OCD is not an adjective

This week, I’m saying more about OCD and being an OCD therapist.

Somehow mental health diagnoses make it into mainstream culture in ways that are minimizing and further stigmatizing. I remember back maybe 5+ years ago it was “this weather is bipolar” or jokes about suicidal ideation “if that happens, I’ll die”. In the past couple years there’s been more and more OCD versions of this “I’m so OCD” or “Arent’t we all a bit OCD?” 

The way OCD is used casually in our culture really does not represent OCD or capture the experience of living with OCD. Generally: if you enjoy it—-it’s not OCD. The stereotype of someone arranging the bookshelf just so, or washing their hands repeatedly are not the most common experiences of OCD, at least in my experience working with people. OCD is made of two parts: obsessions and compulsions. You can read much more about it here. One of the main therapies and most effective therapies (with medication management) is Exposure and Response Prevention (ERP). It’s also made up of two parts: exposure & response prevention. It is a very different therapy and one I’m super passionate about.

In my experience working with people living with OCD, the stereotypical examples of what OCD is, is not what most people experience. Here’s a snapshot: Imagine doing something you know is irrational, but feeling like you have to in order to avoid really scary things from happening. Imagine not being able to move on with your day or blink because you’re replaying everything you did that day (or years ago) to make sure you didn’t harm someone. Imagine washing your clothes every time a negative thought occurred. Imagine feeling responsible for the thoughts your brain comes up with. These are the sorts of beliefs OCD convinces people of. It’s not a personality trait, it’s not cute or funny, and it’s not an aesthetic decorating choice. People who experience OCD would be the first to tell you they wouldn’t wish it on anyone. 

OCD is not an adjective. I love that this phrase is becoming a sort of movement calling attention to the way mainstream culture misuses then invalidates people’s real life mental health experiences. It feels like we’re all living in a time where more people are aware of mental health issues than ever, while simultaneously there’s a common narrative that each generation is getting more “soft”. By calling attention to problematic happenings in our collective culture, perhaps like pointing out misuse of mental health terms in common vernacular, we can take shed light on something important and take personal responsibility.

A few challenges to being an ERP therapist are: supporting people gain confidence in the ability to face fears (ERP is hard work), building insight, getting distance from thoughts (cognitive defusion),  encouraging self-advocacy, learning/practicing to do nothing in the presence of anxiety, and teaching people’s support systems how to strengthen the work their person is doing in therapy.

In training to learn ERP, there’s instruction on how therapists can identify and respond to the validity of someone’s anxiety. Essentially, that someone can be experiencing anxiety for invalid reasons (imagined, hypothetical, irrational, illogical, etc.) and the therapist should be careful to validate the difficulty of experiencing symptoms, not the reason for having fears itself. This is because ERP therapists do not want to reinforce the fear cycle that people with severe anxiety and OCD get stuck in, which often drives compulsions. To not validate OC-thinking, therapists are challenged to demonstrate an understanding of a clients experience without strengthens OCD and anxiety.

This was super hard for me, personally. Coming to this particular niche as someone with a trauma focus and a lot of art therapy experience I had thought the main role of any therapist would be listening/validating. I questioned how it’s possible to be a warm therapist and not validate someone’s feelings? Today, I know so much more and understand how to balance being warm, caring, supportive and strong in the presence of strong OCD symptoms. It’s actually helped me think through and be more specific about how I validate all people.

One phenomenon I have noticed with people who have been in therapy for a while, especially those with trauma histories and those who have ERP experience, is some difficulty trusting one’s judgment and feelings. OCD by nature causes people to second-guess feelings and even the symptoms. OCD is called the doubt disorder. Therapies like ERP and ACT can encourage anxiety sufferers to lean into fears despite feelings, to not engage in safety-seeking behaviors, and to learn to take thoughts/feelings more lightly (rather than literal truth). Sometimes, self-doubt or being mistrustful of feelings comes as a result of successful therapy. It’s what being self-reflective requires, but it’s not black and white. In trauma, people often feel disconnected from themselves or reality (depersonalization/derealization) because the brain is protecting itself from actual danger. In OCD, people’s brains are misfiring often confusing hypothetical or imagined danger from actual danger. People with OCD can be known to also question whether their obsession or intrusive thought occurred or if symptoms they are experiencing are even real. Finding a therapist who really understands OCD, has ERP training and experience are important criteria to consider. I recommend looking for folks through the IOCDF website.

A nuance to consider is that people with trauma histories may have severe anxiety for valid reasons, even if the danger is imagined or irrational. While anxiety symptoms, like hyper-vigilance, may have helped a person possibly survive the trauma in the past, it may no longer be necessary to continue doing (post-trauma), but the brain has not learned another way. Through ERP and cognitive restructuring, new learning occurs and so much healing can happen. I believe in the power of ERP and hope to expand on it’s use with sensitivity.

In general, for folks who’ve done ERP or are in the maintenance phase of OCD management, I find that learning to practice self-compassion consistently is beneficial for recovery. Kimberly Quinlan has a wonderful workbook and Kristin Neff has a lot of free content out there. I’m sure I’ll write more on this in the future too: practicing self-compassion can feel like an exposure. Here’s a couple self-compassion with OCD examples using the 3 tenets (Neff & Germer):

Mindfulness:

OCD is really giving me a hard time today.

I’m noticing a thought about ___.

Common Humanity:

I know other people out there share my same OCD theme. Others with OCD struggle with this compulsion, just like me.

Self-Kindness:

I’ll do my best to keep trying to resist/delay compulsions and not to disqualify myself from care or love if I have a rough day.

My thoughts and obsessions don’t represent me.

I’m worthy of love and care no matter what I think about.

While OCD is not an adjective itself, calling OCD complicated is one adjective I’d bet many would agree on. I hope this post helps you say OCD is not an adjective the next time you hear it used like one! Looking forward to saying more next time, about parenting.

*Disclaimer: My posts here are not intended to be a replacement for individual psychotherapy; the content is my opinion based on my life experiences and education; and, the content is not going to be ‘a one-size fits all’ model. If you are suffering, please reach out to your supports, seek out a therapist of your own, and contact crisis lines like 988 if needed.