What is OCD?

"Omg, I am so OCD!" no... no you're not.

OCD is a very misunderstood disorder. How it is represented in the media is often terrible and misinformed.

If you enjoy being organized or wanting your home clean, that doesn’t mean you are “OCD”. OCD is egodystonic, which means it goes against who you are as a person. It attacks your values and what you love, your identity, and this creates intense anxiety and panic. At its worst, it takes a person’s life away from them. Life can become very small and trapped. OCD can be extremely debilitating, and it is not enjoyable to experience.

OCD comes with Obsessions and Compulsions. There are several different main themes that I will go over, BUT if you are reading this and your theme is not mentioned, that does not matter. It is whatever thought (feeling, sensation, or urge) gives you anxiety and eventually turns obsessive.

However, more importantly, the content of your thought does not matter; it is how you are responding to it. And how someone with OCD responds to these unwanted thoughts is through compulsions.

Compulsions are done to find certainty and get rid of anxiety, discomfort, guilt, and disgust. However, the relief compulsions give do not last because that thought, feeling, sensation, or urge will pop up again. You can’t control your thoughts (fix them, get rid of them, give them certainty).

Let’s give an example:

In this example, I use a more taboo theme, which, for those experiencing it, can bring shame. Remember that OCD attacks someone’s values, and people tend to value their relationships, their children, their sanity, and not harming their fellow humans.

Ross is walking his dog one day as he usually does in the morning. He is thinking about life, whether he will need a sweater later today, and what he needs to do for work. His dog, Swanson, stops to sniff and pee. As he looks down at his dog, his brain goes, “What a cute dog! Swanson is the best.” “Wow, look at him peeing.” “I wonder what his pee tastes like?” “That is a weird thought.” “Yeah, what if you taste his pee and even touch him inappropriately!!!” TRIGGER “OMG WHAT KIND OF THOUGHT IS THAT I SHOULDN’T HAVE THOUGHT THAT!! WHAT IS WRONG WITH ME????” Ross races home with his dog, panicking. Gives his dog to his partner and does his best to avoid being around Swanson. He even stops taking him for walks or petting him. He takes Swanson’s photos off his phone, and Swanson can no longer sleep in the same room as him and his partner. His partner is at a loss for what to do with Ross’s change in behavior and keeps reassuring Ross that he is a good dog owner and person in general.

This is what OCD can look like. Ross had a taboo thought (obsession around hurting his dog) and now is doing compulsions (avoidance) to make sure it does not happen.

Ross loves his dog (value), so this taboo OCD theme is triggering. It goes against who he is as a person. When he has those thoughts and sees his dog, his fight-or-flight is activated. When he does compulsions that tells his brain that his thoughts are actual threats, but since no one can control the thoughts they have, Ross will most likely get stuck in an OCD cycle when those thoughts come back around.

Intrusive thought happens - triggers anxiety (goes against value) and their primal brain - does compulsion(s) which inadvertently tells their brain those thoughts are threats - feels better - then has the thought again and brain sends out anxiety because threat is there - urge to do compulsions - and we are in this cycle again

Here are some other themes: harm, sexual orientation, gender identity, just right, perfectionism, contamination (both physical and emotional), scrupulosity (religious/spirituality), existential, pedophilia, incest, bestiality, postpartum, health, mental health, sensory stimuli, and suicide. Just to name a few.

If you have OCD and don’t see your theme, REMEMBER the content does not matter. OCD tries to pull you in by saying, “THIS IS DIFFERENT! PAY ATTENTION TO THIS. YOU’RE BEING IRRESPONSIBLE IF YOU DON’T!”

Anything can turn into an obsession, and if your brain is like mine, it can imagine some quite strange situations.

What might one do to stop the OCD cycle? Let’s take a look. (This is not meant to be used as treatment. I am just describing what therapy could look like. It is for educational purposes only. Please seek therapy if you’re interested in treatment, and if it’s an emergency, call 911.)

One place for Ross to start in getting out of this OCD cycle is by realizing he cannot control his thoughts, his thoughts are morally neutral, and he cannot manifest his thoughts (magical thinking).

You might be reading this and believe in manifestation. Things like “I am going to manifest positivity and calm connections.” That’s fine. I am not here to tell you that’s wrong. Just saying from where I stand, since you cannot control your thoughts, then by thinking them, you are not manifesting them. Making something a reality is much more complex than simply having a thought or intention and it happening. Sorry, The Secret (a book that was published a while back and was popular for a second), not gonna subscribe. Yes, you can influence your life and future, but that is not the same as having a thought and making it a reality.

So Ross has come to terms with the fact that he cannot control his thoughts. Now he can use mindfulness with his thoughts. Mindfulness is a nonjudgmental awareness of your experiences. He is going to try to see his thoughts as just thoughts rather than judging them as good or bad. When he judges his thoughts as bad, “This thought shouldn’t be here, and I need to get rid of it,” then they stick around, paradoxically, fight-or-flight ensues due to his thought being a threat, and that leads to compulsions.

Seeing thoughts as just thoughts is detaching from them. Ross is an observer of his thoughts. He isn’t trying to get rid of them, check on them, avoid them, neutralize them, or do anything to them. Detaching and witnessing your thoughts (feelings, anxiety, urges, sensations) is the opposit to what your anxiety is telling you to do, and when starting treatment, it can feel very uncomfortable and irresponsible.

“Detaching” and being a “witness” might sound like an abstract and distant idea, but there are ways to practice this alternative way of being.

Before, let’s take a look at compulsions. There are four kinds. Compulsions are done to get rid of anxiety (feelings, urges, sensations, thoughts) and to find certainty. Those with OCD have an extremely hard time sitting with uncertainty/being uncomfortable (being a witness).

