November 28, 2025 • 27 mins
Do you think you might have OCD and are wondering whether you need a diagnosis? Or do you already know you’re living with it and feel frustrated by the myths, stereotypes, and misunderstandings that surround it?
In this episode of But Are You Happy, clinical psychologist Dr Anastasia Hronis breaks down what OCD actually is, how it shows up in everyday life, and the evidence-based treatments that can genuinely help.
You’ll also learn:
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The different types of obsessive themes that can occur with OCD
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How intrusive thoughts and compulsions operate and impact daily life
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What to do if you think you might have OCD
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How clinical psychologists use Exposure and Response Prevention (ERP) in therapy
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CREDITS:
Hosts: Ashani Dante & Dr Anastasia Hronis
Senior Producer: Tahli Blackman
Executive Producer: Naima Brown
Audio Producer: Tina Matolov
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
You're listening to I'muma Mia podcast.
Speaker 2 (00:09):
What if I accidentally emailed curse words to all of
my coworkers and I just don't remember that I sent it,
and now I'm gonna get fired. I have a pain
in my leg and it's definitely deep thing from process.
What if I never really graduated college and this whole
time that I thought that I did, I really didn't,
and I've been lying about my degrees.
Speaker 1 (00:31):
For Mama Mia. I'm your host, Ashani Dante. Welcome to
But Are You Happy? The podcast for people that say
I just need a quiet weekend every weekend forever.
Speaker 3 (00:42):
And I'm doctor Annasata Heronus, a clinical psychologist passionate about
happiness and mental health. Now, there are a lot of
misconceptions about OCD, and today we're setting the record straight.
Speaker 4 (00:54):
We'll explore what OCD.
Speaker 3 (00:56):
Actually is, how it shows up in real life, and
what evidence based treatments are available.
Speaker 1 (01:02):
Jesa heads up some parts of this episode maybe challenging
and confronting, especially for those that have lived experiences with OCD,
So please do listen mindfully. Let's get into it. So
we love us a good myth busting episode. I know
previously we have unpacked ADHD to anxiety, but today we
(01:24):
are unpacking OCD because it's a term that gets thrown
around in conversations.
Speaker 5 (01:29):
Right.
Speaker 3 (01:30):
There are so many myths that exist when it comes
to OCD, and I think, you know, media, television shows, movies,
et cetera, have kind of perpetuated certain stereotypes about what
OCD is. You know, often when people think OCD and
don't have a whole lot of knowledge about it, they
might think of the person who, you know, likes to
wash their hands a lot, or likes everything kind of
(01:51):
in order, nice and neat and straight, as we saw
in the video at the start. But really, OCD is
so much more than that. So I think it's important
that we unpack some of the myths that surround it
and also kind of bust this myth that like every
one's a little bit OCD, which is not really true.
Speaker 1 (02:08):
Yeah, I think this is going to be a really
good one. So I guess what I'm curious about. Let's
start with unpacking the definition, Like what is OCD?
Speaker 3 (02:17):
Yeah, so OCD stands for obsessive compulsive disorder and it
is a clinical diagnosis that we can provide. It exists
in our diagnostic manuals as a clinical disorder that we
can diagnose someone with. Now, as the name of this
disorder suggests, there's two key features to OCD, the obsessions
(02:40):
and the compulsions. So the obsessions are essentially these intrusive
thoughts that are repetitive in nature and generally quite distressing
for a person. Now, I want to pause here and say,
every single one of us, we all get intrusive thoughts
at particular points in time. Right. We've talked about this
(03:02):
in one of our previous episodes a little bit as well,
but I think it's important to bring back up here.
We all get intrusive thoughts. It's a normal natural experience.
The way our brain works, it will sometimes throw in
intrusive thoughts and we go, hang on, why did I
just think that?
Speaker 4 (03:15):
So this might be.
Speaker 3 (03:16):
An intrusive thought around. What if I'm crossing the road
and I suddenly just step in front of a car
and I'm like, well, hang on, I don't want to
step in front of a car. I don't want to die.
You know, that's not my intention here, but my brain
just sort of throws out this intrusive thought. Everyone has them,
and they can be quite scary at times, especially because
they're not congruent to how we actually feel. So when
(03:39):
it comes to OCD, what we find is that people
who develop OCD attribute a lot of meaning to these
intrusive thoughts that they get. So if, for example, they
are standing ready to cross the road and they have
that intrusive thought of what if I just stepped out
in front of a car or a bus, that's very
distressing for them and they start to think, well, if
(04:01):
I thought it, there must be a part of me
that wants that to happen or believes that to be true.
And so we end up with these obsessive thought patterns
that occur around these intrusive thoughts, and then compulsive behaviors
to try and stop that from happening. So we have
these two key features.
Speaker 1 (04:19):
Yeah, okay, I think this is it's a really big
conversation because as you're talking about it, when I think
about OCD, like I do fall into thinking it's just
around people obsessed about keeping everything clean. So like I'm
curious around are there different types of OCD or is
that kind of just the standard?
Speaker 3 (04:38):
OCD presents in so many different ways, And that's why
I like that We've called this a myth busting episode
because there really is that misconception about it being around
cleanliness or order or sort of perfectionistic tendencies, and it's
really so much more than that. So I'll share some
of the kind of common themes that we might see
in OCD. And this is certainly to say it's not
(05:00):
an exhaustive list. So if anyone is listening and has
OCD but you don't relate to these, that's okay. It
doesn't mean that you don't have OCD. It's just that
I'm going to share some of the more common things.
