317. The psychology of OCD

Have you ever heard someone say they are “so OCD” for simply having a tidy house? Obsessive-Compulsive Disorder is one of the most misunderstood mental health conditions, frequently reduced to stereotypes about neatness or organisation. But for those living with OCD, the reality is far more complex - and far more invisible. In today’s episode, we go beneath the surface to explore the lived experience of OCD: the hidden compulsions, the mental spirals, and the exhausting need for certainty. We unpack the psychology behind it, challenge common misconceptions, and explore what recovery and support can actually look like.

We explore:

• The role of the OCD cycle
• Why intrusive thoughts can feel so threatening
• Types of OCD beyond cleanliness and order
• Why compulsions don’t always look like rituals
• How OCD thrives on shame, secrecy, and doubt
• Approaches to treatment and the path toward healing

Whether you live with OCD, love someone who does, or just want to understand it more deeply, this episode is for you.

Treat my OCD: https://www.treatmyocd.com/ 

Zachary: https://www.instagram.com/ocdestigmatize?utm_source=ig_web_button_share_sheet&igsh=ZDNlZDc0MzIxNw== 

Elizabeth Colbert was our researcher for this episode! Thank you Libby! 
 
Listen to my NEW PODCAST, Mantra: https://open.spotify.com/show/4Ckds0BoJDDpODInN9cWcc?si=b6ad5d555c1940e0 
 
Follow Jemma on Instagram: @jemmasbeg
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The Psychology of your 20s is not a substitute for professional mental health help. If you are struggling, distressed or require personalised advice, please reach out to your doctor or a licensed psychologist.

See omnystudio.com/listener for privacy information.

Episode Transcript

Speaker 1 (00:04):
Hello everybody, and welcome back to the Psychology of Your Twenties,
the podcast where we talk through some of the big
life changes and transitions of our twenties and what they
mean for our psychology. Hello everybody, Welcome back to the show.

(00:25):
Welcome back to the podcast. New listeners, old listeners. Wherever
you are in the world, it is so great to
have you here back for another episode as we of
cause breakdown the Psychology of our twenties. Before we begin,
I wanted to let you guys know, those of you
who lived in the US, that we are going on
a mini podcast tour in the kind of middle to

(00:46):
end of August. I will be going to Seattle, Boston, Chicago,
and there are tickets still available. Each night slash afternoon,
we'll be doing a small live podcast recording, plus a
Q and A. Then they'll be a chance for you
to get your book signed if you have a copy
of my book Person in Progress, and then just really
mingle with me and other listeners of the show, make

(01:10):
new friends, have a glass of wine, have some snacks,
and just kind of get to know each other. So
if that is something that interests you, if you are
ready to meet some like minded people and myself. There
are a couple of tickets still available for some select cities.
I'm going to leave a link in this episode description.
Hopefully I can see as many of you there as possible. Okay,

(01:33):
let's get into the episode. Today. We are tackling a
topic that feels very personal to me, very recently personal
to me. We are talking about OCD. If you guys
don't know, and you probably don't because I've actually never
talked about it before, so this is probably new information
to everyone. I was recently diagnosed with OCD, and it

(01:58):
is a diagnosis that, in retrospect and in hindsight, has
been a long time coming. For so long, I thought
I just had anxiety, and I thought I had a
panic disorder. I thought I just have panic attacks. And
this is where all my issues with thoughts spiraling, repetitive thoughts, rumination,

(02:18):
this is where it all comes back to you. I'm
an anxious person. But at the end of last year,
I began to kind of realize, wait a second, I
actually don't really have panic attacks. You know, probably only
had like three or four in my lifetime, and I'm
actually not an anxious person. I don't get anxious meeting
new people. I don't get anxious trying new things. I

(02:41):
don't get randomly anxious throughout my day. I don't even
get anxious when my life is really busy. The only
time I'm really anxious or I would say, you know, distressed,
is when it comes to this very specific loop of
thoughts that I can't get out of about very specific
things for me, primarily my health and like this grand

(03:03):
philosophical concept of like death and existence. But other than that,
I don't really have anxiety. And at the end of
the end of last year, I kind of had a
mental health player up, which I talk about on the podcast,
and that kind of caused me to go and see
a new therapist, someone i'd never spoken to before. And
when I walked in, I was like, I'm not going
to put any label on my symptoms. I'm not gonna say, oh,

(03:28):
I have depression, I have anxiety. I'm just gonna describe
how I am feeling, and I'm gonna see what she
has to say. And after a while she kind of
said to me, have you considered the fact that you
may have OCD? And it just kind of clicked for me.
I definitely didn't go in thinking that, I was just like, Oh,

(03:49):
this is a theory I want to test out. Something
doesn't seem right around the diagnosiss I've been given. And
in that moment, I was like, Wow, do you know what, Yeah,
you're probably right. I've spent my whole life talking about psychology,
talking about mental health, and I kind of got it wrong.
How was this never apparent to me? How come I

(04:10):
didn't realize all along that this is what was really
going on? And throughout the episode you'll hear some things
around specific symptom patterns and obsessive obsessive patterns that were
very indicative from an early age that just kind of
were missed. And I think the reason that they were
never apparent to me or to anyone else, is that

(04:31):
no one ever talked to me about OCD in a
way that related to my experiences or that I could
understand when we talk about OCD. It was and it
has always been, even when I was at UNI and
I was studying psychology, it was so surface level. It
was so surface level, and I could never really see
myself in the descriptions, the descriptions of cleanliness and organization

(04:54):
and neatness and tardiness. But that is really just the
tip of the psychological iceberg here. OCD is so multi dimensional,
and the reality of it is far more intricate, far
more debilitating, and frankly, a lot more deep than the tidy, neat, clean,

