August 20, 2025 • 50 mins
Have you ever heard someone casually say “I’m so OCD” just because they like things neat and organized? That kind of language often oversimplifies a serious mental health condition and can make it harder for those living with OCD to be seen and understood. Today, we’re digging into what Obsessive Compulsive Disorder actually is and how it uniquely impacts Black women. Dr. Jameeka Moore joins us again for this conversation. During the conversation, we explore what OCD looks like beyond the stereotypes, the ways it often goes unrecognized or misdiagnosed in Black women, and how effective treatment can help. Dr. Moore also offers insights on supporting loved ones with OCD and tips for finding culturally responsive care.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:10):
Welcome to the Therapy for Black Girls Podcast, a weekly
conversation about mental health, personal development, and all the small
decisions we can make to become the best possible versions
of ourselves. I'm your host, doctor joy hard and Bradford,
a licensed psychologist in Atlanta, Georgia. For more information or
(00:32):
to find a therapist in your area, visit our website
at Therapy for Blackgirls dot com. While I hope you
love listening to and learning from the podcast, it is
not meant to be a substitute for a relationship with
a licensed mental health professional. Hey, y'all, thanks so much
(00:57):
for joining me for session four twenty five of the
Therapy for Black Girls Podcast. We'll get right into our
conversation after word from our sponsors. Have you ever heard
someone casually say I'm so OCD just because they like
(01:19):
things neat and organized. That kind of language often oversimplifies
a serious mental health condition and can make it harder
for those living with OCD to be seen and understood. Today,
we're digging into what obsessive compulsive disorder actually is and
how it uniquely impacts black women. I'm so excited to
welcome back doctor Jamika Moore for this conversation. You may
(01:41):
remember doctor Moore from session four oh seven, where she
joined us to talk about driving anxiety. She's a licensed
clinical psychologist who specializes in OCD, anxiety and trauma, and
she's deeply committed to making mental health care more accessible
and affirming for Black women and girls. During our conversation,
we explore what OCD looks like beyond the stereotypes, the
(02:03):
ways it often goes unrecognized, are misdiagnosed in Black women,
and how effective treatment can help. Doctor Moore also offers
insights on supporting loved ones with OCD and tips for
finding culturally responsive care. If something resonates with you while
enjoying our conversation, please share with us on social media
using the hashtag tbg in session, or join us over
(02:27):
in our patreon. To talk more about the episode, you
can join us at Community dot therapyfrom Blackgirls dot Com.
Here's our conversation. Well, thank you for joining us again,
doctor Wore. It's a pleasure to see you again.
Speaker 2 (02:42):
Thank you.
Speaker 3 (02:42):
I'm so excited to be back. It's a pleasure to
see you again as well.
Speaker 1 (02:45):
Yeah, so when we talked last, you were talking about
your actual specialty is working with clients with OCD, and
I was like, we haven't had a full episode on OCD,
so we definitely got to bring you back to talk
about that. OCD. It feels like it's one of those
terms even for clinicians that is misused. People don't quite know.
You know, I think what all of the symptoms are
(03:06):
required to meet the diagnosis. So tell me a little
bit about what OCD is and how you actually got
started with this as your specialty.
Speaker 3 (03:14):
Okay, Yeah, that's one of the reasons why I was
super excited to come back and talk about OCD because
there is a lack of information and misinformation about what
it actually is. And usually people will think about OCD
in the context of contamination or order in symmetry, but
it's so much more than that. And broadly speaking, OCD
is this experience of having intrusive images, thoughts, or impulses,
(03:39):
and as a result of that, it can trigger a
lot of distress in clients, and in order to neutralize
or get rid of that distress, people will perform what
we call rituals or compulsions, which can also be thoughts
behaviors that people feel compelled to do in order to
experience some relief, and compulsions do work sometimes, and because
(04:00):
they work and bring down that distress, it increases a
likelihood that the client will do that behavior again. And
before you know it, OCD just takes hold and it
will make your life smaller and smaller and smaller.
Speaker 1 (04:14):
So when you say it makes your life smaller, what
do you mean?
Speaker 3 (04:17):
People will start performing what we call safety behaviors, and
that could be escape, avoidance, distraction, and the compulsions in
and of themselves. And so that means that things that
are important to you, the ways that you used to
show up in your life, you may no longer be
showing up in that way because you are operating from
fear and because you could be spending more time doing
(04:39):
the actual compulsions or having other people join you in
doing those compulsions. And so it can just take things
away from you because OCD really operates on a value system,
and so you'll typically find it in areas of your
life that are really important. And if you've developed like
an anxious response to that, you can understand how people
will initially think that avoidance is the best thing to do,
(05:02):
or that the compulsions are the best thing to do
in order to feel better. But OCD is a liar
for sure, and it'll have you doing things in the
best interests of the OCD and not in the best
interests of your own life.
Speaker 1 (05:16):
So doctor boy, I don't feel like that is something
I've heard talked about, and I don't think we talk
about most diagnoses like this, like that. It operates on
a value system. What do you mean by.
Speaker 3 (05:24):
Matt so with OCD, because it has a great imagination
and it can actually attach to anything. And so when
I'm talking about the misinformation and lack of information about OCD,
this is exactly what I'm talking about. When we see
it in such a limited view as OCD is hand washing,
OCD is straightening these pictures behind me, it totally disregards
(05:47):
how wide reaching it can be. And so when I
say it attaches on a values level, think about it.
Speaker 2 (05:52):
If I have an intrusive.
Speaker 3 (05:53):
Thought about something I don't care about, there's no reason
for me to develop as much disgust or anxiety or
shit or guilt around it. But if it's something that
I genuinely care about, then it's like WHOA wait a minute.
And so an example would be, let's take a new
parent they really obviously love this beautiful bundle of joy
that they have. But then an intrusive thought comes in
that says, what if I just toss this baby across
(06:15):
the room? That's going to generate a lot of anxiety
because it's like, why did I have that thought? Do
I actually want to do this? Am I losing it?
What is this about? And so because it's intrusive and
the person is paying attention to it, it also increases the
likelihood that you're going to have that thought again and
that it's not going to be like a passing or
fleeting thought. And so now the person's going to develop
(06:38):
some safety behaviors because they're responding to the thought and
the anxiety discomfort that it generates. And so now it's like,
maybe I won't do the breastfeeding, maybe I won't change
the diapers, maybe I won't hold the baby as much.
And they're doing that as a reaction because they ultimately
want to keep the baby safe. And when I say
(06:59):
OCDS liar, what I mean is what you really want
to do is protect the child.
Speaker 2 (07:03):
But when you avoid the child.
Speaker 3 (07:04):
There is no protection of the child in that because
you're impacting the way you will bond with the child,
and so the OCD is constantly looking for what's important
to you because if it hooks onto that, it increases
the likelihood that it can get the compulsion, and it
absolutely needs the compulsion in order to exist.
Speaker 1 (07:23):
So what do we know about how OCD actually develops?
Because it feels like there's like general kind of garden variety,
so to speak, anxiety, but this definitely feels much more severe,
much more kind of personalizings in the way that you're
talking about it. So how does OCD develop?
Speaker 3 (07:39):
It's that same thing we say about how anything develops.
There's a component that's definitely structural in the brain, surrounding
things like you're serotonin and actual brain structures. But then
there are alongside of that, there can be some modeling
that can take shape.
Speaker 2 (07:54):
And I believe that.
Speaker 3 (07:55):
You can be predisposed for OCD. But just because you
have that predisposition, it doesn't always mean that it will
present inside of itself. There can still be some sort
of mitigating factor in the same way that you could
carry a trade for like my brains, but it doesn't
mean that that gene will actually be realized inside of you.
So there's still a lot more. Seems like as much
(08:15):
research as we do on ideology, we still are like
and actually specifically how does it start? But we have
some understanding that we can speak about along those lines.
Speaker 1 (08:26):
M And I know so much of your work is
working with black patients specifically who struggle with OCD. What
have you seen about how OCD shows up differently in
black women specifically.
Speaker 3 (08:37):
In black women specifically? That's a very interesting question, and
I do I want to say that from research, what
we can see is OCD will show up and people
like equally across the board. But when we try to
think about how it impacts black communities specifically, and I'm
going to deviate from the specific woman conversation, one thing
(08:58):
that we do notice is there there can be an
increase in more contamination based fears. But when they actually
looked at some of the limited research that's been completed
on this, they found that to be also found in
non clinical populations as well. And so what they're essentially
saying is that, how do I say this?
Speaker 2 (09:17):
Culturally?
Speaker 3 (09:17):
We may have some differences in our approach to cleanliness
and what's important to us surrounding cleanliness, and I think
that if we look through a historical lens, we can
understand why that may be the case, right, And so
if you're a group of population who's been told that
interacting with you causes harm to someone else and you
have to try to find a way to survive in
(09:38):
a society that has a lot of oppression against you,
we can understand how safety behaviors towards cleanliness could have
been conditioned over time. And so I think that's why
contamination is one area of focus, and again it can
be plenty of other areas of focus. And that's one
of the main points that I do want to make
is that when we have such a limited view of OCD,
(09:59):
we can deal treatment for people, and so we have
to take it outside of that lens of contamination in
order and symmetry. But that is something that's on the
table and I think interesting to dissect when you look
through that historical lens.
Speaker 1 (10:12):
Yeah, I mean immediately I'm thinking about how many years
we've been told goy skin is not clean, or even
recent conversations I feel like developing on social media where
people are saying, like, oh, dermatologists suggests like you only
need a shower like every other day or every three days,
and like black people are like absolutely not like that,
it's what we do kind of thing, right, And so
(10:33):
it definitely feels like there is clearly some ties to
our history and our association with clearness.
Speaker 3 (10:39):
And I think the social media impact of it all,
like we get exposure to the things of the I
don't wash my legs or I don't do this, and
like black people are like, wait a minute, what or
other behaviors that we may find to be a bit
more disgusting based off of what we are not willing
to do and putting that in a context of OCD.
So if generally speaking we have that condition conditioning connect
(11:00):
to cleanliness, you can imagine that if you have OCD,
that's going to be the temperature around that is going
to be turned up higher than it would be. But again,
I don't think that's to say that black people won't
necessarily have a worse presentation of that. It is just
something that you can be on the lookout for based
off of some research that's been conducted.
Speaker 1 (11:22):
So you've already talked about the fact that like cleaning
and checking are the most common ways I think that
we see OCD presented. What are some other presentations of
OCD that may be a little less typical.
Speaker 3 (11:33):
Okay, I love that question. And so because I said
OCD can attach to anything, I really mean anything. We
have like relationship OCD, how it will attach to your
romantic relationship. We have sexual orientation OCD, and I want
to say these are subcategories. If we treat OCD, we
don't think any of these hold more power over any
other presentation because they all get the same treatment.
Speaker 2 (11:56):
But sometimes clients like.
Speaker 3 (11:57):
To be like, oh, you know, I have ROCD, which
is a relationship OCD, or this pedophilia OCD POCD. That's
another way that it can show up. We have like
religious OCD with the scrupulocity, which can also have the
moral or ethical component to it. Am I being a
good person? Am I going to cheat someone out of money?
How do I know that I'm actually good? And there's
(12:19):
this existential category as well, where people will ask bigger
life questions. Am I here? Or am I in the matrix?
