Why Removing Inferences Helped Me Through A Harm Exposure

I’m about to do an exposure for harm OCD. It means confronting a fear of harming my partner with sharp objects. And so, by bringing up harm-intrusive thoughts for the exposure, I’m scared I’ll act on them. My partner doesn’t for one minute think I will. Still, I’ve been thinking about aggressive obsessions and how it feels like a genuine impulse to do the thing you don’t want to do. For me, it’s like I actually feel a desirous urge to act on the thoughts. Even though I read that OCD thoughts are the opposite of one’s true wishes and desires, I have doubts, and right now, as I hold a knife in my hand for the exposure, I’m terrified. 

Kinaesthesia

I did read about kinaesthesia online once. It made me a little less doubtful that I would carry out the harmful thoughts constantly going over in my head. I read how the perception of body movements (kinaesthesia) works. It involves detecting changes in body position and movements without relying on information from the five senses. For example, it confirmed that if I were to feel the urge to lunge at my partner with a knife during exposure, I would have the muscle sense to restrict the lunging movement automatically. But then I think, is this reassurance? I say that because it’s not that I don’t know an obsession is invalid. So, in that case, I realise there’d be no tangible movement through exposure that I would need to restrict. It’s just the doubts that bother me.

Even still, being aware of kinaesthesia and knowing obsessions are invalid gives me anxiety relief. It clarifies that my compulsive actions to prevent harm are not required. So, on the one hand, it feels like reassurance, and on the other hand, it confirms I don’t need to hide the knife through exposure. 

Inferences

But right now, my anxiety is starting to rise again. The problem is that I’ve immediately begun worrying if there’s something wrong with my muscle sense. What if it doesn’t apply to me? Let’s face it; I might be the one-in-however-many who will have a problem with it. So it’s like, what if I have another disorder, not OCD? Besides, I once heard that some people do all kinds of dangerous things on impulse. So maybe they don’t have muscle sense or obsessive-compulsive disorder, and perhaps I’m one of them. 

Okay, that’s hearsay; it’s an inference that adds credibility to the story in my head. I know it doesn’t make the obsession valid or make me have faulty muscle sense, but it still scares me more than I already am. I hate that it increases doubt, so I wish people wouldn’t tell me things like that. Someone also said to me that anyone could snap and do something dangerous out of the blue. But, again, assumptions like this cause havoc for people who have harm-OCD or any obsession. People like me don’t like hearsay and abstract facts adding credibility to their obsession. It makes us half-belief that there is some truth about it.

The trouble with reassurance

Why is it that I’m fine one minute and then panic and worry again about the same thing the next minute? This is the trouble with reassurance. It’s a compulsion, so the more I read about kinaesthesia, the more I needed to. Even being reassured again that muscle sense can prevent terrible things from happening and that OCD is a bunch of nonsense helps. But it still comes with doubts. I guess it reminds you that you don’t need the reassurance because obsessions aren’t valid. But at the same time, you flip back to the inferences again. It makes me think of potentially being among a group of people who feel urged to do impulsive things they secretly want to do. All because of hearsay and abstract facts about unpredictable things people might do.

The point is that reminding myself of these things gets in the way of following through with my exposure. Instead, it makes me want reassurance again and again, even though I don’t need it. 

Pay attention to ritual prevention

Honestly, I have come up with so many generalisations and hypothetical truths about my obsession that there’s little wonder I think my OCD is something else. Still, right now, I’m going to get my head around accepting that my OCD is the same as everyone else’s and that I do not need to check further. After that, I must (positive must) pay attention to response prevention while doing my exposure. It’s time for me to break the connection with thinking that rituals eliminate fear when it’s quite the opposite. That’s whether it’s seeking reassurance, ruminating or avoiding sharp objects like knives. 

Possible but improbable

In that case, I will keep hold of the knife (with my partner present) until my exposure time ends. That means bearing with my anxiety until it reduces by half of what it was before starting the exposure and managing uncertainty. By the latter, it means learning to say in therapy that there is a higher likelihood that you will not do what you fear. So that means living with the low probability that you might. The longer you manage that little bit of uncertainty, you find the obsession fading.

Removing Inferences

And removing inferences, you learn to replace them with sense information in the here and now. For example, ‘I had no doubt that I would stab my partner before this obsession. Therefore, my problem is an imaginary fear, not a legitimate concern, and I do not need to check further.’ Telling yourself, you don’t need to check further helps with what-ifs. More specifically, it gets you out of your imagination and grounded in the present.

Following Through

So back to my exposure with the knife. I followed through and completed it. My anxiety was 80/100 on a nought-to-one-hundred distress scale when I started it, and I kept going until it dropped to 40/100. I’ve done mild to moderate exposures before. But this was the highest one on my hierarchy of fears, so I’m proud I followed through, and my partner is too. I was scared, but I did it anyway. And now I know I can do it again. The goal is that the more I practise paying attention to ritual prevention and following through, my fear will get less and less, and I won’t feel urged to hide knives anymore. More importantly, I know I did not have doubts before the obsession. So it helps me see that my authentic self would never do what inferences suggest since these are associated with my OCD and the harm obsession.

Inferences: “Clinician’s Handbook for Obsessive-Compulsive Disorder” by Frederick Aardema and Kieron O’Connor

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