Written by Cameron Hollister

 

I am a therapist who both experiences and treats OCD. Here is what I wish people knew about it.

As I freely tell my clients and pretty much anyone who asks, the reason I specialized in treating obsessive-compulsive disorder (OCD) as a therapist is because I struggled with my own OCD for several years. Although I still experience OCD to this day and in fact OCD cannot be “cured”, its impact on my daily life has decreased to the point where I can function as desired and live a fulfilling life.

I have spoken with many others, mental health professionals and otherwise, who have expressed a fear of addressing OCD as a concept. In light of the upcoming 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 hopefully 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.

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I would like to begin by clarifying that yes, OCD is a mental illness. I say this 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. I have yet to meet anyone with OCD who considers 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. I’ve heard the phrase “in remission” used in the OCD community to refer to OCD that is being clinically well-managed, perhaps with medication or infrequent “maintenance” therapy sessions.

I will not reinvent my own descriptions of the OCD basics when scholars before me have done such a phenomenal job themselves. I encourage everyone interested to read the scholarship of Dr. Jonathan Abramowitz – the “Getting Over OCD” (2nd Edition) workbook has been an invaluable resource for me as both client and clinician. I have also heard positive things about “The Self-Compassion Workbook for OCD” by Kimberley Quinlan and “The OCD Workbook” by Bruce M. Hyman and Cherlene Pedrick.

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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 friend once asked me about how to tell the difference between OCD and clinical delusions. I suspect this is largely what frightens many and significantly contributes to OCD’s current stigma. If you have never experienced OCD and you watch as your 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.

The way I 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!

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If you are reading this and you have OCD, I see you. 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 we need from our loved ones is a degree of support and patience. One common compulsion is reassurance-seeking from others – the therapist who trained me to perform Exposure and Response Prevention therapy has a philosophy that he will 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 I hope that during OCD Awareness Week more individuals will get the education they need to fully understand what having OCD really means.