The ABC'S of OCD

about o c D, obsessive compulsive disorder. I did do an episode a few months ago with my friend Andy Kindler, who is a comedian who suffers from o c D, and it was great to get his perspective of what it feels like for him, how it moved through his life, what it felt like in his body when he was having o c D experiences, what he's come to now

after getting treatment. But I also wanted to talk to someone who is a specialist in o c D so we could really dial down into the nitty gritty of what exactly is obsessive compulsive disorder and what are the many, many ways that it can manifest. And I'm sure in

this interview we have only scratched the surface. But what I enjoyed in my conversation with Kimberly Quinlan is that she talks about what is perhaps the most normal O c D symptom is unwanted thoughts, and I actually, if you had asked me, I would have thought it was more the handwashing and the you know, germ phobia, contamination phobia, and she said, while those are pretty common, what most people rushed to seek treatment for are the unwanted thoughts.

Thoughts that they might harm someone they love, Thoughts that they might uh, you know, harm a child, that they might harm their partner, someone in their family. And it's it's difficult to talk about because it sounds like the minute you say that, right, someone should luck you up

and throw away the key. And what has been discovered in o c D treatment is that people who have these thoughts are the least likely people to do anything about it, because what they're worried about is what if, because they it is the last thing they want to do is to harm someone, especially someone they love. And it's really debilitating and it disturbs people and it's it's tough. So she talked all about having a sense of humor about it and how that is actually part of the treatment.

That it may seem like it's such a big deal to be having these thoughts, but again, the key component of it that makes it obsessive compulsive disorder and that makes it harmless is that it is an intrusive unwanted thought, and so you may find this very interesting if this is something this is something that you've been living with, you've been afraid to talk about it. Hopefully this really brings it home for you that it is normal, common, very treatable. And so a little bit more about my

guest today, kim Really Quinlan. Her website is linked in the show notes. She does compassionate, science based treatment for O c D, anxiety disorders, and eating disorders. We didn't even get into anxiety disorders and eating disorders today, but of course you can go to her website and learn more about it. Today we really just focused on obsessive

compulsive disorder involving obsessions and compulsions. And again, an obsession is an intrusive and unwanted thought that creates significant anxiety and discomfort, and a compulsion is an overt or covert behavior done in an attempt to reduce the discomfort of the intrusive thoughts and feelings. And so even though Kimberly Quinland practices out in California, she does have her own kind of online school where you can take courses to

get treated for obsessive compulsive disorders. So again that's in the show notes, but her CBT school dot com has online resources for obsessive compulsive disorder, anxiety disorders, hair pulling, skin picking. She has online video courses Mindfulness for o c D and o c D online course Overcoming Anxiety and Panic, a time management course. So check that all out.

Because even if you are unable to find a therapist in your area or get to a therapist, you can begin doing some of the exposure therapy work by taking a course. So let's get right to it, because Kimberly is she really knows her stuff. She's totally brilliant, and I think you will enjoy learning about exactly what o c D is and what it isn't. All right, I'm gonna start out with what I think you know, hopefully not too basic and boring of a question. But can

you just define o c D obsessive compulsive disorder? Sure? No, that's not a basic question at all. It's actually a really important question because to have o c D you need to have a certain criteria of things. So number one, you have to have obsessions. But obsessions aren't like I love lego, or I love sweaters, or I love or your cookies like I'm obsessed with binge watching Netflix, like it's not. That is what an obsession is. But in the terms of o c D, an obsession is usually

an intrusive, repetitive, and unwanted. So it has to have those three pieces um and it usually shows up in the form of a thought, but it can also show up in the form of a feeling or a sensation or an image that keeps popping up into your brain um or it could even be an urge. This sort of urged comes up and overwhelms your body. So you have to have that first criteria to have the obsession,

and you have to have a compulsion. Now, a compulsion is a behavior that we do um to reduce or remove uncertainty or anxiety or any form of discomfort even maybe even discussed. A big misconception is that that compulsion has to be physical, so we know sort of Hollywood o c D, which is like jumping over cracks, washing your hands, counting objects. They're all great portrayals of having o c D. But there are other ways in which people can do compulsions that are actually completely unseen by

the eye. Like one really big one is mental compulsions. Mentally ruminating and and resolving and trying to solve problems in your mind. Another one is simply avoidance. So some people, a lot of people unfortunately who have O c D, will go to a doctor and they'll say, you don't have a CD. I don't see you doing anything. I don't see you doing any behavior. But this person has avoided of their life, right, And that's the compulsion that

they do. And the other one is reassurance seeking, So they're constantly googling or asking for reassurance from a person, you know, did this happen, could it happen, will it happen? Did I do something wrong? So, so there are many ways in which a compulsion can show up, um, that our society isn't aware of. And then the deep part disorder what I mean, that's just the name of an obsessive compulsive disorder? So is there anything in the deep part that makes it the disorder like that you have

to look for? Yeah, Well, to be diagnosed with a c D, it has to disrupt your life and you're functioning to a degree that is problematic. Um. You know, some people will often say like they have some symptoms of obsessive and compulsive they have to be haveviors, but it's not to the degree in which it is disordered, meaning there is now lack of order. Um that it's

not debilitating their life taking away their functioning. So the people that I see how usually coming in there doing it for more than one or two hours a day. Most of the time it's taking up many, many, many hours of their day to the degree where they've lost some functioning. So that's sort of where the wood disorder comes into play. And that's true for any disorder, anorexier depression, it's usually you know, the symptoms have started to impact

my well being. And do you like the name obsessive compulsive disorder? Does that work for you in terms of, um, what what it is that you know, the people you treat and what they have, and what it's called. Do

you find that that's an accurate description of it? A lot of people with o c D find that the disorders name actually describes even the treatment right and the way in which we treat it, because it helps identify that there are multiple components of this disorder and that we have to look at each component in order to treat them really well. So I you know, we look at other terms like anorexia nervosa, it's like that doesn't even that's just syllables match together to make a certain word,

