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OCD Does Not Lead to Terrorism

You can have dark thoughts and not be a murderer.

In the wake of the recent mass shootings, mental illness has become a scapegoat for violent terrorists with access to guns. In the words of Donald Trump, “Mental illness and hatred pull the trigger, not the gun.” This unfounded statement flagrantly masks the real and complex problem that perpetuates misinformation and stigma surrounding mental health.

Pixabay License, Free for commercial use
Source: Pixabay License, Free for commercial use

Research on mental health and mass shootings suggests that less than 1% of gun-related homicides each year are carried out by people with serious mental illness. Furthermore, only about 3% of people with serious mental illness contribute to violent crimes. An even smaller percentage than this accounts for violence that involves firearms.

The factors that influence a person to carry out such violent acts are complex (hatred is not a mental illness) and there doesn’t appear to be a strong connection between mental illness and violent crime.

The implications made by people who blame mental illness are troubling for those suffering from mental health conditions. In a recent article, the ex-girlfriend of Dayton shooter Connor Betts claimed that Betts was open about his mental illnesses: bipolar disorder and possibly Obsessive-Compulsive Disorder (OCD). She wrote, “When he started joking about his dark thoughts, I understood. Dark thoughts for someone with a mental illness are just a symptom we have to learn how to manage. Joking about wanting to hurt people was just heard as ‘I have uncomfortable thoughts that are inappropriate to express, but I need to joke about them otherwise they’re too scary and real.’”

This article implies that “dark thoughts,” and mental illness, are the cause of mass violence. While my intention is not to diagnose Betts, it is to clear up misconceptions that have arisen from this article that are extremely harmful to those living with mental illness and OCD.

“Dark thoughts” and “OCD” existing in an article about a mass murderer sent sufferers of OCD into a spiral because OCD can involve unwanted thoughts of a “dark” nature that go against that person’s core beliefs, values, and desires. However, you can have “dark thoughts” are not be a murderer. Having thoughts of wanting to harm people is very different from the intrusive and unwanted thoughts those with OCD experience.

“Dark thoughts” of OCD are egodystonic: distressing and inconsistent with one’s values and self-concept. Those with OCD do not value the content of their obsessions or want them popping into their mind, although they have no control over intrusive thoughts.

“Dark thoughts” that are in alignment with one’s values and acceptable to the self are egosyntonic. Wanting to hurt people is egosyntonic. It lines up with the person’s desires.

As a mental health clinician and someone living with OCD, I can tell you that “dark thoughts” of OCD do not signify a person who is going to turn into a monster and commit mass violence or harm others. Quite the opposite, those with OCD are overly moral people who are no more likely to act violently than someone without the disorder.

Let’s start by looking at what OCD is. OCD involves Obsessions (fears) and Compulsions (physical or mental attempts to get rid of the anxiety) that only increase the distress associated with the Disorder.

Diagnostic Criteria for Obsessive-Compulsive Disorder states that obsessions are recurrent and persistent intrusive thoughts, urges, or impulses that are unwanted and that cause extreme distress and anxiety for the person experiencing them. If you like your thoughts or your behavior or want to do something, it is not OCD. Compulsions are physical or mental acts that a person carries out to reduce anxiety and distress or prevent some dreaded event or situation from happening.

Contrary to popular belief, OCD is not just about hand-washing and organization. Obsessions of OCD include a wide array of content: fears of harming others, fears about being a pedophile, sexually intrusive thoughts, fears about living a life of sin or praying in the wrong way, and much more.

A mother with OCD could have sexually intrusive thoughts about her newborn daughter. The thoughts (obsessions) terrify her and so she avoids any contact with her baby (avoidance is the compulsion). She no longer changes her diaper, stops breastfeeding and makes her husband feed her. The obsession is highly distressing and against her values, so the poor mother avoids creating an attachment with her newborn to ensure that her thoughts never become a reality. In the same way that someone with OCD washes their hands to prevent illness, someone with OCD could also stop holding their baby to prevent harming her. This is what OCD can look like.

