Habituation & Neurodivergent Nervous Systems:
Now that we’ve covered some important groundwork, let’s dive into why ERP’s goal of habituation may not be effective (and actually harmful) for neurodivergent nervous systems.
The ERP model recognizes difficulty habituating to feared stimuli as a significant challenge faced by individuals with OCD. What it misses is that different nervous systems are differently sensitive or activated by the same external stimuli. It views compulsions or external attempts to regulate as “irrational,” even though it’s important to understand that internal regulation may not function in the same way for neurodivergent nervous systems, making the whole model flawed for the vast majority of OCD sufferers.
For many with OCD, relying on external regulation measures makes perfect sense. It’s a valid coping mechanism when internal regulation doesn’t offer the same relief.
Additionally, the ERP model does not hold space for the fact that habituation can override important signals. Sometimes initial responses / sustained heightened responses offer important warning signs. While this may be touted as “irrational” or “overdrive,” the world for marginalized folks is filled with high threat and not acknowledging this is harmful.
We know systemic issues are a contributing factor to OCD obsessions and compulsions. Habituation as the blanket goal can miss honoring the ways in which neurodivergent bodies are rightfully responding to systemic issues. Pushing clients to do exposure therapy and discouraging talk therapy or exploring content of themes is problematic. Exploring content of themes can provide more information, which is especially helpful for autistic individuals to process, and is also important for connection, relational healing, and advocacy.
The ERP model also misses that habituation is different, harder, or even impossible for neurodivergent (especially autistic) nervous systems. Due to this truth, habituation cannot be the goal of OCD treatment for every individual. The inhibitory learning model offers an alternative, but still requires exposure and has its limitations.
As understanding around neurodiversity grows, there is more conversation around what approaches and experiences have been touted as ideal while pathologizing neurodivergent people’s different brains and nervous systems. Pathologizing refers to the process of viewing something different as problematic or abnormal, and in need of fixing. When we are told the way we are coping (compulsions) is pathological, it adds immense shame to a disorder that already comes with a hefty side of shame. What if we could see compulsions as attempts to cope with overstimulation instead? Compulsions, under ERP, are then treated with exposures, which end up activating some nervous systems even more. More shame and more activation? It’s no wonder people often drop out of ERP “prematurely.”
We often pathologize the ways our bodies are trying to protect us and keep us safe and are alerting us to signals in the environment that something isn’t right. You may have heard the idea that activation or hypervigilance from trauma is actually the body doing its job responding to overwhelming experiences. Through this lens, we understand that activation and compulsions and feeling highly alert is in many ways, albeit not a fun experience, a protective alerting that everything is not okay. When we add in layers of understanding around intergenerational trauma, we can see that OCD is, in some ways, a right response to things that feel deeply uncertain and scary, that deserve certainty.