Like it doesn't really even make any sense. But with this case, it does help us to identify the two core pieces that are showing up and you have to have both. And then it also it helps us to sort of put forward a plan. Um. So, I mean, I think that the problem with it, if we were to look at both sides of the coin, is because it's so misunderstood and stigmatized. I know a lot of people who don't like the term because of the stigma that go with it. But in terms of the correctness

of the name, I think it's wonderful. And you are an O c D specialist, and I've heard you said, I've listened to some other interviews you've done that that there's very few of you in that sense to kind of I mean, I'm putting words in your mouth. You didn't say like this, but like you kind of know what they're doing, you know, is it hard? Um? Tell me what makes you? Tell me? Um? Tell me what sets you apart from other people that think they're treating O c D and and why it's important to I

don't know. I guess go see someone like you as opposed to just any kind of therapist or anxiety specialists. Yeah. Well, what I will say before I start is, thankfully, over the last decade that I've been specializing in it, we've had such growth of more therapists. So you know, there's so many therapists now who are trained and correctly you know, supervised and so forth. So thankfully that's going in the right direction. But the O c D community has still

a crisis on their hand. It still takes seven to fourteen years to get correctly diagnosed. That's a lot of years. So that means that these people have sought treatment from some other kind of therapist, maybe even doctor, and the person has not even named what they have as o c D, or they've been named with o c D, but they're they're not getting the right help with it both. So a lot of people will be declined the diagnosis and therefore can't get the treatment because of the misinformation

around the compulsions. Right, like you don't have O c D. You can't your room's messy, you can't have O c D. Right, So, like what you were saying before they they're not noticing, they're not know speed on the other compulsions. Yeah, yeah, So there's that group there, the other group who get told they have a c D but then may be referred to a form of treatment that you know, out of the goodness of their soul, have tried to help, but often what they're using is techniques that actually make

the compulsion and the disorder worse. So with the treatment of O c D, we actually purposely face our fears. That's the gold standard treatment. It's called exposure and response prevention. But if you're not trained in that naturally, any human I'm sure before you listen to this episode or knew anything about O c D, naturally your instincts would be, oh, if you have a fear that sounds really painful, you

should avoid it. More like, can we figure out a way, Like there are even apps that have been created to help people take photos of their stove so that they know for certain they have turned their stove off or they've locked their door. And instinctually that makes sense, right, like, well, if you know you've locked your door, you shouldn't worry. But those behaviors actually act as compulsions. And keep the

disorder going. So it's it goes against the recovery. And so that's where there's sort of there was a crisis and we are working our way out of it in edge acting mental health and medical professionals to to direct people to the correct care because it can go so wrong. We'll be right back. I haven't talked to anyone yet about exposure therapy. It's been casually mentioned in other episodes I've done, but the focus wasn't that, so I didn't

really follow that trail. And I know that it's it's probably obviously different with every anxiety disorder, and but weird it's been brought up has been episodes that are more centered on panic attacks and things like that. Um, so I'm sort of familiar with it in terms of what I've done for panic attacks. But can you tell us what is exactly you said exposure and what response prevention?

Tell us what exposure response prevention is? Sure? So, Um, Exposure and response prevention we call it e r P for short, is where we so go back to the obsessive and compulsive parts, so we expose them to their obsession. Right, So that's pretty easy, right, you identify your fear, we find a way to face your fear. Back in the day, we only used to do exposure. We go, okay, if you're afraid of dogs, go and hang out with dogs, or if you're afraid of germs, go and touch germs.

But what we found there was that's manly really fifty of the work, because then they just go and do all these compulsions to undo their fear or reduce or remove their fear. So the response prevention is where once you've exposed yourself to your fear, the response prevention is

targeting eliminating those compulsive behaviors. So not only would you, you know, touch germs or be around germs, but then you would reduce and remove the compulsive hand wash or the rumination, or the reassurance seeking or the googling and that kind of behavior. So both must be a part of treatment for the treatment to be really successful. So if I come to you, um, how soon do we

get into exposure therapy? Is it session one? Usually session two or three, depending on the complexity of the case. So we always want to do a thorough assessment, make sure we have the right diagnosis. We also want to do a ton of education because let me ask you, how how excited are you about facing your worst fear? Not excited? No, I mean I think of ump. I'll say a couple of my worst fears. I think I'm pretty excited about them because I don't need them in

my life, so they don't debilitate me. But I used to have a fear flying and I was not excited to face that, but I did. So that's the thing. So anyone, I always say to my patients, like, no one wants to see me, no one likes to come visit me, no one likes to come and be my client. But they want to get better and so that's why

they do. And so I have to do a lot of education about what is o c D, what is exposure and response prevention to build trust with them because I'm going to ask them to do the thing they absolutely don't want to do rightfully. So um, and that's probably the thing that frightens them the most. And usually o c D attacks the things we value the most. So if you value your relationships, it will target your relationships. If you love your job, it'll target your job. If

you will love your children, it'll target your children. So because I'm asking them to do really scary things and things they value. I do give them some time and education, but I also emphasize the faster we can start getting you to face your fear, the quicker you recover. And so it's sort of a little dance that we do together of trust and courage and repair and encourage and like it's an encouragement, it's it's a dance that we

do together. And I just realized in my example I gave about you know, I had a fear of flying, and I did do some exposure therapy for that. I'm not really talking about O c D. So tell me, Like I had to visitly, get exposed to an airplane, get on it, touch you know whatever, touch the outside of the airplane, first, had to look at it. But again, I wasn't dealing with an O c D issues, dealing with the phobia. So what are you being exposed to

