Today we have Natasha Daniels, an OCD specialist, talking all about how to help children and teens with OCD and phobias. In this conversation, we talk all about how to motivate our children and teens to manage their OCD, phobias, and anxiety using Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), and other treatments such as self-compassion, mindfulness, and ACT. We also address what OCD treatment for children entails and what changes need to be made in OCD treatment for teens. In this episode, Natasha and Kimberley share their experiences of parenting children with phobias and OCD.
Obsessive-compulsive disorder (OCD) is a common mental illness that affects approximately 1-2% of the general population and up to 40% of individuals with depression.
In this episode, I addressed a question that was asked of me by a loyal follower. They asked, “What do I do if the present moment totally sucks? Like, what if I have a migraine , nausea , chills , pain? Any suggestions ?!”
This is such a great question and one we probably have all asked ourselves or our therapist at some point.
Obsessive-Compulsive Disorder is a common psychiatric condition that affects about 1-2% of the population. People with OCD have obsessive thoughts and urges (obsessions) that cause anxiety and discomfort unless they engage in mental or physical rituals (compulsions) to relieve the anxiety caused by their obsessions.
Individuals with OCD are often plagued with persistent, unwanted thoughts or images that they feel they can’t control. For example, they might have constant thoughts about harming someone or committing a terrible act like murder or suicide.
The resulting stress and worry can lead to behavior such as constantly checking things over and over again to make sure something bad doesn’t happen—a classic sign of OCD known as “ritualizing.”
Content
What OCD is not…
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Due to a lack of knowledge, OCD is often misunderstood and frequently trivialized which can be very upsetting for OCD sufferers.
So whilst it is important that this guide informs you of what this disorder IS, it is worth taking the time to define what it is not.
You may have heard people throwing around the phrase, “I’m just so OCD!” when they feel a twang of frustration seeing their desk askew or their clothes not packed away in the correct place.
Whilst this is a rudimentary explanation, I’d encourage you to answer this question...
Do you feel an overwhelming, uncontrollable anxiety and intense sense of uncertainty with an ‘I must do this thing or else’ feeling attached to a physical or mental ritual born from a disturbing, shocking or simply unwanted thought or image?
If the honest answer is, no, then you likely do not have OCD.
Due to a lack of knowledge, it may be easy to confuse ‘neat-freak’ or perfectionist tendencies with OCD. And whilst this is in no way a formal diagnosis – please see a medical professional if you have any concerns about potentially having OCD – unless you feel a degree of fear surrounding the obsession and what might happen if you don’t follow through with the compulsive behavior… you are likely not OCD.
Who can OCD affect?
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This particular disorder does not discriminate.
OCD can affect anyone from any background, age, ethnicity, gender etc. A diagnosis is usually given during late teen years and young adulthood with boys typically developing onset of OCD in the years leading up to puberty.
While genetics and environmental factors can impact the likelihood of developing this particular disorder, there aren’t any studies to suggest that OCD is overly prevalent in a particular type of person.
What is known, is that OCD is actually more common than you might think, affecting up to 2% of the world’s population.
OCD Symptoms
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The severity of OCD symptoms can vary wildly from person to person, it lies very much on a spectrum of intensity. Having said that, those who are diagnosed with OCD typically experience the following in one form or another in a predictable cycle of events (sometimes known as the OCD Cycle)…
1. Intrusive thoughts, feelings, sensations, urges, or images
All sufferers living with OCD experience intense and unwanted mental intrusions which are known as obsessions in OCD.
For some, this comes in the form of intrusive thoughts which may sound like:
“What if I drive this car off the bridge?”
“What if i’m attracted to my mother?”
“What if I harm my child?”
For others, it may appear in the form of mental images and can sometimes occur as impulses (the urge to want to do something), as well as a physical trigger that sparks anxiety.
There are a variety of OCD subtypes which we will touch on below, but the context of these mental intrusions – how and when they appear – is often determined by the particular subtype.
For example, someone who struggles with Pedophilia OCD with an overwhelming fear about being attracted to a child may be triggered by the idea of being at a playground.
These mental intrusions are often taboo in nature, scare us, and are generally the opposite of who we truly are. This is why they cause such distress and trigger overwhelming fear and anxiety in us.
Because the thought of them coming true can feel utterly terrifying.
2. Anxiety
Naturally, OCD sufferers then experience an emotional response to these mental intrusions.
Feelings of stress and anxiety arise following those unwanted thoughts or images, anxiety is the body’s response to the obsession.
With this, you may feel shortness of breath, heart palpitations, excessive sweating, nausea, overheating, and other feelings and sensations that anxiety typically brings.
Anxiety is a very primal emotion and rears its head when our brain thinks we are in a state of danger. For OCD sufferers, anxiety confuses these mental intrusions as being a source of danger. The intrusive thought coupled with the physical feelings of anxiety is what makes them feel so real.
It is because anxiety now associates these unwanted images and thoughts with danger that they become sticky. We feel compelled to respond. This is the vicious cycle of OCD and what makes it a difficult disorder to navigate.
3. Compulsions
Compulsions are the repetitive behaviors OCD sufferers feel the urge to enact in order to gain short-term relief from anxiety and symptoms caused by the obsessions.
