Images get stuck

[April F]

My son who is 13 struggles with seeing images then getting them stuck in his mind. So like he will have a book that has skulls in it and he will but a paper over it to hide it or rip it out. Well now that he is in puberty if he sees an image in a book, magazine, mail, etc. He has to rip it up inorder to move on. He feels that ripping it is the only way to get unstuck. What is this called? What kind of exposures can we do to help him? We don’t have a therapist yet but are looking for one.

[Natasha]

Hi April,
Yes, intrusive thoughts can also be intrusive images. I wouldn’t get stuck on naming a particular theme as not all intrusive thoughts/feelings fall neatly into a category. With OCD a person will have an intrusive thought/feeling or image get stuck and then they have the need to avoid/or do something to get brief relief. But the more they do (or avoid) the more that thought or image sticks around.

Here is a YouTube video for him to watch if he is open to it: https://youtu.be/nyWd_6D5DVc and another one on the same topic here: https://youtu.be/wKLIi3WRT7k

[April F]

I watched the videos and they were very helpful. Just curious if an exposure would be look at the image and wait say 1 minute before he rips it up and throws it away and keep making it a longer time. Or should the exposure be not to rip it and throw it away and how would you teach him to quiet the urge to rip it up? Does that make since?

[Natasha]

Hi April,
Typically we want to target OCD in two ways: offense and defense (I have a video he can watch about that here: https://youtu.be/HR-Cs23UNl8

Defense: (This is when OCD comes knocking)
When he sees an image that his OCD says he needs to tear up he tries to delay it longer and longer until he is able to resist doing it.

Offense: (this is when he knocks the door to OCD)
Exposures are purposely provoking OCD and sitting with the discomfort without doing the compulsion – ever. So he would do an exposure where he would see an image and wouldn’t ever rip it up. I would recommend that you remove the image afterwards so he doesn’t ever have access to it again and get rid of it in such away that you can’t even get access to it. Perhaps a digital image might be a good way to start since he can’t tear it up? Just a thought.

Part of the process is teaching him why learning how to sit with discomfort is such a valuable thing. There is no easy way to sit in the discomfort but over time it usually tends to get easier.

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