The featured guest is Christian Hernandez in discussion about Obsessive Compulsive Disorder, specifically Scrupulosity. The follow is a transcription of a live recording which was conducted on 1/31/17. View the DSM-5 criteria within the menu as well as original art work by the interviewee on the right column below.

Give an example of ERP.
ERP practically is a psychiatrist’s way of getting in there, catching what is giving you the OCD or what is causing you to loop, and exposing you to that fear.

And not letting you to do your compulsions to fix it.
Correct. I will say this, a lot of people that go through the treatment, and this includes going to a therapist and doing the ERP and getting your medication, are left with nothing if they fully recover. So when you have OCD and that gets eliminated, you’re left with a bunch of free time and a lot of these people don’t know what to do with it because its kinda, its very much like the little mermaid a whole new world. Or is that Aladdin?

Wait that is Aladdin. I love that song.
It really does become a whole new world. That territory is uncharted for so long, that when you finally free yourself from it, when you have time to live your life, its easy to relapse.

Oh. Yeah. You have that freedom.
Yeah. You do.

What do you do with it?
I might as well go back to OCD. *laughing*

Describe your childhood and family growing up.
My childhood was very, honestly, sincerely, a lovely childhood. I have a very supportive father. My mother was an amazing person. She’s not here with us anymore. But I did have to grow up through a Catholic upbringing and although it was traditional, it did have an effect on me later with OCD. We moved here when I was 5 from Mexico. My mother was seeking medical treatment for cancer. We finally got here and my mother passed away and that also affected my OCD.

Did it make it worse? Sorry, how old were you?
I was actually 9 years old when my mother passed away. I don’t want to bring anybody down but it did affect the person that I am today.

Do you have any standout memories, good or bad? Something that off the top of your head stands out.
Memories from my childhood are very sparse because we were so occupied with my mother’s illness but now artistically, in my artistic life, I always refer back to those moments. They’re not very prominent memories but I’ll have glimpses into the past that I feel very nostalgic for.

DSM-5 Criteria of Obsessive Compulsive Disorder

The DSM-5 (Diagnostic and statistical manual of mental disorders) is the standard classification of mental disorders used by mental health professionals in the U.S. Below are the DSM-5 attributes for obsessive compulsive disorder.

  • Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress
  • The individual attempts to ignore or suppress such thoughts, urges, and images, or to neutralize them with some other thought or action
    • Examples: contamination, unwanted sexual thoughts, losing control, harm, perfectionism, religious (scrupulosity)
  • Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
  • Behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded situation or event; however they are not connected in a realistic way with that they are designed to neutralize or prevent, or are clearly excessive
    • Examples: washing and cleaning, checking, repeating, mental compulsions
  • Obsessions or Compulsions are time-consuming (e.g. more than 1 hour per day) or cause distress or impairment
  • Biological
    • Generalized vulnerability
    • Low serotonin activity
  • Psychological
    • Behavioral
      • Operant Conditioning with reinforcement
    • Cognitive
      • Lack of yedasentience – the subjective feeling when something is enough
  • Biological
    • SSRIs – Selective Serotonin Reuptake Inhibitors
  • Psychological
    • Exposure with response prevention (ERP)
    • Cognitive restructuring – changing the way a person thinks

Do you have certain smells, certain songs?
Certain smells, certain songs. When I meditate I really see that. I see the visual aspect of it and feel very serene and want to be there. Memories are really what you make of them. I really choose to isolate the negative stuff from the positive stuff. And even the negative things can be humorous memories for later. So don’t get rid of them.

So when you were growing up did you feel different?
Absolutely. I think for me, being a gay man, it was very obvious. I knew I was gay before puberty. And that itself was a big milestone to deal with.

But I really started questioning my religious upbringing as well. And it wasn’t really something that I wanted to partake in, any of it’s influence. To be having these kinds of thoughts, at a young age, it really creates a ball of confusion. You really don’t know to associate with it, what to do with it, so you just let it sit on the back burner. I will say this. With my sexuality, I have always been confident with it and I can honestly say that a lot of people did not make me fall back on it.

What do you mean by that?
I was bullied a lot, later in life when people start noticing that you’re different of whatever. Not necessarily the OCD because thats something that I knew about myself. I wasn’t fazed. It was something that I was like “ I know who I am, I’m in touch with it.” There was some sort of shame and guilt associated with being gay but I was always confident about who I was.

