Treatment of Aggressive Obsessions in an Adult with Obsessive-Compulsive Disorder

The treatment of a 35-year-old woman (“Molly”) with aggressive obsessions is described. Molly was disturbed by persistent intrusive thoughts about harming her husband and her dog. She had become severely impaired, avoiding a variety of situations and spending approximately 6 h/day either attempting to suppress her thoughts about harm or trying to figure out whether she was the type of person who would commit violence. Molly responded favorably to cognitive behavior therapy centered largely around exposure and response prevention, described in detail in this chapter. The chapter also outlines additional interventions implemented to address various complications encountered during the course of treatment. Issues common in the treatment of aggressive obsessions as well as those more unique to this case are discussed.