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 very weird, scary, dark intrusive thoughts: 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 and it is much more than that. 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 is multifactorial and may include all or a blend of:

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.

I-CBT: Inference Based Cognitive Behavioral Therapy:
In this modality, we help you learn about the inferential confusion process- the core of OCD. This is the process that takes us out of reality, and into the “OCD Bubble.” We help you “shine the light’ on the tricks of OCD, so that we can learn to turn away from using OCD’s strategies and learn to tune into our true, reality based sense data to guide our behaviors. In this process we also identify your feared possible self (who you are afraid you might become if your intrusive thoughts are real). This helps us get to the root of your suffering, so that treatment may be lasting. This model is all about building self trust and moving away from trusting OCD. This model requires no exposure and may be a more effective approach for neurodivergent brains that do not habituate or cannot tolerate the extreme anxiety involved in exposure therapy.

Acceptance and Commitment Therapy (ACT):
ACT is an evidence based model that helps us develop new ways of relating to our thoughts so that we aren’t so fused with our intrusive thoughts. ACT helps us develop mindfulness strategies in order for our thoughts to begin floating by rather than getting hooked into them. It helps us become an observer of our mind so that we can get ‘unstuck’ and make room for us to focus on our true self values. When we can unhook from our thoughts, we can get back into our present life and live more in line with our values, which research has shown leads to greater life satisfaction and psychological relief.

Medication:
Though we do not prescribe medication at ED & OCD Therapy, we can walk you through your options for how medication may or may not help you in your healing from OCD. There are effective pharmacological interventions that can help turn down the volume on intrusive thoughts and decrease the co-occurring anxiety and depression that often comes with OCD. SSRI’s are the front line of treatment, and we can help you get connected to a psychiatrist that specializes in OCD. This is not a mandate for treatment, plenty of people do not utilize medication in OCD recovery. It is simply an option that is good to know about- and personally, has been life saving for me.

Through a combination of ERP and other therapies such as I-CBT, 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.