What therapists who treat OCD wish people knew
OCD is one of the most misunderstood mental illnesses. It cannot be “cured,” but with the right treatment its impact on daily life can decrease to the point where a person can function as desired and live a fulfilling life.
Many people, mental health professionals and otherwise, express a fear of addressing OCD as a concept. In light of OCD Awareness Week (the second full week in October), it is important to discuss why OCD remains one of the lesser-discussed mental illnesses and to dispel some misconceptions that perpetuate its current reputation. OCD still carries a great deal of stigma, but as this article will demonstrate, there is no practical reason why it should.
Yes, OCD is a mental illness
Yes, OCD is a mental illness
Let’s begin by clarifying that yes, OCD is a mental illness. This is worth saying because there is a wonderful and valid push to have some states of being that were originally classified as mental illnesses (autism, gender dysphoria, etc.) removed from the classification of mental illness. But people living with OCD rarely consider it a fruitful aspect of their identity, or something they would like to actively experience during their remaining lifespan.
OCD is inherently ego-dystonic and distress-inducing, and seeking treatment for OCD is important to prevent a “snowballing” of related concerns. With humanity’s current capacities, OCD cannot be cured in a true sense. The phrase “in remission” is used in the OCD community to refer to OCD that is being clinically well-managed, perhaps with medication or infrequent “maintenance” therapy sessions.
Rather than reinvent descriptions of the OCD basics when scholars before us have done such a phenomenal job, we encourage everyone interested to read the scholarship of Dr. Jonathan Abramowitz - the “Getting Over OCD” (2nd Edition) workbook is an invaluable resource for clients and clinicians alike. “The Self-Compassion Workbook for OCD” by Kimberley Quinlan and “The OCD Workbook” by Bruce M. Hyman and Cherlene Pedrick also come recommended.
Intrusive thoughts and compulsions
Intrusive thoughts and compulsions
The core of OCD is intrusive thoughts. Everyone experiences intrusive thoughts from time to time. Many people who don’t live with OCD are able to shake off their intrusive thoughts without much bother and resume whatever activity they were doing prior to the thought. People living with OCD, however, experience such repeated and highly disturbing intrusive thoughts that are so disruptive to their quality of life that it produces a severe desperation to stop the thoughts. This is how compulsions form.
Compulsions serve as desperate, makeshift traffic cones and barricades that do their best to prevent the careening intrusive thoughts from progressing further down the road. There are different subtypes as well - the common societal image in the United States is of the hand-washing “germaphobe”, and while contamination OCD is a common subtype, it is by no means reflective of everyone’s OCD experience. Other subtypes include intense concerns about causing harm to others, order and symmetry, and scrupulosity.
A common question is how to tell the difference between OCD and clinical delusions. This is likely part of what frightens many people and contributes significantly to OCD’s current stigma. If you have never experienced OCD and you watch as a friend agonizes over whether they hit a pedestrian with their car (when very clearly they didn’t), it can feel like your friend has broken away from reality.
One way to describe the distinction is that OCD is ego-dystonic. Meaning, the individual’s brain does not wholly “agree” with the thoughts being produced and knows that the thoughts do not align with objective reality. We know cognitively that it is highly irrational to believe that if we don’t check 45 times to make sure the door is locked then someone in our family will die, or that we might contract HIV if we touch a public doorknob. OCD is not a battle that can be fought with logic - if only it were that easy!
Treatment and support
Treatment and support
If you are reading this and you have OCD, you are not alone. It sucks and it can feel like you are beyond help. But that is not the case. OCD can be effectively treated with a combination of methods such as Exposure and Response Prevention (ERP) and Acceptance and Commitment Therapy (ACT). You can find therapists and other mental health care providers using the International OCD Foundation and Psychology Today websites.
If you are reading this and you know someone with OCD, oftentimes all a person with OCD needs from their loved ones is a degree of support and patience. One common compulsion is reassurance-seeking from others - a common philosophy in Exposure and Response Prevention therapy is to reassure someone about a specific topic one time only, which can be reasonably expected of most people (e.g., saying once “You can’t contract HIV from touching a doorknob”). Beyond that, providing repeated reassurance can fuel compulsive behavior.
However, there is a big difference between reassurance and encouragement! If your loved one is in therapy or otherwise practicing not performing their compulsions, remind them as much as you’d like that they can do this. They are in control of their actions. OCD is manageable with professional help and practice.
OCD is a pernicious illness, but it is not a life sentence of misery. It does not warrant the societal stigma it receives, and we hope that during OCD Awareness Week more individuals will get the education they need to fully understand what having OCD really means.