It sounds to me like moral scrupulosity which is a type of OCD. The important thing to remember with OCD is that it doesn’t mean a person wants to act out their thoughts. Im guessing he came to you because he was overwhelmed with intrusive thoughts, not because he was dangerous. A person with OCD is usually so scared by their unwanted thoughts they can’t stop thinking about them. This relieves anxiety by constantly monitoring the feared behavior as a way of feeling in control. Exposure Response Prevention can be helpful for this type of OCD. I’ve seen doctors give assignments like hanging pin up girls or picking pictures of young children and rating them by cuteness. I’m sure it was incredibly difficult but there was absolutely no judgment either from staff or patients. My advice is not to avoid him or walk on eggshells. People with OCD often “catastrophize” or jump to the worst case scenario. Having a bit of a “so what” attitude can help treat this. For example if I say “I’m too afraid to drive. I could get in an accident”. A therapist might say “well yes, that could happen” and allow me to sit with that anxiety. Over time the person will learn to cope with the uncertainty. It’s okay to confront him with his fears. It’s important for him to see that even if he has intrusive thoughts, it doesn’t mean they’ll turn into actions. Every time they don’t, he’ll feel less of a need to fixate on these thoughts as he develops the mental processes to have confidence in his own reasoning and morality. Of course, always consult a therapist and take any changes at a slow and measured pace.
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