in obsessive compulsive disordered people? Like, what are they being exposed to when they seek exposure therapy? If someone's having um intrusive thoughts, emotions, or urges, which maybe we should define that before you tell me how you do it. Um, I'd love to know because I'm assuming the exposure therapy

is different than like for a phobia. Right. So there are multiple different categories of types of o c D. Again, majority of people know about contamination o c D, which is the fear of germs and bodily fluids and so forth, things like that. Um. Other people know about symmetry obsessions, right, which is like lining things up and making sure things are very straight and perfectionist stick right. Um. Other people

know about checking obsessions around danger. You know, will I put the you know, if I don't unplug my um my hair curlor, will the house set on fire? And I'll be responsible for you know, terrible terrible things. Um. So we know about those, but in fact they're the lesser concerns that we see in our practice. Right. We see a lot of people have obsessions around, um, harming people,

and this is a very common one. Usually when I do interviews like this, I get like an influx of emails from people going, oh my god, I never thought I had O c D until you said, like these obsessions because no one had conceptualized them as o c D. So harm O c D is actually really common one. It Usually obsession is what if I harm somebody that I love or person in my life. The thing to remember again is the thought is unwanted, repetitive and distressing.

Like we talked about, so people who have harm obsessions are probably like the sweetest people in the world. The thought of this is so just heartbreaking, and for them it's repetitive, like it's all day in their head, in their head, in their head. And so for E. RP.

For that example, we would expose them too often the people that they're having thoughts about, right, and then the response prevention would be not to do those safety behaviors like you know, okay, so don't do the safety behaviors that they used to do to try to stop the thoughts, right, yes, so you know, And exposure can be just about very simple like go and be with the people that you're

afraid of being with. In some cases it needs to be more aggressive if they've got very severe O C d um of you know, having them chop vegetables because for them, they have avoided knives for months or years in fear that they are not responsible with a knife like that they're just gonna go crazy and run down the hall and stab their husband or something exactly exactly. So we also have people with sexual obsessions, particularly around orientation.

So let's say if you're heterosexual, you may be fear that am I You have a lot of uncertainty around am I gay or straight? Again, think of O c D. We call it the uncertain disorder. It usually thrives on uncertainty, right, So the more uncertain you are, the more anxiety you feel, so you may have fears around that. In that case, we would expose you to the thoughts or the feelings or the sensations, and then you would practice not engaging

in avoidance safety behaviors or ruminaty of safety behaviors. So there's just a couple of examples. There's probably twenty common ones that could be related to religion. Um. It could be related to existential like the obsession around what's the point of life? Um. There are many ways in which these obsessions can target. It could be a relationship obsession. A lot of people with relationship obsessions ruminate on whether they will cheat on their partner, or ruminate on whether

they've picked the quote unquote right one. Um. And then again and for some people listening, they may maybe like, but I do a little bit of that right. So it's important to know that people who don't have o c D maybe having these same fears, but not at the at the degree of repetition or extremely how extreme it is, and then you're able to manage that uncertainty. For people with o c D, they've very much struggle

to stop doing compulsions around the obsession. And that's when we would intervene and with someone with like, for example, the relationship obsession, you know, interests of thoughts about relationships. It's not even based in any real thing I assume where it's like, you know, actually this isn't working out for me. We have different life goals. I mean, it's really not based in the same reality that someone who goes,

oh I have that. Sometimes it's like is it that like you could be with the perfect partner and having no problems, but your mind is just going and going yea. So from this is a little bit of psycho clinical talk, but there is a term called ego dys tonic and egosyn tonic. So for people with o c D, their obsession is clinically ego dys tonic, meaning the obsession doesn't line up with their values. So just as you were saying. Often a client will come to me crying, sobbing in disbelief,

and they'll say, it makes no sense. I love my child so much, but I can't stop thinking that maybe I'll harm them. So you can see that it doesn't line up with their values, and that's why it's so distressing, because it's so confusing. Ecosyntonic is where you have a thought or a feeling or a sensation and urge that does line up with your values, right um. And so people with O c D, their obsessions are usually egodis tonic um. So if that helps sort of clarify, they

usually will say, like, it makes no sense. I really do care for my partner. I don't know understand why I'm having these obsessions about cheating or I love. It could be again religion, like I am so committed to my religion, but I keep having this intrusive image of a sin or so for we'll continue the interview on the flip side of a quick message from our sponsors. As part of my anxiety journey, I I've dabbled in some O c D thoughts. I know exactly what an

intrusive thought feels like, and it's terrible. You know, how does someone know who's just sitting at home hearing this the difference between that and what it would be like to be maybe schizophrenic and you're hearing voices saying go push this woman in front of the subway. So how does someone know? I mean, I would assume the difference is, like you said, it's they don't want these thoughts. They're

not like excited by them. Um, so does that mean that people who are going to harm people like the thoughts feel different? Like, how does someone know and they're if they're just listening? Well, I think I think number one don't if if listeners. If I could offer one piece of advice is don't try and figure that one out on your own. Um, try and seek out somebody who can do a good assessment on you. Because one thing to know is if you have anxiety, you will

most likely at some point think you're crazy. Like they just go together. It feels you feel like a crazy person. I have anxiety myself, like, so you're not really probably the best person as an anxious person to assess yourself. I would always encourage you to go to try, just even if it's just for the assessment. And just get the assessment so you know specifically what you meet criteria for. The other thing is is because O c D is

around uncertainty and targets uncertainty. Often people with O c D or some of the other anxiety disorders then question the diagnosis. A part of their obsessive and compulsive disorder is questioning whether or not they have O c D and maybe that this is just a mistake and they really are a killer or they really are a pedophile, right, so that that in and of itself is also a symptom of O c D. Most people who meet criteria for a c D question their diagnosis at some point.

