Unacceptable Taboo Thoughts & Mental Rituals
The “taboo,” or “unacceptable thoughts,” symptom dimension characterizes individuals with unwanted obsessions that are often of a religious, violent, or sexual nature. This group has often been referred to as “pure obsessional” due to their lack of overt rituals . However, it is now apparent that these individuals tend to engage in covert rituals, such as mental compulsions and reassurance-seeking. This symptom dimension captures individuals who experience intrusive thoughts that severely violate their morals or values. Examples include thoughts of sexually molesting children, blasphemous thoughts about religious figures, and impulses to do violent things, such as to push pedestrians into oncoming traffic. Individuals who have these thoughts typically have no history of violence, nor do they act on their urges or impulses; however, because OCD patients often believe their thoughts are dangerous and overly important, they devote a large amount of their mental effort in attempts to suppress them.
Other attempts to control intrusive thoughts include mental ritualization (e.g., arguing with oneself over the morality of one’s character), neutralizing (e.g., mentally “cancelling out” bad thoughts by replacing them with good thoughts, engaging in excessive prayer or confession), and performing some form of checking (e.g., reviewing one’s behaviors, seeking reassurance from others, etc.) Behavioral avoidance of known triggers is also especially common in this group. For example, sufferers may make excuses to avoid childcare responsibilities or religious ceremonies that might trigger unwanted thoughts. Individuals with unacceptable thoughts may suffer with more severe obsessions than those with other forms of OCD.