(Compulsive behavior should not be confused with impulsive behavior)
Most who have a very basic knowledge of compulsions are quick to think about excessive hand-washing and checking locks.
However, compulsive behaviors differ from person to person and, like obsessions, vary depending on the OCD subtype. But what remains true across all varieties of OCD is that the sufferer feels compelled to perform this behavior because it offers them a sense of relief from anxiety and a feeling of temporary safety.
The feeling is often, “I have to do this thing, or else something bad will happen”
4. Rumination
People in the past have not considered rumination a compulsion however, it is important to recognize that rumination is a non-physical form of compulsion.
It is a natural human behavior to ruminate on things that worry or scare us. We may spend more time than we’d care to admit thinking, thinking, and thinking some more, in the hope that we can think our way out of a negative situation or experience.
We play out scenarios in our minds of what could happen, or replay the things that have happened, wondering how we could have done things differently.
When the OCD cycle is triggered and the anxiety rises, what follows is typically a phase of rumination.
Like most, the OCD sufferer ruminates on the ‘what if’s’ the ‘could be’s‘ and ‘should’s’ of a scenario in the hope to eliminate the uncertainty. Hoping to find an answer or solution that will offer relief and a sense of control.
And this leads us on to…
What are obsessions?
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We’ve briefly discussed the role of obsessions in OCD, but let’s dive in a little further.
How do we identify an obsession?
The frequency, duration, and negative impact the thoughts have on the sufferer help us to define whether or not we can classify it as an obsession.
What people with OCD often find surprising (and indeed, what non-OCD sufferers are mostly unaware of also) is that everyone experiences intrusive thoughts and images. What makes it different for the OCD sufferer is the intense fear these thoughts induce.
As they tend to go against the nature of who we are, they shock and scare us. With that arises feelings of anxiety, followed by the compulsion for momentary relief. This is the cycle in which OCD thrives.
And so when we are discussing obsessions, we are talking about those sticky thoughts that we cannot seem to stop thinking about. They hold on and have our full attention because we think that if we do not react to such things – that we find shocking or disgusting – it must mean something about who we are as a person.
For example, someone with Harm OCD may suffer from images of hurting their child.
Understandably, these thoughts may feel disturbing in nature and have the individual question what that means about them as a parent. Not only are they worried they will lose control and cause harm to their child, but they also begin to believe that having these thoughts must make them a ‘bad person’ or ‘bad parent’.
They obsess over these thoughts in the hope to gain a sense of control, and so the cycle begins.
Types of obsessions
Intrusive thoughts, feelings, and images
Intrusive thoughts typically arise in the form of ‘what if’ thoughts. For the sufferer, the uncertainty of what might happen if they don’t perform the mental or physical ritual associated with the obsession is what triggers the anxious response.
When we step back, we may even consider these questions to be quite absurd when looking at the scenario from a place of logic. But these questions are not driven by logic, they are driven by fear.
When coupled with mental images, these intrusive thoughts can be highly distressful and may give a sense of ‘going crazy’ or ‘losing control’.
Impulses, urges, or sensations
When talking about impulses, we are referring to any strong urge to act. For a non-OCD sufferer, this can come in handy if we find ourselves in a situation where we need to flee from danger (that handy fight or flight response). Or can also appear in a way that is relatively harmless… Did anyone else feel compelled to eat that last cookie?
But in the context of OCD, these impulses are often unwanted and can scare us.
An OCD sufferer may find themselves in a situation where the impulse to do something would ordinarily be considered ‘wrong’ or ‘terrifying’. For example, someone may feel the urge to lick the toilet rim or jump in front of an oncoming vehicle.
It is not because they want to do either of these things, but because they feel the urge to do so.
What follows is typically a form of self-questioning.
Why would I want to do that?
What would happen if I did?
What does it mean about me that I have the urge to do that?
Anxiety arises and they enact the compulsion that awards them temporary relief. The OCD cycle continues.
Similarly, someone with OCD may experience unwanted sensations. A common example would be the groinal response.
In this instance, the sufferer may experience a groinal response at a time where they deem it inappropriate (such as when they are in a park, near children). Similar thoughts may arise like the ones above which have them questioning who they are.
Because of the nature of this particular sensation, the sufferer often carries a lot of unnecessary shame and guilt.
Triggers
Triggers are incredibly common in all varieties of OCD. Triggers are an external stimulus, a circumstance, that brings about the onset of mental intrusions and anxiety for the sufferer.
For example, someone with religious OCD may be triggered by seeing a copy of a religious text, the image of a religious building, or a conversation with family about religion. Once triggered, they may find themselves questioning their faith and their dedication to their religion despite being completely devout.
This then brings about feelings of anxiety and compulsive behaviors to manage those intrusive thoughts.
What are compulsions?
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Compulsions are the behaviors performed to reduce the anxiety caused by obsessions.
For someone living with OCD, the cycle is completed by enacting a specific behavior that temporarily relieves them of their anxiety if only until the next trigger appears.
From an outsider’s perspective, these compulsions may appear helpful. After all, they provide a moment of comfort in an otherwise distressful circumstance. However, it is in performing these compulsions that we keep the OCD cycle in motion.