So in terms of doing an exposure therapy, so let's say, okay, we're ready to do it. Um, you know, I'm like the woman used you know an example of a woman who's sitting there thinking, ruminating over is this the right relationship from your something, or someone who's worried about harming someone? If do you give them suggestions of what to do and then they go home and do it alone, or does exposure therapy like does anyone ever have their therapist with them in the situation or you send them out

on their own kind of thing. Listen, and I say to all my patients this was pre COVID, of course, but I always say to them, like the walls of this office when I used to be face to face have seen everything, Like all the exposures have been done in this room. So yes, we do it often, we will do it together because I want to be able to coach the person through the rise and fall of discomfort.

So it's like a wave, right, You'll do the exposure and then if you practice response prevention, you're going to have to ride out a big wave of anxiety, similar to I'm sure you felt on your the airplane, right is right, And so yes, we'll do that in session. But we are pretty clear at the front end of treatment like this is homework heavy therapy. Recovery isn't going to therapy once a week. Recovery is doing around forty to ninety minutes of exposure and response prevention a day,

right a day. So and that doesn't have to mean you have to schedule it and do nothing. You could be doing exposures while you wash the dishes, or you could be doing a lot of what we do is you know, here is a great example, um to use the harm exagm pull. If let's say you have a fear of harming your baby or your husband or your

wife or so forth. Is as you're washing the dishes, you could sing to the happy Birthday song like I'm gonna hurt my my husband to day doo da or whatever you mean, Like you can you can be exposing yourself to the obsession in your mind while you drive to work, while you have a shower, and so forth. Right, um, The work of exposure therapy is to change the way

you respond to a thought. So instead of responding to it with importance and and terror and you know that it has to be solved right away, we actually solve it by either treating it with no importance at all or making fun of it being creative. People with OCD and anxiety are usually super creative people, so we'd be creative with it. And like you said before, you could do exposure therapy by being around the people you're afraid

you're going to harm. But now it sounds like in the homework section, you're washing your dishes and you're exposing yourself to your own thoughts. Right okay? And I love this because I love the notion of not giving the thoughts importance. And you know, like we hear this all the time in so many different ways. You know, if we're doing mindful meditation, we don't have to latch onto

the thoughts and get distracted in anxiety. We don't have to believe the thoughts that we're dying right now during this panic attack. So it all always boils down to the same thing that we have, um, maybe not control over the thoughts coming in, but we can control how we react to them. It's always about that, right, And what I love about this is it's so counter intuitive, as was as his panic disorder recovery is like, I'm sorry, did you not hear me? I am thinking of harming

my husband? And it's like, no, no, you're not thinking of harming your husband. You're obsessively worrying what if I did that? Almost the way that like if you're in church or something and you have this thought like what if I just screamed fuck right now, you know, in the middle of Christmas Eve Mass, And you know, I think the average person has had those weird little moments

and then it goes away. Actually, I just had a session with a patient where I said exactly this, which is, your thoughts aren't the disorder, you're The disorder comes when we respond to them as if they're super important and need to be taken away and stopped. But people without O c D have the same O c D thoughts

that people with O c D have. Um, Yes, there's some cognitive and and actual physiological differences in the brain, but the main thing is they go, huh, that was the weird thought, and then they go on with their day. People with O c D have the thought and they go, this must mean something really important. And I think it is my responsibility to make sure this doesn't happen right, And so that in again in that little places where we intervene mean and go, let's have some fun with

this again. I love like I always joke with clients like no one wants to see me, Like it's it's terrible to have to see Kimberley because it means you have to do really hard things, and you're going to have to face some really hard things. But we can also find some really great, creative fun ways to do this. Right.

If you're afraid of screaming out fuck you, could you know, write the word out if you're afraid of certain things, you can, you know, get your I've had clients right full scripts about their obsessions and turn it into art. I've had people, you know, turned it into poetry, purposely staring their fear in the face. You know it's funny. I'm in comedy and I'm a writer, and I've been doing it the whole time. I've had anxiety. And I treated my anxiety with such reverence, you know that. It

was like, never the two shall meet. There shall be no laughter or creativity about my anxiety. And there wasn't until a few years ago. Finally, literally decades, I was like, oh, okay, maybe I'll apply a sense of humor to it, which is why I wanted to start this podcast. And I had the psychiatrist who was the guy that prescribed my medication for twenty years, and seriously a lot of the time he would say things that I would go home and just get so upset about because I think he

went to school for this. I need a more serious doctor. This is he is not. He is bad at his job and people are going to die because of him. And now I realized he was trying to appeal to my creative side. And he was right. So it's like I kept thinking he was saying do something easy, because he was saying do something creative, and it's not easy, Like you have to first admit that you were wrong about how you're thinking about this, and I guess I

just I don't know. I didn't want to be wrong about it, or I just thought if I tried this silly thing and it doesn't work, them really screwed you know. Yeah, well now, actually, I mean I want to validate you, because fear is a response to danger for and that's what we've developed, we've grown on all these years because of that. Right when the wilder beast ran at us,

fear showed up and we knew to run. And so when our brain, now in this evolved world, shows up with fear and there isn't an imminent danger, we it naturally we're going to be like, let's take this really serious, Like this is what kept us alive for so many years and has allowed us to evolve, so it must be important and worthy of our attention. So it's hard to flip the switch on that, right, It's it's hard to treat fear like it's a thought. Um that is

kind of intuitive. So it does take some time and trust to sort of make that step, but once you make it, then you're often you're running. So with o c D, like, is there a spectrum you know, it's like to like least severe to most severe or is it like, oh, you can have some of the symptoms but not all of them, or is it different than other anxiety disorders in that way. No, so yes, we have like mild, moderate, and severe, but no, one obsession is different than the other. In fact, we treat them

all the same. Um. The severity is very much person dependent, so it really just see, so it doesn't matter really what the symptom is. It's all the same. Like you said, reaction to uncertainty. Yeah yeah, so um, again, it depends on the degree in which it debilitates you. So some patients my essay, I have a small fear of germs. COVID was a big trigger for a lot of people like I have a small fear of germs, but I

can handle it. What really bothers me is this other obsession whereas and and often this is something to think about. Two is, when I used to run groups for O c D in my internship, you would have a group of eight people with eight different types of o c D, and the guy over here who's having hum obsessions or pedophilia obsessions, or sexual obsessions like more of those, like things that we don't know about. He would sit across from the guy with contamination and be like, I wish