What's the meaning of life?
Speaker 2 (12:28):
How do I know? This is not a simulation?
Speaker 3 (12:30):
So it really can hit like OCD is creative. I
mean it is very creative. And so when I'm saying
like it can attach to anything. I really mean that
the possibilities are endless, and.
Speaker 1 (12:43):
So relationship OCD, I don't think I've heard very much
about what does that mean? Is that like a fear
of cheating? Like what is the concern around?
Speaker 2 (12:49):
Relationship with can be right?
Speaker 3 (12:51):
So the intrusions can center around is this the perfect
partner for me? How do I know that I've made
the right choice? How do I know that I'm actually
really attracted to this person? Are they good enough for me?
Are they smart enough for me? Are they whatever enough
for me? And now it's natural to have some questions
about your relationship, as you should, you know, as you're
trying to progress anything we inside questioning reflection is important,
(13:15):
but this is pervasive, it is persistent, it's constant, and
it's extremely extremely distressing, and especially because oftentimes people are
feeling the opposite of what the intrusive thoughts.
Speaker 2 (13:26):
Are telling them.
Speaker 3 (13:27):
So they really want the relationship, but these intrusions are
coming in that's creating a lot of doubt. OCD had
a nickname called the doubting disease, which makes them believe
that because they start to feel anxious around it. And
now we have emotional reasoning right, I have these thoughts,
I'm anxious. I start a reason from my anxiety. I
need to know. I have to have absolute certainty that
(13:47):
this partner is right for me, and uncertainty is the
core distortion of OCD. Essentially, people are struggling with intolerance
of uncertainty.
Speaker 2 (13:57):
Will it will it.
Speaker 3 (13:59):
Won't, and they're just trying to answer those questions. But yeah,
relationship OCD can present like that, or it can be
I looked at someone and I found them attractive, and
as I looked at someone, I experienced like a grano,
which is maybe there was a sensation somewhere in the body.
Speaker 2 (14:15):
Now what does this mean?
Speaker 3 (14:16):
Does this mean that I really don't love my partner,
that I don't like my partner, that I want to
be with someone else, And so again, the questions can
be endless. But it's just this idea that the OCD
has attached to, and it's coming for your perception of
your relationship, and you're going to start to doing some
compulsions around that. And so compulsions could be checking I'm
(14:36):
going to check my body to make sure I still
feel attracted to this person, or I'm going to ask
reassurance or I'm going to confess I looked at someone
else the other day and I thought they were like,
really attractive. I just need to let you know that
I found someone else attractive. Now, imagine someone's constantly doing this.
At first, you might be like, okay, cool. But if
someone's doing this and you're experiencing these confessions and wawful
(15:00):
times a day or a week, that's the thing that's
going to actually at tax your relationship. So when I
says that OCD will have a tendency to do the opposite,
this relationship is really important to you. You are engaging
your behaviors that can definitely impact your relationship in a
negative way. But the OCD is lying to you and
telling you that you absolutely need to do these compulsions.
Speaker 1 (15:22):
So I want to talk about the religious OCD also
because I think that that feels like one that could
be something that maybe will maybe not in terms of
like the actual stats and numbers, but because of the
history of the Black community with religion and spirituality, it
feels like this could be something that it does attach
to you, right, Can you say more about that?
Speaker 3 (15:41):
I think that the religious aspect of OCD becomes very
difficult to treat especially when some of the things that
we learn in our association with whatever our religion is,
it perpetuates, It can perpetuate some of the thoughts connected
to the compulsions, like there is this idea that you
(16:01):
are praying or whatever those expectations are, and sometimes people
will blur the line between how do you show up
as a faithful participant of your religion versus showing up
for the OCD, and those are two totally different things.
And that's why I think it's important when you're working
with someone who's presenting with scrupulosity that you get that
(16:23):
release of information signed if it's okay with the client
to maybe talk with their spiritual leader, their pastor their preacher,
whatever the case may be, because we can understand if
there's a difference between saying a prayer, and there's a
difference between praying for two hours because you're getting a
word wrong or because an intrusive thought or image came
into your mind that forced you to have to start
(16:46):
over again. That doesn't serve your relationship with God. That
serves your relationship with OCD.
Speaker 1 (16:52):
Right, Yeah, this does feel like the well, I probably
all of the OCD sometimes have some particular nuance that
makes it difficult. But this I think in particular, does
I feel like it's difficult to tease out because you know,
how do you know what is the line between like
I'm being very faithful, I'm being obrient so to speak,
versus OCD. But the question you just asked feels like
(17:12):
it's an important one, right, like does this actually serve
my relationship to my higher power? Or does this serve
the relationship to OCD?
Speaker 3 (17:19):
I found some percent right, who is actually being served
by engaging in this compulsion? And it's always the OCD
that's being served in the person might temporarily think they're
being served if that compulsion still works for them, because
if you're still in that pattern of negative reinforcement where
you are receiving some relief, it works, but oftentimes it
(17:41):
starts to, you know, take up more time, create more agitation,
and so people aren't experiencing as much relief, but it's
worth it to do it because in their mind, the
alternative I've offended God, I'm not being a perfect Christian.
That can get in the way of the treatment. And
so now we're back on wanting to do the compulsion.
Speaker 1 (18:01):
Again and so what do you feel like? Clinicians often
miss maybe when diagnosing OCD.
Speaker 3 (18:10):
I think that because there's so much limitation around people's
understanding of what OCD is, they miss it, like if
it's not presenting in a way that media portrays it
and it's more nuanced, like in your relationship or in
your religion, or you have that new mom coming in
and saying, oh my goodness, like I'm afraid I might
(18:32):
harmless baby. What clinicians will typically do if they don't
have exposure to ERP training is let's.
Speaker 2 (18:40):
Look at this.
Speaker 3 (18:41):
Why would this happen even if they're doing solid general
CPT work. Let's examine the evidence for this behavior. You've
never heard anyone before. You don't want to hurt the baby. Now,
the issue with that is the client. Okay, that's reassurance.
This feels great, and that's a reason why people will
attend their sessions and feel better in the moment. But
(19:02):
then they go home and that intrusive thought comes in again,
and if this doesn't feel great, because I'm not still
afraid of harming this trial. So I think just doing
a more like using measures like the Y box can
be helpful in making sure your assessment is on point,
because then they have all of these different obsessions and
(19:22):
compulsions that people will in different categories, aggressive counting, ordering,
symmetry just right, those sorts of things that will help
pick up some of the war less known OCD subcategories.
And then that'll be like, okay this, And I've had
clients all the time in sessions say I never even
(19:43):
considered that a part of my OCD category, like that category,
I would have never considered that. And so that's why
I think proper training is important, and inside of that,
proper assessment is important, and just us having these conversations
to just say hi, it is more than just cleanliness
checking and perfectionism is helpful as well.
Speaker 1 (20:06):
You mentioned the why box. Can you tell us what
that stands for and how might like a client use
it or even.
Speaker 3 (20:12):
As AFROHANMS, But I think it's the yell obsessive compulsive scale.
Speaker 2 (20:18):
That's where it is.
Speaker 3 (20:19):
And that's just one of the measures. And now you
can also do some general measures of generalized anxiety and
social anxiety as well as part of your assessment, just
to kind of see where your client is standing on
those metrics and how I do it I start with
a general intake just so that I can get to
learn more about the client, and then I do a
(20:40):
more specific OCD based assessment once we have that initial
check in. Some therapists may just move straight into a
Y box, but I don't do that because I think client,
you know, I want the client to warm up a
little bit and then we can get to know your
history because I want to also be assessing for traumatic
experiences and how that's want to intersect with the OCD.
(21:01):
I want to know who the members are, like what
the social context, like who does this person have on
their team? Are they married, are they not married? Or
do they have siblings? Are they close with their family?
I want to understand some of those things because it
can also matter when we get into the OCD treatment
as well. And I'm saying it matters because if someone
(21:22):
co compolsing with the client, right, like, how does the
system support and maintain the OCD and so in order
for me to get that, I want to know who
the support system is in the role that they play
in the client's life.
Speaker 1 (21:37):
More from our conversation after the break, I want to
go back to something about the why box because I
think that there are lots of like checklists or like
DIY kind of things that like clients can take online
(21:57):
as like a screener almost yes, why box and like
some of the other things that you have mentioned and
that even other clinicians use are not actually things meant
for a client to do themselves.
Speaker 2 (22:08):
Right you, you may be.
Speaker 1 (22:10):
Able to find a copy online online they are online, Okay.
Speaker 3 (22:14):
By time people get to meet, some of my clients
are so they are experts in anxiety, right and not
I won't say a great significant number half, but because
my clients are experts in understand and anxiety, and part
of the composition can be hitting the Googles and being
like they come in they tell me about OCD and
I'm like, you got it, okay, so what are we
(22:35):
doing now? You you took a y box and like
that's great. How are we going to further this treatment?
Because now I just know how powerful the compositions can
be in your life.
Speaker 2 (22:45):
Once you've already reached me and.
Speaker 3 (22:46):
You've you can teach me about so but that's a
very big composion that you'll see people do is research
research research, research, research in more research. But it is
true that like clients who reach me that a lot
also haven't. It's taken the why box zombie in a
little bit silly when I say that, but it is
important to know that you get experts in anxiety by
(23:11):
the time they reach you, you have to know how
to deal with that.
Speaker 1 (23:14):
Yeah, And I think that that is an important distinction
to make, right because there are instruments like this and
others that may not be so easily findable online although
I don't even know. A lot of stuff probably is
online just because of where we are in the world
right now. But just like you mentioned, like you wouldn't
necessarily start with the Y box and you consider that
as a part of an assessment not. The only thing
(23:35):
I think that that's important for non clinicians to hear
is that, Okay, you take this Y box because you
find it and you feel like, oh, I checked like
all of these boxes. That doesn't necessarily mean that there
is an OCD diagnosis, but it could be grounds for
a larger conversation with your clinician to.
Speaker 3 (23:50):
Consider, especially in this day and age where we use
words casually right like people say I'm so OCD or
I'm so on the spectrum.
Speaker 2 (23:59):
And I think that with OCDOCD. It is painful.
Speaker 3 (24:02):
It's not like I wish I had a little bit
of OCD. People are struggling. It can be a pretty
disabling condition for people when they're in the thick of it.
There's a severity level to this, and so that's why
I like for us to be careful with our words.
These are things that actually impact the quality of people's lives,
and it can derail your life. And so it's not
(24:24):
a casual thing to be tossed around. It's very serious.
Speaker 2 (24:28):
And we wouldn't do.
Speaker 3 (24:29):
That same thing with other medical conditions, right, we wouldn't
be like, oh my gosh, I wish I had a
little cancer. It means it's not the same and like that,
the OCD can be as impactful on people's lives and
we just need to be more sensitive to that.
Speaker 1 (24:43):
Yeah, So you mentioned that a part of what you're
doing in the assessment is also thinking about like the
history of trauma and like considering how that impacts how
the compulsions of showing up. Can you talk about how
trauma might inform an OCD diagnosis?
Speaker 3 (24:57):
I think that in how I work with trauma, Well,
first of all, if it's like big trauma to the
point where it's hard for us to get to OCD treatment.