I really respect that. I’m glad that you had that self-confidence even though people were going out of their way to bully you.
Thank you. I think thats something that a lot of us, well back in the day, really dealt with. I’m sure there’s more awareness now with bullying and sexuality, especially sexuality in youth. But I knew that being gay fueled something in me, especially artistically, so i was not letting go.

That’s beautiful. So you mentioned that you were raised in a Catholic household. And then I mentioned scrupulosity earlier. How did Catholicism and your religious and moral obsessions play off of each other?
It was a cruel time because being raised Catholic you are brought up on the whole idea of guilt and repentance and that kind of thing. And scrupulosity is very much that. So the threshold between both of them are very blurred. So, again going back to the confusion, it was very hard for me to differentiate what was OCD and what was religion. I had such a fear for God, I had a fear of cursing at religious figures. I had a fear of insulting any kind of religious figure.

by Christian Hernandez

I have a question about that. So by religious figure you mean any religion?
Specifically the Christian religion. It would come down to “What if I sell myself to the devil?” So all these things start plaguing your head, but with Catholicism making that so obvious and prevalent within its religion. I was just kinda *insert stressed out sound*

It’s easy to see the blurriness of “Am I a really religious person or are these thoughts wrong?”
Or is this the religion at work. What is it?

Is this what everybody’s thinking?
Right. I really did think that. I did think that people would go out in their lives thinking that they had to recheck themselves, and do these rituals too.

Could you give me an example of an obsession for you within scrupulosity and also a compulsion that you would pair with it?

I think at one point it was all about not cursing at God. I would never curse at Him, never say anything bad. It was really odd. Its even odd to talk about it really.

I’m trying to wrap my head around it.
It was more like God will always be my friend and God will always do this and that. And constantly having to check that. Even though, at a very young age I was “losing my religion”. I was not about it. And part of it was, I had my family pretty much everyday doing rosaries and blah blah blah. So there was always something religious going on. My dad, even now, has a little alter with the virgin. I think the religious aspect of my lifestyle was always prevalent. And I think for me, keeping up with it, and not letting myself slip was part of it.

We talked about mental compulsions. What was a mental compulsion that you would have?

It would sound something like, in my head, or I would even say it: “I’m sorry God, I would never do it again, I would never do it again.” And this kept playing over and over and over… to relieve the anxiety and guilt associated with it. This could go on. Like I mentioned earlier, not everybody spends a specific hour doing a certain thing, which isn’t to say that some people won’t wash their hands and that kind of thing for hours, but when it comes to mental OCD, you’ll have people who will just go on about their day. I would be at Starbucks making a latte and I’d be like “I’m sorry I would never do this again”. It’s just in the back of your head, it’s there all the time.

I feel like if you were doing it the whole day it would add up.
Yeah it kind of consumes your life. In the sense that if you’re not doing it you’re living in crippling anxiety.

And we can’t have that.
And without any medication to treat it.

by Christian Hernandez

And thinking it was normal.
Thinking this was normal and having to put up a front that you were doing okay. It’s a lot for one person to handle. Putting up a poker face and talking to yourself inside and having a conversation with your head. It’s a lot to handle. And the anxiety of even letting it slip or being heard, people catching you wording stuff, it’s hard.

We’re going to change direction. You said you lost your religion when you were younger. Around what age was that? And you mentioned that your scrupulosity transitioned into harm OCD. Can you explain both of those.
Absolutely. To answer your first question, in my teenage years I was a complete emo kid and I was later a scene kid but they’re pretty much the same thing. I was extremely exposed and influenced by the emo movement. You had figures like Marilyn Manson, LGBT figures, figures talking about human issues. For example I brought up Marilyn Manson, his videos were very explicit in that sense. I think early on in my early teens I just started feel disconnected to my religious upbringing, it was not something that I was about . Later in my teenage years i finally, with the servicing of Tumblr in 2007 or 2009, was getting to know more people. Especially within my interest and age groups and artistic interests. I started to meet people who were thought I was cool.

Okay quick question. While that was happening were you still having the religious thoughts?
I sure was. Because as I was becoming more detached, my OCD was like “Hey bro, what’s going on?” It kind of got worse.

by Christian Hernandez

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) Arlington, VA: American Psychiatric Publishing.