perfectionism and - Obsessive-Compulsive Foundation

6/14/13
CASE EXAMPLE
• 39 year male with co-­‐morbid borderline personality
disorder, PTSD, and simple phobia
• History of mulple sexual assaults by peers, clergy,
and stranger
• Contaminaon to places associated with the trauma
which generalized to the enre town
• Disgust reacon to conversaons about the town or
the trauma
• Rituals involve washing, avoidance of specific
locaons, repeve discussions (“need to
understand”) about the trauma
OCD AND TRAUMA: IS THERE A RELATIONSHIP
• Co-­‐morbidity rates between OCD and PTSD are unclear (6.2%
in one study; 39% of treatment resistant OCD paents)
• PTSD has a negave impact on treatment outcome for OCD
• Complex relaonship between the two disorders
• Traumac events are ogen trigger for OCD
• Is OCD contaminaon a coping response to a traumac event
– Rituals and avoidance provide Illusion of control over
situaon
– Washing to remove the sense of internal dirness/
polluon or the negave emoons or thoughts brought on
my trauma memories
MENTAL CONTAMINATION
MENTAL CONTAMINATION
• Rachman differenates between:
– Physical contaminaGon – disease, dirt, etc. and involves
direct physical contact with contaminant resulng in
“feeling dirty”
– Mental contaminaGon (“mental polluGon”)
– “Sense of internal un-­‐cleanness which can and usually
does arise and persist regardless of the presence or
absence of external, observable dirt’’;
– feeling unclean can be triggered by images, thoughts, or
memories (immoral religious, sexual obsessions)
– ogen triggered by life events that are wrong,
inappropriate, immoral
– Linked with feelings of disgust and morality
• Emoonal contaminaon may take on
qualies of mental contaminaon especially
when the obsession is linked to abuse
• Thoughts, images, and memories rather than
direct contact with the contaminant may
trigger urges to ritualize (wash away the
internal sense of unclean)
SUNDAY
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