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Unread July 14th, 2005, 07:27 AM
joel p joel p is offline
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Join Date: Sep 2004
Posts: 8
Default Re: EX/RP for impulse control

Thanks for the insightful response. I think that part of my confusion here is based on the multiple diagnostic elements. I will briefly supply some more background info. (amply distorted for the sake of confidentiality), hopefully this will advance the dialog.

J. comes from a very strict household, his extremely dominant father has instilled in him an overdeveloped sense of responsibility and fear of authority. J. suffers from many ‘classic’ OCD symptoms – DSM verified - (counting, checking, washing) many of which he has succeeded in controlling in various degrees over the years. He describes what sounds like a hoarding problem (which, ironically, spares him the temptation to search for pornography on the net, since he fears he will not be able to delete these files!) When in therapy, if he has a thought which he has planned to share, he feels compelled to share it otherwise he will be troubled by obsessive thoughts the following week). In addition, we have completed some sessions focusing on his thought-action-fusion tendencies (i.e. if I think of my friend’s wife miscarrying this hastens the probability). ERP was quite successful.

Regarding the specific problem, I tend to agree that the primary component isn’t OCD related (especially since engaging in the act is initially pleasurable for him) but rather impulse-control related, exacerbated by religious – and overall - rigidity. On the other hand, J.’s tendencies to employ OCD mechanisms are quite existent here as well (the attempt to suppress the repetitive and undesirable thoughts to engage in the voyeuristic act). My impression is that J. doesn’t meet the voyeuristic criteria, since when he is able to distance himself from the stimuli (such as by attending an all-male college far from home), he is able to avoid such activities.

The sequence of thoughts/fantasies could be something like this: ‘I am on my way home, there is a TV there, I’m going to end up watching/masturbating, I know that I will not be able to stop myself, It’s wrong I shouldn’t do this, I wish my parents had allowed me to block access to some channels’. Once in front of the TV.: (repeatedly), ‘I shouldn’t be doing this, this is sinful….. as long as I am already sinning it doesn’t matter if I carry on…I hate myself, why don’t I have any self control…’
Part of my difficulty in laying out a therapy plan, is that – as opposed to compulsive gambling for instance – the possibility of having him avoid the stimulus is limited (unless he locks himself up at college… ). Some brief attempts at working on the rigid beliefs were unsuccessful.

My current thoughts are to seek out a religious authority acceptable to J who would sanction frequent masturbation, thus possibly reducing the sexual buildup to a more manageable level hopefully reducing the need to get to this vicious cycle. The obsessive tendencies may kick in doubting the validity of such an authority etc.

As a postscript, any thoughts as to why in the case of addictions, ERP wouldn't reduce anxiety buildup?

Last edited by joel p; July 21st, 2005 at 10:46 PM.
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