I had contamination. I could totally handle contamination. That would be so much easier. And the guy with contamination is sitting across from him, going, what if I had your type of o c D that would be so much easier. So I think the thing to remember is the suffering is the same for all of it, right, It's all the same degree of suffering, and that it's you have to tolerate high levels of uncertainty, high levels of anxiety. Often there's a lot of shame associated um so no,

we treat them all equally. So when you say uncertainty, I mean obviously that's life is the most uncertain thing. When you see that O c D targets uncertainty, like, what exactly does that mean? So let me dig down the person who says, you know, I'm ruminating, I'm obsessing over if my husband is the right person for me. I mean unlike the the more quote normal person who's like, oh,

I think that sometimes. Like to me, that seems like the quote normal person is having some moments of uncertainty, whereas the O. C D person it's not real uncertainty. So am I getting this wrong? Like what what do you mean by it targets uncertainty? Well, similar to like you talked about with the egodystonic piece, right is, clients will often say like I don't wanna hurt that person or I don't want you know, I really love my partner.

So they may even have some really great ground in knowing who they are in that moment, but it's the uncertainty that really gets them. Oh of like what I don't know if I will or not. I don't know what the future will hold, And that uncertainty is really painful, right, And it's repetitive. It's not just like I don't know, it's like I don't know, I don't know, I don't know.

You've got to solve it. You've got to solve like in their head, it's like think of it like um in if you had the radio station in the background saying, but what if you want to what if you want to what if you want to what if this isn't right? What if bad things are going to happen? What if? And it's all uncertainty based, right, It's it's often focusing on you might lose control and bad, bad, bad things

are going to happen and so um. And that's true for any anxiety disorder, but for people again with O c D, it tends to be more repetitive and disregulating, right, because when you have that degree of discomfort, naturally your instincts will be, well, let's just solve this, let's figure it out. But when you figure it out with a compulsion means you've treated the thought like it's important, which means now your brain thinks it's important and you're stuck

in a loop. So if someone has a c D, um that isn't the obvious kind of washing my hands and checking the stove. If it's more like the ruminations like what if? What if? What if? What could like their worst day look like like they call in sick to work and they just sit in bed and kind of ruminate all day until like they can't eat sleep.

I mean, is that kind of what happens? The best way a client multiple clients have explained this, but a client once said to me, it's like you have a jigsaw puzzle and your entire life is depending on whether you can finish the jigsaw puzzle, and no matter what you can do, you cannot get the pieces to match. Like in your mind it feels like if I just get these pieces to go in riot and I get the final piece, and then I can have relief, but they can't find it. And then what they're tolerating with

it is not just uncertainty. It's the distress of that and the and the frustration of that, and then it becomes also about the you know, sort of it targets your identity, like what does it mean about you? If you keep having these thoughts? You must be a terrible person who thinks about sexual thoughts like this all day? What kind of human are you? And because you can't solve the puzzle, you're left with this massive mess of just thinking, and so it could be just laying in

bed ruminating. For many people, it's repetitive actions, like asking reassurance over and over and over and over and over again, even though you know they've answered it as soon as you ask the question. The uncertainty just comes right back. And it's not just like, oh, maybe uncertainty, it's like urgent uncertainty. Anxiety bites will be right back after a quick little message from one of our sponsors. I don't

mean it's like where does this come from? But is there a known reason why, like someone may develop O c D as opposed to like a phobia of driving or something like that. Is there any kind of genetic reason or nature nurture thing both, So we understand there is a nature and a nurture components. So genetics are very strong. If you have a family member with O c D, you're more likely. But the truth is, I think of we think of an umbrella, and the umbrella

is what we call O c D related disorders. So O c D is under there, as is panic disorder, health anxiety, phobias, hair pulling, skin picking. So there are many other disorders that fall under the obsessive compulsive umbrella, and often genetically you will have one or more of those disorders. Social anxieties another one. Um. So yes, there

is a genetic component. There's also a nurture component in that if you were raised with very of course, like strict rules and and strong, very strong beliefs that that

can can impact it. What we know scientifically about the brain of someone with OCD is think about everyone can just imagine in your brain is a pair of brakes and an accelerator, right, and everybody has intrusive thoughts, right, But for the person with o c D, they their brake system is not connected very well, and so it's really hard to pump the brakes on those thoughts, and their accelerator is a little overreactive or overactive, and so

when you have those thoughts, it presses the accelerator really really fast. Imagine, Um, this is not physiologically correct. As you know, we don't have brakes and accelerators in our brains, but imagine our brain has an accelerator. So when you have no CD and you have a thought, it's like they've pushed the brakes and they're going strong, like really loud, really repetitive and so forth. So that we know that this physio logical pot is happening in their brain as

well for reasons, yet we don't understand. Yeah, do you think that, Like, I mean, it sounds like every anxiety disorder when it gets down to it is fear of the unknown. It's like a big existential crisis that we all have, right, we all have our different disordered ways of dealing with it, and for some people aren't even

bothered by this. You know, who knows. But do you think if if we had certainty in life, like if we had every answer we wanted, that we would just find a way to still have all of our anxieties and O c D, Like, I'm sure that wouldn't be enough either, right, or that would be the cause of our stress or something. Well, and let me use O c D as the perfect example. So let's say there's another kind of o c D called need to know o c D, and so it's often love I never

heard of this. Yeah, there's many different subtypes, but one is called need to know. So it's not even that there's a danger involved. It's just that their brain is saying, but I just need to know. So like example might be the one that I was given when I was in training. Is like, let's say someone has the need to know about a certain brand of toilet, Like it could be as random as that, but the urgency and the urge to find out the answer is so strong

and so uncomfortable. I don't want to minimize this is so painful. They just have to go and find out, like I just have to know. So they go and they check and they get the name of the toilet or they get the name of whatever it is that their obsession has targeted. And so, okay, I got it. I relieved it right. But it only takes one millisecond for the brain to go, are you sure? Are you sure? So imagine you go okay. Like health anxiety is another example of this, Oh what if I'm dying of cancer?