So one of the common themes that we hear about,
and this is the sort of one of the stereotypical ones,
is around contamination. So this is where someone will have
intrusive thoughts that might be about germs, it might be
(05:22):
about illness, it might be about getting sick in some way,
and these thoughts come into their head repeatedly and without
them wanting those thoughts to come into their head. So
a common theme is around contamination, but we also see
themes around losing control. So these can often be very distressing.
Speaker 4 (05:42):
They may be.
Speaker 3 (05:43):
About harm, harm to oneself or harm to others. So
an example might be if I'm in the kitchen cooking
and I'm chopping up some veggies, I might have an
intrusive thought around what if I grab this knife and
hurt myself? What if I grab this knife and hurt
someone else in the room. So it's this fear of
losing control and that often associated with some sort of
(06:06):
harm to self or others. Sometimes we actually see this
with parents who are in that perinatal period. So say
a mum who's got a new baby and has intrusive
thoughts about what if I dropped my baby or what
if I hurt my baby? And these kind of intrusive
and repetitive thoughts become all encompassing, very distressing for them
and then lead to a whole range of compulsions that
(06:27):
someone might engage with to stop themselves from acting out
that feed behavior.
Speaker 1 (06:34):
So with the intrusive thoughts that you've kind of already
started to unpacking these different types specifically around losing control
and harm. Is there a difference between intrusive thoughts and
anxiety or are they connected?
Speaker 4 (06:48):
They're different, but they're connected.
Speaker 3 (06:49):
Yes, So intrusive thoughts we're very much talking about a
mental process and a mental process that we don't have
control over. Right, hence the word intrusive. It just happens
to us. We don't choose to think of these things.
Whereas anxiety we're talking about more of an emotional experience. Now,
the two of these can absolutely be tied together because
the intrusive thoughts people have, particularly when they're around distressing themes,
(07:12):
can often cause a lot of anxiety for someone.
Speaker 1 (07:15):
So what are the other types that are out there
with OCD?
Speaker 3 (07:18):
So there can be other types around. For example, the
obsessions might be about religious themes, so people are doing
things that might be blasphemous, fearing God, So a lot
of intrusive thoughts that are related to religion or spirituality
in some way. In addition, people can also have which
can be quite distressing, unwanted sexual thoughts. Yeah, and I
(07:42):
think it's important to talk about all these because we
want to take off any layers of shame. Right, we
see the hand washing, the stereotypical hand washing, but we
don't see the unwanted sexual thoughts. So these might be intrusive,
distressing thoughts where someone worries that they have sexual thoughts
towards someone else and worries that they might act on those.
We can even actually see this where people have intrusive
(08:05):
thoughts relating to sexuality. So am I straight, am I gay?
Speaker 4 (08:09):
Am I by?
Speaker 3 (08:10):
Am I attracted to people of the opposite sex which
I didn't think I was, etc. So these thoughts are
often incongruent with their actual internal experiences, but because they
think them, they feel quite distressed by them.
Speaker 1 (08:24):
You know.
Speaker 3 (08:24):
Another version of this is people who have intrusive thoughts
relating to children, so around the theme of pedophilia and
being worried that they're a pedophile, and it's absolutely not
that they are. They've just had an intrusive thought that
popped in their head relating to a child. And again,
we all have intrusive thoughts that are not congruent to
our own experience, but people with OCD fear these and
(08:49):
worry about them.
Speaker 1 (08:51):
I think it's so good, and I mean, you're already
articulated it so beautifully around how there can be layers
of shame that can be attached to this, especially when
it comes to religion and sex, which can be so personal.
So I love that we are shining a light on
this conversation. So I know you've uncovered and unpacked the
O in OCD. But what about the C compulsion you
(09:11):
were mentioning that earlier.
Speaker 3 (09:12):
Yes, yes, So the O is that kind of intrusive
part that someone feels they don't have much control over
the C. The compulsion is what a person does to
relieve or alleviate the distress and the anxiety that they
feel from the obsessive thoughts. So, for example, if someone
has obsessive thoughts about contracting a disease or HIV, this
(09:37):
is a common one that we hear, even though there's
no reason to suggest that they would have contracted it.
They might sort of go around their day to day life,
catch the bus, go here and there, have these intrusive
thoughts come in, and then they do a lot of
checking behaviors to alleviate the anxiety that they're feeling from
those intrusive thoughts. So they might go to the doctors
a lot, they might get lots of tests. I've worked
(09:57):
with people who constantly call the HIV hotlines and talk
to the people on the phones to get reassurance that
they may not have contracted it. So the compulsions are
sort of the behaviors that someone does to help them
deal with the stress that comes from those obsessive thoughts.
So we can have compulsions in themes again, And what
(10:18):
I want to say is that the compulsion might not
to us logically match up to what the obsessive thought is.
So I might have an obsessive thought about harming someone
else and then I, you know, tap my leg three times.
So it's not that I have an obsessive thought about
(10:39):
harming someone else so I put all the knives away
in the kitchen. It's I do something that may not
to us logically seem like it matches up. Yeah, but
it relieves distress for that person. So there can be
themes around these compulsive behaviors. So some of them might
involve checking, so rituals relating to kind of checking things repeatedly,
(10:59):
as I was talking about sort of that fear of
contracting an illness, It might it might be that there
are rituals relating to repeating certain behaviors. So for example,
if it is something like hand washing, I need to
wash my hands repeatedly, maybe I need to do it
ten times to feel satisfied. Or for some people there
is no number in terms of the repetition it's more
(11:22):
of a feeling of it kind of being. And this
is what I hear from people, this kind of quote
unquote just right, I wash my hands until it feels
just right, or I do the compulsion until it.
Speaker 4 (11:32):
Feels just right.
Speaker 3 (11:35):
And then one other example I want to provide around
themes of compulsive behaviors is mental compulsions.