(05:16):
freak stereotypes really suggest. Also, you know, for so long,
OCD has just been a punchline of so many jokes.
I don't think any mental health disorder has been as
trivialized as OCD. But if you're living with it, it's
so complex and it's pretty freaking relentless, if I do

(05:39):
say so myself, And I think our society is really
lacking in an understanding of this, and lacking in how
many people are actually walking around with thoughts, really serious
scary thoughts they can't get out of their head, and
how many people are suffering because of that. And it
really sometimes has nothing to do with the tidy with
the tidy kitchen or hand sanitizer or whatever like order

(06:03):
in their life. It goes so much deeper. So today,
you know, given my diagnosis was almost six months ago,
now I really want to do a bit of a
deep dive into what OCD actually is. Now that I
feel like I know more, I want to dissect some
of its core components, the obsessions, the repetitive behaviors, both

(06:24):
visible and hidden, and also the vast and very varied
ways that OCD can show up in our lives, why
it's often confused with other mental health disorders, why it's
made fun of, and also what is happening in our brains.
I also really want to discuss some of the treatment options,

(06:47):
the ways in which you can find relief if you
are suffering from OCD. I feel like there will never
be a time on this podcast where we don't finish
on a high note. I try not to make it
or make it seem like it's toxic positivity, but I
do think with things like OCD, with any mental health disorder,
with anything that we're going through, there is actually a

(07:09):
lot more hope than there is despair. And there are
really smart people who have come up with really amazing
ways to deal with this and to address the things
that are going on in our brains and in our
minds and in our bodies. So that's really where I
want to leave the end of this episode with a
bit of a brightness on the horizon, a bit of
a silver lining, I will say before we begin small caveat.

(07:32):
This episode is not for diagnostic purposes. If you think
you may be suffering from OCD, please go and see
a registered psychologist or a psychiatrist in your local area
to get help. My real aim for this episode is
just to kind of provide a bit more information about
my own story, why it's actually not a rare story,
and also, yeah, just kind of provide you with some

(07:55):
information general information around what this disorder of really means
for people who are enduring it, because I think we
could all really benefit from knowing more about the lived
experience of people with OCD, whether you have it or
whether you don't. So, without further ado, I don't want
to say excited for this episode. I'm very invested in

(08:17):
this episode and it was a real pleasure and really personal,
personally motivating to research it. So I hope you get
something out of it. Let's go into the complex origins, symptoms,
and experience, but also treatments for OCD. Stay with us.

(08:37):
Let's kick things off by firstly just busting some myths,
because honestly, the popular image of OCD wildly off the mark.
It is not about being unique freak. It's not about
being particular about details. Whilst some individuals with OCD do
experience symptoms related to order and cleanliness, that is just

(08:59):
one faset and it doesn't do justice to what is
really happening under the surface. So what is OCD A
very basic perspective. At its core, OCD is actually one
of the most revalent mental health conditions in the world.
And every time I tell people that, they're always surprised,
but it's true. About one to three percent of the

(09:21):
population has OCD. And if that doesn't sound like a
big amount, I will say that makes it the fourth
most diagnosed mental health condition in the world, coming under depression,
generalized anxiety disorder, and panic disorder. And if we translate
one to three percent into a number, that's around seventy

(09:44):
eight to two hundred and thirty four million people worldwide.
And let's also be clear, that's just the number of
people who are diagnosed, so it's not including the people
that havn't yet been able to access a diagnosis for
various reasons because of health inequality, because they don't even

(10:05):
recognize the symptoms in themselves, because of stigma, any number
of reasons. So if you want to understand ocd's are more.
You basically have to understand as a starting point how
it is described in the DSM five. So the DSM
is basically the reference point for all mental health or

(10:25):
brain related conditions, OCD being one of those, and OCD
is characterized in this book by two main components, obsessions
and compulsions. You have to have both to have a
diagnosis of OCD. Let's break down these components. So obsessions
these unwanted, intrusive and often very distressing thoughts, images or

(10:48):
urgers that just pop into someone's head seemingly out of nowhere.
They are persistent, they typically cause a lot of anxiety
and stress, and they are frequent. They're frequent visitors in
our minds. Here's the key point. These aren't just excessive

(11:08):
worries about real life problems. If you are going broke
and you are worried about money, you are obviously going
to be thinking about money all the time because it
is a present day issue for you that is very,
very stressful. That doesn't make it an obsession in OCD terms.
Obsessions as a part of OCD are very different. They're

(11:29):
what we call ego dystonic, meaning they clash with a
person's true values, realities, beliefs, desires. They also are not
always particularly relevant to what that individual is experiencing in
that moment. So, for example, you may have intrusive thoughts
about hurting someone even though you're not hurting someone at

(11:51):
that point. You can have intrusive thoughts that you're a
bad person, even though you know that doesn't match reality.
You're not a bad person. You can have intrusive thoughts
about the meaning of life that go against your beliefs
about your purpose. Here, you can have false beliefs that
someone in your family may be ill or that you
may get ill, that are totally unreasonable when we actually

(12:15):
pair them up with reality, but which your brain thinks
one hundred percent factual, true information. It's the fact that
these thoughts are so counter to who we are, what's
going on in our lives, how we wish to see ourselves,
that they cause so much fear and such intense anxiety

(12:36):
or stress at times. Here's the other crucial thing. We
can't help it. Of course, you know, if your life
is falling apart, if your world is crumbling like, you're
going to be anxious about what's happening in your environment
and your circumstances. But with obsessive thoughts, they just come
out of nowhere. There's no typically, there's no real reason

(12:59):
that they're there. They just are. How I like to
explain it is that these thoughts are kind of like
a smoke alarm going off on your head, and no
matter how many times you push the button, it won't
turn off. So you just have this alarm going on
and on and on. Someone without OCD can easily turn
off the button, but if you have OCD, you can't.
So that's the first component these obsessions. Then we have compulsions.

