This week on the blog, I want to share a post from a Chicago-area therapist, Lora Dudek. Lora specializes in working with women with anxiety-based disorders and the transition to motherhood. I asked her to share a little about OCD and some of the misconceptions so you can see how therapy can be really beneficial for people experiencing these difficulties!

What You Need to Know About Obsessive-Compulsive Disorder

I once asked a room of people unfamiliar with OCD what they thought it looked like. Some answers included:
● Incessant hand washing
● A quirky personality with a need for order
● Little ticks that someone can’t quite control
● Making sure a frame is hung absolutely straight on the wall before walking away
● A need to turn the light switch on and off exactly seventeen times before leaving a room

This is the prevalent (mis)understanding of what OCD looks like. We see these depictions in the media and hear them in conversation with phrases such as, “I’m so OCD about that.” To fully understand this disorder, it’s important to know that it has received some heavy misrepresentation. Depending on how OCD presents, things like hand washing or organizing might be non-existent even with an OCD diagnosis.

So what is OCD?

Two things need to be present with OCD: obsessions and compulsions. An obsession is defined as unwanted (or intrusive) thoughts, images, or urges that trigger very distressing feelings for the person who has them. These thoughts, images, or urges lead the person to engage in a behavior that helps ease the distress. This behavior is called a compulsion. Avoidance of anything that might trigger the distressing thoughts is a compulsion. Reassurance-seeking is another compulsion (for example, you have intrusive thoughts of intruders in your home so after you lock the door, you ask someone to confirm it’s locked).
Other common compulsive behaviors such as washing, cleaning, checking, and repeating, are physical in nature, but compulsions can also take on a mental form that isn’t easy to recognize from the outside. Some examples include reviewing or rewinding scenarios in your head, replacing “bad” thoughts with “good” thoughts, repeating a lucky phrase, and praying with the intent to prevent harm.
Here’s an example of intrusive thoughts that lead to compulsive behavior: Sarah is fearful that while driving, she might do something to hurt someone. Because of this fear, she is always vigilant behind the wheel and obeys all traffic laws. One evening while driving to get groceries, Sarah feels a bump in the road. She has the thought that she might have just hit someone. She turns the car around to go check. She doesn’t see anyone in the road so she continues on to the store. While grocery shopping, she replays the moment she felt the bump over and over in his mind, trying to remember if she saw anyone and might not have realized it. On the way home, she drives very slowly past where she felt the bump, looking closer this time. The next time she goes to the grocery store she decides to take a new route just to be safe. This fear continues to manifest and eventually, Sarah has her husband drive her to the grocery store each time she needs to go.

Not all intrusive thoughts look the same

Intrusive thoughts that plague someone with OCD often have a theme. The theme a lot of people are familiar with involves contamination obsessions (fear of germs, diseases, and/or infecting yourself or someone you love with an illness) that can lead to hand washing and cleaning as a compulsion. Some other common obsessive-compulsive disorder themes involve:
● Fear of hurting yourself or someone you care about and/or fear of something bad happening to someone you care about
● Fear of offending God or going to hell
● Obsessions surrounding relationships; is this person right for me, what if we’re not meant to be, what if they don’t really love me or I don’t really love them
● Fear of or preoccupation with the nature of existence or why we’re here, the afterlife, or existential questions
● Fear of intentionally or unintentionally hurting your child (often occurs in new mothers)
● Obsessions around organization, symmetry, or needing something to feel “just right”
● Unwanted sexual thoughts
● Fear of losing control or fear of being unable to stop yourself from acting on an impulse such as yelling something offensive in public
Intrusive thoughts can change themes over time or might land in several areas at the same time. The taboo nature of these thoughts can keep people from seeking help. People who suffer from obsessive-compulsive disorder might even believe that deep down the thoughts reflect who they are. This could not be further from the truth. These thoughts are called ego-dystonic, which means for the OCD sufferer, they go completely against the person’s true values.
Let’s explore a real life scenario: Amanda is a 31 year old first time mom, who began struggling with anxiety shortly after the birth of her son. At first, she was doing okay with managing her anxiety. She made sure her son was eating enough and sleeping enough. She knew that postpartum anxiety can be a common condition as a new mother, and discussed concerns with her son’s doctor who assured her that her son was thriving. Eventually, Amanda’s worries grew from him not growing to thoughts of something awful happening to her son. Her thoughts were so graphic and vivid that she questioned if deep down, this meant she wanted something awful to happen to him. Each time she felt overwhelmed by these thoughts, she asked her husband or mother what they thought about her as a mom. She would only ever speak in generalities such as, “I don’t know if I can do this – what if something bad happens?” They assured her she was an amazing mother and nothing bad was going to happen. Amanda found herself incredibly relieved each evening when her husband arrived home because she could leave her son in her husband’s care (where she believed he would be much safer) and she stayed in her room for the rest of the night.

I’ve had an intrusive thought – do I have OCD?

Research shows we all have intrusive thoughts to some degree. At some point, everyone will have a thought that makes them think, “Where did that come from?!”
The difference between a person with OCD and someone without the disorder is what happens when the thought pops up. In a brain without OCD, the thought disappears and is forgotten (even if it initially causes some anxiety). In a brain with OCD, the thought sticks and the brain interprets this as a threat.
With obsessive-compulsive disorder, the compulsion that follows a thought is viewed as the problem, not the thought itself. Very simply put, the compulsion adds fuel to OCD’s fire because it makes the brain believe the thought is important. Understanding that the thought is not important is half the battle and is a goal when an OCD sufferer seeks therapy. The other goal is to reduce (and eventually resolve) compulsive behavior. By reducing compulsive behavior, the brain comes to understand the thought is not as important as once believed. This is why the gold-standard treatment for OCD is the same, no matter the theme. Exposure and Response Prevention (ERP) is a form of therapy used to gradually expose the person to the feared images, thoughts, or scenarios while preventing them from engaging in compulsions. A therapist trained in ERP can help break the vicious cycle between obsessions and compulsions.

Tying it all together

In summary, the most important things to know when dealing with obsessive-compulsive disorder are:
1. Intrusive thoughts are not wanted and deeply scare the person who is having them
2. A behavior called a compulsion (can be physical or mental) is done to alleviate the fear
3. These thoughts and behaviors take up a significant amount of time in the person’s life who is suffering from them. The person would much rather be doing something else than washing, checking, reviewing, or making the fifth phone call of the day to seek reassurance.

How to find help

People with OCD need support from a community that understands their disorder isn’t a quirk or a choice. They need people to recognize it can be painful to face head-on. If you or a loved one is struggling with symptoms of OCD, please know that recovery is possible and with the proper treatment, a full and meaningful life is more than possible! Help starts with finding a great therapist who can support you in finding the resources, community, skills, and healing that will change your life. If you or a loved one are struggling with obsessive-compulsive disorder symptoms or behaviors, reach out to me for a free therapy consultation – there is help and healing!

Lora Dudek is a Licensed Clinical Professional Counselor who specializes in working with women struggling with fears & obsessions, panic, irrational thinking, and the identity shift that motherhood brings. Listen to Lora speak from her own experience, here. Lora works with Grace & Gratitude Counseling, PLLC, an Illinois based private practice serving teen girls and women with anxiety and trauma. To schedule a free 20 min therapy consultation, click here. GGC accepts BCBS PPO, self pay, or can help you utilize your out of network benefits.