Obsessive-Compulsive Disorder

If you struggle with OCD, I promise you're not alone. In fact, you likely know someone who has the disorder, but folks often suffer in silence due to the misinformation and stigma associated with intrusive thoughts. Often, this disorder is misdiagnosed, and many go years without the appropriate treatment. Research tells us that the average time from symptom onset to diagnosis and/or treatment can be up to 17 years! That is way too many years of unnecessary suffering, especially when effective treatment is available. Too often, people are terrified to reveal their obsessive themes to others, which leaves them in a mental prison of shame and helplessness. Please know that your OCD thoughts do not represent who you are, and I will never judge you based on your intrusive thoughts, obsessions, or compulsions.

What are obsessions? 

Obsessions are unwanted thoughts, images, or urges that constantly pop up. These are highly distressing to someone with OCD and can involve shocking or disturbing content. They often feel like a lightning bolt of anxiety, distress, guilt, or disgust, and they feel very, very urgent. 

These intrusive thoughts send off major alarm bells in the brain and body that demand immediate attention. Unfortunately, people tend to believe that the thoughts mean something about their character, which is so far from the truth. The hundreds of clients I’ve treated for OCD have been some of the kindest, most compassionate, intelligent, and creative people I’ve ever met.

What are compulsions? 

A person suffering with OCD will do specific acts (behaviors or mental) to try and get rid of the emotional distress their thoughts bring. These acts become highly repetitive and the person feels they must be done, even if the act isn't connected to the thought or doesn't make logical sense. Folks believe that the compulsions are the only thing that will offer relief, even though they realize the relief is temporary, at best.

The result? An OCD cycle that can consume a person’s life. Although compulsions feel that they offer relief from the intrusive thoughts, the relief is fleeting, and only lasts until the next intrusive thought pops up. The compulsions actually fuel the cycle and make the intrusive thoughts stronger, louder, and more frequent.

Treatment for OCD:

Exposure and Response Prevention (ERP) is an evidence-based treatment that is considered the gold standard for treating OCD. ERP involves exposing someone to their feared thoughts/images/urges without doing anything to “fix” the anxiety or “solve the problem. This allows the person to learn that they can tolerate the uncertainty that everyone else seems to live with.  By doing exposure, the brain learns that thoughts are not dangerous, no matter how uncomfortable they might feel at the time. With ERP, the "alarm bells" that OCD sets off become less loud and the person is able to engage in their life without being consumed by OCD’s chatter and false urgency.

OCD “themes” or “subtypes”:

OCD often plays “whack-a-mole”, shapeshifting into different themes, depending on what’s going on in a person’s life. Some folks may struggle with just one or two main obsessional themes, whereas others have multiple obsessions. Below are some of the most common I see in my practice: 

Pedophilia OCD
People with this type of OCD fear that they may be sexually attracted to children. This type of OCD feels absolutely horrifying to the sufferer, due to the stigma they associate with these thoughts. However, the thoughts in no way represent the person's true desires, no matter how much OCD makes the sufferer question this. Often, people go without treatment for years due to the fear that they will be judged for these thoughts. Compulsions may include avoiding children, avoiding schools, reassurance seeking, and searching for evidence that the feared thoughts are not true.

Sexual orientation OCD
This theme involves the fear of being unsure about one's sexual orientation, the fear of being attracted to a particular gender, or the fear that they might be the "wrong" sexual orientation. This is not homophobia or discrimination against any sexual orientation. Rather, this is moreso the fear of possibly living a lie. Compulsions include avoidance of triggers, reassurance seeking,  or "checking" whether arousal / sexual attraction is present (which ironically creates what is called a “groinal response” which triggers folks even more!)

Contamination OCD
Contamination OCD involves the fear of contracting or transmitting germs or other contaminants (chemicals, bacteria, feces, urine, blood, saliva, etc.) Some folks experience emotional contamination, which is the fear of taking on certain character traits just by being in the presence of someone or something.
Compulsions include excessive cleaning, avoidance of germs/contaminants, mental rumination or excessive online research, and avoidance of people/places/things.

Relationship OCD
This theme involves constant questioning of one's feelings about a romantic relationship. Compulsions include "checking" for feelings of love, focusing on real or perceived flaws in one's partner, obsessing about whether one's partner is "the one," comparing to other relationships, or analyzing the relationship to obtain evidence of whether the relationship is “okay”.

Harm OCD
This type of OCD involves the fear of harming self or others, either physically or emotionally. Compulsions include avoidance of people, avoidance of places, and avoidance of items, such as knives. Some fear driving, because they have obsessions about hitting someone and not realizing it. This results in compulsive checking, reassurance seeking, mental review, and avoidance.

Symmetry or order OCD
This type of OCD can also present as "just right" obsessions and compulsions. Folks feel the need to have items ordered or aligned in particular ways, or they might have to touch items a certain number of times, count, re-do actions, or do rituals in a specific order/way.

Somatic OCD
Somatic OCD is concerned with bodily-related functions, such as blinking, breathing, heart rate, etc. People become overly focused on their bodily functions and fear that they will always be aware of the sensations or that they are not performing these functions correctly. Compulsions include checking, mental review, online research, and avoidance.

Scrupulosity OCD
People with this type of OCD fear that they have violated their religious, ethical, or moral beliefs. Compulsions include trying to figure out whether one has acted ethically, confessing wrongs to others, seeking reassurance, praying, and revisiting/analyzing memories. 

These are just some of the themes I treat; there are many more. No matter how your OCD presents, I have yet to hear one that I haven’t heard of before. I promise, your intrusive thoughts won’t shock, embarrass, or disgust me. Quite opposite: I consider OCD pretty predictable now, and I am so honored when clients trust me enough to share the thoughts they feel are abhorrent. The greatest thing you can do for yourself is to free yourself from the false prison of OCD by booking an appointment or consult call with a therapist who can guide you towards freedom. Please reach out by texting, calling, or emailing me to get started with OCD Therapy today!