(13:21):
These are the repetitive behaviors or mental acts that an
individual feels driven kind of to perform in response to
the obsessive thought. So you think something that's scarer, you
think something that's causing you panic, you think something that
feels terrible in your body, and so the only way
to stop that thought is to go and do a

(13:43):
repetitive behavior, to perform a compulsion that makes that thought
feel less sharp. The goal of the compulsion is to
prevent or reduce the feeling of distress that is caused
by the obsession or it's kind of this weird, this
weird thing that we do that we think is going

(14:04):
to stop something terrible from happening. We think that it's
like protective either way, we kind of do see it
as a good thing that we are doing these and
that we are performing these compulsions because they are somehow
neutralizing a threat or somehow saving us. You know, for example,
you may have this fear that something's going to happen
to your family, But if you flick a light switch

(14:27):
on and off twelve times arbitrary number, well then it's
not gonna happen. How could you not do that if
you genuinely think that your family will perish in a
car accident if you don't flick the light switch on
twelve times exactly, Like, of course you're going to do that.
Of course you're going to perform the compulsion. It's the

(14:47):
only thing that in your mind is preventing this terrible
thing from happening. It's the only thing that is cooling
off the obsessive thought. It's not about pleasure, it's not
about avoiding reality. It's about escaping the terror of the
thought in your mind. It's about escaping what you think

(15:08):
is going to happen if you don't address this thought
with this compulsion just to nail this home. Think about
it like this. An obsession is screaming at you something
terrible is going to happen if you don't do X,
and the compulsion is the desperate, often illogical attempt to
silence that scream and avert the perceived disaster by performing X.

(15:32):
And both of these components, like I said before, are essential.
There is actually something called purely obsessional OCD. They call
it pure o OCD, where the obsession is obviously the
distressing thought, but the compulsion is just to think about
that distressing thought more. And sometimes people can look at
that and think, well, that's not OCD. There's no compulsion.

(15:54):
This person isn't acting in a certain way to prevent
the negative, distressing thought. It is still OCD because the
act of thinking is actually the compulsion is actually the compulsion.
You can understand how frickin' frustrating that can be, but
in some ways it is soothing. Thinking about something constantly
over and over again until it feels safe is actually,

(16:16):
in some ways a form of OCD. It's a way
that we try and try to turn the smoke alarm off,
and that brings us to the OCD cycle, which is
really what defines this disorder. So the OCD cycle starts
with an intrusive thought. Now here's a crucial piece of
understanding that we can't miss out on. Intrusive thoughts are
actually really common. Around eighty to ninety percent of the

(16:38):
general population experiences intrusive thoughts on a regular basis. That's
why intrusive thoughts alone are not enough to be diagnosed
with OCD. Intrusive thoughts are basically just like random, unwanted,
bizarre things, sometimes disturbing that just like pop into your head.
You know. The best example, you're standing on the train
platform and you're like if I just jumped, Or you're

(17:01):
driving your car and you're like, what if I just
crash my car? You're holding a baby, You're like, you
just have this image of yourself like throwing the baby
on the ground, and then it disappears. You know, for
most people, those thoughts are quickly dismissed. You might think
that's really weird. Obviously I'm not going to do that,
like that's crazy, and your brain just filters it out,

(17:22):
recognizes it as just like a random brain blip. But
for someone with OCD, those thoughts don't just pass by,
They become sticky. Their brain doesn't filter it out. It
flags it as really important, really important information. It flags
those thoughts as dangerous. It flags those thoughts as something

(17:42):
that they have to pay attention to. And so when
that thought enters the part of our brain that filters
our thoughts that are are useful in those that aren't,
grabs onto it and holds onto it tight. So like,
let's say you are spending time with your family and
for like a split second, you think, what if I
end up hurting my family member? What if I stab
my family something bizarre like that. Someone without OCD might think, like,

(18:09):
think that, and be like, that is so weird that
I just thought that. What a random thought, What a
horrible thought. I'd obviously never do that when you could refocus.
For someone with OCD, though, instead of just being able
to dismiss it, the brain immediately interprets this thought as
highly significant and threatening, thinking, oh my god, but why

(18:30):
did I think that? Obviously, if I thought that, it
means some part of me really wants to do that,
And if some part of me really wants to do
that, that I'm a monster. And if I'm a monster, I
shouldn't be around my family because if I'm having those
thoughts and obviously I'm going to act on them. You
can see how this creates a lot of anxiety a
lot of dread. Individuals with OCD often have an inflated

(18:51):
sense of responsibility. Inflated responsibility basically means that they have
this exaggerated belief that they as individuals, have the power
to cause or prevent negative outcomes, even when objectively they don't.
This feeling of being excessively responsible for preventing bad things
from happening, even if it sounds delusional to people who

(19:15):
don't have OCD, what it means is that the thoughts
that they're having around family members being hurt, them hurting
family members, terrible things happening really difficult to shake. But
this is where the compulsion comes in. The compulsion is
introduced as this behavior that can make all of that
go away. There is some behavior they believe they can

(19:38):
do that will shield them from the bad thing happening,
that will shield the people they love from bad things happening,
And so of course they're gonna do it. They're gonna
wash their hands as many times as they need, They're
going to ask for reassurance until the cows come home.
They're going to check every single lock twelve times, because
that's how many times they need to do it to
assure ensure that they haven't been anything. You can kind