So you go and you get the m R I, and then all that has to happen is as you're walking out of the doctor's office, he says, yours healthy as can be. All you have to do is have the thought, well, what if the doctor missed it MHM, or what if the m R machine wasn't working well that day, or what if um I didn't answer a question correctly? And that meant like it only takes one thought to undo all of the certainty that you've got.

And that's a very typical experience of O c D. It sounds like a real control issue two in the sense of like, if I do this correctly, I will get the absolute right answer and then I can rest well. Most anxiety disorders are caught up in what we call cognitive errors or cognitive distortions, and often one of the most is black and white thinking like it's has to be all good or all bad, right, So so those distorted thoughts can often fuel our urgency to get certainty

or relief. Does o c D ever get confused with other disorders? Like do people get misdiagnosed You've mentioned I think that you know in the seven to fourteen years to get it right, Like, what are common things people get misdiagnosed with? It could be unfortunately anything Commonly, a d h D is a common one because people will report difficulty with concentrating, you know, racing thoughts. You know, it's very common for that to be and vice versa. People who have actual diagnosis of a d h D

can sometimes be diagnosed with anxiety as well. UM. So often a d h D sometimes bipolar UM, often mostly generalized anxiety. They'll get a generalized anxiety diagnosis. UM. You know, it could be any diagnosis right that they could be misdiagnosed with. Most commonly, what I hear is more of the dismissive like you don't have a disorder, you just think too much, or you know, like you need to you know, you need to eat this whole grain diet and this this sort of quirkiness will go away. So

it's more of that kind of thing. And so what are some treatments for o CD? We've talked about exposure therapy? Is there like a most successful or is it a company you know, is there a great medication for their What are you seeing people who are really recovering? What are they doing? Right? So, the gold standard treatment for our c D is exposure and response prevention. However, if you can match that with an S s R at

an o c D dose, that's your golden combination. If scientifically, if you had to choose between medication and e m P, you would choose EMP. It has better outcomes, right, UM, But that's what we know at this date and time.

But what we've really learned in the last decade is there also these supplemental treatments that can elevate the EMP and the medication and they are mindfulness practice as you've mentioned um all, So acceptance and commitment therapy UM, which is an amazing supplement to e P which helps you to number one, practice some very under the lens of my mindfulness skills, but also helps you to define what

your values are. So instead of doing compulsions, you would engage in value based behaviors UM, which is really wonderful. App Like another way for us to frame e m P is not only we're not going to take away your discomfort and just let you sit in terrible nous, We're actually going we're going to actually pivot towards the thing that you value and you want in your life. UM.

So that's really wonderful. There's new research now around adding dialectical behavioral therapy UM, which is for those who struggle with regulation. So so we're getting these new sciences every day that sort of helps supplement and complement the work UM. But at the end of the day, what I would say to to anyone with O c D is EP he has to be the focus because if you aren't facing your fear UM, it's likely you're avoiding it. And if you're avoiding it, you're doing that compulsion right and

you're like feeding it exactly. And and so in the acceptance and Commitment therapy, I love. That is that What does the word commitment means? That? Is that like the defining your values part? Like, yeah, so the commitment pieces not just committing to the values, but committing to the actual experience. So there's a lot of radical acceptance in there. It's committing to staying in the present and staying with

the feeling instead of running away from the feeling. So commitment can take multiple can be multiple aspects to it, right, So imagine you're uncomfortable. You have to commit to being uncomfortable. You have to commit to not doing the compulsions. You have to commit to your values, like, there are many things that you commit to in that moment. I'm assuming you do a lot of um helping people get acquainted with uncertainty or to the point where they're tolerating uncertainty

and getting comfortable with it. Is that sort of the goal in all of this on yes, I mean I yes, I will preface is last year I wrote a book UM called the Self Compassion Workbook for a cd UM published stud New Parbenter Publications. I wrote that book because number one EP sucks and it's really hard and no one wants to do it, and so it is also important that you sort of what I say is you wrap the exposure in self compassion. So I'm not doing

saying that as a plug. I'm saying it as more of because it sucks so bad and because it's so heavy lifting kind of therapy, it is important that you also have a gentle, compassionate approach to it. Um that tends to keep morale up and motivation up. I think it's a huge piece of the work as well. So the compassion part isn't saying, you know, take a break. It's like, you're gonna do this thing, but we're going to. No, compassion doesn't say take a break. That's the misconception of compassion.

So let me let me just quickly say, so compassion, if you really dropped into the compassionate person inside you, it never it doesn't say take And of course if you're sick and you're exhausted, yes it would say that. But when it comes to fear, the wise compassionate part would say, I got you. Let's face this fear like this. By facing this fear, you get your life back. Let's do that. That's the compassionate act um. So no, at the beginning of the book, as a whole chapter on

like compassion is not unicorns and fairies. It's facing fear and writing waves of really uncomfortable ship. But it's so rewarding and so empowering if you can do that. It sounds like it's just the opposite of like beating yourself up, like you loser, What do you mean you're gonna check your stove again? Like come on, normal people don't do this, Like that's not a compassionate approach. No, it's very supportive and almost coaching, like I call it like the kind coach.