So yes, people with mental illness do experience dark thoughts. People without a diagnosable mental illness experience them, too. You know, those weird intrusive thoughts like “What if I had sex with a dog?” or “What if I just drove my car into the median?” What’s imperative in this is understanding the context of such “dark thoughts,” which will help determine what is OCD—or mental illness—and what is not.

Intrusive thoughts are the nature of being human. OCD or not, we all experience them at one time or another. The difference is that those with OCD have a brain that is wired differently. Their intrusive thoughts stick and they become obsessions because they are so opposite to what the person actually values.

There is something called “harm OCD,” which is a nickname for a theme of OCD to describe people who have fears about harming others or themselves. Someone with this OCD theme would probably not come close to stepping foot in a gun range. A gun is probably the last thing they would want to touch. They would not pull up a video of a mass shooting and show it to their date with fascination. They would not write threatening letters to place on their ex-girlfriend’s car.

What someone with “harm OCD” would do is compulsively avoid anything and everything that has to do with the content of their thoughts in an attempt to make sure that a dreaded event does not become reality. They might lock away the knives at night for fear that they would unknowingly get them in their sleep, avoid spending time with their partner, etc. It’s highly irrational, but the person with OCD will do anything to prevent a dreaded outcome.

The treatment for OCD is Exposure & Response Prevention (ERP), which involves exposing the client to their fears without them responding compulsively. Clients learn to tolerate uncomfortable thoughts, feelings, and urges and begin to understand that thoughts, feelings, and urges are not facts. Just because we have thoughts does not make them true. Just because we have anxiety does not mean we are in danger. Just because we experience impulses or urges does not mean that we will act on them. OCD therapists commonly have their clients with the harm theme hold a knife to their neck, as part of the Exposure & Response Prevention (ERP) treatment, and they are not afraid that their client is going to act. That’s how much they trust their clients and understand what OCD is.

Now that we understand what OCD is, we can truly understand how detrimental the ex-girlfriend’s OCD implication is.

In the context of what Betts was experiencing, the “dark thoughts” and red flags were something that should have been paid attention. These flags cannot be attributed to OCD. Calling your girlfriend and telling her that you want to hurt a lot of people does not line up with someone who has OCD. Wanting to threaten your ex-girlfriend is not OCD. These dark thoughts are egosyntonic. There is a desire in these thoughts. Thoughts of OCD are distressing and undesirable.

OCD is not hatred. OCD is not racism. OCD is not homicidal ideation with intent to act. OCD is not a fascination with murder and mass shootings. OCD is not the cause of a mass shooting. OCD is not terrorism. OCD is not harmful to anyone other than the person suffering.

I often hear clients or people living with OCD tell me that they would rather die than hurt anyone or experience what they are experiencing. Research has found that about 25% of people with OCD have attempted suicide. Another research study of Swedish patients found that the risk of death by suicide is roughly 10 times higher in the OCD population compared to those without OCD.

In a world in which OCD is highly misunderstood, and people avoid seeking treatment for fear that they will be established as harmful to others, it’s more important than ever to get it right. Those accessing treatment might see a therapist who does not specialize in the treatment of OCD and who might misdiagnose them (or wrongly hospitalize them because they do not understand what obsessions are: egodystonic).

It’s important for people who spend years and years of their lives suffering in silence because they are too afraid to talk about, and don’t know, what is going on in their mind. It’s important for people who are considering ending their lives because they would rather do that than live in terror of a mind that produces thoughts about the last thing they would ever want to think. It’s important for those with mental illness being scapegoated to mask the real issue. It’s important for the people who reach out to me via my Instagram profile desperate for help and for the people I see in my office as a therapist.

Donald Trump’s unfounded comments linking mental illness to mass violence are detrimental. They hurt. They don’t help. Gun control for people with mental illness won’t stop over 97% of these tragedies because there is not a strong link between mental illness and mass violence. As research suggests, biological, social, and psychological factors must be taken into account instead of scapegoating mental illness as the one and only cause. Such factors include substance abuse, a history of violence, fragile self-image, feelings of anger and resentment, racism, fantasies about violence and harming others, and much more.

Having a mental illness does not make someone a murderer. The factors at play are very complex. Mental illness is not terrorism.

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