Speaker 4 (11:42):
So compulsion doesn't have.
Speaker 3 (11:44):
To necessarily be a behavior that we can see, but
it can be like a mental ritual. So for example,
if someone has an intrusive thought, they then repeat a
mantra in their head three times, or they then say
a prayer, or they then count backwards from ten. It
could be anything, but it's a mental process rather than
a physical one.
Speaker 1 (12:06):
So what is the cause of OCD.
Speaker 3 (12:09):
It's a good question, and I think, like many things,
there's a range of different factors that constitute if someone
develops OCD. We know that there is a genetic component
to it, but we also know that certain life experiences
like trauma might be more likely to result in someone
(12:29):
developing OCD, or at least make sort of a tendency
towards obsessive compulsive themes worse. And then there are sort
of certain conditions like, for example, with autism, where we
see high rates of OCD as being a common co
occurring diagnosis that we see as partly related to the
way that autism can present with certain patterns of rigidity.
Speaker 1 (12:53):
So I was reading something online the other day and
they were talking about r OCD. What's that all about?
Speaker 3 (13:00):
Another version of yeah, yes, which is why it's just
so important to talk about the different ways in which
OCD can manifest. So r OCD refers to relationship OCD.
So this is where people can have repeated intrusive thoughts
about their relationship and the rightness of their relationship. You know,
(13:23):
is this the right relationship for me? Do I feel
like I'm well connected to my partner? So they question
the strength of the connection that they might have with
their partner and how right the relationship is for them,
And as we said, from a sort of compulsive side,
they might engage in certain checking behaviors like testing or
(13:43):
checking certain parts of the relationship to sort of check
the strength of the connection, check how right the relationship
feels for them. But this can be a really distressing
form of OCD and a really confusing form of OCD
for people and it's a really important one because you know,
we see people in the clinic who come specifically for ROCD, but.
Speaker 4 (14:05):
As opposed to certain other kind.
Speaker 3 (14:07):
Of forms of OCD where a person might come in
thinking that they might have OCD. This is usually one
where people are not actually aware it's OCD. They come
in and they think they're having relationship problems. Yeah, and
actually when we sort of assess and unpack it, we
find you're not really having relationship problems. Actually, you're just
having these intrusive thoughts that are so distressing that have
(14:29):
developed into an OCD like presentation. So it's really important
to be able to distinguish between relationship difficulties versus ROCD
so that we can provide the right treatment.
Speaker 1 (14:41):
Wow, that's so interesting, like knowing that OCD can be
in the context of relationships too.
Speaker 3 (14:47):
Yeah, yes, yeah, absolutely absolutely. And I'll add to that
talking about sort of people that we might see in
the clinic and say that we mentioned shame before, and
I think shame is a really important point to discuss
here when we're talking about OCD because I think I
think those very stereotypical presentations of OCD about hand washing
(15:09):
and ordering things, you know, people who don't have that
kind of OCD often come into the clinic feeling very
shameful about the intrusive thoughts that they're having and feeling
like that it reflects on them as a person when
it really doesn't. Right, I come back to intrusive thoughts
and not things we have control over. They're just words
that happen in our head. But people can feel immense
(15:31):
amounts of shame because of the types of thoughts that
they're having. Even when they come to talk to a
psychologist about it, which is meant to be a safe
open space, we see the shame come through, and so
that's why I think it was really important that we
did do this myth busting episode to really say OCD
comes in all shape, sizes, and forms, and no one
(15:52):
form of OCD is.
Speaker 4 (15:54):
More moral or pure or better than the other.
Speaker 3 (15:56):
It's simply the same manifestation but different types of obsessions
and compulsions.
Speaker 1 (16:01):
Yeah, I think it's good that we're shining a light
on not just the stereotypical type of OCD, but also
the nuances of it. Okay and Sejah, I want to
ask you a two prong question. We love our two
prongs number one, what do you do if you think
you have OCD? And number two, if you already do
(16:23):
have OCD, what's the best way to treat it? Yeah?
Speaker 3 (16:26):
Okay, So if you're someone and you think you've been
listening along and you're questioning whether you might have OCD,
first point of contact, I always recommend go to your GP,
have a chat with them. You may want to seek
out a referral to a mental health clinician, so perhaps
a psychologist or a psychiatrist, depending on the severity of
how much distress anxiety.
Speaker 4 (16:48):
It's causing you.
Speaker 3 (16:49):
And from that point on you can get a clinical
assessment done so that the treating clinician can either provide
a diagnosis of OCD or can rule out or look
for other kinds of conditions that might present similarly to
OCD but are not actually OCD. So it's always good
to get a thorough assessment done so that we can
(17:10):
get an appropriate diagnosis and provide the treatment that's most effective.
So that's the kind of initial process I would recommend
people go through. I also want to highlight that there
are some great online resources and options. There's a website
called this Way Up and they have a lot of
great self help self paced online programs. If you are
(17:32):
a general member of the public and you want to
access them.
Speaker 4 (17:36):
There is a fee.
Speaker 3 (17:36):
It's about fifty sixty dollars to be able to access
their OCD program. But if you're working with a clinician,
the clinician can actually quote unquote prescribe the course. So
I've done this with some of my clients. While sort
of I can prescribe the course and then they get
to access it for free. That's a great option in
the evidence base, They've been studied and researched and evaluated
(17:57):
by the university. So highly recommend this way up.
Speaker 1 (17:59):
That's great. I haven't heard of them before. So that's
so great we have that resource. So what if you
already have OCD, what's the best way to treat that?
Speaker 3 (18:08):
Yeah, So, as a psychologist, if I'm working with someone
who has OCD, the gold standard treatment approach that has
the most evidence behind it is something called ERP Exposure
response prevention.