Speaker 2 (25:06):
I will work for out.
Speaker 3 (25:07):
I can do CBT in form trauma, but I believe
in specialists. You know, if there's someone who can treat that,
they're going to be more helpful than I can be.
Speaker 2 (25:15):
So I want to make that referral.
Speaker 3 (25:16):
But if it's it's that they have some well managed trauma,
it's in their history, it might like pop out and say, Hi,
I am.
Speaker 2 (25:24):
Here paying attention to me. I can work with that.
Speaker 3 (25:27):
And what we're doing is really looking at how the
OCD wants to reinforce the trauma, and so think about behaviors.
If you're talking about a fight or flight reaction, it
can say I need to keep myself safe above anything else.
So if this compulsion is keeping me safe, then it
makes sense for me.
Speaker 2 (25:44):
To do this compulsion.
Speaker 3 (25:45):
If avoiding this is keeping me safe, it makes sense
to have that avoidance.
Speaker 2 (25:49):
And I do think.
Speaker 3 (25:50):
That that's a functional way of being when you have
had some trauma. But even if you're doing trauma informed
exposure work, at some point it is going to be
about confronts those uncomfortable feelings in finding safe ways to
confront those situations that you have been avoiding, because again,
it's just another way to shrink your life and keep
it smaller. If there are safe spaces and safe and
(26:14):
I'm not using this in a healthy way.
Speaker 2 (26:16):
It's like, this is a safety behavior, this is a
safe space.
Speaker 3 (26:19):
And so I only go here. These are safe people,
so I only talk to them. That puts limitations on
your life. And so we really want to understand the
trauma and have the utmost respect for it and acknowledge
like you have values that you're dissonant in because we're
allowing your trauma and your OCD to come together to
(26:39):
be like you can't, you can't do this, And I'm like,
what feels like it can't is more of a willingness
issue is will you do this? Because you can right
if you want to, if you make that decision, But
it's are you willing to take the risk and sit
with the uncertainty connect it to whatever the OCD and
trauma are telling you.
Speaker 1 (27:00):
You also mentioned who's in the support system and how
might they be co compulsing, which is also a newer term.
I've not heard that one, but it makes complete sense, right, Like,
if I have a loved one and I'm trying to
support them, I may unconsciously maybe sometimes support them in
ways that aren't actually helping them to be better. So
talk to me more about co compulsing and how to
(27:20):
be attentive to that.
Speaker 3 (27:22):
Okay, So yeah, co compulsing is what it sounds like.
It's when you pull someone into your pattern of compulsing
and a lot of people are willing to do it
because they want you to feel better, right, and so
unfortunately that serves as a safety to the OCD is
if every time I ask you for reassurance, you give
it instead of learning what happens when I don't get
(27:42):
that reassurance, I'm just learning that this behavior makes my
anxiety go down, and therefore I'm going to continue to
do this behavior.
Speaker 2 (27:50):
I really like to take the same way. I like
to take a.
Speaker 3 (27:52):
Team approach and working with OCD, and so I'm like,
I'm going to be the Phil Jackson, You're MJ. We
have our Pippins and on the team, we're all going
to work together in that same system that could help
progress your treatment.
Speaker 2 (28:06):
It's the same system that can.
Speaker 3 (28:07):
Derail the treatment. And that's why the conversations the assessments
are really important to make sure we aren't having the
team not support the treatment around that. And when you're
talking to people who are on the team, it can
be a relief to know I don't have to do this,
like I don't have to carry this along with you.
(28:29):
Because ultimately, at the end of the day, the person
in the treatment is the person in the treatment and
they have to be accountable for their treatment. We cannot
overly rely on the system. And so people can feel relieved,
but they can also feel distressed because now they.
Speaker 2 (28:41):
Have to watch someone go through.
Speaker 3 (28:44):
The anxiety discussed or shame connected to whatever is involved
in that OCD cycle, and that can be hard to watch,
and so they also have to learn how to resist
that urge to rescue and provide that compulsion.
Speaker 1 (29:00):
So you mentioned that CBT is not necessarily like the
gold standard when we're talking about an OCD treatment plan.
You mentioned ERP. So what does ERP stand for and
can you say more about what treatment for OCD actually
looks like.
Speaker 3 (29:15):
Yes, so we have our umbrella CBT and ornder that
we have exposure and response prevention. In exposure and response
prevention is, like you said, the golden standard for treating OCD,
because you're not going to be able to talk your
way out of OCD p will and traditional talk therapy.
And that's because the part of the brain where the
OCD is, like the mid brain, that's where you're getting
(29:35):
that firefly reaction language is in the cortex, and so
OCD does not care about all of that. It's going
to always provide you another what if or what if?
Speaker 2 (29:46):
What if? What if? Right, It's an endless what if maker.
Speaker 3 (29:49):
And so because of that, we have to have a
treatment that allows people to get exposed to the things
that are anxiety provoking for them, and that can be
an actual situation or feeling or thought. And then we
want to teach them a strategy called response prevention, which
essentially means you are not engaging in that compulsion anymore.
And so a big picture, we're trying to teach people
(30:10):
that they can sit with whatever that emotion is in
the absence of that compulsion, because the OCD says you
cannot sit with this. You need to do the compulsion
in order to feel better or prevent a negative outcome
from occurring. Right, And if the compulsion is always completed,
the person doesn't really get to learn what actually happens.
(30:31):
And at the end of the day, ERP is a
learning model.
Speaker 2 (30:33):
We want to.
Speaker 3 (30:34):
Teach people new behaviors and allow them opportunity to practice that,
so that as they're practicing this new behavior, they get
those older behaviors can shift to the background, and they
learn that they're competent and they can do it.
Speaker 1 (30:48):
So in the example that you gave around like, Okay,
I'm a new mom and you know, I feel like
I might just throw this baby. Would an ERP kind
of treatment look like there?
Speaker 2 (30:57):
Okay?
Speaker 3 (30:58):
And so if we're doing exposure your work around harm
based OCD, I would ask of that client what I
want to know what they're avoiding? First of all, because
if I can figure out what you're avoiding, I could
turn that into an exposure and it's likely going to
be things that are naturally occurring and repeating. So that's
a helpful one. So what that means is have you
(31:20):
stopped holding the baby as much? We're going to hold
the baby, we're going to change the diapers, we're going
to do the breastfeeding. We're also might write what we
call in a magical script, which is obviously we're not
going to tell someone to throw a baby, like that's
you know whatever. But we can use our imagination to
create a script that says, there's a possibility that I'm
(31:41):
not a safe mom. There's a possibility that I may
throw this baby when I am feeding the baby, and
despite this unwilling to take the risk, I may never
have one hundred percent certainty that I will not throw
this baby. But it's important for me to buy with
my child, and so I'm going to work through these
interests of thoughts and sit with these uncomfortable feelings and
(32:01):
hold my baby.
Speaker 2 (32:02):
Right.
Speaker 3 (32:03):
That could be an example of script work. And so
when we're talking about exposure, I do want to say
like there are different types of exposures we do. That
example was an imaginal exposure, and we do imaginal exposures
when it might be illegal unethical to do an exposure,
and so we use our imagination and vivo exposures are
(32:23):
things that we can actually do right. Like I can
lick my finger and touch a door knob and lick
it again. I can totally we can do that. We
can get in a car and practice driving over bunks
without practicing turning around to make sure we didn't hit someone.
Speaker 2 (32:38):
So when we can do.
Speaker 3 (32:39):
In vivo, we do in vivo and in narrow interro
stuftive exposures when people may have trouble sitting with the
physiological sensations of the anxiety, and so I might have
someone hold their breath, spin in a chair, do some
jumping jets in order to get their body really disregulated,
and teach them how to sit with that. And then
we combine all of them. So I might do an
(33:00):
intero sceptive with an imaginal script for a more deepened
extinction to facilitate that learning.
Speaker 1 (33:07):
And how would you work? Even if we stay with
this example, right, like we know babies fall like they've
bum been to stuff, And if you are somebody who
is struggling with like OCD type symptoms related to like
can I actually keep this baby safe? And then something happens?
Like what does that then look like now when I
bring that back into treatment?
Speaker 3 (33:25):
Yes, I love when those things happen, because what we
do know is babies will fall and toddlers will scrape
the knee.
Speaker 2 (33:32):
And so it's not OCD is not about always.
Speaker 3 (33:35):
Did the outcome happen or not happen? Because sometimes when
you get into that pool, it can unintentionally trigger a
series of compulsions. It's also about what could you tolerate
it the baby fail and then what happened? Did you
explode or were you able to sit with that dysregulation?
And how did that anxiety respond over time? How did
(33:57):
that guilt I can't believe I let my baby fall?
How did that respond over time? And so when the
worst case scenarios happen, it gives us an opportunity to
see and how did you handle it? Because we want
clients to learn that your OCD is lyned to you
can handle more than it's telling you you can handle, right,
And so that would be a great example when we
know the baby's going to fall again, the toddler's going
(34:18):
to scrap the knee again, and so the parent gets
an opportunity to learn that they can actually sit with
whatever emotions, like if that guilt is there, that the
guilt doesn't stay at one hundred percent for the rest
of their life, that it is a thing that's going
to ebb and flow.
Speaker 1 (34:35):
And what does the treatment look like when you bring
in like the support system, like what kinds of things
are you talking with family members and friends about around
how to support them while they're going through ERP.
Speaker 3 (34:45):
Yeah, so I want to understand where the co compolsients
are happening so that we can have a plan to
decrease and then stop those I also want to talk
about how you can support in a way that doesn't
allow the OCD to score points or to feel better.
And sometimes that might mean saying things like if the
person says, well, what if I harm the baby? Are
(35:06):
you sure you want me to do the feeding tonight?
And you say maybe you will, maybe you won't. We're
just willing to take that risk. And what it does
is now the person was seeking certainty and reassurance and
now we're back in the gray. And so if that
other person doesn't come and do that compulsion by taking
the baby and doing the feeding, now this gives the
(35:27):
client and opportunity to learn what actually happens in the
absence of that compulsion and what they can actually tolerate.
Speaker 1 (35:35):
I would imagine that this could be something and you
talked about like it being a very disabling kind of condition,
because I could also see like relationship concerns being a
spin off of this, right, Like, now I don't feel
supportive because you know you're not enabling me to kind
of keep up with the compulsions, right, So I would
imagine there could be a whole host of other concerns
that pop up as a result of trying to manage OCB.
Speaker 3 (35:55):
Yeah, And as you can imagine when you're trying to
do this work and you're used to receiving reassurance and
you're not getting it. We all have our natural reactions
to things, and so OCD aing or is a thing,
like people get upset and we have to work through
that and learn how to navigate that. But as we're
having our team conversation and I try to remind people
(36:16):
that it's us against the OCD, right, Like, ultimately, at
the end of the day, even if we have to
do some things that feel uncomfortable, let's remember what we're
in it for, like who our actual opponent is, and
it's not us against each other, it's us against the OCD.
Speaker 1 (36:34):
Something else you've talked about, doctor More is how hoarding
can be like a part of the OCD spectrum and
how this might look especially in black families. Can you
talk about like hoarding and what that look like.
Speaker 3 (36:46):
Yeah, I think hoarding is one of those interesting things.
