I'm so OCD

Ten years ago when I would tell people I was a therapist, it I usually was met with some discomfort. People don't really know what to talk about next when you bring up the idea of therapy and begin to think that you are starting to psychoanalyze then. I mean, I was, but I've since learned how to turn that off. But as mental health treatment becomes even more common place, people have a lot to say about it. They are quick to talk about their experience in therapy and how it's helped them, which is something that I feel very blessed to get to hear.

But there is something that I also hear nowadays that is very frustrating to me. People usually want to know what my speciality in therapy is, and when I tell them that it's OCD, almost everybody has something to say about it. And there is one phrase that still feels quite triggering to me.

"I'm so OCD."

Agh! Even just the grammar of it is annoying. It would be like saying "I'm so flu" rather than saying I have the flu. You can't be OCD, you can only have OCD symptoms.

But beyond that, people are usually referring to their affinity to being neat and organized. That they love to load the dishwasher a certain way, or can't walk out of the house until all of their throw pillows are arranged in a perfect Joanna Gaines like manner. People get a little bit of a twinkle in their eyes when they tell me about these things and I can tell how they usually like those attributes about themselves. Which, I don't blame them for. Who doesn't want to be put together, efficient, organized, stylish, and clean? I've certainly got little quirks about myself that I enjoy.

But the OCD experience is far from the cute little ways that we prefer for life to be that we pat ourselves on the back for. And if you think I need to take a chill pill in regards to this one, let me phrase it this way.

The WHO ranked having an OCD diagnosis as one of the top ten most debilitating illnesses of any kind. This is not just mental health diagnoses, this is on the list with cancer and musculoskeletal disorders.

This would be a bit like telling people that I work in oncology and them saying they relate because they had a bad stomach ache last week after eating too much spicy food.

I don't think that it is hyperbolic to say that obsessive compulsive disorder is one of the most misunderstood mental disorders that we have. And this is not just the case within the general public. It is also widely misunderstood and mistreated in the mental health community. We see a number of clients who have been to three or four therapists and never been correctly treated for their obsessive thoughts. I even have firsthand experience with this after coming out of grad school and believing I was equipped to treat OCD (I wasn't). It wasn't until I received specialized training on what an effective treatment plan looked like that I should have actually been helping people with their compulsive behaviors. But you don't know what you don't know, and most people assume that getting their master's in clinical mental health would qualify them to properly identify and treat the symptoms of OCD. But it is unfortunately not the case.

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How OCD Looks

Trying to describe what OCD looks like would sort of be like trying to describe a dog to somebody who had never seen one. Sure, there are a lot of factors that dogs have in common, such as walking on four legs, having fur, and having a tail. But dogs massively range in terms of how they look. There are dogs that weigh ten pounds and dogs that weigh 150 pounds.

Whatever form of OCD one has it is going to include a few key components. The first is the presence of obsessions.

Obsessions are unwanted thoughts that continue to cycle through your mind, even though you do not want for them to be there. You might try and ignore them but find that the avoidance of the thoughts or quick reassurance seeking does little to nothing to deter or alter the presence of that thought.

When most people think of obsessions, they think of some of the more classic examples such as if you locked the door, properly washed your hand, or perhaps even if something is ordered or balanced. And it's true, that these certainly are common obsessions, but unwanted intrusive thoughts show up in so many more ways.

OCD can show up in the form of violent thoughts, such as "what if I suddenly stabbed one of my family members?" or "What if I swerved my car into the carb and hit that pedestrian?" In fact, there is entire theme of OCD dedicated to hit and runs, which is aptly labeled as Hit and Run OCD. You may think that's too specific but I have worked with a least a dozen people who have this exact form of OCD. They do not trust that they did not run somebody over and will go back and check the same spot multiple times to make sure they didn't hit anybody. A number of those clients would call emergency phone numbers to see if any pedestrians were hit on their normal commute to work just in case that speed bump was actually a person.

Even more disturbing to a lot of people are the intrusive sexual obsessions that show up in one's mind. OCD might conjure up an incestual image of a close family member or intrusive sexual thoughts about cheating on your partner, even though it's the last thing you would ever do.  OCD sufferers who identify with this type might also obsess over their sexual orientation and not be able to trust themselves with who they are actually attracted to, even though there are no real indicators that they have a different sexual orientation which they have historically identified as.

To add to the misunderstanding, another form that shows up in this subset is POCD (pedophilia OCD). I have seen experience of OCD to be one of the most disturbing to those who have it. There was an unfortunate incident a few years ago where a respected OCD therapist posted a video trying to explain some of the nuances of this subset to the public. One of the things that he went over is that people experiencing this symptom of OCD have no proclivity towards pedophilia and are most likely the least likely people to sexually offend a child.

