Interview by Sunil Punjabi
Hi Carol, Congratulations on getting your book published and thank you for speaking with me. To start, tell us what inspired you to write this book?
I wanted a better understanding of why some people who have sexual, religious, and harm obsessions in obsessive-compulsive disorder (OCD) endure "liking" the thoughts that come from those obsessions.
That is interesting. Can you summarise your book in one to three sentences as if you were speaking to someone unfamiliar with your book and its topic?
Some people mistakenly think they like the feelings or urges that come from pure obsessions, and several struggles with the erroneous belief that they might act on them. My book discusses this issue in-depth.
How do you explain that? What is the overall theme (central topic, subject or concept) of your book?
Well, the overall theme is about imagination or absorption in sexual, religious and harm obsessions and how erroneous desire might play a part in absorption. When one is absorbed in an obsession, it can lead to a term known as dissociation peculiar to OCD (Dr. Nirit Soffer-Dudek, 2018). It isn't to be confused with pathological dissociation such as with the experience of derealisation and depersonalisation. Instead, it's when somebody's attention is lost in imagination and needs to re-establish the ability to engage in treatment to lessen the impact OCD has on their lives. The evidence-based treatment is exposure-response prevention (ERP).
It sounds like it was a complicated topic to pursue, with a more scholarly leaning. Would you agree?
Perhaps, although I didn't invest my time naively. The problem affects people's lives, and I believe it deserved a comprehensive evaluation. I'm happy with the result of my research.
So, the audience? Where do you think the audience for this book is?
People appear to suffer from the central topic of my book worldwide. So it extends to a global community in which many will identify, including therapists who treat OCD.
I see. So how do you make sure that people across various strata identify with your book then?
I portray a true-life story of living with OCD, coupled with the researched information. It's important to my readers and me that I tell some of the story through my lens. I believe it helps people identify with the problem and offers hope that recovery is a reachable goal.
That is indeed a great approach. I agree that a slice of life is more relatable. So tell me, how is this book different from the plethora of books available on the subject?
I think generally, it provides specific information that appears to be missing in the educational handouts for people who struggle with the desire-aversion concept. Many want answers, say about groinal response, but the rebuttals knock them back. For example, suggesting that reassurance-seeking isn't the solution is correct but doesn't answer the question directly. It's often about comprehension that correlates with the question that people want, not reassurance. But that's mainly from a biological standpoint and where I did a lot of my research.
What about relevance to today's society. How is your book relevant?
It's relevant to today's society because of how many people suffer from intrusive thoughts. The NICE guidelines report 5.5% of sufferers of OCD have obsessions related to sexual thoughts, and 4.3% have obsessions related to harm. Add to the number of people who struggle with suicide obsessions yet are misdiagnosed with suicide ideation, and it brings more relevance. My book also brings attention to the distinction between harm-intrusive thoughts and non-suicidal self-injury. Dissociation peculiar to OCD that involves my desire-aversion theory means the book could become even more relevant to people worldwide.
You've mentioned dissociation in OCD. Can you explain the concept of dissociation peculiar to OCD in a little more detail, say with the example of a suicide obsession?
Yes. Let's assume a person who struggles with suicide-intrusive thoughts mistakenly thinks she should end her life. She might set plans, such as setting a suicide date repeatedly. But what she doesn't know yet is that the dates are the compulsion to relieve anxiety. When the ritual doesn't work anymore, it's because she's likely become more deeply absorbed in the obsession. She thus loses sight of the original safety behaviour, the ritual. As a result, her imagination, or her personal story about the obsession, sways her to the thing she doesn't want to do, and she inadvertently puts herself in danger with more hazardous rituals. In all intents and purposes, the behaviour looks like suicide ideation. Still, and despite that healthcare providers should keep a watchful eye when people have suicidal thoughts, the proper treatment for the right diagnosis should not go amiss, hence having a grasp on dissociation peculiar to OCD.
How might the desire component play a role in a suicide obsession, then?
Well, let's suppose the obsession involves thoughts that make some people think they have a desire or calling to do the thing they don't want to do. For example, to please God. Well in that case, religious OCD would morph itself into the suicide obsession. And, as noted already, somebody might accidentally put themselves at risk with deceitfully-led rituals driven by OCD (or the person's imaginative story about the obsession). That is to say that a deeper level of absorption in OCD could cloud the person's mind to ritual and response prevention, which would inadvertently allow the persuasion towards the more dangerous activity.
What about self-harm intrusive thoughts versus non-suicidal self-injury, how would you describe the difference?