Speaker 1 (18:22):
That sounds that sounds very clinical.
Speaker 4 (18:25):
Yes, yes, it's quite. It does sound a bit clinical,
a bit scary.
Speaker 3 (18:29):
Sometimes when we say to people, okay, exposure response prevention,
they're like, oh, what is that?
Speaker 4 (18:33):
Yes, what are you about to do?
Speaker 1 (18:35):
Yeah?
Speaker 3 (18:35):
Yeah, So essentially what we do this is based on
cognitive behavior therapy, which we've talked about before. So we're
really examining thoughts and behaviors to create change for a person.
So with exposure response prevention, what we are doing is
we are exposing them to the thing that causes them
stress and anxiety. So I'm going to use the stereotypical
(18:59):
cleaning type example. We would expose someone to a situation
where they might have those anxious thoughts about germs and
becoming unwell, and we would then help them to prevent
themselves from engaging in the compulsive behavior, which might be
something like hand washing. I'm using a really basic example
here to explain. So we would develop a hierarchy with them.
(19:23):
So we would work on a scale of one to ten.
Let's come up with a whole range of situations that
are going to bring up some stress and anxiety for you,
all the way from a one and two out of
ten low level anxiety up to ten out of ten.
That's the most stressful situation I could possibly think of
in relation to OCD. And so we come up with
a list of different activities or exercises that we can do,
(19:46):
and as clinicians we will often do them with a clients.
So we will work up that hierarchy and work to
prevent the person from engaging in the compulsive action. So
it might be that a level one or two is
kind of touching this couch and then not washing my hands.
It might be that a eight, nine or ten out
(20:07):
of ten is going onto a public bus, touching the
hand rails, then touching, you know, parts of my body
and not washing my hands for five hours or something
like that. So, depending on the person's individual circumstances, we
come up with that hierarchy and work through it with them.
Speaker 1 (20:24):
Wow, that's so effective. I mean, I really love how
individualized and specific it is as well.
Speaker 3 (20:29):
Yeah, and at the core of it, this idea of
exposure is how we work with many people who have
different kinds of anxiety, right, because we see that at
the root of OCD is anxiety. When someone has these obsessive,
intrusive thoughts, they feel stress and distress and anxious types
(20:50):
of feelings, and that's why they engage in the compulsive
behaviors to help themselves feel better in some way. It's
just that over time that becomes unhelpful and maladaptive for them.
So this idea of exposure is not unique to OCE.
It's how we would deal with a lot of different
types of presentations of anxiety so that people can sort
of build that tolerance to the feeling of distress that
(21:14):
comes with those thoughts.
Speaker 1 (21:15):
So have you done this with clients as well?
Speaker 4 (21:18):
Absolutely, absolutely so.
Speaker 3 (21:20):
I've worked with people who have intrusive, distressing thoughts around
contracting COVID. I've had people who've had distressing thoughts around
their relationship and engage in a lot of checking behaviors,
so maybe constantly asking their partner do you love me?
Do you want a future with me? Are you happy
in this relationship? And so part of the exposure and
(21:41):
response prevention would be about not asking those questions and
sitting with the discomfort of not asking those questions. And
we've worked with people who have intrusive thoughts around their
sexual orientation and being able to kind of notice those
thoughts and have some sort of exposure to maybe they're
avoiding looking at people of the same sex. If we
(22:02):
see people who are worried about being gay, for example,
even though they're not, so they avoid looking at people
of the same sex, so weep.
Speaker 4 (22:08):
Part of the hierarchy is.
Speaker 3 (22:10):
Okay, you can look at someone of the same sex
and if that thought comes up, that's okay.
Speaker 4 (22:14):
It's just a thought, it's just words.
Speaker 3 (22:16):
In your head, but prevents yourself from engaging in that
compulsive behavior.
Speaker 4 (22:20):
To break that cycle.
Speaker 5 (22:26):
Bierb bierb bib impowving a serious crisis, BRB having a crisis.
Speaker 1 (22:33):
We've reached that time in our episode where we answer
a question or dilemma from one of you. But are
you happy listeners, Anastasia, This one's from Sandy.
Speaker 5 (22:42):
One of my closest friends recently opened up to me
about having OCD. I knew they had anxiety, but I
didn't realize the extent of it until they shared more
about the intrusive thoughts and compulsions they deal with daily.
I really want to support them, but I don't always
know how, Like do I challenge the compulsions do I
just go along with them? I want to be there
(23:02):
for them, but then I also don't want to our
friendship to revolve around managing their mental health either, If
that makes sense. I guess my question is what's actually
helpful when someone you love is dealing with OCD, and
how do I show up for them in a way
that's supportive but also healthy for both of us.
Speaker 1 (23:18):
Oh, Sandy's a good friend.
Speaker 3 (23:20):
I know.
Speaker 4 (23:20):
I was just thinking.
Speaker 3 (23:21):
I was like, I love that Sandy has asked this question,
because they're obviously a very thoughtful person.
Speaker 1 (23:26):
Yeah.
