Understanding OCD: Skills to Control the Conscience and Outsmart Obsessive Compulsive Disorder

217 Pages·2015·1.61 MB·English

by  Leslie Shapiro

Understanding OCD

Understanding
OCD
Skills to Control the Conscience
and Outsmart Obsessive
Compulsive Disorder
Leslie J. Shapiro
Foreword by Michael A. Jenike
Copyright © 2015 by Leslie J. Shapiro
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,
or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or
otherwise, except for the inclusion of brief quotations in a review, without prior permission in writing
from the publisher.
Library of Congress Cataloging-in-Publication Data
Shapiro, Leslie.
Understanding OCD : skills to control the conscience and outsmart obsessive compulsive disorder /
Leslie J. Shapiro ; foreword by Michael A. Jenike.
pages cm
Includes bibliographical references and index.
ISBN 978-1-4408-3211-6 (hardback)—ISBN 978-1-4408-3212-3 (e-book) 1. Obsessive-compulsive
disorder—Treatment. 2. Obsessive-compulsive disorder. I. Title.
RC533.S53 2015
616.85ʹ227—dc23 2014041236
ISBN: 978-1-4408-3211-6
EISBN: 978-1-4408-3212-3
19  18  17  16  15 1  2  3  4  5
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To Jerry, Sam, and Maxine
This book is all the lessons my patients taught me to teach.
Contents
Foreword by Michael A. Jenike ix
Acknowledgments xi
Part I: Hard-wired at Birth
1 Your Brain Has a Mind of Its Own 3
2 Hypersurvival: Evolutionary Survival Instincts Gone
Awry—Too Much of a Necessary Thing? 11
3 All Walks of Life: Global Prevalence and the Universal
Culture of Rituals 21
4 We All Have “Bad” Thoughts 37
5 In Good Company: A Who’s Who of Obsessive Conscience 47
Part II: The Exploited Conscience
6 Scrupulosity: It’s Not Religious 59
7 Moralosity: Nonreligious and Moral Perfectionistic OCD 79
8 Obsessive Guilt 93
Part III: “You Want Me to Do What?”
9 Taking Control Where You Can and Must 107
10 Helpful Treatment Augmentations 145
Part IV: Other Guiding Considerations
11 It’s Impulsive, Not Compulsive 165
12 A Word about Countertransference 173
viii Contents
Appendix A: Glossary 177
Appendix B: Types of Guilt Found in Western Literature 181
Appendix C: Harder Personal Feelings Questionnaire 185
Appendix D: Rate Your OCD 187
Appendix E: Pennsylvania Inventory of Scrupulosity 189
Appendix F: The Loyola Religious Obsession and
Compulsion Checklist 191
Appendix G: Family Accommodation Scale for
Obsessive–Compulsive Disorder 193
Index 199
Foreword
Leslie Shapiro has worked with me for over two decades treating some of the
most disabled OCD patients in the world at the McLean Hospital OCD Insti-
tute outside Boston. We hired her because she was exceedingly well trained and
experienced in the treatment of OCD, and we knew we were going to tackle
some of the worst OCD cases extant in the first OCD residential facility in the
United States. Leslie has become one of the most skilled and effective cognitive
behavior therapists in the world. I was delighted when she told me she was
going to write a book to share her vast experience and creative thoughts.
This book represents her decades of experience administering effective
treatment for OCD. She has become our primary expert in the area of reli-
gious and moral OCD. She coined the term “moralosity” to describe a key
facet of successful treatment of OCD patients. Understanding OCD: Skills to
Control the Conscience and Outsmart Obsessive Compulsive Disorder addresses
her unique observations not addressed by other researchers and OCD authors.
Understanding OCD: Skills to Control the Conscience and Outsmart Obsessive
Compulsive Disorder also provides a viable framework to facilitate healing for
OCD patients, family members. Her advice and guidance will enormously
benefit those who are caring for OCD patients and students.
This exciting book outlines the biologic basis of OCD and discusses how
the illness hijacks the conscience. Most important, it discusses what caregivers,
family members, and patients can do to control the illness so that they can lead
more normal lives. Leslie’s case examples bring the illness and those who suffer
from it to life while clarifying what can be done to bring relief.
This remarkable book will be invaluable to those who are involved with
OCD in any way. There is innovative material here that is not available in any
other book on the subject. I highly recommend this book and am honored that
Leslie has asked me to contribute this foreword.
Michael A. Jenike
Professor of Psychiatry, Harvard Medical School
Founder, OCD Program, Mass General Hospital
Founder and Director, OCD Institute, McLean Hospital