As an example of self-harm intrusive thoughts, people may jab themselves with a sharp object to try to evoke anxiety if they're not feeling it during an exposure. In contrast, people who self-injure would do this as a consequence of anxiety. For the person who has intrusive thoughts, they don't know why they're not feeling anxiety and think jabbing themselves will increase it. They think it will help them follow through with the exposure, which might be holding a knife and resisting the compulsion to put it down or hide it. But even though prodding oneself with a sharp object might increase anxiety, it is not the way to level up an exposure. Such behaviour is imaginative testing which obstructs the ERP process. In other words, people become so absorbed in the obsession that they appear to lose awareness of everything else around them, then jolt out of that experience and cannot make sense of what happened. Some think they've acted on their thoughts, which they haven't, nobody acts on their thoughts per se. Others struggle with magical thinking, such as, "If I don't slap my face seven times every hour on each side, my mother will die." In contrast, and as mentioned already, non-suicidal self-injury is done in response to one's stressors and negative self-evaluation, and to regulate emotions around that. I discuss this in more detail in the book.
Wow. It is so important to understand the difference so as to be able to offer the correct intervention. On a different note, is there any subject currently trending in the news that relates to your book for sexual-intrusive thoughts?
I haven't seen anything currently trending in the news from my desire-aversion concept. However, there are articles and books out there on sexual, religious and harm obsessions. I've noticed that some psychological professionals have written about the groinal response, and others talk about sexual non-concordance. One book is Sexual Obsessions in Obsessive-Compulsive Disorder by Monnika T. Williams & Chad T. Wetterneck. Another one is Pure by Rose Bretecher, which features the author's true-life story of living with sexual-intrusive thoughts. It was also made into a TV drama in the UK.
Sexual non-concordance? What is it? Are you covering it too, in your book?
Legitimately, it means that people can feel physically aroused even though they aren't thinking about sex, or they might think of sex but do not get physically aroused. From my book's perspective, it's about grasping that if you have a sexual obsession and experience genital arousal, it doesn't mean your mind agrees with that sensation and vice versa. More specifically, since it's instigated by OCD, it is seen as an anxious-stroke-somatic-response. It means the thoughts and bodily sensations are not about sex but an obsession about it. Therefore people cannot reciprocate with something that's not valid. I do talk about sexual non-concordance in my book a little bit because it correlates with the groinal response and unwanted arousal in OCD.
Let's explore more about exposure-response prevention. How does it work for people who have the desire component?
It helps prevent the actions people do in response to intrusive thoughts, including those that involve erroneous desire. When people do ERP, they learn to face their fears in small steps (this is the EXPOSURE) and to then resist the compulsions in response to the obsession (this is RESPONSE PREVENTION). Over time, it helps them build a tolerance for anxiety and leads to reduced symptoms or remission. The only difference is that when a therapist who is treating a patient struggling with a deeper level of absorption, they would need to enhance the treatment approach. For example, it would require helping the patient to learn how to pick up on the cues, such as identifying when they are getting too involved in the obsession and immediately redirecting themselves back to response prevention. Again, much of this is explained in the book.
What else do you want readers to take away from your writing that relates to sexual obsessions?
First, that the groinal response is automatic in a sexual obsession and is not a person's fault. And second, that increased arousal pertains to somatic signs of anxiety and is consequently nonsexual, noted earlier. For example, when a person pays attention to the arousal, it increases it, hence the anxious-stroke-somatic-response. The sensation is not proof that their sexual-intrusive thoughts are about them. As a further example, checking for arousal usually heightens one's anxiety, which increases the somatic sensation (sweating and throbbing down there), which the individual mistakes for authentic sexual feelings and urges, and thus strengthens their erroneous beliefs about the thoughts. What's crucial is that, since all sexual-intrusive thoughts are empty of meaning, it explains that the desire component is also false; it has no reciprocity between obsession and self.
It is such a unique take on the disorder. What else made you delve into this aspect and how did you go about researching it?
I learned some of it through personal experience, and also foreknowledge of how one's imagination could be a factor involving absorption. I also had a feeling that erroneous desire could potentially come from certain brain regions as well as the physiological symptoms described already. After studying OCD as part of my training to be a therapist for this disorder, I became more interested in the pure O side, meaning the sexual, religious, and harm obsessions. Moreover, as a cognitive behavioural therapist specialising in OCD, I received desperate pleas from people. These people wanted me to help them understand the pull or urge towards the unwanted desire that became an additional feature of their obsessions. I'm still getting those requests. All of these things gave me a reason to research why intrusive desire appears to coincide with pure-obsessional thoughts and nonsexual arousal.