There are two types of compulsions, both equally valid and both equally troublesome to manage.
1. Mental compulsions
You guessed it, mental compulsions are those that happen in our minds. The difficulty with these mental compulsions is that, unlike physical compulsions, they can’t be seen. For the sufferer, this can often make it harder to explain to those around them exactly what they are experiencing.
They can also feel as though the difficulties that come with these compulsions are less valid (which they are not).
The following is how mental compulsions may present themselves:
Counting – A person may feel compelled to count to a certain number in their head or silently count objects for fear of what might happen if they don’t.
Rehearsal – A person may ruminate over all of the different possible outcomes of a scenario hoping to gain a sense of control when the circumstance arises. They try to mentally prepare themselves for what is ahead with the desire to gain certainty.
Reassurance – A person may feel the need to excessively reassure themselves that ‘that won’t happen’ following an intrusive ‘what if’ thought.
Repetition – A person may repeat words, phrases, or songs until they feel ‘right’. They may need to repeat them a certain number of times before they feel safe again.
Making lists – A person may review a mental list. It may be a checklist of names, things, places. It can vary wildly and is often related to a particular subtype.
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2. Physical compulsions
Physical compulsions are perhaps more commonly known and understood however, hand-washing and checking are the two that most are aware of. There are a variety of other physical compulsions that do not get the same amount of time in the limelight.
Physical compulsions may include:
Checking – This physical compulsion tends to arise from the need to check on the obsession. For example, you may need to check that all of the cutlery has been washed properly, you locked the doors, or turned the oven off. (Checking in OCD is both a symptom and a subtype)
Cleaning/washing – Also known as decontamination, is often seen in contamination OCD although it is not limited just to this subtype. This is the most well-known and most talked about physical compulsion. It tends to look like excessive hand-washing or cleaning of the surroundings or the individual.
Symmetry – A person may feel the urge to create order and symmetry within their environment in a ritual-like fashion. Arranging and ordering things until they feel ‘right’, it is much more than wanting things to be tidy.
Hoarding – A person may struggle to throw away certain ‘useless’ possessions. The urge here is to keep and collect and is associated with very specific worries.
Counting – Similar to the mental compulsion of counting, physical compulsions involve actually counting physical things to avoid something disastrous from happening. It may be counting objects or counting steps, for example.
Avoidance – For an OCD sufferer, it makes complete sense to want to avoid people, places, or things that trigger their anxieties and overrun them with unwanted obsessions. Because of this, they may find themselves with a strong desire to avoid any circumstance that may trigger the cycle. For example, someone with pedophilia OCD may avoid playgrounds and parks.
Reassurance-seeking – Similar to the mental compulsion of seeking reassurance from oneself, as a physical compulsion reassurance-seeking looks like gaining validation and a sense of safety from someone else. The sense of reassurance given provides momentary relief from their anxiety.
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Before we talk about what actually causes OCD, it’s necessary to first mention that whilst there are factors that may make someone prone to the disorder, there is very little evidence currently to identify the precise causes of OCD.
With that said, there are some things worth considering…
1. Genetics
According to research, a particular variety of genes that provide instructions for proteins that react to or transport serotonin are found to be prevalent in OCD sufferers.
“Family aggregation studies have demonstrated that OCD is familial, and results from twin studies demonstrate that the familiality is due in part to genetic factors”
NCBI
Genetics have been found to influence OCD anywhere from 45% to 65%.
While there is a hereditary factor involved here, it is possible to be related to someone with OCD and not develop the condition yourself.
2. Learning theory
According to Learning Theory, OCD can develop through learned negative thinking and behavioral patterns. Through a process of conditioning, everyday neutral events become fear-inducing after being associated with something that conjures feelings of anxiety and discomfort.
3. Chemical Imbalance
Chemical imbalances of the neurochemicals serotonin, dopamine, and glutamate can be present in OCD sufferers.
For these chemical imbalances, two types of medication are typically offered: tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRI’s). Both medications can counteract the chemical imbalances and often provide much-needed relief to many OCD sufferers.
4. Personality
It is important to know that a specific personality type is unlikely to be the cause of OCD.
However, certain personalities could be at higher risk and may increase the chances of developing OCD. For example, an individual who is generally less capable of managing stress with necessary coping strategies may be more likely to develop the condition than someone who handles stress more effectively.
Other personality traits such as perfectionism, neuroticism, or impulsivity may also contribute to how likely a person is to develop OCD.
A child diagnosed with PANDAS will develop sudden and seemingly out of the blue, rapid onset of OCD along with potential behavioral and movement abnormalities.
Unlike typical pediatric OCD, symptoms for PANDAS can develop quickly over the course of just a few days and become very severe. It is hypothesized that this condition is caused as the result of autoimmune antibodies mistakenly attacking the basal ganglia, an area of the brain, instead of the present infection.
6. Stress and trauma
Experiences of stress and trauma do not necessarily cause the onset of OCD. However, traumatic events and high-stress experiences can contribute to the emergence of OCD.
OCD patients who have developed the disorder following a highly traumatic event typically show a specific pattern of symptoms which can include more severe suicidal thoughts and panic disorder.