I'm not a hoarding specialist, but again, like if it's
hoarding connected to OCD, I work with that, and I
just think about like generations of families where collecting things
was like not having access to things, and then having
access you get these knickknacks, you get these plastic containers
that just seem to be endless, and sometimes people have
(37:09):
had to oppern Maybe if we looked at it, we
can say, I don't know if that comes from like survival,
but it definitely can be a thing where every space
seems to be filled with something. Right in OCD, what
we're looking at is what's the function of that behavior,
And the function of that behavior can be different from
how traditional orbing presents. And so if someone's holding on
(37:32):
to an item because they're afraid that they'll never be
able to find that perfect item again, and it has
to be that way even if they don't like it
or use it, they want to hold on to it.
Or people who will just keep buying things like new
shirts and that they don't want to break the new
shirt in, so they'll just leave it in the closet
and then they'll get another shirt and they don't want
(37:53):
to break it in and so they just keep accumulating
shirts because they don't want to rooining.
Speaker 2 (38:00):
It by actually using it.
Speaker 3 (38:02):
That's a presentation that I could see in OCD, and
so that's why again the assessment in understanding the function
of the behavior is really important because both will present
with distress though, but I want to understand the function.
Speaker 1 (38:15):
Right more from our conversation after the break. Something I've
learned more about recently is PANDACE. So this is like
an OCD type disorder that happens in kids as a
(38:36):
result of them getting stripped through correct Yes, yeah, and
so that is a newer kind of thing. I feel
like that's recently something that medical professionals have discovered. Is
there an equivalent or something like that where people will
develop an OCD like symptoms related to a medical condition
in adults?
Speaker 3 (38:54):
So yeah, that's very specific. There is PANS and pandas.
I may treat an adult and what they may find
is that they've had like they started having struck when
they were younger in life that was unmanaged, and so
I'll work for them to a medical provider and maybe
they keep having like getting struck over and over again.
There's that resurgence and so I may have them go
(39:14):
see a medical provider so that they can get on
some long term management for that, because that could actually
be activating and maintaining OCD symptoms. But typically I see that.
I don't really work with kids anymore I used to,
but even with younger teens when I work with them,
I would see that presentation and it would be interesting.
And again that's why proper assessment is important, because if
(39:37):
you're asking those questions now that we know that, that
is a thing that can inform your treatment in your referrals,
right because we can see those symptoms, severity drop down
a lot if it is a PANDACE presentation once they
get that management for the STREPP or whatever else is
underlying condition that's activating the OCD. And I think that's
(40:00):
super that's interesting.
Speaker 1 (40:02):
Yeah, it is very interesting. And I feel like, again
that's probably something in the last ten years or so
that they are learning more about. So we're always learning.
I think as weel what this looks like. So what
if somebody is enjoying our conversation and they are thinking, like,
you know what, this sounds like a condition that I
might meet qualifications for, or I think a loved one
may actually have some OCD symptoms. Where should they start?
Speaker 3 (40:24):
The International OCD Foundation is a really great resource. They
have so many different things, articles, books that you can
look into on OCD. They do a lot of trainings
for professionals as well. So if you're a professional out
there and you think you might want to do some
OCD work, I think IOCDUF is a great place to start.
(40:44):
There's also a newer resource it's called erp Kaleioscope, and
it's actually founded by a group of black women, and
I think they're just recently getting it off the ground.
And again it's meant to be a space for providers
and people who.
Speaker 2 (41:01):
May be struggling with OCD.
Speaker 3 (41:02):
And so I think that those like IOCDF, erp Coaleidoscope
are great places if you're looking for some specific OCD resources.
Speaker 1 (41:12):
Something else I wanted to ask you, doctor Moore, what
is the connection? And I feel like you talked about
this a little bit around the religiosity, but you know,
what is the connection between like OCD and things like superstitions?
Right like how can you tell the difference?
Speaker 3 (41:27):
Okay, that's also a great one. Like I can say
in my family, we have a lot of superstitions that
we operate on. You know, like some cultural things don't
put the person on the floor. Even this thing with
the broom or a filiures like a whole bunch of things. Now,
the difference with that someone splits the pole, I'm like,
wait a minute, turn around. If someone did not turn around,
I'm probably not going to experience a lot of distress.
(41:52):
I might be annoyed momentarily like why couldn't you just
do that? You know how I feel about this, But
it's not something that's going to stick with me and
create the amount of distress that they have to turn
around or else is going to derail my next hour
or the rest of my day. That's how we can
differentiate with superstition from OCD. OCD has a high level
(42:13):
of distress around it, and if that person is in
that base, the compulsion has to be completed or they're
going to be very dysregulated. With us, it's probably just
going to be more of a fleeting thing if it's
just regular superstition.
Speaker 2 (42:27):
M hm.
Speaker 1 (42:28):
Thank you for that. So are there any affirmations, books,
or other resources that you would like to offer to
people who would like to learn more about this or
feel like this is something they're struggling with.
Speaker 3 (42:38):
My affirmation is you must be willing to risk, right.
It's not the type of affirmations that people think about
that are reassuring. My affirmation is if you want your
life back, you have to go get your life back.
That means you have to take actions and steps. I
say things like, let's be in our value here, and
what is the value? Is it to kind of stay
here and copepost with your OCD or is it to
(43:01):
be able to go out and connect with your friends
in this space that might not be ideal for you, right,
So my affirmations are more things that are here toward
pushing people into more discomfort willingly than just are sort
of like feel good affirmations. Like I said, IOCD have
like there are great resources listed there. I just think
it's a great place to start.
Speaker 1 (43:23):
You know, as you're talking, I definitely think the way
you show up as an ERP therapist or a therapist
who does ERP feels maybe a little different than would
you and might see in terms of like a typical presentation,
but it feels like it fits the condition, right, Like
that is why every therapist is not going to be
the right therapist for everybody because we all have different
trainings and our presentations I think can look very different.
(43:45):
And so what you're talking about, like you said, it
is very different than like the touching feeling when not touching,
but you know, the more feeling, Yeah, the more feeling
kind of like, let's support you as opposed to this. Really,
it sounds like there's a high level of challenge that
that is necessary for this disorder.
Speaker 3 (44:02):
There is a high level of challenge, and I think
that if you're going to do ERP work, you have
to be willing to do the exposures that your clients do,
and you have to be really willing to sit with
other people's discomfort. A lot of providers like the techniques
like breathing exercises and things like that because if helps
clients feel better and people struggle with watching people reacting
(44:25):
to things. And here where like we don't really do
breathing exercises when we're doing ERP. We don't really try
those interventions because we're willing to sit with our clients
having that distress because it's an important part of the treatment, right,
Like those sorts of interventions become distractions when it's directed
towards OCD. And that's why I think proper training for
(44:46):
clinicians is really important because a lot of times we
would love it inadvertently co compose with our clients because
we don't fully understand OCD and the mechanisms that kind
of maintain it. And you could be now, I will say,
outside of ERP, if someone wants just as a life,
they're like, I breathe like this, this is me and
my self care go for it. But it's just not
(45:08):
in the context of doing ERP work. So I think
you bring up a very important point in that the
treatments can look different and pertaining to OCD. You want
to be trained to implement ERP, and you have to
have some willingness to sit with discomfort.
Speaker 2 (45:24):
I mean all be infested with a lot of discomfort.
Speaker 3 (45:26):
But a lot of anxiety, and you have to be
willing to show up and do the things that your
clients are doing.
Speaker 1 (45:34):
And is the IOCDF the place there you get trained
in ERP or where would clinicians go to get training
for this?
Speaker 3 (45:40):
Yeh, that's one of the places they do some advanced
training in OCD, And so I did some training with
them as well. A knowledge tree is a place that's
popped up that's doing some more specific training and you'll
get some overlap of experts in the field to work
in those different spaces. So yeah, those are two places
to look for training. But I just think ERP it's
(46:03):
great to watch people level up in there. They feel
more confident, they learn how they can actually tolerate things
that the OCD told them that they can't tolerate. It's
great watching people like grab bits of their life bag
that they haven't been able to do things in years.
And I just think that when we talk about a
barrier to treatment, one thing I see is people feel
(46:24):
away by the time they reach an ERP specialists because
sometimes people have had treatment and they're like, why didn't
I know this treatment was available to me seven years ago,
because I would have like, I've had some great therapeutic experiences,
but it just didn't move the needle on my OCD.
Help with my trauma, help with some general coping strategies,
but MYOCD seemed to never quite benefit from that. And
(46:48):
I think the reason why I wanted to do this
podcast is the information out there that there is specific
OCD treatment that it is very effective. We just want
to make sure we are pushing people in that direction
so that we don't delay treatment and have people and
curing extra things that cost time a waste of resource
when it comes to.
Speaker 1 (47:08):
Time, and I'm sure there's no kind of standard on
like how long you would be in ERP, but is
there kind of generally like how long you would be
in sessions?
Speaker 3 (47:19):
Yeah, I want to check in around twelve and twenty sessions,
and so I just want to look like if we're
doing treatment for three months, I want to kind of
look and see where they are. And part of that
Wybox scale, there's a severity scale that goes along with it,
and so it's two parts. We look at the severity
scale and I'll reassess that just to see how that
number is decreasing over time. And when I say that
(47:40):
number is decreasing over time, that doesn't always mean like
the client gets to be anxiety free. ERP is about
learning how to live with anxiety versus pure symptom reduction,
and so a lot of people will come in thinking
like OCD work means I don't have intrusive thoughts anymore,
or I don't have anxiety anymore. And I'm not signing
that tree plan. This is really learning how to live
(48:03):
with in all caps. So I say things like when
we talk about affirmations, be anxious and do it anyway.
Be disgusted and do it anyway. And so yeah, like
we can look at a session limit and I use
that resource, the y box of Verity scale, in order
to help us know if we're on track. And I
think it's a great accountability for me and for the client,
(48:24):
so that we're holding ourselves accountable for the treatment.
Speaker 1 (48:27):
Perfect. So, doctor Moore, where can we stay connected with you?
What is your website as well as any social media
channels you'd like to share.
Speaker 3 (48:34):
Yes, my website is doctor Jamikamore dot com and I
am on Instagram at jam Sessions that's Jam Underscore s
E S s IO n Z and so you can
connect with me there.
Speaker 1 (48:47):
Perfect. Thank you so much for joining us again, doctor Moore.
Speaker 2 (48:50):
Yeah, thank you. It's good to see you.
Speaker 1 (48:52):
Of course, I'm so glad doctor Moore was able to
join me for this conversation and helping us better understand
OCD and its impact on black women. If you want
to learn more about her and her work, be sure
to visit the show notes at Therapy for Blackgirls dot
com slash Session four twenty five for more information, and
(49:13):
don't forget to text this episode to two of your
girls right now and tell them to check it out.
Did you know that you could leave us a voicemail
with your questions or suggestions for the podcast. Whether you
have ideas for future topics, book or movie suggestions, or
just something on your mind, we'd love to hear it.