Speaker 3 (23:27):
My biggest piece of advice here would be when in doubt,
ask your friends. There's not going to be a one
size fits all answer here. I think it's very much
going to be individual and dependent on the kind of
friendship and relationship that Sandy has with their friend. And
so I want to say, have this conversation with your friend,
ask them. You know, when you do have these compulsions
(23:48):
come about, do you want me to help you challenge them,
or do you want me to be a kind of
neutral bystander, or do you want me to just sort
of provide encouragement to you? You know, how can I
best show up for you and how can I help
you given what's happening with the OCD. We want to
prevent falling into the role of the therapist. I think
sometimes friends, you know, ride in with these questions with
(24:10):
really good intentions, But I would say, don't feel like
you have to take the responsibility on of being the
therapist for your friends when she's in these moments of
having these obsessive and compulsive thoughts and behaviors. Sometimes the
best way you can be a friend is to just
be there for someone. I know sometimes when we're working
with people who have OCD, we do sort of recommend
(24:33):
to family and friends not to enable the compulsions. But
this can come with risks, right risks to the friendship
as well. So depending on whether we actually are involving
sort of family and close friends in the treatment process,
don't feel like you need to necessarily challenge. Ask your
friend what's going to be most helpful for them, and
then also celebrate their wins. You know, if they are
(24:55):
able to kind of combat certain compulsive behaviors or have
intrusive thoughts and not sort of act out the compulsions,
celebrate those wins with them. I think that's one of
the best things as a friend you can do to
help and support someone through this journey.
Speaker 1 (25:07):
You gave some really good solid advice. Good luck, Sandy,
You've got this, Anastasia, Can you reiterate the main takeaways
from today's episode?
Speaker 3 (25:16):
Absolutely, First of all OCD comes in all sorts of
shapes and sizes, well beyond the stereotypes of what we
see on TV. Second, OCD can be incredibly distressing and
debilitating for individuals who have it. Third, there are a
range of different types of themes that both the obsessions
and the compulsions can take. And Lastly, exposure response prevention
(25:39):
or ERP can be a very effective gold standard treatment approach.
Speaker 1 (25:43):
If you have a burnie question for us, there are
a few ways to get in touch with us. Links
are in the show notes.
Speaker 3 (25:48):
And remember, while I am a psychologist, this podcast isn't
a diagnostic tool, and the advice and ideas that we
present here should always take into account your personal medical history.
Speaker 1 (25:59):
If you missed our mythbusting episode on ADHD, feel free
to scroll back through our feed to listen to it.
Next week, we're talking about procrastination, a relatable topic.
Speaker 3 (26:10):
The senior producer of But Are You Happy?
Speaker 1 (26:13):
Is Tylie Blackman, Executive producer is Naima Brown, and social
producer is Jemma Donaho.
Speaker 3 (26:19):
Sound design and editing by Tina Mattalov.
Speaker 1 (26:22):
You can find us on Instagram and TikTok search but
Are You Happy? Pot, I'm a Shani Dante.
Speaker 3 (26:28):
And I'm doctor Anaesthetia Heronus. The names and stories of
clients discussed have been changed for the purpose of maintaining anonymity.
If this conversation brought up any difficult feelings for you,
we have links for more resources in the show notes
around the topics we discussed today. You can also reach
out to organizations like Beyond Blue or Lifeline if you're
(26:49):
wanting more immediate support.
Speaker 1 (26:51):
Thanks for listening, See you next time you're listening to
Amma Mia podcast.
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Mamma Mia acknowledges the traditional owners of the land and
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You're listening to I'muma Mia podcast.
Speaker 2 (00:09):
What if I accidentally emailed curse words to all of
my coworkers and I just don't remember that I sent it,
and now I'm gonna get fired. I have a pain
in my leg and it's definitely deep thing from process.
What if I never really graduated college and this whole
time that I thought that I did, I really didn't,
and I've been lying about my degrees.
Speaker 1 (00:31):
For Mama Mia. I'm your host, Ashani Dante. Welcome to
But Are You Happy? The podcast for people that say
I just need a quiet weekend every weekend forever.
Speaker 3 (00:42):
And I'm doctor Annasata Heronus, a clinical psychologist passionate about
happiness and mental health. Now, there are a lot of
misconceptions about OCD, and today we're setting the record straight.
Speaker 4 (00:54):
We'll explore what OCD.
Speaker 3 (00:56):
Actually is, how it shows up in real life, and
what evidence based treatments are available.
Speaker 1 (01:02):
Jesa heads up some parts of this episode maybe challenging
and confronting, especially for those that have lived experiences with OCD,
So please do listen mindfully. Let's get into it. So
we love us a good myth busting episode. I know
previously we have unpacked ADHD to anxiety, but today we
(01:24):
are unpacking OCD because it's a term that gets thrown
around in conversations.
Speaker 5 (01:29):
Right.
Speaker 3 (01:30):
There are so many myths that exist when it comes
to OCD, and I think, you know, media, television shows, movies,
et cetera, have kind of perpetuated certain stereotypes about what
OCD is. You know, often when people think OCD and
don't have a whole lot of knowledge about it, they
might think of the person who, you know, likes to
wash their hands a lot, or likes everything kind of
(01:51):
in order, nice and neat and straight, as we saw
in the video at the start. But really, OCD is
so much more than that. So I think it's important
that we unpack some of the myths that surround it
and also kind of bust this myth that like every
one's a little bit OCD, which is not really true.
Speaker 1 (02:08):
Yeah, I think this is going to be a really
good one. So I guess what I'm curious about. Let's
start with unpacking the definition, Like what is OCD?
Speaker 3 (02:17):
Yeah, so OCD stands for obsessive compulsive disorder and it
is a clinical diagnosis that we can provide. It exists
in our diagnostic manuals as a clinical disorder that we
can diagnose someone with. Now, as the name of this
disorder suggests, there's two key features to OCD, the obsessions
(02:40):
and the compulsions. So the obsessions are essentially these intrusive
thoughts that are repetitive in nature and generally quite distressing
for a person. Now, I want to pause here and say,
every single one of us, we all get intrusive thoughts
at particular points in time. Right. We've talked about this
(03:02):
in one of our previous episodes a little bit as well,
but I think it's important to bring back up here.