Stress and trauma may increase the risk of OCD as the response to such events may trigger intrusive thoughts. However, it is worth noting that it is very common to experience high levels of stress and trauma without developing OCD.
Types of OCD
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There are a variety of OCD subtypes that are not spoken of as often as the most famous of all, contamination OCD.
Most people are aware of the mental health struggle someone with contamination OCD suffers with. It is apparent in their excessive hand washing. This particular subtype has had the most exposure and so, whilst there may still be a lack of sound knowledge surrounding it, it is the subtype most think of when we hear about this disorder.
However, there are many other types of OCD and unfortunately, they are vastly misunderstood.
As you might imagine, this only attributes to a sense of shame and stigma surrounding the condition and we’d like to rectify that.
1. Checking OCD
For this particular subtype, it does what it says on the tin.
People who struggle with checking OCD feel compelled to perform repetitive acts of checking believing that failure to do so will result in something catastrophic to themselves or others.
Their obsession to check ‘just in case’ triggers those feelings of anxiety and in turn, they perform the checking ritual in a bid to try and regain a sense of certainty and control.
An example of checking OCD may involve checking the locks on your windows and doors before going to bed in case someone tries to break in.
Another could be checking and re-checking that all electrical sockets are switched off before leaving the house to avoid fire hazards.
2. Contamination OCD
Contamination OCD is the one we all have a vague grasp of.
An incredibly common and most well-known subtype, contamination OCD presents itself in the form of excessive cleaning, washing, or decontaminating of the individual or surrounding things.
Someone with contamination OCD will obsess over germs and the possibility of contracting or spreading illnesses. They feel compelled to wash/clean to soothe these worries.
Contamination OCD is so much more than wanting things to be clean.
It’s driven by a deep and overwhelming fear of getting sick or being dirty in some way.
An example of contamination OCD could be someone who avoids public restrooms (or even public spaces in general) for fear of coming into contact with germs or contracting illnesses. If this person were to venture out into a public restroom, they would likely find the intense urge to reduce her anxiety following this event by excessively washing her hands afterward and even changing their clothes when they arrive home.
3. Religious OCD (Moral/Scrupilocity OCD)
Obsessions for someone with religious OCD are born from spiritual fears.
A person with this particular subtype may experience intrusive thoughts questioning their commitment to their religion, blasphemous thoughts, or even images that abhor them such as burning a religious script.
Compulsions that accompany this subtype typically take the form of excessive prayer, reassurance seeking, or excessive reading of the religious text.
As with most OCD subtypes, the reason these thoughts stick around and feel so disturbing to someone with religious OCD is because they are the opposite of who they truly are.
It can also be known as scrupulosity OCD and may even affect those who do not consider themselves to be overly religious. These particular individuals may obsess over being morally compromised, for example.
4. Harm OCD
Harm OCD is greatly misunderstood and can cause inordinate feelings of shame. For Harm OCD sufferers, the obsession lies in fear of hurting themselves or others.
They may experience intrusive thoughts such as, ‘What if I took that knife and cut my wrists’ or alternatively ‘What if I took that knife and stabbed my partner’?
The misunderstanding with this disorder is when it’s confused with intent to harm. Without knowing the workings of OCD, it is easy for an onlooker or outsider to assume that someone having these thoughts could be potentially dangerous.
This is simply not the case.
Someone living with Harm OCD is scared and disgusted by these thoughts, living with an intense fear of losing control. It is precisely this element that shows that they are not dangerous. If a person intends to harm another person or themselves, these thoughts and images do not scare or disgust them.
An example of harm OCD may be the parent who has ‘what if’ thoughts about hurting his son. They may feel compelled to lock away any sharp objects or remove them from the house entirely, they may even feel compelled to avoid the child for fear of losing control.
5. Pedophilic OCD
There’s a lot of shame that accompanies pedophilic OCD. People living with this particular subtype experience intrusive thoughts and images that revolve around feelings of attraction toward children.
The fear is that of becoming a pedophile.
Just like harm OCD, this is greatly misunderstood by the world and the sufferers. People with POCD are swarmed with thoughts about what this must mean about them as a person. They are left feeling disgusted and abhorred by themselves wondering why they would even think these thoughts if they weren’t rooted in truth.
Once again – because this is worth repeating – these thoughts stick around precisely because they go against the nature of who you are.
With POCD, people typically feel compelled to avoid interaction with children. They may avoid going to parks or playgrounds. They may avoid going to visit friends with young children, and generally avoid anywhere where children may be present.
6. Just Right OCD (A.K.A – Not Just Right OCD)
For those with just right OCD, they feel compelled to do something until it feels just right.
Unlike other OCD subtypes, just right OCD isn’t necessarily driven by fear but an extreme desire for something to be just so. Driven by the nagging and uncomfortable feeling that something just feels wrong.
The compulsions are enacted not necessarily to combat the fear of obsessions but to shake off the feeling of discomfort that comes with things feeling ‘off’.
An example of just right OCD could be someone needing to put the shoes on and off the shoe rack until it feels just right. Or hoovering the carpet over and over again until it feels just right.
7. False Memory OCD
False memory OCD is categorized as the persistent intrusive thoughts and doubts surrounding an experience of the past that may or may not have happened.
