Obsessive Compulsive Disorder

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OCD is characterized by intrusive, unwanted thoughts (or obsessions) that create significant distress, uncertainty, anxiety, and a range of other difficult emotions. OCD used to be characterized as a subtype of anxiety disorder, and anxiety is the most common emotion we see connected with OCD, but very commonly OCD also triggers other emotions as well, such as disgust, distress, guilt, and shame.

Obsessions often target the things that matter most - including our relationships, identities, belief systems, and more. This helps us to understand why the stakes of the "what ifs" feel so high. The very things we care about feel threatened. As a result of this threat, people with OCD feel compelled to engage in safety seeking behaviors (compulsions) in an attempt to avoid or alleviate the discomfort.

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These mental or physical compulsions offer temporary relief, but they also reinforce the cycle of OCD. In other words, by acting on the thought, you  have taught your mind that this was a useful thing to bring up, and reinforces the mind to bring up the intrusive thoughts again. This cycle often costs people significant time, energy, and emotional wellbeing. People with OCD often report high levels of loneliness and depression, feeling like their lives are made smaller and more limited by the rules of OCD. 

You are not alone, and there is hope. But hope will not come from a place of following the rules of OCD. That takes facing the fears, getting good at having uncomfortable feelings, and learning how to hold yourself with kindness through them. My clients tell me that going through OCD treatment has helped them feel better prepared to deal with life and the hard challenges that come. I am here to walk beside you, cheer you on, give gentle (consensual) pushes when you decide you need it in order to face these hard challenges. 

OCD can show up in a number of ways, and in fact, most people will find that they have OCD about more than one thing, often even at the same time. Common content for OCD:

• Contamination
• Disease or Illness
• Morality/Spirituality
• Relationships 
• Discomfort when things aren't Just-So
• Harming self or others on impulse, or by accident
• Being responsible for something terrible happening
• Doing something inappropriate or hurtful
• Existential fears (death and dying, nature of the universe, unanswerable questions)
• Hyperawareness and discomfort with body "noise"

And many more. Rather than focus on the content, I find it more helpful as part of the treatment process to explore the fears underneath, and identify which of the three core fears of OCD is most relevant:

1. Fear of a specific outcome
2. Fear of uncertainty
3. Fear of being unable to handle emotional overwhelm 

Being able to identify the core fear and "zoom out of the content" is important in developing exposures for treatment. 

There are a few disorders that are under the OCD umbrella, but slightly different in content and in treatment. 

• Body Dysmorphic Disorder (BDD) - persistent and intrusive critical appraisal of one or more body parts
  • Accompanied by a strong urge to correct these perceived flaws, including up to plastic surgery, and continued discomfort despite these efforts 
• Hoarding - excessive difficulty with removing items from the home, sometimes accompanied by excessive purchasing of items
  • Hoarding often requires a lot of work on grief and relationships 
• Body Focused Repetitive Behaviors (inc trichotillomania and excoriation) - characterized by repeated behaviors that are damaging (short term and long term) to the body, and the person has made repeated but unsuccessful efforts to stop 
  • Treatment for BFRBs is an integrated approach, called Comprehensive Model for Behavioral Treatment (ComB)