We all get intrusive thoughts. It's a normal natural experience.
The way our brain works, it will sometimes throw in
intrusive thoughts and we go, hang on, why did I
just think that?
Speaker 4 (03:15):
So this might be.
Speaker 3 (03:16):
An intrusive thought around. What if I'm crossing the road
and I suddenly just step in front of a car
and I'm like, well, hang on, I don't want to
step in front of a car. I don't want to die.
You know, that's not my intention here, but my brain
just sort of throws out this intrusive thought. Everyone has them,
and they can be quite scary at times, especially because
they're not congruent to how we actually feel. So when
(03:39):
it comes to OCD, what we find is that people
who develop OCD attribute a lot of meaning to these
intrusive thoughts that they get. So if, for example, they
are standing ready to cross the road and they have
that intrusive thought of what if I just stepped out
in front of a car or a bus, that's very
distressing for them and they start to think, well, if
(04:01):
I thought it, there must be a part of me
that wants that to happen or believes that to be true.
And so we end up with these obsessive thought patterns
that occur around these intrusive thoughts, and then compulsive behaviors
to try and stop that from happening. So we have
these two key features.
Speaker 1 (04:19):
Yeah, okay, I think this is it's a really big
conversation because as you're talking about it, when I think
about OCD, like I do fall into thinking it's just
around people obsessed about keeping everything clean. So like I'm
curious around are there different types of OCD or is
that kind of just the standard?
Speaker 3 (04:38):
OCD presents in so many different ways, And that's why
I like that We've called this a myth busting episode
because there really is that misconception about it being around
cleanliness or order or sort of perfectionistic tendencies, and it's
really so much more than that. So I'll share some
of the kind of common themes that we might see
in OCD. And this is certainly to say it's not
(05:00):
an exhaustive list. So if anyone is listening and has
OCD but you don't relate to these, that's okay. It
doesn't mean that you don't have OCD. It's just that
I'm going to share some of the more common things.
So one of the common themes that we hear about,
and this is the sort of one of the stereotypical ones,
is around contamination. So this is where someone will have
intrusive thoughts that might be about germs, it might be
(05:22):
about illness, it might be about getting sick in some way,
and these thoughts come into their head repeatedly and without
them wanting those thoughts to come into their head. So
a common theme is around contamination, but we also see
themes around losing control. So these can often be very distressing.
Speaker 4 (05:42):
They may be.
Speaker 3 (05:43):
About harm, harm to oneself or harm to others. So
an example might be if I'm in the kitchen cooking
and I'm chopping up some veggies, I might have an
intrusive thought around what if I grab this knife and
hurt myself? What if I grab this knife and hurt
someone else in the room. So it's this fear of
losing control and that often associated with some sort of
(06:06):
harm to self or others. Sometimes we actually see this
with parents who are in that perinatal period. So say
a mum who's got a new baby and has intrusive
thoughts about what if I dropped my baby or what
if I hurt my baby? And these kind of intrusive
and repetitive thoughts become all encompassing, very distressing for them
and then lead to a whole range of compulsions that
(06:27):
someone might engage with to stop themselves from acting out
that feed behavior.
Speaker 1 (06:34):
So with the intrusive thoughts that you've kind of already
started to unpacking these different types specifically around losing control
and harm. Is there a difference between intrusive thoughts and
anxiety or are they connected?
Speaker 4 (06:48):
They're different, but they're connected.
Speaker 3 (06:49):
Yes, So intrusive thoughts we're very much talking about a
mental process and a mental process that we don't have
control over. Right, hence the word intrusive. It just happens
to us. We don't choose to think of these things.
Whereas anxiety we're talking about more of an emotional experience. Now,
the two of these can absolutely be tied together because
the intrusive thoughts people have, particularly when they're around distressing themes,
(07:12):
can often cause a lot of anxiety for someone.
Speaker 1 (07:15):
So what are the other types that are out there
with OCD?
Speaker 3 (07:18):
So there can be other types around. For example, the
obsessions might be about religious themes, so people are doing
things that might be blasphemous, fearing God, So a lot
of intrusive thoughts that are related to religion or spirituality
in some way. In addition, people can also have which
can be quite distressing, unwanted sexual thoughts. Yeah, and I
(07:42):
think it's important to talk about all these because we
want to take off any layers of shame. Right, we
see the hand washing, the stereotypical hand washing, but we
don't see the unwanted sexual thoughts. So these might be intrusive,
distressing thoughts where someone worries that they have sexual thoughts
towards someone else and worries that they might act on those.
We can even actually see this where people have intrusive
(08:05):
thoughts relating to sexuality. So am I straight, am I gay?
Speaker 4 (08:09):
Am I by?
Speaker 3 (08:10):
Am I attracted to people of the opposite sex which
I didn't think I was, etc. So these thoughts are
often incongruent with their actual internal experiences, but because they
think them, they feel quite distressed by them.
Speaker 1 (08:24):
You know.
Speaker 3 (08:24):
Another version of this is people who have intrusive thoughts
relating to children, so around the theme of pedophilia and
being worried that they're a pedophile, and it's absolutely not
that they are. They've just had an intrusive thought that
popped in their head relating to a child. And again,
we all have intrusive thoughts that are not congruent to
our own experience, but people with OCD fear these and
(08:49):
worry about them.
Speaker 1 (08:51):
I think it's so good, and I mean, you're already
articulated it so beautifully around how there can be layers
of shame that can be attached to this, especially when
it comes to religion and sex, which can be so personal.
So I love that we are shining a light on
this conversation. So I know you've uncovered and unpacked the
O in OCD. But what about the C compulsion you
(09:11):
were mentioning that earlier.