(20:02):
of see where this is going. One of my compulsions
when I was a child, And again I don't know
how anyone freaking missed this, but I guess I never
told anyone. But when I was a kid, every single night,
before I went to bed, I would pray, and I
would have to pray for exactly one minute and forty
five seconds, and my prayer would have to be very

(20:25):
very specific. I would have to mention every single member
of my family. I'd have to say all of these
certain things. I'd have to thank God for five different
things every single night, although something bad was going to happen.
My family was not religious at this stage. I had
never stepped foot in a church. I think I started
doing this when I was like four. I had I'd

(20:46):
like I had no. I didn't go to a religious school.
I lived in like a part of Australia where, you know,
religion wasn't really a huge thing. But I'd gotten in
my mind that you know if I didn't do this,
people would be hurt. Here's the cruel irony of that.
Though performing the compulsion only provides a very temporary brief

(21:07):
sense of relief before the anxiety comes racing back, but
this just momentary relief actually reinforces the compulsion. Of course,
you're so distressed by these thoughts you're having. Any sense
of calm is one that you are going to pursue.
But what that means is that your brain learns, Okay,
when I have the scary thought that a family member

(21:27):
is going to die, I'm going to get a disease,
something terrible is going to happen. If I do X,
the bad feeling goes away. Well, then of course I'm
going to keep doing X. And this really strengthens the
link between the obsession and the compulsion, making it more
likely that the cycle will repeat the next time the
obsession appears. The child will continue to pray, the person

(21:48):
will continue to wash their hands, they will continue to
check the lock twelve times. And because the compulsion momentarily
feels like it prevents the feared outcome, probably because the
feared outcome was never going to happen anyway, You never
get to test whether the fear was realistic in the
first place. The cycle gets stronger, the anxiety returns, the

(22:10):
compulsion becomes more rigid and frequent. I think something that's
really key to highlight when talking about OCD is actually
how vast this condition really is. Like we said at
the beginning, it's not just tidiness. There are all these
different categories of OCD symptoms that I think is really
important that we know of. So we are going to

(22:31):
take a short break here, but when we return, I
want to talk through these very important categories and how
they are very very distinctive and different. Stay with us.
So researchers and people in the clinical mental health space

(22:51):
often categorize OCD symptoms into various common themes or dimensions,
just to kind of make it easier to label people
and to choose what treatment would work best for them.
I'm going to share some of these with you guys. Now,
this is actually, by no means an exhaustive list. It's
just the most common ones. So the first is the classic,
it's the most recognized type of OCD. Contamination and cleaning

(23:14):
obsessions to do with this might involve intense fears of germs, dirt,
bodily fluids, chemicals, chemicals in your food, or even mental contamination,
feeling dirty from a negative thought or an interaction. The
underlying fear is not of the dirt, not of the germs.

(23:34):
It's of illness. It's of death, it's of moral impurity.
It's of something being in your body that you can't control.
Compulsions around this might involve excessive hand washing, showering, cleaning objects,
avoiding perceived contaminants, or asking others to clean things because
you trust them more, all driven by that desperate need

(23:56):
to alleviate that fear. I actually read a really fascinating
article about a group of people, well, there weren't really
a group, but people individually who would not get the
COVID vaccine because they were so scared of obviously, of
having something in their body that they couldn't control. It's
not that they thought the vaccine was bad, it's not

(24:16):
that they didn't even believe in vaccines. They were just
so fearful of chemicals or things they didn't understand being
in their body. And so you can see how this
goes very very deep and has a real societal impact.
The next kind of category is around symmetry around symmetry, ordering,

(24:37):
and feeling that things need to be just right, perfectly aligned, balanced, exact.
This fear can be rather vague, but it can also
be really intense, and really what it's coming down to
is this sense that something bad might happen if the
world doesn't have order, and that there is an impending

(24:57):
sense of doom or terror that will afflict the person
if their environment isn't ordered just so. Compulsions around this
might involve arranging objects repeatedly, repeating actions until they feel perfect,
so reentering a doorway until it feels just right, because
if it doesn't feel right, maybe that's a sign that

(25:19):
something's off. Doing counting rituals is another one. The sheer
distress and fear comes from things feeling out of place,
and this like very unbearable internal tension that doesn't settle
on its own. It needs to be settled by things
in the environment or certain sensations. Another really common dimension

(25:42):
of osity centers around harm and responsibility, something that we've
kind of alluded to already in today's episode. This is
where it can get quite dark and distressing for the individual.
These obsessions often involve really terrifying fears of harming oneself,
harming others accidentally harming them, or being violent or aggressive

(26:07):
towards people without really wanting to be. For example, a
new parent might have a terrifying, intrusive image in their
brain of harming their child, even though they have absolutely
no desire to do that, and that creates really immense
guilt and shame, and some psychologists and researchers have even
suggested that it's the very fact that they know they

(26:30):
won't do it, and that it is so terrible that
their brain feels like continuously drawn to it like a magnet, like, wow,
this thing is so intense and so dark. When we
have to sit with this even longer to store really
make sure, but in sitting with it, the lines kind
of get blurry. You don't actually want to do it.