Physical compulsions: behavior done to get rid of anxiety or find certainty. You are doing something. Actions are taken. You drive back the way you came to see if you hit someone. You check on your kid or pet. You check your heart rate every few minutes. You visit the doctor repeatedly. You check the locks multiple times. It might take someone an extra 30 minutes to leave their house in the morning.

Ross might check to see if his dog is okay to affirm has hasn’t hurt Swanson. Or ask his partner to check. He could be taking a look at their cameras to see if he is okay.

Mental Compulsions: aka mental gymnastics. Rumination around the theme that’s bugging you. We love this for us! Jk. It involves lots of being in your head, spiraling, and getting stuck worrying. It is often time-consuming and exhausting.

Ross might spend a ton of energy trying to figure out if he will actually hurt his dog. It might keep him up at night. Get in the way of work. Or interfere with his relationships. He might be mentally checking throughout the day to see if that pesky thought has come back.

Avoidance: avoid the situations, people, items, places, pets, etc., to be safe and not trigger yourself. It makes life small and takes away what matters most to you.

Ross avoids his dog (walking him and petting him), he might avoid movies with dogs in them, and he eventually might avoid dogs altogether. This has ripple affects and his partner and friends might worry. It can also be extraordinarily private, and Ross might be suffering in silence without others noticing much.

Folks with OCD can figure out how to make what they are doing (compulsions) seem completely justifiable. “I have to recook this chicken. I don’t want us getting sick and missing work.” “Hey, do you think you can check this weird-looking mole one more time, it kinda itches.” “Thank you for being so kind to me and understanding that I can’t watch this genre of movie currently. I’m just not in a good place mentally to do so.”

Reassurance Seeking: asking people questions that have to do with your theme to find certainty.

Ross might ask his partner whether people who have thoughts about abusing their dogs are bad.

Someone else might ask their partner 10 times a day if they still love them. Or their thoughts on the matrics. Or if they would still be with them if they were in a mental health ward, or became physically disabled, or had a TBI that altered their personality, or went to prison.

Google is a common compulsion. Someone with health anxiety might look up whether a symptom is a sign of cancer.

REMEMBER: anything can be a compulsion. If it is done to find certainty or get rid of anxiety, disgust, guilt, or discomfort, or thoughts, it is a compulsion.

So Ross has now realized what his compulsions are. What's next?

I have already mentioned mindfulness, which is used in the treatment of OCD. You do not judge your thoughts, feelings, urges, and sensations. Thoughts are just thoughts. Feelings are distortions and not factual. They can be both factual and not factual at the same time. And sensations (like anxiety) are neither good nor bad; they just are.

Next… Do nothing about that intrusive thought. That’s right. Just sit with it. AND sit with uncertainty.

“What if I snap and kill my dog?!”

Let the anxiety be without judgment and sit with the uncertainty, “I might kill my dog,” or “I’ll never know for sure if having this urge/thought makes me a bad person.”

There are four different mindful affirmations, and not the affirmations you’re thinking of, like “I am worthy of love,” which are great but not what we are talking about here.

These are called NERs or Non-Engagement Responses:

Affirmation of anxiety: “Yep, that thought is making me anxious.” - You acknowledge you are experiencing anxiety. Detaching and witnessing.

Affirmation of possibility: “It is possible that I will go insane.”

Affirmations of uncertainty: “I will never know for sure if I will harm my husband.”

Affirmation of difficulty: “It would suck if I were secretly a pedophile/cheater/murderer.”

All of these are done to sit with anxiety and uncertainty. You willfully tolerate the discomfort of not doing something about your thoughts, feelings, sensations, or urges.

KEY: Remember when I said you can’t control your thoughts? Well, another element of that statement is that you can never have certainty. Uncertainty is part of everyday life. That thought will come back, and you will never know for sure the answer to that question.

Exposures are part of this work (ERP therapy), where you expose yourself to what makes you anxious, sit with it, and respond with these affirmations to sit with uncertainty.

Exposure Response Therapy, NERs, and mindfulness are all happening here.

So Ross has the thought:

“What if I snap and abuse my dog?!” But rather than avoiding his dog, he would go pet his dog as an exposure while being anxious and responding to his thoughts by saying, “I might abuse my dog right now.” “It is making me anxious to be around my dog.” He is willfully tolerating his anxiety, being mindful of the experience, and sitting with uncertainty.

By doing these exposures, over time, his brain will stop associating those thoughts as threats, and he will get back his life with his dog/work/relationships, which OCD was taking away.

He is doing the opposite of what his brain is telling him to do, and by doing so, his brain learns that his obsessions are not threats.

If you are reading this and have OCD, you might be thinking, “That sounds so difficult, and even the thought of sitting with uncertainty is making me uncomfortable.” For sure, this is hard work. And it can seem impossible. I get that and won’t lie to you by saying it’s not difficult. However, it is a way to get your life back. Rather than obsessing about your OCD theme, you can start living by your values and making your life meaningful again. And remember, self-compassion. You’re not doing yourself any favors by beating yourself up over the thoughts you cannot control.

If you are reading this and don’t have OCD, rather than judging people who do, try to be understanding. It can be sooooo difficult for those with OCD to seek treatment. Often it comes with shame, especially for those with the more taboo themes.

There are lots of OCD therapists out there, including me. Treatment for OCD includes mindfulness, ERP, ACT, and CBT. These treatments also help with eating disorders and anxiety disorders, which can accompany OCD. And neurodivergence is a common comorbidity with OCD.