Speaker 3 (09:12):
Yes, yes, So the O is that kind of intrusive
part that someone feels they don't have much control over
the C. The compulsion is what a person does to
relieve or alleviate the distress and the anxiety that they
feel from the obsessive thoughts. So, for example, if someone
has obsessive thoughts about contracting a disease or HIV, this
(09:37):
is a common one that we hear, even though there's
no reason to suggest that they would have contracted it.
They might sort of go around their day to day life,
catch the bus, go here and there, have these intrusive
thoughts come in, and then they do a lot of
checking behaviors to alleviate the anxiety that they're feeling from
those intrusive thoughts. So they might go to the doctors
a lot, they might get lots of tests. I've worked
(09:57):
with people who constantly call the HIV hotlines and talk
to the people on the phones to get reassurance that
they may not have contracted it. So the compulsions are
sort of the behaviors that someone does to help them
deal with the stress that comes from those obsessive thoughts.
So we can have compulsions in themes again, And what
(10:18):
I want to say is that the compulsion might not
to us logically match up to what the obsessive thought is.
So I might have an obsessive thought about harming someone
else and then I, you know, tap my leg three times.
So it's not that I have an obsessive thought about
(10:39):
harming someone else so I put all the knives away
in the kitchen. It's I do something that may not
to us logically seem like it matches up. Yeah, but
it relieves distress for that person. So there can be
themes around these compulsive behaviors. So some of them might
involve checking, so rituals relating to kind of checking things repeatedly,
(10:59):
as I was talking about sort of that fear of
contracting an illness, It might it might be that there
are rituals relating to repeating certain behaviors. So for example,
if it is something like hand washing, I need to
wash my hands repeatedly, maybe I need to do it
ten times to feel satisfied. Or for some people there
is no number in terms of the repetition it's more
(11:22):
of a feeling of it kind of being. And this
is what I hear from people, this kind of quote
unquote just right, I wash my hands until it feels
just right, or I do the compulsion until it.
Speaker 4 (11:32):
Feels just right.
Speaker 3 (11:35):
And then one other example I want to provide around
themes of compulsive behaviors is mental compulsions.
Speaker 4 (11:42):
So compulsion doesn't have.
Speaker 3 (11:44):
To necessarily be a behavior that we can see, but
it can be like a mental ritual. So for example,
if someone has an intrusive thought, they then repeat a
mantra in their head three times, or they then say
a prayer, or they then count backwards from ten. It
could be anything, but it's a mental process rather than
a physical one.
Speaker 1 (12:06):
So what is the cause of OCD.
Speaker 3 (12:09):
It's a good question, and I think, like many things,
there's a range of different factors that constitute if someone
develops OCD. We know that there is a genetic component
to it, but we also know that certain life experiences
like trauma might be more likely to result in someone
(12:29):
developing OCD, or at least make sort of a tendency
towards obsessive compulsive themes worse. And then there are sort
of certain conditions like, for example, with autism, where we
see high rates of OCD as being a common co
occurring diagnosis that we see as partly related to the
way that autism can present with certain patterns of rigidity.
Speaker 1 (12:53):
So I was reading something online the other day and
they were talking about r OCD. What's that all about?
Speaker 3 (13:00):
Another version of yeah, yes, which is why it's just
so important to talk about the different ways in which
OCD can manifest. So r OCD refers to relationship OCD.
So this is where people can have repeated intrusive thoughts
about their relationship and the rightness of their relationship. You know,
(13:23):
is this the right relationship for me? Do I feel
like I'm well connected to my partner? So they question
the strength of the connection that they might have with
their partner and how right the relationship is for them,
And as we said, from a sort of compulsive side,
they might engage in certain checking behaviors like testing or
(13:43):
checking certain parts of the relationship to sort of check
the strength of the connection, check how right the relationship
feels for them. But this can be a really distressing
form of OCD and a really confusing form of OCD
for people and it's a really important one because you know,
we see people in the clinic who come specifically for ROCD, but.
Speaker 4 (14:05):
As opposed to certain other kind.
Speaker 3 (14:07):
Of forms of OCD where a person might come in
thinking that they might have OCD. This is usually one
where people are not actually aware it's OCD. They come
in and they think they're having relationship problems. Yeah, and
actually when we sort of assess and unpack it, we
find you're not really having relationship problems. Actually, you're just
having these intrusive thoughts that are so distressing that have
(14:29):
developed into an OCD like presentation. So it's really important
to be able to distinguish between relationship difficulties versus ROCD
so that we can provide the right treatment.
Speaker 1 (14:41):
Wow, that's so interesting, like knowing that OCD can be
in the context of relationships too.
Speaker 3 (14:47):
Yeah, yes, yeah, absolutely absolutely. And I'll add to that
talking about sort of people that we might see in
the clinic and say that we mentioned shame before, and
I think shame is a really important point to discuss
here when we're talking about OCD because I think I
think those very stereotypical presentations of OCD about hand washing
(15:09):
and ordering things, you know, people who don't have that
kind of OCD often come into the clinic feeling very
shameful about the intrusive thoughts that they're having and feeling
like that it reflects on them as a person when
it really doesn't. Right, I come back to intrusive thoughts
and not things we have control over. They're just words
that happen in our head. But people can feel immense
(15:31):
amounts of shame because of the types of thoughts that
they're having. Even when they come to talk to a
psychologist about it, which is meant to be a safe
open space, we see the shame come through, and so
that's why I think it was really important that we
did do this myth busting episode to really say OCD
comes in all shape, sizes, and forms, and no one
(15:52):
form of OCD is.
Speaker 4 (15:54):
More moral or pure or better than the other.