(26:51):
That's something we really have to be clear of here.
You don't want to hurt someone, you don't want to
hurt yourself. But the fact that the thought is there
confusing to you because you think, well, why would I
be thinking of it if I didn't want to do it.
Compulsions to do with this involve extreme avoidance of sharp
objects of children of certain people, but also constantly seeking

(27:15):
reassurance that you haven't harmed anyone, constantly confessing perceived bad thoughts,
or just constantly mentally reviewing past events to check for
any wrongdoing. You can see why this is sometimes confused
with anxiety. Right. This overthinking element, this rumination element, is
something that OCD and anxiety have in common. There's also

(27:39):
religious or moral OCD. This is sometimes referred to as scrupulosity.
Scrupulosity you know when you see a word written down
but you've never like actually said it before. Like scrupulosity, Yeah,
basically involves obsessions and compulsions centered around religious, moral, or
ethical beliefs. I was actually listening to a podcast about

(28:01):
this the other day that was interviewing priests, new priests
who were dealing with these people who just like wouldn't
stop calling them members of their church, who would confess
every single little thing that they'd done, even when it
wasn't bad. And the priests were having to deal with
this fact that they were like this. One guy was like, oh,
you know, I went to vacuum my carpet and I

(28:23):
missed a bit, and is God going to be mad
at me about that? And the priest had to be like,
oh no, and this woman who was like, oh, you know,
I cooked dinner for my husband, but I was gonna
cook something else. But what if he wanted the other
thing more than he wanted the thing that I gave him,
I've displeased him. I'm evil? Does this mean I'm going
to Hell? And the priests had to be like no,

(28:45):
it's these fears of sinning, of being immoral, and really
it's a deeper fear of divine punishment, of hell, of
eternal damnation. So these people might pray excessively, repeat religious rituals, obviously,
seek constant forgiveness from members of the church, or really
avoid situations that they think could lead to immoral thoughts.

(29:07):
The final one I want to mention is relationship OCDA.
I feel like some of you probably saw this coming.
We actually have an entire episode on this from earlier
this year with an expert. All she does is talk
about relationship Osiday. She is amazing. She knows every single
dimension on this. If this is something that you feel
particularly drawn to understanding more, you can go and listen

(29:28):
to that episode. But relationship OCDY really involves intrusive doubts
and obsessions about your romantic or close personal relationships. These
obsessions might really focus on a partner's flaws, the rightness
of the relationship, any doubts you have in your mind
about how much you love them, about your attraction to them,

(29:50):
whether other people feel this way about their partner, whether
your relationship is wrong, whether it's right, whether you're doing
the right things. The core fear here is off and
around making the wrong decision, around hurting someone by not
loving them enough and leaving them, of wasting your time,
of wasting their time. Compulsions really often include excessive comparison,

(30:14):
constantly comparing your relationship to others, mentally reviewing the relationship history,
constantly seeking reassurance about the relationship's validity, constantly asking other
people about their relationship, what was their timeline, how were
they feeling at this point in their relationship, to kind
of compare your own. This intense doubt and fear can

(30:37):
really damage almost every single relationship that you're in, even
the ones that are almost perfect, even the ones that
there is absolutely nothing wrong. If you look for something
wrong in a relationship, you will find You will find it.
You will absolutely find it, because no relationship is perfect, right,
So if you have OCD and your brain is real

(30:58):
hell bent on hunting for that hunting for that thing
that's wrong, you are going to find at least something
that you can cling onto. So with these categories, it
might be that someone has just one type of OCD,
but it is also possible for OCD to change and
attach itself onto different themes because the core underlying mechanism

(31:21):
is the same, it just might have a different expression.
The sheer variety of themes as well, means that true
people with OCD might present completely differently, yet they will
both be battling the same underlying mechanisms of intrusive thoughts
and compulsive responses. The issue that comes with this is

(31:42):
that sometimes they don't get the proper treatment or diagnosis
because people don't understand where OCD came from, even some
you know, professionals, even some people who are meant to
specialize in mental health disorders, because this disorder is so varied,
they just might not recognize a new permitation. So before
we get into that part of this story and that

(32:04):
part of why this happens, let's actually talk about what
causes OCD. Where does this come from? Obviously, our brains
play a very significant, if not the most important role,
hence why this is called a mental health disorder. But
it's not that you have a broken brain by no means.
It's that it's that there are just specific differences in

(32:26):
how certain brain circuits function versus how they function in
someone else. And these differences, which no one can really control,
no one's in charge of, they do predispose someone to
developing OCD compared to someone else, and they contribute to
profound feelings of being trapped by thoughts and compulsions. The

(32:48):
crucial structure we need to understand and bear with me.
It's a long name, but it's called the cordico striato
thalamo cortical loop CSTC loop. I know you're probably thinking,
what the heck is that? That sounds like you just
made that up. I didn't. It's a real thing. It's
a real structure. It's basically a brain circuit that acts

(33:10):
like the best way I can describe it is like
it's a busy highway in your brain for information and
it connects all these areas that are involved in decision making,
error detection, habit formation, reassurance, checking, observation, all these things.
It's a very important structure, and when part of this
highway doesn't work or it's closed down, the loop obviously

(33:31):
can't function, and that is where a disorder like OCD emerges.
So the first area that we need to understand as
part of this loop is the part that's responsible for
decision making. It's called the orbitofrontal cortex. In OCD, research
has shown that that cortex, that part of the cortex
I should say, is hyperactive. It's like an overly sensitive

(33:54):
alarm bell, constantly flagging thoughts as critical threats, feeding that
fear that something terrible is going to happen even when
it's not. The way I describe it as like a
really anxious parent who sees everything as something that's going
to harm their child. So that is the first part
of the brain that's quite hyperactive or something's going wrong.
The second area is the area responsible for error detection.