Continuous doubts over a previous event may leave the sufferer wondering if what they think happened, actually happened. They may start to ruminate over what they should have said or done instead and may believe their actions to be ‘wrong’ in some way.
Often, there is no tangible evidence to suggest that what they believe is true.
However, the presentation of constant doubt will have the sufferer believe that there must be something to doubt. They are left agonizing over thoughts like, “Why would I think this if it weren’t true?” or “If I’m worried I did that horrible thing, surely I must have done it?!”
This leads them to believe that this false memory must have actually happened.
Typical compulsions for this subtype include mental reviewing and reassurance seeking in a bid to gain clarity and relief from the uncertainty.
8. Existential OCD
Existential OCD is characterized by excessive fear, worry, and uncertainty surrounding life and death.
For those with this subtype, they feel trapped in cycles of rumination about the meaning of life, the purpose of one’s existence, and what happens when they die.
They mind themselves questioning what is real and what is not and these obsessions and compulsions typically rob them of experiencing life to the fullest in the present moment.
9. Real Event OCD
Most OCD subtypes cause the sufferer to fixate on future-focused fears and outcomes. However, those with Real-event OCD – also known as ‘real-life’ OCD – is distinguished by obsessions and compulsions surrounding an event that has happened in the past.
In the case of real-event OCD, the sufferer finds themselves scrutinizing and ruminating over past events. Doubting the things they’ve said and done, leaving them with immense feelings of guilt and shame that they attempt to navigate through compulsive behaviors.
Someone with real-event OCD will exert a great deal of energy to try and find certainty around a past event which makes it very difficult to live and embrace the present moment.
10. Suicidal OCD
Suicidal OCD is a truly terrifying OCD subtype that leaves sufferers questioning their morality.
Those with this subtype have no desire to end their life. This is where many are misinformed and why this subtype is misunderstood.
Suicidal OCD is characterized by the fear of ending one’s life, whereas suicidal ideation is characterized by an individual’s desire to take action.
People with suicidal OCD engage in compulsive behaviors for fear of the perceived catastrophic consequences of what might happen if they lose control and act on their thoughts.
11. Sexual Orientation OCD
Sexual orientation OCD (SO-OCD) is an OCD subtype that is characterized by immense fears about an individual’s sexual orientation.
SO-OCD affects people of all sexual orientations.
Those with SO-OCD are plagued with highly distressing intrusive thoughts and urges that make them doubt their true sexual orientation. Sometimes this appears as fears about whether you prefer one gender over another, and other times it’s the sheer sense of not knowing that causes the greatest distress.
Choking phobia is a rare condition where sufferers hyperfocus on the sensations they experience when eating and swallowing food in a desperate bid to avoid choking at all costs.
Avoidance becomes a dominant behavior in this cycle. People with choking disorder may restrict their diet and avoid certain food types, blend their food to reduce the risk of choking, and may also avoid taking tablets.
13. Relationship OCD
Relationship OCD (ROCD) plagues sufferers with distressing and persistent doubts about their most valued relationships. These unwanted obsessions thrive in the uncertainty surrounding the quality of the relationship and their love for their partner or child.
It’s incredibly common for anyone in a relationship to have moments of doubt, but for those with ROCD, the uncertainty can be crippling.
Those with these subtypes often struggle to maintain quality relationships because of the nagging sense that something isn’t quite right. In ROCD the relationship itself becomes the source of those fears and the core obsession.
14. Hoarding OCD
Hoarding OCD is distinguished as having a hoarding disorder with an OCD diagnosis.
There are many reasons why someone may suffer from hoarding OCD, but common fears include fear of contamination, fear of things not being quite right, or fear of what might happen if they throw an item away.
Those with hoarding OCD do not find any enjoyment in holding on to these items and feel a great deal of shame and embarrassment. Many believe that those who hoard get personal pleasure from keeping hold of these items, but this simply isn’t the case.
It is equally as painful as all other subtypes.
OCD Diagnosis
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Diagnosis for OCD can be a little troublesome.
The unfortunate reality is that many patients can go misdiagnosed as the symptoms typically overlap with many other mental illnesses such as obsessive-compulsive personality disorder, anxiety, or depression, for example.
Likewise, it is not uncommon to develop OCD alongside another related disorder. And so it is possible that a patient may be diagnosed with one and not the other.
However, a prognosis should be given by a qualified mental health professional so that you receive the best support possible. It can feel embarrassing or shameful to ask for help with these symptoms.
Yet, the sooner you are able to receive a firm diagnosis, the sooner you can begin down the path of recovery.
Typically, the process of diagnosis may include the following:
A psychological evaluation – In order to determine whether or not what you are experiencing may be an obsessive-compulsive disorder, a mental health professional will discuss your thoughts, feelings, behavior patterns, and presenting symptoms. We use the Yale Brown Obsessive Compulsive Scale (YBOCS).
DSM -5 – The Diagnostic and Statistical Manual of Mental Disorders was published by the American Psychiatric Association as guidelines for diagnosing various mental illnesses. DSM-5 states the criteria for diagnosing OCD in patients.
Physical examination – A physical check may also be included in this process simply to rule out any other symptoms that could be behind your symptoms or cause any potential complications.