It it's saying instead of saying like get down and give me twenty your loser, it's saying, you can do this just one one more minute. You can do it to stay on, stay with it just a little longer. We got to like hang on. It's it's that kind of thing. And so in your work, how I don't mean like how long does this take? But you know someone out there who's like, Okay, I'm gonna go start going in there be for my O, C D. What can they look forward to if they put in the work.

I mean, well, they feel monumentally better in a year. Yeah, So yes, you should definitely see an improvement by a year. So as a typical host of treatment for a CD, I don't like to kind of give dates because everybody is different and if you've got um extra a diagnosis, it takes a long But under science they say twenty four sessions and you should have some pretty massive change. Right. That's great. Yeah, But I even go as far as to say, like, the way that we do treatment is

very gradual. We don't throw you under the bus. We start baby steps and you get you know, you get the hang of it, and then you go for it. Then what we do is we usually do a huge inventory of all the compulsive behaviors you do, and we just work our way up them, right, like start easy, and you work your way cross out the list, cross

out the list. So often when people start crossing out these compulsions, that in and of itself is rewarding, like, wow, I'm doing it right, like I'm starting so as I think real recovery is really looking at that list and getting it all the way down. But a lot of people will be shocked at how even the first exposure of going wow, I didn't do that compulsion and I faced my fear, or maybe I even had the full on panic attack and I survived. That in and of

itself will change how they view themselves. They'll feel more empowered, like it's a it's it's hard work, but it's so empowering and it's so like it's badass work. Yeah. I know in my own work that my self esteem would just leap when when I was able to say I did this thing. And sometimes I have to not belittle myself and go, yeah, you got on a plane. Good for you. So it's like no, no, no, this is I'm a big girl. This is a big deal, Like

I have to celebrate that. You know. Um, of course it's easy to do something you're not afraid of, but like, I'm even more badass than the people on this plane that aren't afraid because it is easy for them, but you know, I had to reframe it that way. And and so lastly, what should people look for, you know, when they're looking for, um, a therapist to help them with their O c D. I mean, there's no messing around, like that person has to have O c D in there.

I don't I don't mean title, but but it can't be like, oh, I just you know, I do everything like that's not going to work, is it. No? No, No, We Like I said, a thorough assessment can determine how much you can recover, right, And the truth is, um, it's also how honest you are. So often you know, I have staff that work for me and we're constantly consulting. Is a lot of times people don't even want to tell their therapist about their thoughts because they're so ashamed.

So the more the more you could be honest with your therapist, reach out and get a O c D therapist who treats using e r P. And if you can really just sort of oh, let it come out, like, just really be honest with them, you can make massive, massive changes. Um. So absolutely yeah. It does require, um first, knowing you have O c D and be an assessed correctly,

but then it does require some work for sure. The crossover between talking about these things and the world I was in before of comedy is that I say things on stage that I think in my private mind, and I I know it's going to be relatable because I know I'm not special. So if I thought it, so does everybody. And it's like a magic trick you're doing when you say confessional things and then people go, oh

my god, I thought I was the only one. And I can't believe the things I say that people come up and go, I thought I was the only one. I want to go, really, you really didn't think anyone else thought this? You know. It's like and so it seems like in that same way, I mean, there's really uh, it's like there's really nothing anyone could say that would shock the therapist. Right, it's like there's no the worst

I thought you're having anyone out there. I mean, I hate to say, you're probably not that special, right, No, No, I I I love I'm a big goofy this way, but I love like the first few sessions where I say, like, I guarantee you won't shock me, and they say, oh, but you haven't heard my thoughts, like you know, like ah, and they when I always just love that moment when they do tell me, and I'm like, nah, I had better, like like I've read worse. Like I think that that

is so true. I think it's shocking to people that there are more. I think because often the content of their obsessions are pretty scary. But no, there's there's nothing I haven't heard, right, Um, and there's always those people who are so overjoyed that they're not the only one, which just shows you how much work we've got to do with stigma around mental health. You have this course that we were talking about before we started recording. Can

you just tell me a little bit about that, right? Yeah, So, Um, I have a private practice, so I see clients face to face. But what was happening is I was having an influx of people who I couldn't help. They they lived in out of this country, out of the state, or so forth, or the fact that therapy is expensive, um, and so out of sort of a sense of desperation, I decided I'd make a course basically explaining exactly how

I would tell my clients the process. Remember we kind of talked about like the first session is explaining what is the e O CIT, what is e r P how you would put together like the list of all the compulsions. So it's called e ar P School. Um CBT school is the name of the website, but e r P School is the course, and it basically helps teach you how to put together a plan where they can start facing their own fears in their own time, in their pajamas, if that's how they want to do

it from home. It was really great during COVID because you know, it was hard to get access to care. So yeah, it's it's I'm just so proud of it and happy to offer it. I'm so glad you do. Yeah, and anything we can do in our pajamas, I think is just really exactly Well. Thank you so much for enlightening me. And I'm hoping a lot of people hear this and they go, oh my god, I don't have this major major craziness. I'm oh my god, I can maybe live a full life and get some recovery. Oh

my god, I'm not so special, but you're special. But you know what I mean, You're you're special. But that was a lot of good information, wasn't it. I hope you're feeling a lot better if you relate to any of these symptoms and you've been avoiding getting treatment and just thinking something's really really wrong with you. No. No, So here are some of the takeaways from my chat with Kimberly Quinlan. To have o c D, you must have a certain criteria of things. First and obsession, which

is defined by an intrusive repetitive and unwanted thought. Second, a compulsion the behavior that we do to reduce or remove uncertainty or anxiety or discomfort usually due to those thoughts. And third, it's a disorder, which means that the obsessions and compulsions are disrupting your life and you're functioning to

