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Bill, LCSW, Consultant, Expert Witness
Category: Mental Health
Satisfied Customers: 3707
Experience:  35 years treating individuals, couples, families with mental health and substance abuse prob's
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I have a girlfriend who has a constant, rather repetitive

Resolved Question:

Hi there, I have a girlfriend who has a constant, rather repetitive battle with herself. There are times when she has obsessive thoughts that cause her alot of distress, creating anxiety, always asking "what if" and not knowing how to cope with such thoughts. For example, at the moment she is battling with understanding if she has commited the "unforgiveable sin" which is from the Bible and as a Christian it creates uneasiness in her. She has read over scripture and books that state it is not possible for a believer to commit such a sin, however she believes that having the thought is a bad thing. It would be very easy to simply diagnose this as OCD-type symptoms, but I need advice on how to help her create a coping mechanism whenever such thoughts/obsessions may occur.
Submitted: 4 years ago.
Category: Mental Health
Expert:  Bill replied 4 years ago.
Bill :

Hello- Thank you for asking the question. I have over 30 years of experience working with individuals, couples and families & am happy to reply.

Bill :

I am happy to help with this:

Bill :

Understanding OCD obsessions and compulsions

Obsessions are involuntary, seemingly uncontrollable thoughts, images, or impulses that occur over and over again in your mind. You don’t want to have these ideas but you can’t stop them. Unfortunately, these obsessive thoughts are often disturbing and distracting.

Compulsions are behaviors or rituals that you feel driven to act out again and again. Usually, compulsions are performed in an attempt to make obsessions go away. For example, if you’re afraid of contamination, you might develop elaborate cleaning rituals. However, the relief never lasts. In fact, the obsessive thoughts usually come back stronger. And the compulsive behaviors often end up causing anxiety themselves as they become more demanding and time-consuming.

Most people with obsessive-compulsive disorder (OCD) fall into one of the following categories:

  • Washers are afraid of contamination. They usually have cleaning or hand-washing compulsions.

  • Checkers repeatedly check things (oven turned off, door locked, etc.) that they associate with harm or danger.

  • Doubters and sinners are afraid that if everything isn’t perfect or done just right something terrible will happen or they will be punished.

  • Counters and arrangers are obsessed with order and symmetry. They may have superstitions about certain numbers, colors, or arrangements.

  • Hoarders fear that something bad will happen if they throw anything away. They compulsively hoard things that they don’t need or use.

Bill :

It appears that your girlfriend would fall into the category of Doubters and Sinners. As above:

Bill :

Doubters and sinners are afraid that if everything isn’t perfect or done just right something terrible will happen or they will be punished.

Bill :

This is an anxiety based issue that can be successfully treated with medication and cognitive behavioral therapy. I see you have tried CBT, however, it there has not been lasting success,, it is an indication that medication may be needed.

Bill :

I am attaching the protocol from University of Michigan for the medical treatment of OCD.

Bill :

Variations on Panic CBT for Other Anxiety Disorders:

Obsessive Compulsive Disorder (OCD)

Exposure and Response Prevention

Cognitive restructuring is less helpful in patients with OCD. The critical ingredient for successful CBT with OCD patients is direct exposure to the situations that trigger the patient's obsessions or compulsive rituals. This technique is referred to as exposure therapy. Simple exposure to fearful stimuli, however, is not enough for these patients. When patients expose themselves to anxiety provoking stimuli they must block any rituals used to prevent the harm that they anticipate as a consequence of the exposure. This technique is referred to as response prevention. Exposure and response prevention are used together in the behavioral treatment of OCD. For example, a patient with contamination fear and washing compulsions must practice repeated and extended exposure to his or her feared sources of contamination (e.g., touching door knobs, the floor, toilet seats) and resist all urges to wash or engage in any other "decontaminating" or anxiety reducing ritual in response to the exposure. At least 20 hours of actual exposure and response prevention are usually necessary for clinically meaningful desensitization to occur.

Obsessions are intrusive, disturbing thoughts that generate anxiety, disrupt functioning, but cannot be controlled by the patient. They often have violent, sexual, or blasphemous content. Patients with pure obsessions (no compulsive behaviors) are more difficult to treat behaviorally, but techniques using prolonged exposure to taped recordings of their obsessions, in their own voices, can be effective in some cases.

Bill :


Most common - Sertraline (Zoloft) and paroxetine (Paxil) and citalopram (Celexa). These allow a low starting dose (12.5mg of Zoloft, 5mg of Paxil or Celexa) and slow titration (anxiety patients are very vulnerable to initial activation and worsening of symptoms). Effective ranges -- 50 to 200 mg of Zoloft, 20 to 40 mg of Paxil or Celexa. We routinely go much higher in OCD.

Bill :

Encourage your girlfriend to talk to her Doctor about a medication trial...from what you describe- I believe it is indicated.

Bill :

Should you have additional question, feel free to ask-

Bill :

I am happy to help.

Bill :

Kindest regards, Bill

Bill :


Bill :

Thank you.

Customer: replied 4 years ago.

Hi Bill,

What are the possible methods to help her?

Expert:  Bill replied 4 years ago.
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