NICE guidelines
For UK-based practitioners, the NICE guidelines are widely used as a reputable resource in the aid of diagnosing OCD.
The National Institute for Health and Clinical Excellence (NICE) provides these guidelines on treatments and care for those using the NHS services in England and Wales.
NICE place a large emphasis on gently guiding the patient through the process of diagnosis. In doing so, they typically ask questions such as:
Do you wash or clean a lot?
Do you check things a lot?
Is there any thought that keeps bothering you that you like to get rid of but can’t?
Do your daily activities take a long time to finish?
Are you concerned about putting things in a special order or are you very upset by mess?
Do these problems trouble you?
Whilst it can feel upsetting to have to answer these questions, it is important to be as honest as possible so a correct diagnosis can be given. Only then can you work on implementing the most effective treatment.
Online Tests
If you type into Google ‘online test for OCD’ you with see a plethora of options available to you. Now, we cannot confirm or disconfirm the validity of these tests and some even provide helpful information.
However, I would urge you to read articles like this and to please visit a mental health professional for a sound diagnosis if you suspect yourself of having OCD.
These online tests can be a helpful starting point but we would advise against using them to self-diagnose, leave the diagnosis to the professionals.
OCD related disorders
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OCD seldom lives in isolation. Whilst there are many who solely struggle with this disorder, there are surprising statistics that show how common it is to suffer from more than one medical illness at the same time.
You may have heard these as being called comorbid conditions.
Below we have listed some common comorbidities that often align with OCD.
1. BDD (Body Dysmorphic Disorder)
What is body dysmorphic disorder?
Someone with BDD will spend a disproportionate and inconvenient amount of time worrying about flaws in their appearance.
BDD sufferers notice flaws and imperfections in their appearance that aren’t apparent to those around them. They fixate on these areas of imperfection, may avoid mirrors, or spend an excessive amount of time looking at themselves in them wishing their appearance were different.
A person with BDD is not vain or self-absorbed, they are insecure and can spend a lot of energy comparing themselves to others believing they are not good enough as they are.
BDD and OCD stats
BDD is found in between 8% and 37% of people who suffer from OCD.
2. Bipolar Disorder
Bipolar disorder can also be known as manic depression where an individual experiences extreme mood swings which can often make them appear like a different person.
BD sufferers may move from an emotional state of extreme happiness, joy, exhilaration, or excitement to intense anger, rage, frustration, or sadness within a short space of time.
BD and OCD statistics
More than 20% of those living with bipolar disorder are also diagnosed with OCD.
3. Depression
In simplest terms, depression is the heavy weight of feeling down and in a low mood for a persistent and prolonged period of time.
For those with depression, it isn’t a case of feeling sad for a few days at a time, it is something that can last weeks or even months.
The experience of depression can feel very different from person to person. Some feel hopeless, others unhappy, and physical symptoms such as exhaustion and lack of appetite may also be present.
Depression exists on a spectrum from mild to very severe, the important thing to note here is that this is a very serious mental illness that can negatively impact day-to-day life. It is so much more than fleeting moments of low mood.
Depression and OCD statistics
The IOCDF states that anywhere between 25% and 50% of people with OCD also experience depression.
4. Paranoia
Someone living with paranoia may constantly feel on edge. Fearful of letting their guard down or trusting those around them.
There is a recurring sense of threat or danger in some form even when there is a lack of evidence to justify this feeling of unease. Paranoia differs from person to person in the sense that there are many different types of threats that may cause someone to feel suspicious.
Fears become amplified and it can feel impossible to relax, or even trust your own thoughts as delusions are often present in those with paranoia.
5. Hoarding
The British TV Show ‘The Hoarders Next Door’ may have made light of this particular mental health condition but it is as serious as any other and can have damaging effects on an individual’s quality of life.
A person with a hoarding disorder typically keeps hold of an inordinate amount of seemingly useless possessions and stores them in a chaotic manner (from an onlooker’s perspective).
They have the urge to hold on to these possessions and avoid throwing them away ‘just in case I need it someday’.
Hoarding and OCD statistics
Compulsive hoarding is widely considered a subtype of OCD. Certain studies have shown that up to 1 in 4 people with OCD also suffer from compulsive hoarding.
6. Eating disorders
There are many variations of eating disorders including anorexia, bulimia, binge eating, rumination disorder, and many more.
All are considered psychological conditions where the individual develops unhealthy eating patterns combined with distressing thoughts and emotions. For many, it stems from a desire to feel in control of an aspect of their life.
Eating disorder and OCD statistics
According to the IOCDF, a recent study found that up to 64% of people living with an eating disorder also had an anxiety disorder of some sort. And of those, 41% presented with OCD in particular.
7. Skin picking
Skin picking may also be known as excoriation disorder or dermatillomania. And it may come as no surprise to learn that according to research, skin picking is far more prevalent in OCD sufferers than in the general population.
Someone with excoriation disorder may spend hours picking at the skin around their nails, picking at scars or lesions, or in fact creating lesions themselves by picking at healthy skin.
Arguably, skin picking may be considered to be an impulse control disorder over an obsessive-compulsive disorder. Although the two often co-exist.