(34:18):
It's called the anterior singulate cortex. It's located very deep
inside the brain. When it's not working right, it keeps
again sending this something is wrong signals. So that orbitofrontal
part of your brain is saying that it's wrong, as
saying that something is wrong. And then the second part
of your brain is interpreting that and sending these alarm

(34:39):
bells that it doesn't really need to. That is what's
creating this fear response or this distress that you can't
turn off. And then we also have the basal ganglia,
which is responsible for habit formation. So errors or issues
with this area mean that you are going to start
performing these compulsive, ritualistic actions and falsely associating those actions

(35:02):
with a positive outcome. So you know, you think something
bad's gonna happen, you perform an action, the bad thing
doesn't happen. You know that. Logically you can kind of
see that, well dah, like maybe the bad thing wasn't
gonna happen anyways, But this part of your brain thinks,
oh no, like, actually this action has been reinforced by
something bad not happening. Obviously I saved myself. Obviously I

(35:27):
did something right. This is the cure. So basically, when
this part isn't working, it makes it really hard to
stop performing your competitive action in response to an unwanted thought.
So you can kind of see when the communication between
these brain areas is a little bit off. This is
what creates that loop that we were describing before. Basically,

(35:48):
what I'm trying to say is it's not you, it's
your brain. So let's talk about when these symptoms first
begin to emerge. So OCD can actually emerge at any age,
kind of scary when you think about it, But there
are two primary ages where it is most likely to begin,
or occur or first be noticed, and that is between

(36:12):
the ages of nine to eleven and then again around
twenty to twenty one years of age. If we think
about those years, they are really significant periods in our lives.
The first is basically when puberty begins, and then the second,
when we reach out twenties, is where we have this
second huge shift in our lives in terms of gaining independence,
maybe moving away from home, forming new relationships, this added

(36:35):
sense of responsibility, which we know people with OCD really
struggle with. It's even what some people call second puberty,
that first those first two years of your twenties, like
so much is changing. There are monumental shifts, and this
can you know, cause a massive impact on our stress
levels and our mental health. So some researchers will say

(36:56):
that it's not that OCD is more likely to occur
that these time periods are significant, is probably what I
should say. It's not that these periods of these years
are special in any way, like that number doesn't mean anything.
Is actually what's happening developmentally, and it's actually what's happening
in terms of life stress. So much is changing during

(37:17):
those periods of our life. It's the change, and it's
the stress that is triggering OCD. Another really critical time
when people are more likely to be diagnosed with OCD
is right after a child has been born, right after
they've given birth, because obviously that's like, that's a huge

(37:38):
life change. Your whole center of orbit shifts to be
that child. And often when someone develops OCD around this
period in their life, the symptoms often focus around the child,
around accidentally accidentally harming the child, contaminating the child in
some way. So it is really tied to the context,

(37:58):
and it really does highlight how stressful significant life changes
can act as a trigger, especially if you already have
a biological predisposition, especially if a family member, a parent,
a sibling has OCD, it's likely that you have some
of the same elements of your DNA blueprint that make

(38:20):
you more predisposed. Doesn't mean that it's going to happen.
Doesn't mean that you are determined to develop OCD. It
just means that it may be more likely and that
you are more susceptible to triggers. Another explanation also comes
down to the role of serotonin. A lot of people
think of serotonin as purely like the happy chemical alongside dopamine,

(38:41):
but we do know that they are really involved more
deeply in motivation and in emotional regulation, being able to
have a feeling, have a thought, and not invest in
it entirely. So people who are more predisposed to developing
OCD might also have some differences in terms of how

(39:04):
their brain processes, interprets, stores, releases serotonin, which is why
if you go to a doctor, if you're to a psychiatrist,
one of the first things that they will often offer
you as a solution is SSRIs selective serotonin reuptake inhibitors
complicated name, basically just means that there's more serotonin in

(39:27):
your brain for your neurons and your synapses to use,
so you are less likely to suffer from a deficit
in that neurotransmitter that could contribute to OCDA symptoms. Actually,
just recently, a really big paper came out talking about
whether SSRIs are actually even effective at all. I'm not

(39:47):
even going to get into it because I don't even
think that I have formed my own opinion about the research,
but it's something on the horizon. People are kind of
starting to rethink this purely biological approach to mental health
out aside. Basically, what we want to understand is that
OCD really isn't just caused by one thing. It is
a complex interplay of various factors, kind of like a

(40:10):
perfect storm of psychological vulnerabilities or patterns to do with biology, predisposition,
environmental triggers that all kind of come together and mean
that someone ends up in this terrible obsessive compulsive loop. Okay,
we're going to take another short break, but when we return,
I want to talk about the light at the end

(40:31):
of the tunnel. I guess, some of the treatment options,
some of the ways that we can better understand our
OCD and also just advocate for ourselves in a system
that doesn't really understand it. So stay with us. We
will be right back after this short break. So, as

(40:52):
my story kind of explained at the very beginning, getting
an accurate OCD diagnosis isn't always straightforward. In fact, significant
delays are incredibly common. You know, I was looking into this,
I was like, I cannot be the only one whose
experiences and it's not like I'm blaming anyone or saying
you know, yeah, I'm not blaming anyone. I'm not blaming

(41:12):
my family, I'm not blaming previous mental health professionals. I
think it's just because of like the inherent invisibility of
many symptoms, the fact that sometimes people don't see the
nuances between symptoms, that anxiety and o city are different
because of like there's like a five percent difference, but
that five percent means everything. And also the shame the

(41:35):
fact that sometimes a lot of the compulsions or the
obsessions are things we don't really want to admit, and
that leads to more severe symptoms and more prolonged suffering.
Like I said, I was researching this, I found this
study from twenty twenty one from the University of Leipzig
which actually found that the average time between the age

(41:56):
that symptoms appear in the age that people get diagnosed
OCD is on average thirteen years. Thirteen years over a decade.
That's the average, the average, and that was just like
absolutely shocking, and to break down some of those factors,
I think firstly, a lot of people do hide their
OCD symptoms. Obsessions can contain really disturbing content, thoughts about violence, sexuality, blasphemy.

