The “OCD bully”

BMJ 2010; 341 doi: (Published 06 October 2010) Cite this as: BMJ 2010;341:c2596
  1. David Veale, consultant psychiatrist, NIHR Specialist Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King’s College London,
  2. Steve Caplin
  1. david.veale{at}

This installation is displayed in the entrance to the Anxiety Disorders Residential Unit at the Bethlem Royal Hospital. The unit provides a national service for the treatment of severe obsessive compulsive disorder (OCD).

People with OCD often consider their OCD to be like a bully or a demon that has to be obeyed. During cognitive behaviour therapy, they may be encouraged to “externalise” their bully and to act against it by doing the opposite to what the bully demands in terms of compulsions and avoidance behaviour. We decided to enhance the environment at our unit by making a humanoid version of an OCD bully. On the outside of the bully are various manifestations of OCD—such as chains, a clock that represents the wasted time of compulsions, a toilet seat that is full of “germs,” knives for fears of being violent, words such as “Paedophile” and numbers such as “666,” which are characteristic of the fears in OCD. The bully has several eyes to depict hypervigilance for threat. A door in its chest opens to reveal a heart of stone.

The humanoid also has a more important therapeutic role. It holds a transparent receptacle in which residents are encouraged to give up their various “safety objects” to the humanoid as a commitment to change. Safety objects are items that are instrumental to aid safety seeking or avoidance behaviours and therefore maintain a person’s obsessional doubts and fears. Initial donations have included a pair of handcuffs to prevent a fear of being violent to others; a bottle of bleach, alcohol wet wipes, and rubber gloves used to prevent contact with “contaminants”; a mobile telephone used for seeking repeated reassurance; a magnifying mirror and implements for skin-picking. The installation is interactive and will evolve over time as each resident makes a donation of a new safety object. Each donation has its own story and provides encouragement for a new resident to change by following the example of previous residents who have made the commitment to change. The receptacle is long, making it difficult to retrieve items once they have been deposited. It therefore depicts another aspect of OCD—hoarding. When the receptacle is full, another will replace it so that the unit will eventually be full of clutter.


Cite this as: BMJ 2010;341:c2596

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