Re:Ego-dystonic harming obsessions

I'd respectfully disagree. With OCD, the individual typically is plagued by thoughts about an act which they have never performed in the past and which they actually are unlikely to perform in the future. A classic example would be the parent troubled by intrusive thoughts of harming their child. If the individual has never been violent towards their child and shows no significant indications that there is a risk of harming their child, the suggestions posted by "anxiety specialist" would be quite appropriate. However, if the individual has a history of violence towards children and is doing their best to refrain from repeating those violent acts, the treatment approach would be quite differtent (making sure the child is safe, anger management, developing adaptive alternatives to violence, etc.)

When a person who has engaged in prior self-harm is troubled by intrusive thoughts of self harm, it is possible that the treatment they have recieved thus far has been effective enough to end the self-harm for the time being but has not been effective enough to eliminate the impulses to engage in self-harm. The individual may be at significant risk for resuming self-harm when under stress.

I would recommend a "relapse prevention" approach (i.e. identifying high-risk situations, developing adaptive alternatives to self-harm, and practice in using the adaptive alternatives in real-life). It also could be useful to monitor the situations in which the thoughts of self-harm occur, to identify the automatic thoughts which preceed thoughts of self-harm, and to examine the individual's expectations regarding the consequences of self-harm vs the consequences of using the adaptive alternatives.

I would treat the intrusive thoughts about self-hard as OCD only if it is clear that there is no longer ANY risk of relapse and it is clear that the individual's concerns about self-harm are groundless.

Replies:

Re:Ego-dystonic harming obsessions, by ANGELLA, 03/10/04 Alternatives to self-harm, by Jim Pretzer, 03/10/04 Re:Alternatives to self-harm, by ANGELLA, 03/10/04

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