Tell me, in OCD, can people break the law when their imagination sways them to do the thing they don't want to do?
Yes, it's likely. For example, let's suppose a person engages in voyeurism to prove they do or do not have a sexual preference for children, then they would be breaking the law. That's despite the fact that it is a compulsion to ward off perceived danger and reduce anxiety. It is not voyeurism in the true sense of the word, though it would be hard for a person to explain that if they were to be cross-examined. Also, suppose the person experiences an automatic groinal response, but then feels a strong urge to self-pleasure. Well, in that case, it's the attention on the genitals that increases to dissociation, not sexual preference for children, but it is highly unlikely the judge and jury would understand dissociation in OCD. At any rate, the reality principle usually kicks in later in situations like this, which is when the person feels subsequent guilt and is repulsed by the act.
Right. So how could that be explained in court, then?
It's doubtful that a court of law would take one's guilt as proof that there is no real pleasure principle in a paedophile obsession. More to the point that one's sexual activity does not mean self-pleasuring per se, but is a somatic problem, and inadvertently encouraged by one's imagination. In other words, arousal is not about getting sexualenjoyment from the obsessional input (e.g., paedophilia-themed intrusive thoughts), it's about the physiological symptoms of anxiousness. Factually, arousal holds no capacity to think logically; however, in the case of an obsession, it is an anxiety-driven somatic issue, noted before, and therefore nonsexual. The main thing is keeping a person who might inadvertently break the law to learn how to stay in the present and pay attention to ritual prevention.
That is certainly scary, but illuminating. Hopefully, your readers will learn more about this, and the awareness will spread. Can you tell your readers where they can purchase the book, and is there scope for a another book based on what you've written already?
My book can be purchased on my website here: www.intrusive-thoughts.com. And yes, I want to write another book based on the same topic and this time bring in the inference-based therapy approach (Kieron O'Connor and Frederick Aardema). This fascinating approach looks at helping people move away from imaginary doubts (the obsessional story) to a more realistic view of events. It is a fairly new approach and appears to be helpful in encouraging people through ERP.
Thank you to Sunil Punjabi for this interview. Sunil is a mental health counselor, mindset coach and founder of unshackle.in
Finally a book that has a logical explanation for the desire component in my OCD, which is for me the most confusing part. It is making my sexual obsessions unbearable, feeling wanted and unwanted at the same time. Every behavioral therapist should have read about this, the therapists who treated me did not know about this. There is a great danger to misclassify patients like me. Martin Johannson, Germany
'The book considers pure obsession in three different ways: from Edwards’s perspective, from a therapeutic standpoint, and with fresh scholarship on OCD. Considerations of OCD are expanded upon with a variety of source materials, including both personal and professional work… The book’s more scholastic material draws upon reputable personality and psychiatry studies, delivering concrete advice to alleviate OCD suffering. It proposes therapeutic interventions, including cognitive behavioral therapy and exposure response prevention…’ Clarion Review
'This is a very demanding piece… I'm sure that you are onto something. I long puzzled about obsessions and addictions, not least in my own case!!' Comment prior to publication by Professor F. Toates, author of "Obsessive Compulsive Disorder and Biological Psychology".
'Desire-Intrusive Thoughts draws upon personal experiences with OCD to deliver professional advice about how to help others. The book’s primary focus is on the pure obsession component of obsessive-compulsive disorder. Early on, it contrasts obsessive thoughts with compulsive actions, then enters into a broad overview of OCD-associated issues related to sexuality, self-harm, and religion. It argues that all obsessions, including sexual ones, are involuntary and cause unnecessary alarm in those who hold them. Its foci include addictions, pedophilic thoughts, and intrusive incestuous thoughts, all of which it claims can make people on the OCD spectrum internalize a sense of “moral wrongness” about themselves... Deep examinations of concurrent disorders, like anxiety and depression, are later used to suggest therapeutic approaches like progressive exposure to stimuli and conditioned responses. Foreward Reviews
'It (The book) proposes therapeutic interventions, including cognitive behavioral therapy and exposure response prevention. Verbatim dialogues are included to illustrate how such tools work, as with a lengthy conversation between a woman and her therapist that raises concerns around personal orientation, with the woman seeking constant reassurance that she is not gay. The book’s neuroscientific information is technical in nature... Most geared toward mental health practitioners, Desire-Intrusive Thoughts is a dense text that draws upon personal experiences with OCD to deliver professional advice about how to help others.' Clarion Review cont...
More than helpful, very descriptive of the causes and how to handle the devastating effects it can have. Kevin Roberts UK
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