Honestly, I have only seen research in treatment of violent obsessions or thoughts in persons with OCD before they offend. That is actually an area that needs massive research contributions. Having violent obsessions does not constitute a mental illness by itself, it is usually a symptoms of a larger diagnosis. Also, without knowing the person or the behaviors, it would be difficult to say that that are indeed obsessions (in the clinical sense) and not symptoms of poor emotional regulation. I have read pieces written by persons that are sexually attracted to children (that do not offend) having a hard time finding treatment options.
Once they offend, there is mixed research on the treatment of violent offenders. Researchers often combine all types of treatment into a category leading many to believe the “nothing works” doctrine. Recent research has become more methodologically advanced and most point to cognitive behavioral therapies as the most successful treatment program. A recent thread of research focuses primarily on “treatment ready” signaling.
So there is research in treatment of violent obsessions, most of it seems to revolve around OCD. There are violence avoidance techniques for these persons, but I am not sure how many of them have been rigorously tested.
Anyone else familiar with this literature? psydoctor8 tedbunny cognitivedefusion scienceofeds psychhealth
Hopefully I address this as you asked it, but let me know if I am missing something.
Typically with OCD, the individual is remarkably distressed by the feared event, and so the last thing they want to do is something that would lead to that outcome. There are some individuals with hallucinations or delusions that are violent in nature, and there is some sense of relief that comes from “giving in” to them. That’s usually not how OCD is conceptualized, though.
An example that makes people nervous: there are parents with OCD who are terrified that they will harm their children. For instance, many parents will not let their babies sit in the kitchen with them while cooking for fear that they (the parent) will cause harm upon the baby with a knife. There’s zero intention, and of course the thought causes a remarkable amount of fear, it’s just that thought-action fusion taking place where “what if” turns into “oh my god that will happen.”
Exposure for such individuals is, to the dismay of many, have the baby in the kitchen while the individual is chopping food or cooking. It’s a violent obsession, yes, but individuals with OCD are terrified of those obsessions, and so their safety behavior is to avoid it at all costs. The notion that someone with pure OCD will “give in” to their obsessions by engaging in an act that will lead to the feared outcome, even when it is a violent obsession, just doesn’t seem to fit OCD pathology.
Same thing for people who think they will harm themselves. Exposure would be giving them a knife and holding it to their skin. Or giving them a bottle of pills to hold. (Of course this is only done when there is no history of suicidality.)
Basically if someone has a violent obsession and actually engages in some act that makes that obsession come to fruition, my hunch is that it’s either not OCD, or there’s something comorbid with the OCD that is driving the violence.
As you pointed out, I think there needs to be more research to tease those components out, but pure OCD is typically a persistent attempt to reduce the anxiety stemming from a feared situation as to avoid the situation itself; doing something exactly the opposite by actually fulfilling the violent thought would be very different from that.
Does any of that make sense?