8. Hair pulling
Hair-pulling disorder, also known as trichotillomania, is classed as a body-focused repetitive behavior. The individual feels compelled to pull on – or pull out – the hair on their body.
This may be the hair on their head but also their eyelashes or eyebrows for example.
The act of pulling on their hair is a ritual performed by the individual to reduce their feelings of anxiety. Whilst there are similarities between the two, hair pulling and OCD are two distinct disorders but, just like skin picking, there is a high overlap between them.
Hair pulling and OCD statistics
Up to 79% of individuals with trichotillomania had one or more mental health comorbidity including OCD.
9. ADHD
Attention Deficit Hyperactivity Disorder (ADHD) can affect both children and adults. ADHD impacts people’s behavior and so those living with this disorder, may experience restlessness, a lack of concentration, poor organizational skills, are easily distracted and may appear hyper.
It is worth noting that there is a strand of ADHD in which hyperactivity is not present and so this often goes undiagnosed or misdiagnosed due to the absence of hyperactivity.
ADHD and OCD statistics
Studies have shown that 1 out of 5 children with OCD also have ADHD, with only 1 out of 12 adults experiencing both.
10. Insomnia
It may come as no surprise that those who suffer from OCD also have difficulty getting a good night’s sleep. In the general population, sleep disturbances are highly prevalent with or without the presentation of OCD, however, the relentless obsessions of an OCD sufferer can make it increasingly hard to shut off at night and this can lead to insomnia.
Insomnia and OCD statistics
Up to 48% of individuals with OCD also suffer from sleep deprivation.
11. Fear of Vomiting (Emetophobia)
Emetophobia is the intense fear of vomiting. For those with this specific phobia, extreme fears surround the thought of vomiting, seeing other people vomit, or feeling nauseous.
For those suffering from this disorder, it goes beyond a typical response of disgust toward vomit (after all, who doesn’t recoil a little at the sight of it?). People with emetophobia actually fear it.
To the untrained eye, emetophobia and OCD could easily be mistaken for the other.
But fear of vomiting is technically classed as a Specific Phobia.
Emetophobia may arise as a comorbid condition alongside OCD (occurring simultaneously) or present as a symptom of OCD.
OCD Treatments
Photo Credit: National Cancer Institute
There are a vast array of treatment options for OCD, although it is worth mentioning that CBT (cognitive behavioral therapy) and medications are considered the most effective.
In order to access treatment, please seek assistance from a qualified mental health professional who will be able to guide you on the best course of action.
(Having said this, we realize that treatment isn’t accessible or affordable for all so we will first discuss all of the treatments available as well as the other things you can do to help yourself along the way).
CBT (Cognitive Behavioral Therapy)
CBT is considered to be the gold standard treatment for obsessive-compulsive disorder.
There are two components to CBT that make it perfectly matched to combat this particular mental illness.
Cognitive therapy revolves around understanding the thoughts that pop up and how you respond to them. Raising your awareness of that inner narrative and changing the way you apply meaning to them. This is most helpful in addressing those obsessive thoughts.
Behavioral therapy focuses on changing problematic behaviors, in the case of OCD this refers to those mental and physical compulsions.
The combination of both aspects is what has made CBT the first port of call for OCD treatment. It’s extremely effective and yields excellent results in the field of OCD recovery.
ERP (Exposure Response Prevention)
ERP is a form of cognitive behavioral therapy developed to help those struggling with OCD, PTSD or phobias.
Exposure therapy (as it is often called) helps people to identify their triggers and rewire their response to those triggers. For any anxiety disorder, including OCD, the brain begins to associate seemingly safe thoughts, things or circumstances with being dangerous.
It is because of this that intrusive thoughts or images cause an OCD sufferer such distress. The anxious response considers the thought to be dangerous and so our fight or flight response kicks in with a bid to keep us safe.
It is by then responding to that anxious response by performing compulsions that relieve us of the anxiety that the cycle continues.
The goal of exposure is to practice being around the obsessions or thoughts that we perceive as dangerous and prove that we can tolerate the discomfort and not engage in compulsions to reduce or remove that discomfort.
Surprisingly, this often looks like doing absolutely nothing.
This way, the brain begins to learn that the very thing that triggers us is not in fact a source of danger and we do not need our anxious response to lend a helping hand.
ACT (Acceptance and Commitment Therapy)
Another form of CBT (you can see what CBT is the go-to treatment!), ACT therapy is becoming increasingly popular in the treatment of OCD.
Differing from how we approach recovery using ERP, ACT focuses not on reducing the experiences that come with obsessions but on changing how we experience them. In order to make progress in recovery, we must first accept where we are.
For many, the urge remains to fight or stop those thoughts and this only causes greater distress and prolongs the recovery process.
ACT asks us to explore these obsessions, allow the anxiety to arise, and let them come and go without interference. It is the acceptance of these thoughts as part of everyday life, and in being able to accept them we can find greater ease in changing how we respond to them.
Medication
There is still widespread taboo and shame associated with taking mental health medication. But in certain cases, medication can be life-saving and has greatly improved the quality of many lives.
Usually, anti-depressants called selective serotonin reuptake inhibitors (SSRIs) are used as the go-to medication for treating OCD in adults. Whilst it is not entirely understood why this particular medication is helpful in treating OCD, they appear to reduce symptoms and alleviate anxiety.