(42:23):
That's deeply upsetting. And we have been taught to believe
that our thoughts reflect who we are and that we
have control over our thoughts. So if we think bad things,
we must be a bad person. That's actually not how
our brains work. A lot of our thoughts occur unconsciously

(42:43):
and then flowed up into our conscious mind, and it's
not because we genuinely believe them. It's because our brain
is just shooting out electricity and seeing where it lands.
People are often really terrifying, Like if I reveal these thoughts,
people are going to think I'm crazy, which, by the way,
I hate that word, but that's what they think. People

(43:04):
are going to think I'm crazy. People are going to
think I'm dangerous. People are going to think that I
should be institutionalized. And this immense shame and fear of
misunderstanding really huge barriers. Unfortunately. You know, there have been
documented cases where individuals, especially parents, struggling with intrusive thoughts
about harming their children, have sought help, have said I

(43:26):
don't want to do these things, but I am thinking
about them, and I can't control the thought, not the action,
the thought. They've disclosed those to a healthcare professional, and
they face devastating consequences. Instead of receiving appropriate mental health
support for OCD, they have sometimes been met with suspicion,
They've faced investigations, they've had their children removed from them.

(43:48):
This really deep rooted, I think misunderstanding, this cultural misunderstanding.
It creates a really chilling effect where those most in
need of help are terrified to seek it, fearing these
catastrophic consequences, and so you just suffer in silence, and
that actually reinforces the hidden nature of OTDY, especially some

(44:09):
of its more taboo subtypes. It's the fact that our
society hasn't doesn't understand this, doesn't understand the difference between
a thought, a desire, and an action, and so it
clumps them all together and shames people who have any
of them. Nowadays, clinical guidelines do really strongly advocate for
professionals to be trained in differentiating these egodostonic intrusive thoughts

(44:34):
from actual intent or risk of harm because there has
been a lack of specialized knowledge in the past that
has created really severe and damaging misjudgments. You know, the
International OCD Foundation explicitly states that thoughts are not indicators
of a person's true desire. Someone's actions are more indicative
of their desire, their desire to hurt or harm people.

(44:57):
And they've really tried to say, like, people are not
their thoughts, and if they are infessing their thoughts, they
obviously don't want to act on them. So please treat them.
Please treat them, not just in general in terms of
give them help, but give them respect. But unfortunately, not
all practitioners or even mental health clinicians are fully trained

(45:17):
in recognizing those many diverse presentations of OCD. And it's
not all their fault, you know. They might just be
less familiar with certain symptoms. They may just have previous
misconceptions or their own beliefs about what kind of person
would have these thoughts. It does just end up though,
perpetuating suffering due to missed opportunities for health. Another study

(45:40):
that I found looked at GP physician like family doctors,
their ability to diagnose OCD, and it found that cases
were misdiagnosed. Around fifty percent of the time someone comes
in with OCD, there's a one and two chance half
like a one and two chance that they're going to
get the right diagnosis, which is really really scary, and

(46:04):
it's really crucial that they know what to look for
because they're often the only entry into receive they are
the only entry into receiving treatment. So if they miss
the ball, if they miss certain symptoms, like, that's it.
That's the end of the line. Sometimes it's not all
doom and gloom, though, I really want to make that clear.

(46:24):
Although the road to accessing support may be tricky, OCD
is highly treatable. It is one of the actually one
of the easiest disorders to treat. The absolute gold standard
actually for OCD treatment is something called exposure and response prevention.
It's it's a type of cognitive behavioral therapy, which is
a very common type of therapy that is used all

(46:47):
over the world. So ERP basically involves gradually exposing people
to their biggest fears, their biggest obsessions, whilst preventing the
accompanying compulsive behavior. Yeah, they would they would usually kind
of turn to reduce anxiety, so response prevention. They're preventing
a certain response. And basically, what they're trying to do,

(47:09):
and what this technique is trying to do, is give
them evidence that the worst case scenario won't happen. Because
once they can see that what they're doing isn't actually
doing anything, it's not the reason that they're safe, it's
not the reason that their family is protected, it's not
the reason that something doesn't happen, then they don't have
to perform it as often and they can kind of
just sit with the discomfort of the thought without the

(47:31):
compulsion and see that nothing bad it's going to happen.
A thought is not reality, A thought is not an action. Basically,
you call your OCDS bluff. I heard an amazing analogy
to sum up what this treatment really does and what
it teaches people to do. Imagine you have like a
snowball in your hand, right and at first the ice

(47:53):
is pretty painful, like it's cold, it kind of burns,
and you think, what if I get frostbited? What if
something my hand falls off? What's gonna happen? So you
instinctively want to let go and you want to throw
it on the floor. You want to throw it away,
maybe throw it at someone. But if you just wait
with the snowball in your hand, the ice will gradually

(48:13):
start to melt and it will drip away, and eventually
it will be gone and your hand can start to
warm up again. It's gonna suck having this cold thing
in your hand that's freezing, But then you kind of realize, wait,
this actually can't hurt me beyond the initial the initial
feeling when I first have the thought, when I first

(48:34):
hold the snowball, that's when it's gonna hurt the most.
But if I can just wait it out, if I
can just have a little bit of courage and training
mental health training, there is another side to this that
perhaps my anxiety and my distress is never let me see.
The goal is basically to learn that the feared outcome

(48:54):
doesn't happen, and this process really gradually rewires the brain's
fear response. It realwires basal ganglia, It rewires parts of
your frontal lobe, parts of your interior, parts of your
brain that are assessing situations the wrong way. Given the
challenges in diagnosis and the misunderstandings we've talked about, I

(49:16):
think being your own informed advocate is really crucial here.
If this is something you're going through, this means that
listening to things like this, gaining more information about your
specific OCD subtype is so valuable so that when you
do step into the system, you freaking know your stuff.
You know what you need. You know how to get