Head on over to Memo dot fm slash Therapy for
Black Girls and leave us a voicemail. If you're looking
(49:35):
for a therapist in your area, visit our therapist directory
at Therapy for Blackgirls dot com slash directory, and don't
forget to follow us over on Instagram at Therapy for
Black Girls. This episode was produced by Elise Ellis, Indechubu
and Tyree Rush. Editing was done by Dennison Bradford. Thank
y'all so much for joining me again this week. I
(49:56):
look forward to continuing this conversation with you all real soon.
Take it care
Speaker 3 (50:04):
What
Welcome to the Therapy for Black Girls Podcast, a weekly
conversation about mental health, personal development, and all the small
decisions we can make to become the best possible versions
of ourselves. I'm your host, doctor joy hard and Bradford,
a licensed psychologist in Atlanta, Georgia. For more information or
(00:32):
to find a therapist in your area, visit our website
at Therapy for Blackgirls dot com. While I hope you
love listening to and learning from the podcast, it is
not meant to be a substitute for a relationship with
a licensed mental health professional. Hey, y'all, thanks so much
(00:57):
for joining me for session four twenty five of the
Therapy for Black Girls Podcast. We'll get right into our
conversation after word from our sponsors. Have you ever heard
someone casually say I'm so OCD just because they like
(01:19):
things neat and organized. That kind of language often oversimplifies
a serious mental health condition and can make it harder
for those living with OCD to be seen and understood. Today,
we're digging into what obsessive compulsive disorder actually is and
how it uniquely impacts black women. I'm so excited to
welcome back doctor Jamika Moore for this conversation. You may
(01:41):
remember doctor Moore from session four oh seven, where she
joined us to talk about driving anxiety. She's a licensed
clinical psychologist who specializes in OCD, anxiety and trauma, and
she's deeply committed to making mental health care more accessible
and affirming for Black women and girls. During our conversation,
we explore what OCD looks like beyond the stereotypes, the
(02:03):
ways it often goes unrecognized, are misdiagnosed in Black women,
and how effective treatment can help. Doctor Moore also offers
insights on supporting loved ones with OCD and tips for
finding culturally responsive care. If something resonates with you while
enjoying our conversation, please share with us on social media
using the hashtag tbg in session, or join us over
(02:27):
in our patreon. To talk more about the episode, you
can join us at Community dot therapyfrom Blackgirls dot Com.
Here's our conversation. Well, thank you for joining us again,
doctor Wore. It's a pleasure to see you again.
Speaker 2 (02:42):
Thank you.
Speaker 3 (02:42):
I'm so excited to be back. It's a pleasure to
see you again as well.
Speaker 1 (02:45):
Yeah, so when we talked last, you were talking about
your actual specialty is working with clients with OCD, and
I was like, we haven't had a full episode on OCD,
so we definitely got to bring you back to talk
about that. OCD. It feels like it's one of those
terms even for clinicians that is misused. People don't quite know.
You know, I think what all of the symptoms are
(03:06):
required to meet the diagnosis. So tell me a little
bit about what OCD is and how you actually got
started with this as your specialty.
Speaker 3 (03:14):
Okay, Yeah, that's one of the reasons why I was
super excited to come back and talk about OCD because
there is a lack of information and misinformation about what
it actually is. And usually people will think about OCD
in the context of contamination or order in symmetry, but
it's so much more than that. And broadly speaking, OCD
is this experience of having intrusive images, thoughts, or impulses,
(03:39):
and as a result of that, it can trigger a
lot of distress in clients, and in order to neutralize
or get rid of that distress, people will perform what
we call rituals or compulsions, which can also be thoughts
behaviors that people feel compelled to do in order to
experience some relief, and compulsions do work sometimes, and because
(04:00):
they work and bring down that distress, it increases a
likelihood that the client will do that behavior again. And
before you know it, OCD just takes hold and it
will make your life smaller and smaller and smaller.
Speaker 1 (04:14):
So when you say it makes your life smaller, what
do you mean?
Speaker 3 (04:17):
People will start performing what we call safety behaviors, and
that could be escape, avoidance, distraction, and the compulsions in
and of themselves. And so that means that things that
are important to you, the ways that you used to
show up in your life, you may no longer be
showing up in that way because you are operating from
fear and because you could be spending more time doing
(04:39):
the actual compulsions or having other people join you in
doing those compulsions. And so it can just take things
away from you because OCD really operates on a value system,
and so you'll typically find it in areas of your
life that are really important. And if you've developed like
an anxious response to that, you can understand how people
will initially think that avoidance is the best thing to do,
(05:02):
or that the compulsions are the best thing to do
in order to feel better. But OCD is a liar
for sure, and it'll have you doing things in the
best interests of the OCD and not in the best
interests of your own life.
Speaker 1 (05:16):
So doctor boy, I don't feel like that is something
I've heard talked about, and I don't think we talk
about most diagnoses like this, like that. It operates on
a value system. What do you mean by.
Speaker 3 (05:24):
Matt so with OCD, because it has a great imagination
and it can actually attach to anything. And so when
I'm talking about the misinformation and lack of information about OCD,
this is exactly what I'm talking about. When we see
it in such a limited view as OCD is hand washing,
OCD is straightening these pictures behind me, it totally disregards
(05:47):
how wide reaching it can be. And so when I
say it attaches on a values level, think about it.
Speaker 2 (05:52):
If I have an intrusive.
Speaker 3 (05:53):
Thought about something I don't care about, there's no reason
for me to develop as much disgust or anxiety or
shit or guilt around it. But if it's something that
I genuinely care about, then it's like WHOA wait a minute.
And so an example would be, let's take a new
parent they really obviously love this beautiful bundle of joy
that they have. But then an intrusive thought comes in
that says, what if I just toss this baby across
(06:15):
the room? That's going to generate a lot of anxiety
because it's like, why did I have that thought? Do
I actually want to do this? Am I losing it?
What is this about? And so because it's intrusive and
the person is paying attention to it, it also increases the
likelihood that you're going to have that thought again and
that it's not going to be like a passing or
fleeting thought. And so now the person's going to develop
(06:38):
some safety behaviors because they're responding to the thought and
the anxiety discomfort that it generates. And so now it's like,
maybe I won't do the breastfeeding, maybe I won't change
the diapers, maybe I won't hold the baby as much.
And they're doing that as a reaction because they ultimately
want to keep the baby safe. And when I say
(06:59):
OCDS liar, what I mean is what you really want
to do is protect the child.
Speaker 2 (07:03):
But when you avoid the child.
Speaker 3 (07:04):
There is no protection of the child in that because
you're impacting the way you will bond with the child,
and so the OCD is constantly looking for what's important
to you because if it hooks onto that, it increases
the likelihood that it can get the compulsion, and it
absolutely needs the compulsion in order to exist.
Speaker 1 (07:23):
So what do we know about how OCD actually develops?
Because it feels like there's like general kind of garden variety,
so to speak, anxiety, but this definitely feels much more severe,
much more kind of personalizings in the way that you're
talking about it. So how does OCD develop?
Speaker 3 (07:39):
It's that same thing we say about how anything develops.
There's a component that's definitely structural in the brain, surrounding
things like you're serotonin and actual brain structures. But then
there are alongside of that, there can be some modeling
that can take shape.
Speaker 2 (07:54):
And I believe that.
Speaker 3 (07:55):
You can be predisposed for OCD. But just because you
have that predisposition, it doesn't always mean that it will
present inside of itself. There can still be some sort
of mitigating factor in the same way that you could
carry a trade for like my brains, but it doesn't
mean that that gene will actually be realized inside of you.
So there's still a lot more. Seems like as much
(08:15):
research as we do on ideology, we still are like
and actually specifically how does it start? But we have
some understanding that we can speak about along those lines.
Speaker 1 (08:26):
M And I know so much of your work is
working with black patients specifically who struggle with OCD. What
have you seen about how OCD shows up differently in
black women specifically.
Speaker 3 (08:37):
In black women specifically? That's a very interesting question, and
I do I want to say that from research, what
we can see is OCD will show up and people
like equally across the board. But when we try to
think about how it impacts black communities specifically, and I'm
going to deviate from the specific woman conversation, one thing
(08:58):
that we do notice is there there can be an
increase in more contamination based fears. But when they actually
looked at some of the limited research that's been completed
on this, they found that to be also found in
non clinical populations as well. And so what they're essentially
saying is that, how do I say this?
Speaker 2 (09:17):
Culturally?
Speaker 3 (09:17):
We may have some differences in our approach to cleanliness
and what's important to us surrounding cleanliness, and I think
that if we look through a historical lens, we can
understand why that may be the case, right, And so
if you're a group of population who's been told that
interacting with you causes harm to someone else and you
have to try to find a way to survive in
(09:38):
a society that has a lot of oppression against you,
we can understand how safety behaviors towards cleanliness could have
been conditioned over time. And so I think that's why
contamination is one area of focus, and again it can
be plenty of other areas of focus. And that's one
of the main points that I do want to make
is that when we have such a limited view of OCD,
(09:59):
we can deal treatment for people, and so we have
to take it outside of that lens of contamination in
order and symmetry. But that is something that's on the
table and I think interesting to dissect when you look
through that historical lens.
Speaker 1 (10:12):
Yeah, I mean immediately I'm thinking about how many years
we've been told goy skin is not clean, or even
recent conversations I feel like developing on social media where
people are saying, like, oh, dermatologists suggests like you only
need a shower like every other day or every three days,
and like black people are like absolutely not like that,
it's what we do kind of thing, right, And so
(10:33):
it definitely feels like there is clearly some ties to
our history and our association with clearness.
Speaker 3 (10:39):
And I think the social media impact of it all,
like we get exposure to the things of the I
don't wash my legs or I don't do this, and
like black people are like, wait a minute, what or
other behaviors that we may find to be a bit
more disgusting based off of what we are not willing
to do and putting that in a context of OCD.
So if generally speaking we have that condition conditioning connect
(11:00):
to cleanliness, you can imagine that if you have OCD,
that's going to be the temperature around that is going
to be turned up higher than it would be. But again,
I don't think that's to say that black people won't
necessarily have a worse presentation of that. It is just
something that you can be on the lookout for based
off of some research that's been conducted.
Speaker 1 (11:22):
So you've already talked about the fact that like cleaning
and checking are the most common ways I think that
we see OCD presented. What are some other presentations of
OCD that may be a little less typical.
Speaker 3 (11:33):
Okay, I love that question. And so because I said
OCD can attach to anything, I really mean anything. We
have like relationship OCD, how it will attach to your
romantic relationship. We have sexual orientation OCD, and I want
to say these are subcategories. If we treat OCD, we
don't think any of these hold more power over any
other presentation because they all get the same treatment.
Speaker 2 (11:56):
But sometimes clients like.
Speaker 3 (11:57):
To be like, oh, you know, I have ROCD, which
is a relationship OCD, or this pedophilia OCD POCD. That's
another way that it can show up. We have like
religious OCD with the scrupulocity, which can also have the
moral or ethical component to it. Am I being a
good person? Am I going to cheat someone out of money?
How do I know that I'm actually good? And there's
(12:19):
this existential category as well, where people will ask bigger
life questions. Am I here? Or am I in the matrix?
What's the meaning of life?
Speaker 2 (12:28):
How do I know? This is not a simulation?
Speaker 3 (12:30):
So it really can hit like OCD is creative. I
mean it is very creative. And so when I'm saying
like it can attach to anything. I really mean that
the possibilities are endless, and.
