A recent episode of NPR's new podcast, Invisibilia shed light on a form of obsessive-compulsive disorder that's rarely talked about: One that involves intrusive thoughts about harming others.
The show's hosts, Alix Spiegel and Lulu Miller interviewed an unidentified man who, after watching the violent Brazilian drama, City Of God, developed obsessive thoughts about killing his wife, explaining:
[In the movie] the gangs would go, and they'd fight amongst each other and kill each other. And there was a lot of pretty graphic violence. And about midway through the movie, I started getting just inundated with violent thoughts. What if I were to brutally stab someone or shoot someone or harm my wife?
Those who suffer from "harm OCD" are plagued by these types of thoughts and images, and they experience a great deal of stress, anxiety and discomfort as a result. The thoughts are no indication of a person's true character or desires, according to Dr. Bruce Hyman of the OCD Resource Center of Florida. They occur "completely out of context" of the history and the character of the person experiencing them, he said.
That's a far cry from the repetitive hand-washing and fear of dirty door knobs that are typically associated with the disorder in popular culture. And this narrow view of what OCD looks and feels like can be a source of confusion to those who experience the relatively common disorder in a way that is outside the cultural norm. For example, those with intrusive thoughts of harming others may worry that they are psychopathic, even though their upset suggests otherwise.
The disorder is estimated to affect up to 2.3 percent of the American population. Some data has even suggested that up to 25 percent of adults has experienced either obsessions or compulsions at some point in their lives -- meaning that up to 60 million Americans may have experienced OCD symptoms, even if they do not meet diagnostic criteria for the disorder.
In blanket terms, OCD is characterized by two things: obsessions (intrusive, recurring thoughts) and compulsions (behaviors, typically repetitive, that are performed to lessen the anxiety of the thoughts). But the disorder can be difficult to identify because it can present in so many different ways.
The National Alliance on Mental Illness defines OCD as a "disease of doubt," in which individuals experience "pathological doubt" because they have trouble distinguishing between probable and highly unlikely events.
"The sufferer can get stuck in something of a behavioral loop, where the thoughts recur and the compulsions recur non-stop," Hyman told The Huffington Post. "They repeat many times during the day, causing a great deal of impairment to the person's ability to function."
In the case of "S," the anonymous man interviewed on Invisibilia, he was able to seek therapy and the thoughts subsided, but what about other people like him?
Here are four important truths about OCD that will change the way you see the disease.
Obsessions are more than just worries.
The obsessions that characterize OCD occur in the mind "spontaneously and intrusively," Hyman said, adding: "There is tremendous fear and anxiety attached to the thought."
However, Hyman emphasizes that the thoughts of people with OCD are not substantially different than the thoughts of people without OCD. Research on the content of thoughts has shown that anyone can have an out-of-character intrusive thought (for instance, you might think, What if I was to push this old lady into the oncoming train? when standing on the subway platform). The person with OCD, however, relates to it in a different way -- they might grossly misinterpret the thought to mean that they are a dangerous person, whereas the non-OCD person will not take the thought so seriously.
Because the person perceives the mere presence of the thought to indicate a larger and more disturbing possibility, they will do whatever in their power to get rid of it, performing various compulsions.
Compulsions can be much more subtle than counting or washing hands.
We tend to think of OCD in terms of extreme compulsions, like washing one's hands until they bleed, counting out loud, checking locks over and over again, or rearranging items to make them more orderly. But many, if not most, cases of OCD can't be spotted by these kinds of obvious behaviors.
Roughly 20 percent of OCD patients experience only obsessions, in a variation of the condition is what's known as Primarily Obsessional or Purely Obsessional OCD.
However, as Hyman notes, some research conducted in the 1990s suggests that even in this form of OCD, there are still some compulsions occurring -- they just may not be as evident. Instead, they may take the form of internal compulsions (the repetition of a mantra in one's head, for instance), as well as avoidance behaviors (such as staying out of the kitchen so as to avoid being around knives).
"Just because there aren't any obvious compulsions doesn't mean that there aren't many, many internal compulsions," said Hyman. "The idea of obsessions without compulsions doesn't really hold up."
OCD often has nothing to do with cleanliness or organization.
Around a third of OCD sufferers have conditions that revolve around issues of germs and cleanliness. Commonly, this form of OCD is exhibited by a compulsion to clean one's space and wash oneself, caused by the fear of contamination.
"People do make the mistake of associating OCD with germs and being a germ freak and excessive cleaning," said Hyman. "But in reality, that is a minority. It's a significant minority, but it's a not a complete picture of OCD."
Other common obsessions and compulsions have nothing to do with cleanliness. These fixations and behaviors include violence/harm, sexual deviancy, hoarding, magical thinking, religious beliefs, symmetry/orderliness and checking locks and appliances.
OCD cannot be cured, but it can be treated very effectively.
Hyman emphasized that OCD, while incurable, is an extremely treatable disorder. Popular treatment options include exposure and response therapy, mindfulness-based therapies and medication. Exposure and response is usually the first line of behavioral treatment -- it helps the OCD patient to overcome intrusive thoughts by exposing them to the triggering item, such as a knife or a dirty doorknob. Mindfulness, said Hyman, can be a very powerful complementary intervention.
"Mindfulness is really teaching an impassive non-response to the obsessive thoughts, and learning to be open and accepting of this horrific thought, despite the disturbance it causes," said Hyman. "Mindfulness approaches can have tremendous benefits when combined with exposure and response prevention."