a problematic degree. An obsession usually shows up in the form of a thought, but it can also show up in the form of a feeling or a sensation or an image that keeps popping up in your brain, or it could be an urge that comes up and overwhelms your body. A common misconception about compulsions is that they have to be physical, like washing your hands, but many compulsions can't be seen by the eye, and one of the biggest is a mental compulsion ruminating trying to resolve

problems in your mind, and another compulsion is avoidance. People are often misdiagnosed by doctors unfamiliar with this, who think that people with o c D are only displaying physical compulsions. There has been recently a growth of therapists who specifically treat O c D, but the community is still in crisis as it takes seven to fourteen years for someone

with o c D to get correctly diagnosed. There are apps that have been created for people with o c D. For example, you can take a picture of your stoves so that you know for certain you've turned it off or that you've locked your door, but that still acts as a compulsion and it keeps the disorder going, and a lot of these apps are giving people the opposite of recovery skills. The gold standard for o c D treatment is exposure and response presentation known as e r P.

I don't think the word presentation is correct. I think it's exposure and response prevention. And I don't know why I wrote yes, it's prevention, not presentation. Forgive me, it'll be correct on my website. So the gold standard treatment for o c D is exposure and response prevention known as the RP. You would think that I subconsciously have a presentation do or something. No, I really don't know

whether word came up um. In e ARP, the patient is exposed to their obsession, they identify their fear, they find a way to face their fear, and then the response prevention is that once as patient has been exposed to the fear, the RP targets eliminating the compulsive behaviors, but both must be a part of treatment for recovery to be successful. O c D attacks the things that we value the most, So if you value your relationships,

you'll have o c D around your relationships. If you love your job, you could have o c D around your job. There are multiple categories of o c D. The majority of people are only familiar with contamination o c D the fear of germs or something like symmetry obsession or checking obsessions around danger, like if I don't unplug my hair curl, or I'll set the house on

fire and be responsible for terrible things. The physical compulsion types of o c D are the lesser concerns that most therapists c But most O c D patients have an obsession around harming people. They're terrified that they're going to harm someone they love. It's an unwanted, repetitive and distressing thought. People with harming obsessions are usually the sweetest people in the world, and the thought of harming others is heartbreaking to them, but the thoughts are repetitive all

day long in their head. Some people can have o c D related to religion. It could be an existential obsession like what's the point of life? O c D is a disorder of uncertainty. The more uncertain someone is, the more anxiety they feel. Some people in a relationship have an obsession with ruminating on what if they cheated on their partner or did they pick the right person, or even thinking, you know what if I'm gay and

I thought I was straight this whole time. It sounds normal, but for someone with o c D, this is an extreme degree of repetitive thoughts about all of this, which causes them to do safety behaviors and compulsions to control their obsession. There are terms called ego dis tonic and ego syn tonic, so people with o c D have obsessions that are clinically egodsk tonic, meaning that the obsession

doesn't line up with their values. For example, the patient who would never harm their child but has intrusive thoughts about harming their child. It's distressing because it's so confusing. If you think that you have o c D from listening to this episode, don't try to figure it out on your own. Sec a therapist who can do a good assessment on you, because if you have anxiety, you're

not the best person to assess yourself. Often people with o c D even question their diagnosis, and part of their o c D becomes obsessing on wondering whether or not they really have o c D. Maybe the diagnosis is a mistake and they're really a serial killer or a pedophile. That is a classic symptom of o c D as well. The work of exposure therapy is to

change the way that someone responds to a thought. Instead of responding to an intrusive thought with importance and terror and the urge to solve it right way, the work is to treat the thought with no importance at all and even make fun of it to be creative. People with o c D usually are very creative people, and developing o c D has a nature and nurture component.

Genetics are strong, and if you are raised with strict rules and strong beliefs, that kind of nurturing can impact o c D. Think of the brain as having a pair of brakes and an accelerator like a car, and for the o c D person, their brake system is not connected very well and it's hard to pump the brakes on their intrusive thoughts. There is an umbrella of o c D related disorders, and o c D falls under panic disorder, help anxiety, phobias, hair pulling, skin picking,

and social anxiety. O c D is often misdiagnosed as a d h D, bipolar and most often generalized anxiety. The most common misdiagnosis is, unfortunately, from doctors who can be dismissive and tell patients things like you just think too much. The best treatment for o c D is exposure and response prevention, as well as an SSRI, which is an antidepressant at an o c D dopes. Mindfulness, practice and acceptance and commitment therapy are great solutions as well.

And having compassion towards working on your o c D doesn't mean taking a break and nets ferries and unicorns. Wise, compassion says, I got you. Let's face this fear. But by facing this fear, you're going to get your life back. Let's do that. The work of overcoming o c D is about facing fear and riding waves of really uncomfortable shit. But it's so rewarding and empowering. If you can do it, the average person can see a pretty massive change in their o c D in about sessions or within a year.

You cannot shock your therapist with your thoughts. They've heard it all before. You're unique, but your thoughts aren't. Can Really wrote a book called the Self Compassion Workbook for o c D, and you can get it by going to the link in the show notes. And Kim Really also has an online school to help people with o c D called e r P School. You can face your fears in your own time, in your pajamas, and again that link is in the show notes. Who I

learned a lot today. I hope you did too. Again, just want to normalize everything for everybody before they take that step in in um getting some help with anything. At least I want you to not feel so afraid going into taking your next step. You can email the show at Anxiety Bites Weekly at gmail dot com, and please give the show five star reviews on Spotify or Apple Podcasts. Tell a friend tweet about it. My Twitter is at Jen Kirkman. My Instagram is at Jen Kirkman.

I love when people tag me in their social media. Then I can retweet in then more people find out about the show. Thank you all so much for listening. And again, yes, anxiety bites, but you're in control. For more podcasts for My heart Radio, visit the I heart Radio app, Apple podcast, or wherever you listen to your favorite shows.