Speaker 1 (12:43):
So relationship OCD, I don't think I've heard very much
about what does that mean? Is that like a fear
of cheating? Like what is the concern around?
Speaker 2 (12:49):
Relationship with can be right?
Speaker 3 (12:51):
So the intrusions can center around is this the perfect
partner for me? How do I know that I've made
the right choice? How do I know that I'm actually
really attracted to this person? Are they good enough for me?
Are they smart enough for me? Are they whatever enough
for me? And now it's natural to have some questions
about your relationship, as you should, you know, as you're
trying to progress anything we inside questioning reflection is important,
(13:15):
but this is pervasive, it is persistent, it's constant, and
it's extremely extremely distressing, and especially because oftentimes people are
feeling the opposite of what the intrusive thoughts.
Speaker 2 (13:26):
Are telling them.
Speaker 3 (13:27):
So they really want the relationship, but these intrusions are
coming in that's creating a lot of doubt. OCD had
a nickname called the doubting disease, which makes them believe
that because they start to feel anxious around it. And
now we have emotional reasoning right, I have these thoughts,
I'm anxious. I start a reason from my anxiety. I
need to know. I have to have absolute certainty that
(13:47):
this partner is right for me, and uncertainty is the
core distortion of OCD. Essentially, people are struggling with intolerance
of uncertainty.
Speaker 2 (13:57):
Will it will it.
Speaker 3 (13:59):
Won't, and they're just trying to answer those questions. But yeah,
relationship OCD can present like that, or it can be
I looked at someone and I found them attractive, and
as I looked at someone, I experienced like a grano,
which is maybe there was a sensation somewhere in the body.
Speaker 2 (14:15):
Now what does this mean?
Speaker 3 (14:16):
Does this mean that I really don't love my partner,
that I don't like my partner, that I want to
be with someone else, And so again, the questions can
be endless. But it's just this idea that the OCD
has attached to, and it's coming for your perception of
your relationship, and you're going to start to doing some
compulsions around that. And so compulsions could be checking I'm
(14:36):
going to check my body to make sure I still
feel attracted to this person, or I'm going to ask
reassurance or I'm going to confess I looked at someone
else the other day and I thought they were like,
really attractive. I just need to let you know that
I found someone else attractive. Now, imagine someone's constantly doing this.
At first, you might be like, okay, cool. But if
someone's doing this and you're experiencing these confessions and wawful
(15:00):
times a day or a week, that's the thing that's
going to actually at tax your relationship. So when I
says that OCD will have a tendency to do the opposite,
this relationship is really important to you. You are engaging
your behaviors that can definitely impact your relationship in a
negative way. But the OCD is lying to you and
telling you that you absolutely need to do these compulsions.
Speaker 1 (15:22):
So I want to talk about the religious OCD also
because I think that that feels like one that could
be something that maybe will maybe not in terms of
like the actual stats and numbers, but because of the
history of the Black community with religion and spirituality, it
feels like this could be something that it does attach
to you, right, Can you say more about that?
Speaker 3 (15:41):
I think that the religious aspect of OCD becomes very
difficult to treat especially when some of the things that
we learn in our association with whatever our religion is,
it perpetuates, It can perpetuate some of the thoughts connected
to the compulsions, like there is this idea that you
(16:01):
are praying or whatever those expectations are, and sometimes people
will blur the line between how do you show up
as a faithful participant of your religion versus showing up
for the OCD, and those are two totally different things.
And that's why I think it's important when you're working
with someone who's presenting with scrupulosity that you get that
(16:23):
release of information signed if it's okay with the client
to maybe talk with their spiritual leader, their pastor their preacher,
whatever the case may be, because we can understand if
there's a difference between saying a prayer, and there's a
difference between praying for two hours because you're getting a
word wrong or because an intrusive thought or image came
into your mind that forced you to have to start
(16:46):
over again. That doesn't serve your relationship with God. That
serves your relationship with OCD.
Speaker 1 (16:52):
Right, Yeah, this does feel like the well, I probably
all of the OCD sometimes have some particular nuance that
makes it difficult. But this I think in particular, does
I feel like it's difficult to tease out because you know,
how do you know what is the line between like
I'm being very faithful, I'm being obrient so to speak,
versus OCD. But the question you just asked feels like
(17:12):
it's an important one, right, like does this actually serve
my relationship to my higher power? Or does this serve
the relationship to OCD?
Speaker 3 (17:19):
I found some percent right, who is actually being served
by engaging in this compulsion? And it's always the OCD
that's being served in the person might temporarily think they're
being served if that compulsion still works for them, because
if you're still in that pattern of negative reinforcement where
you are receiving some relief, it works, but oftentimes it
(17:41):
starts to, you know, take up more time, create more agitation,
and so people aren't experiencing as much relief, but it's
worth it to do it because in their mind, the
alternative I've offended God, I'm not being a perfect Christian.
That can get in the way of the treatment. And
so now we're back on wanting to do the compulsion.
Speaker 1 (18:01):
Again and so what do you feel like? Clinicians often
miss maybe when diagnosing OCD.
Speaker 3 (18:10):
I think that because there's so much limitation around people's
understanding of what OCD is, they miss it, like if
it's not presenting in a way that media portrays it
and it's more nuanced, like in your relationship or in
your religion, or you have that new mom coming in
and saying, oh my goodness, like I'm afraid I might
(18:32):
harmless baby. What clinicians will typically do if they don't
have exposure to ERP training is let's.
Speaker 2 (18:40):
Look at this.
Speaker 3 (18:41):
Why would this happen even if they're doing solid general
CPT work. Let's examine the evidence for this behavior. You've
never heard anyone before. You don't want to hurt the baby. Now,
the issue with that is the client. Okay, that's reassurance.
This feels great, and that's a reason why people will
attend their sessions and feel better in the moment. But
(19:02):
then they go home and that intrusive thought comes in again,
and if this doesn't feel great, because I'm not still
afraid of harming this trial. So I think just doing
a more like using measures like the Y box can
be helpful in making sure your assessment is on point,
because then they have all of these different obsessions and
(19:22):
compulsions that people will in different categories, aggressive counting, ordering,
symmetry just right, those sorts of things that will help
pick up some of the war less known OCD subcategories.
And then that'll be like, okay this, And I've had
clients all the time in sessions say I never even
(19:43):
considered that a part of my OCD category, like that category,
I would have never considered that. And so that's why
I think proper training is important, and inside of that,
proper assessment is important, and just us having these conversations
to just say hi, it is more than just cleanliness
checking and perfectionism is helpful as well.
Speaker 1 (20:06):
You mentioned the why box. Can you tell us what
that stands for and how might like a client use
it or even.
Speaker 3 (20:12):
As AFROHANMS, But I think it's the yell obsessive compulsive scale.
Speaker 2 (20:18):
That's where it is.
Speaker 3 (20:19):
And that's just one of the measures. And now you
can also do some general measures of generalized anxiety and
social anxiety as well as part of your assessment, just
to kind of see where your client is standing on
those metrics and how I do it I start with
a general intake just so that I can get to
learn more about the client, and then I do a
(20:40):
more specific OCD based assessment once we have that initial
check in. Some therapists may just move straight into a
Y box, but I don't do that because I think client,
you know, I want the client to warm up a
little bit and then we can get to know your
history because I want to also be assessing for traumatic
experiences and how that's want to intersect with the OCD.
(21:01):
I want to know who the members are, like what
the social context, like who does this person have on
their team? Are they married, are they not married? Or
do they have siblings? Are they close with their family?
I want to understand some of those things because it
can also matter when we get into the OCD treatment
as well. And I'm saying it matters because if someone
(21:22):
co compolsing with the client, right, like, how does the
system support and maintain the OCD and so in order
for me to get that, I want to know who
the support system is in the role that they play
in the client's life.
Speaker 1 (21:37):
More from our conversation after the break, I want to
go back to something about the why box because I
think that there are lots of like checklists or like
DIY kind of things that like clients can take online
(21:57):
as like a screener almost yes, why box and like
some of the other things that you have mentioned and
that even other clinicians use are not actually things meant
for a client to do themselves.
Speaker 2 (22:08):
Right you, you may be.
Speaker 1 (22:10):
Able to find a copy online online they are online, Okay.
Speaker 3 (22:14):
By time people get to meet, some of my clients
are so they are experts in anxiety, right and not
I won't say a great significant number half, but because
my clients are experts in understand and anxiety, and part
of the composition can be hitting the Googles and being
like they come in they tell me about OCD and
I'm like, you got it, okay, so what are we
(22:35):
doing now? You you took a y box and like
that's great. How are we going to further this treatment?
Because now I just know how powerful the compositions can
be in your life.
Speaker 2 (22:45):
Once you've already reached me and.
Speaker 3 (22:46):
You've you can teach me about so but that's a
very big composion that you'll see people do is research
research research, research, research in more research. But it is
true that like clients who reach me that a lot
also haven't. It's taken the why box zombie in a
little bit silly when I say that, but it is
important to know that you get experts in anxiety by
(23:11):
the time they reach you, you have to know how
to deal with that.
Speaker 1 (23:14):
Yeah, And I think that that is an important distinction
to make, right because there are instruments like this and
others that may not be so easily findable online although
I don't even know. A lot of stuff probably is
online just because of where we are in the world
right now. But just like you mentioned, like you wouldn't
necessarily start with the Y box and you consider that
as a part of an assessment not. The only thing
(23:35):
I think that that's important for non clinicians to hear
is that, Okay, you take this Y box because you
find it and you feel like, oh, I checked like
all of these boxes. That doesn't necessarily mean that there
is an OCD diagnosis, but it could be grounds for
a larger conversation with your clinician to.
Speaker 3 (23:50):
Consider, especially in this day and age where we use
words casually right like people say I'm so OCD or
I'm so on the spectrum.
Speaker 2 (23:59):
And I think that with OCDOCD. It is painful.
Speaker 3 (24:02):
It's not like I wish I had a little bit
of OCD. People are struggling. It can be a pretty
disabling condition for people when they're in the thick of it.
There's a severity level to this, and so that's why
I like for us to be careful with our words.
These are things that actually impact the quality of people's lives,
and it can derail your life. And so it's not
(24:24):
a casual thing to be tossed around. It's very serious.
Speaker 2 (24:28):
And we wouldn't do.
Speaker 3 (24:29):
That same thing with other medical conditions, right, we wouldn't
be like, oh my gosh, I wish I had a
little cancer. It means it's not the same and like that,
the OCD can be as impactful on people's lives and
we just need to be more sensitive to that.
Speaker 1 (24:43):
Yeah, So you mentioned that a part of what you're
doing in the assessment is also thinking about like the
history of trauma and like considering how that impacts how
the compulsions of showing up. Can you talk about how
trauma might inform an OCD diagnosis?
Speaker 3 (24:57):
I think that in how I work with trauma, Well,
first of all, if it's like big trauma to the
point where it's hard for us to get to OCD treatment.
Speaker 2 (25:06):
I will work for out.
Speaker 3 (25:07):
I can do CBT in form trauma, but I believe
in specialists. You know, if there's someone who can treat that,
they're going to be more helpful than I can be.
Speaker 2 (25:15):
So I want to make that referral.
