SDN Members don't see this ad. (About Ads) A few weeks ago I posted about a patient with a pulse checking compulsion. I need to come up with some exposures to get him used to constatly feeling his heart beat, no matter what the rate or how "hard" or "soft" it is. He does not have resting tachycardia and his electrophysiologist cannot detect any abnormalities whatsoever. So this is now a psych issue officially. See the thing with OCD is that when he first focused on his HR, it was fine as long as it wasn't over a 100. Then he would check hiss pulse and would see its under 100 and then ignore it for some time. Then one day he started checking more often, getting nervous if it was over 80. Then even more often, getting nervous if it was over 70. Now even regular heart rate in the 60s is a "noxious/annoying/dangerous" feeling. At this point even ritualistic checking behavior offers no relief and he has palpitations (feels/notices his heart beat even without checking his pulse most of the day at a normal rate, rhythm, and blood pressure). ^ as a side note this is a fascinating (albeit devastating disorder). This is an individual of above-average intelligence, who realizes his fears of sudden cardiac death, tachyarrythmia, etc. are completely irrational yet now even his regular, normal, and (comparably) slow heart rate is noxious. Just another example of how giving into rituals to ease anxiety really just makes the problems all the more worse in the long-run. Anyone have any exposure ideas? The goal is to get this kid focused on things other than his heart, so that it gradually fades into the background like everyone else. I'm sure at this point there are medication option but I think the less invasive desensitation protocols (if any of you have any ideas) could be even more effective.