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Real OCD + How it's Treated

Picture this: you are going about your usual day, making breakfast for your kids and getting ready for work. It’s another day at the office, nothing out of the usual. Then, bam, suddenly you are flooded with a very weird, scary, dark intrusive thought: what if I snap and harm my child? This thought terrifies you and triggers anxiety. You’ve never had this thought before and suddenly become consumed with why it is happening. Mentally, you are ruminating and trying to figure out why you had the thought, what it means and become afraid that you may indeed act on it. You might start avoiding knives, do anything to not become angry, and may even avoid spending time with your kids--in fear you may snap. This my friend, is Obsessive Compulsive Disorder (OCD). You are not a monster, you have a mental illness.

OCD is characterized by recurrent, unwanted intrusive thoughts, followed by compulsions. Compulsions can be physical, mental or avoidance based. This means the stereotypical ‘Hollywood’ picture of OCD is very misleading. We grow up thinking OCD is handwashing and a love for cleaning. While sometimes symptoms can manifest as hand washing and cleaning; the person never loves it. The person feels compelled to do it, in fear that something terrible will happen if they don’t. There is no love inside OCD. There is fear, anxiety and dread. OCD has different subtypes, meaning symptoms present in different ways for different people. Common subtypes include:

Harm OCD (HOCD)- fear of harming someone including kids, partner, friends, family members, fear of hit and run, fear of shoving someone in the train, fear of blurting out obscenities

Sexual obsessions- including fear of molesting children (POCD), incest, sex with animals, anything taboo you can think of.

Religious/moral obsessions- feeling compelled to follow religion/morals perfectly out of fear of going to hell if you do one thing wrong.

Just right/perfectionism obsessions- needing things to feel ‘just right’ or perfect, or something bad will happen.

Contamination obsessions -fear of getting sick or getting someone else sick, includes emotional contamination fears (i.e. if I talk about this illness I will get it).

Symmetry obsessions - intrusive thoughts about organization and symmetry

Real Event OCD- obsessions about past events and what people are thinking

Relationship OCD- “Am I with the right person?” “I’m not attracted to them.”

Existential OCD- “What is the meaning to life? Why am I here?”

Perinatal OCD- common during pregnancy, often manifests as obsessions about harming the baby

Sexual orientation obsessions- “What if I am actually gay/lesbian/hetero?”

As you read this list, you might be thinking: “wait so if I have had these thoughts, does that mean I have OCD?” Not quite. Everyone gets these thoughts- they are completely normal and mean nothing about you or your values. The difference is for people with OCD, these thoughts become ‘sticky’ and repetitive, and the person develops intense anxiety and fear of the thoughts. Because of that fear and anxiety, the person then develops compulsions in an attempt to make them go away or ease the anxiety. This becomes a vicious cycle and keeps the thoughts coming non-stop. The paradox is, the harder you try not to think about it, the more your brain will fire them! Thought stopping techniques do not work with OCD.

The treatment for OCD is Exposure and Response Prevention (ERP). When I do ERP with clients, I help them face their fears. We create a hierarchy of all the compulsions attached to the fears and gradually challenge the compulsions. We go slow, at your own pace, but the idea is to break the O-C cycle. When we stop doing compulsions; the obsessive thoughts eventually lose their grip. The overarching goal is to learn to embrace uncertainty. We do the compulsions in an attempt to get certainty, but there is no certainty in life, so we have to keep doing them over and over. Going through ERP teaches you to tolerate discomfort, uncertainty and fosters self-trust. In my clinical opinion, one of the roots of OCD is a lack of self trust. There are also biological factors; as people with OCD have different areas of the brain lit up during brain scans. Basically, you have an overactive fear center of your brain! Times of stress or hormonal changes often trigger this.

The good news is, treatment is totally effective and healing is possible. Through a combination of ERP and other therapies such as Acceptance and Commitment Therapy, and medication management, your life can be a million times better. Treatment changed my life. It can change yours too. I know it is scary, but you can do this and you are not alone! Book a consultation today and let's get started.

By Allyson Ford, MA, LPCC

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