SSRIs offered as a treatment for OCD in adults include:
Fluvoxamine (Luvox)
Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)
Citalopram (Celexa)
Clomipramine (Anafranil)
Escitalopram (Lexapro)
Venlafaxine (Effexor)
Disclaimer:OCD recovery without medication is possible! But, if you are curious to know if medication could be helpful in your own recovery, it must be prescribed by a medical professional following a professional diagnosis. Please see a qualified psychiatrist or medical professional who will advise on the best course of action.
Mindfulness
Mindfulness is a helpful tool alongside the above treatment options. The practice of mindfulness in OCD recovery encourages sufferers to focus on the present moment without judging themselves for what they think, feel, or do.
The absence of judgment is what makes mindfulness successful, though it is the hardest aspect for many to adopt.
It requires the acceptance and processing of negative thoughts without trying to fight, stop or avoid them, or apply meaning to them. As OCD sufferers fixate on the ‘what if’ thoughts and get stuck ruminating on the obsessions in their minds, mindfulness is particularly effective in helping with the mental condition.
For an accessible, affordable, and alternative option to private therapy, ERP School offers an online program designed to walk you through the exact steps to help you overcome your OCD, once and for all.
Alongside effective treatment, it’s always helpful to consider the ways we can help ourselves the best we can. There are plenty of options out there to help learn and better understand OCD, as well as tools and techniques to help us manage on our road to recovery.
Additionally, the unfortunate reality is that many do not have affordable access to treatment and if that is the case for you, we highly recommend considering the following options.
#1. Online courses – There are self-study courses available to purchase to help you learn and manage your OCD at your own pace with the help of expert knowledge. Over at The CBT School, we have our own OCD program called ERP SCHOOL which has been designed to take you through the exact steps we would take if we were working in 1:1 therapy together.
#2. Books, podcasts, blogs – Don’t forget the immense amount of free resources out there available in the form of books, podcasts, and blogs. Our own podcast now has over 300 episodes to listen to which offers free advice to help you better understand your OCD and anxieties. You can also read The Self-Compassion Workbook for OCD which offers practical support and guidance.
#3. Meditation – Formal medication (sitting in silence and focusing on the breath) may not come easy to you, but informal meditation is also a great option. Take time to give yourself some breathing space and ground yourself in the present. You can use apps like headspace to guide you through a meditation or you could take a long walk and allow yourself to take in your surroundings and ground yourself in the present moment. Even 10 minutes a day of this could make a huge positive impact.
#4. Talking – Let us not underestimate the power of talking to someone. Openly speak to someone you trust and who makes you feel safe. This could be a counselor, or it could be a close friend or family member.
#5. Journaling – Getting those thoughts out on paper creates space in your mind. With all of those unwanted thoughts swirling around your head, it’s helpful to get them out and be able to stand back and observe them. You may take just 10 minutes every morning to write down what you are thinking and how you’re feeling to find that it gives you some mental space to start your day on a helpful note.
#6. Support groups – Local support groups specifically designed for those with OCD are an excellent way to surround yourself with people who truly ‘get you’. It can be a lonely and isolating experience, support groups help you to feel included and of course, supported.
#7. Physical health – It can be tempting to neglect physical health when we are struggling with mental health. Yet, this is a reminder that one helps the other. You do not have to engage in excessive exercise but, consider switching to a healthy diet and incorporating some form of movement into your day.
Welcome back, everybody. I am covered in goosebumps. I literally, as we speak, just finished the recording of this episode. I wanted to come on and do the intro right away just because I’m so moved by this week’s guest.
Welcome back, everybody. I am so excited to be here. This is my first recording since returning back from Australia, after having five and a half weeks in Australia with my family and I could not be more thrilled. I had the most incredible time. I tell you, my cup was overflowing by the time I left. My heart was full. I didn’t realize that my heart was very empty, even though I have so much love in my life and joy in my life, and in many areas of my life, my cup was so full. But I didn’t realize how much my heart needed to go home and actually just live in Australia for five and a half weeks and let my kids learn what it’s like to live in Australia and be in Australia. It was so wonderful. I’m just so incredibly grateful to have had that opportunity. (more…)
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One of my favorite episodes is actually number 99, which was the only episode and the only time where I actually have a full conversation with my husband on the podcast, and we talked all about agoraphobia and panic disorder specifically related to flying. So, if you want to hear me and my husband have a good conversation about his experience, that was one of my favorite episodes of all time.(more…)
Welcome back, everybody. How are you? It is a beautiful summer day here in California. I love summer. It is very hot, but so happy to be here with you. I’m sitting in my office. I have a cup of tea. I have my little flowers next to me, and I’m just so grateful to have you here with me as well. Thank you for letting me be a part of your journey. I’m so honored. Really, I am. I know you have many options. It’s just an honor to be walking in this journey with you. (more…)
Welcome back, everybody. How are you really? Just doing a quick check-in.
I love the quick check-in, the drop down into your chest, the drop down into whatever discomfort you may be having. And just take it a minute to actually check-in. So important. How often are you doing this? Hopefully, multiple times every day. (more…)