Speaker 3 (25:16):
But if it's it's that they have some well managed trauma,
it's in their history, it might like pop out and say, Hi,
I am.
Speaker 2 (25:24):
Here paying attention to me. I can work with that.
Speaker 3 (25:27):
And what we're doing is really looking at how the
OCD wants to reinforce the trauma, and so think about behaviors.
If you're talking about a fight or flight reaction, it
can say I need to keep myself safe above anything else.
So if this compulsion is keeping me safe, then it
makes sense for me.
Speaker 2 (25:44):
To do this compulsion.
Speaker 3 (25:45):
If avoiding this is keeping me safe, it makes sense
to have that avoidance.
Speaker 2 (25:49):
And I do think.
Speaker 3 (25:50):
That that's a functional way of being when you have
had some trauma. But even if you're doing trauma informed
exposure work, at some point it is going to be
about confronts those uncomfortable feelings in finding safe ways to
confront those situations that you have been avoiding, because again,
it's just another way to shrink your life and keep
it smaller. If there are safe spaces and safe and
(26:14):
I'm not using this in a healthy way.
Speaker 2 (26:16):
It's like, this is a safety behavior, this is a
safe space.
Speaker 3 (26:19):
And so I only go here. These are safe people,
so I only talk to them. That puts limitations on
your life. And so we really want to understand the
trauma and have the utmost respect for it and acknowledge
like you have values that you're dissonant in because we're
allowing your trauma and your OCD to come together to
(26:39):
be like you can't, you can't do this, And I'm like,
what feels like it can't is more of a willingness
issue is will you do this? Because you can right
if you want to, if you make that decision, But
it's are you willing to take the risk and sit
with the uncertainty connect it to whatever the OCD and
trauma are telling you.
Speaker 1 (27:00):
You also mentioned who's in the support system and how
might they be co compulsing, which is also a newer term.
I've not heard that one, but it makes complete sense, right, Like,
if I have a loved one and I'm trying to
support them, I may unconsciously maybe sometimes support them in
ways that aren't actually helping them to be better. So
talk to me more about co compulsing and how to
(27:20):
be attentive to that.
Speaker 3 (27:22):
Okay, So yeah, co compulsing is what it sounds like.
It's when you pull someone into your pattern of compulsing
and a lot of people are willing to do it
because they want you to feel better, right, and so
unfortunately that serves as a safety to the OCD is
if every time I ask you for reassurance, you give
it instead of learning what happens when I don't get
(27:42):
that reassurance, I'm just learning that this behavior makes my
anxiety go down, and therefore I'm going to continue to
do this behavior.
Speaker 2 (27:50):
I really like to take the same way. I like
to take a.
Speaker 3 (27:52):
Team approach and working with OCD, and so I'm like,
I'm going to be the Phil Jackson, You're MJ. We
have our Pippins and on the team, we're all going
to work together in that same system that could help
progress your treatment.
Speaker 2 (28:06):
It's the same system that can.
Speaker 3 (28:07):
Derail the treatment. And that's why the conversations the assessments
are really important to make sure we aren't having the
team not support the treatment around that. And when you're
talking to people who are on the team, it can
be a relief to know I don't have to do this,
like I don't have to carry this along with you.
(28:29):
Because ultimately, at the end of the day, the person
in the treatment is the person in the treatment and
they have to be accountable for their treatment. We cannot
overly rely on the system. And so people can feel relieved,
but they can also feel distressed because now they.
Speaker 2 (28:41):
Have to watch someone go through.
Speaker 3 (28:44):
The anxiety discussed or shame connected to whatever is involved
in that OCD cycle, and that can be hard to watch,
and so they also have to learn how to resist
that urge to rescue and provide that compulsion.
Speaker 1 (29:00):
So you mentioned that CBT is not necessarily like the
gold standard when we're talking about an OCD treatment plan.
You mentioned ERP. So what does ERP stand for and
can you say more about what treatment for OCD actually
looks like.
Speaker 3 (29:15):
Yes, so we have our umbrella CBT and ornder that
we have exposure and response prevention. In exposure and response
prevention is, like you said, the golden standard for treating OCD,
because you're not going to be able to talk your
way out of OCD p will and traditional talk therapy.
And that's because the part of the brain where the
OCD is, like the mid brain, that's where you're getting
(29:35):
that firefly reaction language is in the cortex, and so
OCD does not care about all of that. It's going
to always provide you another what if or what if?
Speaker 2 (29:46):
What if? What if? Right, It's an endless what if maker.
Speaker 3 (29:49):
And so because of that, we have to have a
treatment that allows people to get exposed to the things
that are anxiety provoking for them, and that can be
an actual situation or feeling or thought. And then we
want to teach them a strategy called response prevention, which
essentially means you are not engaging in that compulsion anymore.
And so a big picture, we're trying to teach people
(30:10):
that they can sit with whatever that emotion is in
the absence of that compulsion, because the OCD says you
cannot sit with this. You need to do the compulsion
in order to feel better or prevent a negative outcome
from occurring. Right, And if the compulsion is always completed,
the person doesn't really get to learn what actually happens.
(30:31):
And at the end of the day, ERP is a
learning model.
Speaker 2 (30:33):
We want to.
Speaker 3 (30:34):
Teach people new behaviors and allow them opportunity to practice that,
so that as they're practicing this new behavior, they get
those older behaviors can shift to the background, and they
learn that they're competent and they can do it.
Speaker 1 (30:48):
So in the example that you gave around like, Okay,
I'm a new mom and you know, I feel like
I might just throw this baby. Would an ERP kind
of treatment look like there?
Speaker 2 (30:57):
Okay?
Speaker 3 (30:58):
And so if we're doing exposure your work around harm
based OCD, I would ask of that client what I
want to know what they're avoiding? First of all, because
if I can figure out what you're avoiding, I could
turn that into an exposure and it's likely going to
be things that are naturally occurring and repeating. So that's
a helpful one. So what that means is have you
(31:20):
stopped holding the baby as much? We're going to hold
the baby, we're going to change the diapers, we're going
to do the breastfeeding. We're also might write what we
call in a magical script, which is obviously we're not
going to tell someone to throw a baby, like that's
you know whatever. But we can use our imagination to
create a script that says, there's a possibility that I'm
(31:41):
not a safe mom. There's a possibility that I may
throw this baby when I am feeding the baby, and
despite this unwilling to take the risk, I may never
have one hundred percent certainty that I will not throw
this baby. But it's important for me to buy with
my child, and so I'm going to work through these
interests of thoughts and sit with these uncomfortable feelings and
(32:01):
hold my baby.
Speaker 2 (32:02):
Right.
Speaker 3 (32:03):
That could be an example of script work. And so
when we're talking about exposure, I do want to say
like there are different types of exposures we do. That
example was an imaginal exposure, and we do imaginal exposures
when it might be illegal unethical to do an exposure,
and so we use our imagination and vivo exposures are
(32:23):
things that we can actually do right. Like I can
lick my finger and touch a door knob and lick
it again. I can totally we can do that. We
can get in a car and practice driving over bunks
without practicing turning around to make sure we didn't hit someone.
Speaker 2 (32:38):
So when we can do.
Speaker 3 (32:39):
In vivo, we do in vivo and in narrow interro
stuftive exposures when people may have trouble sitting with the
physiological sensations of the anxiety, and so I might have
someone hold their breath, spin in a chair, do some
jumping jets in order to get their body really disregulated,
and teach them how to sit with that. And then
we combine all of them. So I might do an
(33:00):
intero sceptive with an imaginal script for a more deepened
extinction to facilitate that learning.
Speaker 1 (33:07):
And how would you work? Even if we stay with
this example, right, like we know babies fall like they've
bum been to stuff, And if you are somebody who
is struggling with like OCD type symptoms related to like
can I actually keep this baby safe? And then something happens?
Like what does that then look like now when I
bring that back into treatment?
Speaker 3 (33:25):
Yes, I love when those things happen, because what we
do know is babies will fall and toddlers will scrape
the knee.
Speaker 2 (33:32):
And so it's not OCD is not about always.
Speaker 3 (33:35):
Did the outcome happen or not happen? Because sometimes when
you get into that pool, it can unintentionally trigger a
series of compulsions. It's also about what could you tolerate
it the baby fail and then what happened? Did you
explode or were you able to sit with that dysregulation?
And how did that anxiety respond over time? How did
(33:57):
that guilt I can't believe I let my baby fall?
How did that respond over time? And so when the
worst case scenarios happen, it gives us an opportunity to
see and how did you handle it? Because we want
clients to learn that your OCD is lyned to you
can handle more than it's telling you you can handle, right,
And so that would be a great example when we
know the baby's going to fall again, the toddler's going
(34:18):
to scrap the knee again, and so the parent gets
an opportunity to learn that they can actually sit with
whatever emotions, like if that guilt is there, that the
guilt doesn't stay at one hundred percent for the rest
of their life, that it is a thing that's going
to ebb and flow.
Speaker 1 (34:35):
And what does the treatment look like when you bring
in like the support system, like what kinds of things
are you talking with family members and friends about around
how to support them while they're going through ERP.
Speaker 3 (34:45):
Yeah, so I want to understand where the co compolsients
are happening so that we can have a plan to
decrease and then stop those I also want to talk
about how you can support in a way that doesn't
allow the OCD to score points or to feel better.
And sometimes that might mean saying things like if the
person says, well, what if I harm the baby? Are
(35:06):
you sure you want me to do the feeding tonight?
And you say maybe you will, maybe you won't. We're
just willing to take that risk. And what it does
is now the person was seeking certainty and reassurance and
now we're back in the gray. And so if that
other person doesn't come and do that compulsion by taking
the baby and doing the feeding, now this gives the
(35:27):
client and opportunity to learn what actually happens in the
absence of that compulsion and what they can actually tolerate.
Speaker 1 (35:35):
I would imagine that this could be something and you
talked about like it being a very disabling kind of condition,
because I could also see like relationship concerns being a
spin off of this, right, Like, now I don't feel
supportive because you know you're not enabling me to kind
of keep up with the compulsions, right, So I would
imagine there could be a whole host of other concerns
that pop up as a result of trying to manage OCB.
Speaker 3 (35:55):
Yeah, And as you can imagine when you're trying to
do this work and you're used to receiving reassurance and
you're not getting it. We all have our natural reactions
to things, and so OCD aing or is a thing,
like people get upset and we have to work through
that and learn how to navigate that. But as we're
having our team conversation and I try to remind people
(36:16):
that it's us against the OCD, right, Like, ultimately, at
the end of the day, even if we have to
do some things that feel uncomfortable, let's remember what we're
in it for, like who our actual opponent is, and
it's not us against each other, it's us against the OCD.
Speaker 1 (36:34):
Something else you've talked about, doctor More is how hoarding
can be like a part of the OCD spectrum and
how this might look especially in black families. Can you
talk about like hoarding and what that look like.
Speaker 3 (36:46):
Yeah, I think hoarding is one of those interesting things.