Unfortunately, a well known social media figure saw this clip and tore it to shreds, saying how ridiculous it is and that this therapist is just helping to mobilize child predators. It was devastating to see and very damaging to the OCD community. But hey, anything for clicks, right?

I bring this story up to help illustrate how massively misunderstood OCD can be and the fear that can come along with disclosing some of those painful thoughts. It's a bit easier to admit that you are afraid of contracting a disease. Hey, after 2020 most people can kind of understand that one. But OCD shows up in so many disturbing ways that it can feel more difficult to talk about the more taboo obsessions.

Compulsions

The second piece that is present in OCD is compulsions. Compulsions are behaviors or rituals that one goes through in order to minimize the anxiety or discomfort that is brought on in regards to the obsessions. They are there as a response to the obsession. There is some debate in the therapy world about if compulsions need to be present in all forms of OCD. Some psychologists promote the idea of "Pure O" meaning a type of OCD that only centers around the obsessive thoughts, where there are no compulsions present. There are others that say there are compulsions present in these OCD themes, though they just may not be visible. As a mental health professional, I tend to align with those that say compulsions are always present, they might just be mental compulsions that are not necessarily observable behaviors.

Let's go back to our example of Hit and Run OCD. In these situations, the obsession would be around the possibility or thoughts "maybe I hit someone." The compulsive behaviors would be turning back around to go check the spot that was previously driven by. It could also be calling law enforcement to see if any accidents were reported. But even if neither of these are present, compulsive behavior can still exist in terms of mental review. The person might continue to drive and try and "replay" their drive in their head. They try and think about if they heard anything and dissect all of the details they can remember.

Compulsive behaviors can also look like avoidance tendencies. When the intense fears associated with POCD come on, the person's OCD will tell them how they need to take extra precaution to make sure that they do not offend a minor. They might make sure to always walk with their hands in their pockets whenever they are in public places.

Some more classic repetitive behaviors that people can think of would be washing hands and checking locks. We have to remember that the reason these compulsions show up are to satisfy the sudden thoughts of "what if that last doorknob had blood on it?" or "what if I didn't lock the door before I got in bed tonight?"

Normalizing

If you are reading this and thinking, I have had some of these thoughts before, you are not alone! And in fact, it probably is a pretty normal human experience to have and unpleasant thought from time to time. I don't know anybody who hasn't at some point had their mind occupied by a scary thought at one point in their life.

But in order to see if you are suffering from an anxiety disorder such as OCD, I think the questions to ask yourself are about how much this is affecting your life.

I would first look to avoidance and ask the question, "is there anything in my life that I value that I want to be doing but am not doing because of thoughts or obsessions that I have?" OCD is generally pretty good at getting us to disengage from our life. It takes over all of our values because OCD really only has one value, which is certainty. And if we look at the different types of obsessions they all take place in the realm of uncertainty. Who is to say that you won't be the next person to contract a terminal illness or experience a psychotic episode? And if that's uncomfortable for you to read, that is okay, because in our journey towards healing from obsessive thoughts our goal is to become comfortable with the uncertainty associated with this life.

The next question I might ask myself is "How much does this bother me?" I have met people that have certain rituals or obsessions that take place for them but do not really cause any sort of distress. The obsessions do not cause them to have panic attacks and others might notice that they take a tremendous amount of time on something, but it is not problematic to the person experiencing the obsessions. However, just because it is not bothering you does not mean that it having zero effect on your life. You might look to how your close relationships or other important areas of your life, such as job performance are being affected.

Treatment

Until something new comes along, the highest standard of treatment for OCD is exposure and response prevention (ERP). ERP is a form of cognitive behavioral therapy that is geared at helping people live with the discomfort of their triggers. In essence, the provider will come up with a treatment plan centered around exposing the patient to the feared stimuli. However, the exposure portion on it's own is not sufficient enough to dramatically alter the distress of OCD. Patients also need to engage in response prevention so that the body can learn to tolerate the distress that comes with not engaging in the compulsive behavior.

The international OCD foundation cites that the best treatment is a combination of ERP and psychopharmacological intervention. As always, you should speak with your health care provider about all medications and go with their recommendations, but research seems to indicate that selective serotonin reuptake inhibitors are the most effective.

Resources

If you are local to Phoenix and wanting additional support for your OCD treatment, look no further than our OCD Group! A weekly ERP group that is made to create community, and work on your OCD. If you are needing more than weekly support, our OCD IOP may be the right fit for you.

In our online membership we feature more psychoeducation like this, but in much more detail, all you have to do is start! We are here to support you, each step of the way.