OCD), where it refers to "recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress" (American Psychiatric Association, 2000). The most well-known subtypes of OCD revolve around washing and checking, and the person is plagued by frequent thoughts that, for example, he or she may be contaminated or has forgotten to lock the door. Subsequently, the person engages in frequent washing or checking to alleviate the distress caused by the obsession. However, one of the largest OCD subgroups (estimates are as high as 50% to 60%) experience obsessions without overt compulsions (Weisman et al., 1994). Typically, these obsessions revolve around thoughts of blasphemy, aggression, and sexuality, including thoughts of performing embarrassing acts, sexual assault, child molestation, acts of violence, murder, or anything else that is considered a forbidden act of thought and/or behavior. These types of obsessions, especially in severe cases, present themselves to a person's awareness with great intensity and have a very strong reality value (i.e., they feel real). For example, a person with the obsessions that he or she might be a child molester or a murderous lunatic experiences this idea with a force that makes it almost impossible to dismiss. However, obsessions are not solely defined by their persistence and intensity.

The main distinguishing characteristic in the clinical use of the term obsession lies in its unwanted nature (Rachman & Hodgson, 1980). The unwelcome entry of obsessions differentiates OCD from other disorders, such as the paraphilias, where the person happily invites persistent thoughts into awareness. A related aspect to the unwantedness of obsessions is that they are usually experienced as unreasonable thoughts. People with OCD will often exclaim, "I know it makes no sense, but I cannot stop thinking about it," "It's unrealistic, but I cannot do anything else other than do the [ritual]," or "It's stronger than me." This incongruence between the person and the obsession has often been referred to as the egodystonic nature of obsessions, where the person experiences the thought as unreasonable but at the same time is unable to distance him- or herself from the thoughts. However, despite egodystonic experience, the person with OCD generally recognizes obsessive thoughts as coming from within and in one way or another as their own thoughts.

Insight into the origin of the obsession as coming from within, as well as insight into its irrationality, is largely responsible for current conceptualizations of OCD as an anxiety disorder rather than a belief disorder. …

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