(49:36):
to someone who knows more than you, but who will
treat you with respect. And this might sound kind of harsh,
but the only way to do that is kind of
bypass people who actually don't know that much about your OCD,
don't know much about OCD in general. So this might
include getting to the appointment and just telling your GP
exactly what you need and what treatment you think is helpful,

(49:58):
even if they might dismiss it. Advocate for your desire
to try that. It could mean asking for a second
opinion or a referral to a specialist when you can
tell someone maybe isn't specialized enough. Also keeping up to
date with emerging research that an average GP wouldn't have
time to look at. It's not that these people are uneducated,

(50:19):
it's not that they're cruel, it's not that they're malicious.
It's that they see thousands of people a year, with
each of them having very specific health problems, very specific
maybe even mental health problems. There are hundreds of thousands
of articles coming out each year about all those specific conditions.
They can't necessarily keep up. But because this is impacting

(50:39):
you and it's individual, you can and you can hopefully
be able to come into those appointments knowing a little
bit more, and not only can this lead the doctor
in the right direction, but also it can be really
empowering for you to be educated and having psycho education
around your symptoms and around what's happening in your brain
is actually research has shown a really powerful contributor to

(51:03):
healing and to finding relief from OCD. Also, remember, if
you do access support and the first professional isn't the
right fit, you are actually totally allowed to say this
isn't working, and you are allowed to request or find
someone new. You know, I did this my first person,
my first couple of people when I first got my diagnosis.

(51:24):
They didn't really understand what was happening, and they kept
trying to guide me back to solutions for someone with
a different type of OCD that wouldn't work for me.
So I just asked to see someone else. It was
really uncomfortable, felt awkward, but I'm glad I did it
because my mental health is more important than someone else's feelings,
and about someone else's feelings about their job performance. You know,

(51:46):
self advocacy it isn't about being confrontational. It's about not
wasting your own time. It's about not putting your mental
health on the line for someone else to learn from
or experiment with if they don't know what they're doing.
And it's also about recognizing that you are the expert
of your own experience. You literally live with these thoughts
every day. You have the right to informed, effective care

(52:09):
and taking an active role I think really allows you
to say this isn't right, this isn't working for me,
and ask for something better because you deserve it. I
think something else to say is that OCD is not
a one and done condition. Unfortunately, it is something that
you have to continue managing and working with. Obviously it

(52:31):
gets easier over time, but this might be a long
journey for you, So don't settle in with someone who
isn't going to be a good companion on that journey.
Find someone who's going to be able to really meet
you where you're out in terms of a mental health professional,
it's going to be able to keep up to date
and really care about you and know what's going on
so that things do feel less sticky, things do feel easier. Okay,

(52:55):
I'm going to quickly finish with some resources that I
personally think of really really helpful if you have OCD.
These are resources that I have engaged with people that
I follow who I think really reduce some of the
stigma and just give you more information and help you
be informed in like a medical context. The first is

(53:15):
Zachary James. He is a UK creator. He runs the
I guess handle OCD Stigmatized on Instagram. I really really
love what this man does. I love how he talks
about his own experience. I love how he talks about
upcoming research, about news story mentions of OCD, about elements

(53:35):
of it that people don't understand. So would really recommend him.
There's also another Instagram handles sush I guess service provider
called Treat My OCD. I personally have never used their service,
but I really like how they share information in a
really succinct way. I also really like how they occasionally
share stories of celebrities or public figures who have OCD,

(53:58):
who talk about it in interviews, use or talk about
it on podcasts because I find hearing what other people
are going through with this is such like an Oh,
it's so soothing when you're like, oh, thank god, I'm
not the only one. And often, you know, celebrities are
the ones who have the platform to talk about it.
They recently shared some clips from Benny Blanco Pink Panthers

(54:20):
about OCD. I did not know Pink Panthers has pure,
pure OCD, purely obsessional, and she was talking about it
and I was like wow, Wow. It was this weird
thing where I was like wow, I've never heard someone
talk about it that way. So that was like quite empowering.
I never thought Pink Panthers would help me with my
mental health, but there we go. And then a podcast,

(54:40):
a podcast that I think is exceptional called It's Not
What You Think. They share so many stories, they specialize
in only talking about OCD. They have such a brilliant
approach to it. So I'll link all of these things
in the description below. I just think if you're looking
for some informed people and some cool stuff, that is
where you should go. But thank you so much. For listening.

(55:01):
If you have made it this far, leave a little
yellow heart below. I don't know, I feel like it's
a nice I feel like that's a nice little symbol of
OCD awareness. Note that I'm really with you in this.
I imagine how hard it is for you to be
dealing with this alone. But I have also dealt with

(55:22):
it alone, and it's gotten easier. And it's the more
I've learned, the more relief I feel. And so I
really hope that you find that kind of calmness and
that peace and that stillness, and I believe you can.
So I'm sending you a lot of love in every
single one of your journeys with this very difficult disorder. Oh,

(55:44):
I know it's so cliche. No, you're not alone, though
it's gonna get better for you. There are people who
know a lot out there about this illness and can
help you even if the first couple of people don't
know anything. Just be your own advocate, be brave, be courageous,
and I really am wishing you all the best. I
hope this episode has helped share it with someone that

(56:04):
you know who might also benefit from it. If you
think this was a good resource, make sure you're following
me on Instagram as well at that psychology podcast. I'd
love to hear your stories or your own experiences with OCD,
as I am still a little young and when it
comes to this condition and this disorder, and until next time,
stay safe, be kind, be gentle to yourself, and sending

(56:25):
you so much love. Stay tuned for another episode. We
will talk very very soon.