I'm not a hoarding specialist, but again, like if it's
hoarding connected to OCD, I work with that, and I
just think about like generations of families where collecting things
was like not having access to things, and then having
access you get these knickknacks, you get these plastic containers
that just seem to be endless, and sometimes people have
(37:09):
had to oppern Maybe if we looked at it, we
can say, I don't know if that comes from like survival,
but it definitely can be a thing where every space
seems to be filled with something. Right in OCD, what
we're looking at is what's the function of that behavior,
And the function of that behavior can be different from
how traditional orbing presents. And so if someone's holding on
(37:32):
to an item because they're afraid that they'll never be
able to find that perfect item again, and it has
to be that way even if they don't like it
or use it, they want to hold on to it.
Or people who will just keep buying things like new
shirts and that they don't want to break the new
shirt in, so they'll just leave it in the closet
and then they'll get another shirt and they don't want
(37:53):
to break it in and so they just keep accumulating
shirts because they don't want to rooining.
Speaker 2 (38:00):
It by actually using it.
Speaker 3 (38:02):
That's a presentation that I could see in OCD, and
so that's why again the assessment in understanding the function
of the behavior is really important because both will present
with distress though, but I want to understand the function.
Speaker 1 (38:15):
Right more from our conversation after the break. Something I've
learned more about recently is PANDACE. So this is like
an OCD type disorder that happens in kids as a
(38:36):
result of them getting stripped through correct Yes, yeah, and
so that is a newer kind of thing. I feel
like that's recently something that medical professionals have discovered. Is
there an equivalent or something like that where people will
develop an OCD like symptoms related to a medical condition
in adults?
Speaker 3 (38:54):
So yeah, that's very specific. There is PANS and pandas.
I may treat an adult and what they may find
is that they've had like they started having struck when
they were younger in life that was unmanaged, and so
I'll work for them to a medical provider and maybe
they keep having like getting struck over and over again.
There's that resurgence and so I may have them go
(39:14):
see a medical provider so that they can get on
some long term management for that, because that could actually
be activating and maintaining OCD symptoms. But typically I see that.
I don't really work with kids anymore I used to,
but even with younger teens when I work with them,
I would see that presentation and it would be interesting.
And again that's why proper assessment is important, because if
(39:37):
you're asking those questions now that we know that, that
is a thing that can inform your treatment in your referrals,
right because we can see those symptoms, severity drop down
a lot if it is a PANDACE presentation once they
get that management for the STREPP or whatever else is
underlying condition that's activating the OCD. And I think that's
(40:00):
super that's interesting.
Speaker 1 (40:02):
Yeah, it is very interesting. And I feel like, again
that's probably something in the last ten years or so
that they are learning more about. So we're always learning.
I think as weel what this looks like. So what
if somebody is enjoying our conversation and they are thinking, like,
you know what, this sounds like a condition that I
might meet qualifications for, or I think a loved one
may actually have some OCD symptoms. Where should they start?
Speaker 3 (40:24):
The International OCD Foundation is a really great resource. They
have so many different things, articles, books that you can
look into on OCD. They do a lot of trainings
for professionals as well. So if you're a professional out
there and you think you might want to do some
OCD work, I think IOCDUF is a great place to start.
(40:44):
There's also a newer resource it's called erp Kaleioscope, and
it's actually founded by a group of black women, and
I think they're just recently getting it off the ground.
And again it's meant to be a space for providers
and people who.
Speaker 2 (41:01):
May be struggling with OCD.
Speaker 3 (41:02):
And so I think that those like IOCDF, erp Coaleidoscope
are great places if you're looking for some specific OCD resources.
Speaker 1 (41:12):
Something else I wanted to ask you, doctor Moore, what
is the connection? And I feel like you talked about
this a little bit around the religiosity, but you know,
what is the connection between like OCD and things like superstitions?
Right like how can you tell the difference?
Speaker 3 (41:27):
Okay, that's also a great one. Like I can say
in my family, we have a lot of superstitions that
we operate on. You know, like some cultural things don't
put the person on the floor. Even this thing with
the broom or a filiures like a whole bunch of things. Now,
the difference with that someone splits the pole, I'm like,
wait a minute, turn around. If someone did not turn around,
I'm probably not going to experience a lot of distress.
(41:52):
I might be annoyed momentarily like why couldn't you just
do that? You know how I feel about this, But
it's not something that's going to stick with me and
create the amount of distress that they have to turn
around or else is going to derail my next hour
or the rest of my day. That's how we can
differentiate with superstition from OCD. OCD has a high level
(42:13):
of distress around it, and if that person is in
that base, the compulsion has to be completed or they're
going to be very dysregulated. With us, it's probably just
going to be more of a fleeting thing if it's
just regular superstition.
Speaker 2 (42:27):
M hm.
Speaker 1 (42:28):
Thank you for that. So are there any affirmations, books,
or other resources that you would like to offer to
people who would like to learn more about this or
feel like this is something they're struggling with.
Speaker 3 (42:38):
My affirmation is you must be willing to risk, right.
It's not the type of affirmations that people think about
that are reassuring. My affirmation is if you want your
life back, you have to go get your life back.
That means you have to take actions and steps. I
say things like, let's be in our value here, and
what is the value? Is it to kind of stay
here and copepost with your OCD or is it to
(43:01):
be able to go out and connect with your friends
in this space that might not be ideal for you, right,
So my affirmations are more things that are here toward
pushing people into more discomfort willingly than just are sort
of like feel good affirmations. Like I said, IOCD have
like there are great resources listed there. I just think
it's a great place to start.
Speaker 1 (43:23):
You know, as you're talking, I definitely think the way
you show up as an ERP therapist or a therapist
who does ERP feels maybe a little different than would
you and might see in terms of like a typical presentation,
but it feels like it fits the condition, right, Like
that is why every therapist is not going to be
the right therapist for everybody because we all have different
trainings and our presentations I think can look very different.
(43:45):
And so what you're talking about, like you said, it
is very different than like the touching feeling when not touching,
but you know, the more feeling, Yeah, the more feeling
kind of like, let's support you as opposed to this. Really,
it sounds like there's a high level of challenge that
that is necessary for this disorder.
Speaker 3 (44:02):
There is a high level of challenge, and I think
that if you're going to do ERP work, you have
to be willing to do the exposures that your clients do,
and you have to be really willing to sit with
other people's discomfort. A lot of providers like the techniques
like breathing exercises and things like that because if helps
clients feel better and people struggle with watching people reacting
(44:25):
to things. And here where like we don't really do
breathing exercises when we're doing ERP. We don't really try
those interventions because we're willing to sit with our clients
having that distress because it's an important part of the treatment, right,
Like those sorts of interventions become distractions when it's directed
towards OCD. And that's why I think proper training for
(44:46):
clinicians is really important because a lot of times we
would love it inadvertently co compose with our clients because
we don't fully understand OCD and the mechanisms that kind
of maintain it. And you could be now, I will say,
outside of ERP, if someone wants just as a life,
they're like, I breathe like this, this is me and
my self care go for it. But it's just not
(45:08):
in the context of doing ERP work. So I think
you bring up a very important point in that the
treatments can look different and pertaining to OCD. You want
to be trained to implement ERP, and you have to
have some willingness to sit with discomfort.
Speaker 2 (45:24):
I mean all be infested with a lot of discomfort.
Speaker 3 (45:26):
But a lot of anxiety, and you have to be
willing to show up and do the things that your
clients are doing.
Speaker 1 (45:34):
And is the IOCDF the place there you get trained
in ERP or where would clinicians go to get training
for this?
Speaker 3 (45:40):
Yeh, that's one of the places they do some advanced
training in OCD, And so I did some training with
them as well. A knowledge tree is a place that's
popped up that's doing some more specific training and you'll
get some overlap of experts in the field to work
in those different spaces. So yeah, those are two places
to look for training. But I just think ERP it's
(46:03):
great to watch people level up in there. They feel
more confident, they learn how they can actually tolerate things
that the OCD told them that they can't tolerate. It's
great watching people like grab bits of their life bag
that they haven't been able to do things in years.
And I just think that when we talk about a
barrier to treatment, one thing I see is people feel
(46:24):
away by the time they reach an ERP specialists because
sometimes people have had treatment and they're like, why didn't
I know this treatment was available to me seven years ago,
because I would have like, I've had some great therapeutic experiences,
but it just didn't move the needle on my OCD.
Help with my trauma, help with some general coping strategies,
but MYOCD seemed to never quite benefit from that. And
(46:48):
I think the reason why I wanted to do this
podcast is the information out there that there is specific
OCD treatment that it is very effective. We just want
to make sure we are pushing people in that direction
so that we don't delay treatment and have people and
curing extra things that cost time a waste of resource
when it comes to.
Speaker 1 (47:08):
Time, and I'm sure there's no kind of standard on
like how long you would be in ERP, but is
there kind of generally like how long you would be
in sessions?
Speaker 3 (47:19):
Yeah, I want to check in around twelve and twenty sessions,
and so I just want to look like if we're
doing treatment for three months, I want to kind of
look and see where they are. And part of that
Wybox scale, there's a severity scale that goes along with it,
and so it's two parts. We look at the severity
scale and I'll reassess that just to see how that
number is decreasing over time. And when I say that
(47:40):
number is decreasing over time, that doesn't always mean like
the client gets to be anxiety free. ERP is about
learning how to live with anxiety versus pure symptom reduction,
and so a lot of people will come in thinking
like OCD work means I don't have intrusive thoughts anymore,
or I don't have anxiety anymore. And I'm not signing
that tree plan. This is really learning how to live
(48:03):
with in all caps. So I say things like when
we talk about affirmations, be anxious and do it anyway.
Be disgusted and do it anyway. And so yeah, like
we can look at a session limit and I use
that resource, the y box of Verity scale, in order
to help us know if we're on track. And I
think it's a great accountability for me and for the client,
(48:24):
so that we're holding ourselves accountable for the treatment.
Speaker 1 (48:27):
Perfect. So, doctor Moore, where can we stay connected with you?
What is your website as well as any social media
channels you'd like to share.
Speaker 3 (48:34):
Yes, my website is doctor Jamikamore dot com and I
am on Instagram at jam Sessions that's Jam Underscore s
E S s IO n Z and so you can
connect with me there.
Speaker 1 (48:47):
Perfect. Thank you so much for joining us again, doctor Moore.
Speaker 2 (48:50):
Yeah, thank you. It's good to see you.
Speaker 1 (48:52):
Of course, I'm so glad doctor Moore was able to
join me for this conversation and helping us better understand
OCD and its impact on black women. If you want
to learn more about her and her work, be sure
to visit the show notes at Therapy for Blackgirls dot
com slash Session four twenty five for more information, and
(49:13):
don't forget to text this episode to two of your
girls right now and tell them to check it out.
Did you know that you could leave us a voicemail
with your questions or suggestions for the podcast. Whether you
have ideas for future topics, book or movie suggestions, or
just something on your mind, we'd love to hear it.
Head on over to Memo dot fm slash Therapy for
Black Girls and leave us a voicemail. If you're looking
(49:35):
for a therapist in your area, visit our therapist directory
at Therapy for Blackgirls dot com slash directory, and don't
forget to follow us over on Instagram at Therapy for
Black Girls. This episode was produced by Elise Ellis, Indechubu
and Tyree Rush. Editing was done by Dennison Bradford. Thank
y'all so much for joining me again this week. I
(49:56):
look forward to continuing this conversation with you all real soon.
Take it care
Speaker 3 (50:04):
What
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