Speaker 3 (15:56):
It's simply the same manifestation but different types of obsessions
and compulsions.
Speaker 1 (16:01):
Yeah, I think it's good that we're shining a light
on not just the stereotypical type of OCD, but also
the nuances of it. Okay and Sejah, I want to
ask you a two prong question. We love our two
prongs number one, what do you do if you think
you have OCD? And number two, if you already do
(16:23):
have OCD, what's the best way to treat it? Yeah?
Speaker 3 (16:26):
Okay, So if you're someone and you think you've been
listening along and you're questioning whether you might have OCD,
first point of contact, I always recommend go to your GP,
have a chat with them. You may want to seek
out a referral to a mental health clinician, so perhaps
a psychologist or a psychiatrist, depending on the severity of
how much distress anxiety.
Speaker 4 (16:48):
It's causing you.
Speaker 3 (16:49):
And from that point on you can get a clinical
assessment done so that the treating clinician can either provide
a diagnosis of OCD or can rule out or look
for other kinds of conditions that might present similarly to
OCD but are not actually OCD. So it's always good
to get a thorough assessment done so that we can
(17:10):
get an appropriate diagnosis and provide the treatment that's most effective.
So that's the kind of initial process I would recommend
people go through. I also want to highlight that there
are some great online resources and options. There's a website
called this Way Up and they have a lot of
great self help self paced online programs. If you are
(17:32):
a general member of the public and you want to
access them.
Speaker 4 (17:36):
There is a fee.
Speaker 3 (17:36):
It's about fifty sixty dollars to be able to access
their OCD program. But if you're working with a clinician,
the clinician can actually quote unquote prescribe the course. So
I've done this with some of my clients. While sort
of I can prescribe the course and then they get
to access it for free. That's a great option in
the evidence base, They've been studied and researched and evaluated
(17:57):
by the university. So highly recommend this way up.
Speaker 1 (17:59):
That's great. I haven't heard of them before. So that's
so great we have that resource. So what if you
already have OCD, what's the best way to treat that?
Speaker 3 (18:08):
Yeah, So, as a psychologist, if I'm working with someone
who has OCD, the gold standard treatment approach that has
the most evidence behind it is something called ERP Exposure
response prevention.
Speaker 1 (18:22):
That sounds that sounds very clinical.
Speaker 4 (18:25):
Yes, yes, it's quite. It does sound a bit clinical,
a bit scary.
Speaker 3 (18:29):
Sometimes when we say to people, okay, exposure response prevention,
they're like, oh, what is that?
Speaker 4 (18:33):
Yes, what are you about to do?
Speaker 1 (18:35):
Yeah?
Speaker 3 (18:35):
Yeah, So essentially what we do this is based on
cognitive behavior therapy, which we've talked about before. So we're
really examining thoughts and behaviors to create change for a person.
So with exposure response prevention, what we are doing is
we are exposing them to the thing that causes them
stress and anxiety. So I'm going to use the stereotypical
(18:59):
cleaning type example. We would expose someone to a situation
where they might have those anxious thoughts about germs and
becoming unwell, and we would then help them to prevent
themselves from engaging in the compulsive behavior, which might be
something like hand washing. I'm using a really basic example
here to explain. So we would develop a hierarchy with them.
(19:23):
So we would work on a scale of one to ten.
Let's come up with a whole range of situations that
are going to bring up some stress and anxiety for you,
all the way from a one and two out of
ten low level anxiety up to ten out of ten.
That's the most stressful situation I could possibly think of
in relation to OCD. And so we come up with
a list of different activities or exercises that we can do,
(19:46):
and as clinicians we will often do them with a clients.
So we will work up that hierarchy and work to
prevent the person from engaging in the compulsive action. So
it might be that a level one or two is
kind of touching this couch and then not washing my hands.
It might be that a eight, nine or ten out
(20:07):
of ten is going onto a public bus, touching the
hand rails, then touching, you know, parts of my body
and not washing my hands for five hours or something
like that. So, depending on the person's individual circumstances, we
come up with that hierarchy and work through it with them.
Speaker 1 (20:24):
Wow, that's so effective. I mean, I really love how
individualized and specific it is as well.
Speaker 3 (20:29):
Yeah, and at the core of it, this idea of
exposure is how we work with many people who have
different kinds of anxiety, right, because we see that at
the root of OCD is anxiety. When someone has these obsessive,
intrusive thoughts, they feel stress and distress and anxious types
(20:50):
of feelings, and that's why they engage in the compulsive
behaviors to help themselves feel better in some way. It's
just that over time that becomes unhelpful and maladaptive for them.
So this idea of exposure is not unique to OCE.
It's how we would deal with a lot of different
types of presentations of anxiety so that people can sort
of build that tolerance to the feeling of distress that
(21:14):
comes with those thoughts.
Speaker 1 (21:15):
So have you done this with clients as well?
Speaker 4 (21:18):
Absolutely, absolutely so.
Speaker 3 (21:20):
I've worked with people who have intrusive, distressing thoughts around
contracting COVID. I've had people who've had distressing thoughts around
their relationship and engage in a lot of checking behaviors,
so maybe constantly asking their partner do you love me?
Do you want a future with me? Are you happy
in this relationship? And so part of the exposure and
(21:41):
response prevention would be about not asking those questions and
sitting with the discomfort of not asking those questions. And
we've worked with people who have intrusive thoughts around their
sexual orientation and being able to kind of notice those
thoughts and have some sort of exposure to maybe they're
avoiding looking at people of the same sex. If we
(22:02):
see people who are worried about being gay, for example,
even though they're not, so they avoid looking at people
of the same sex, so weep.
Speaker 4 (22:08):
Part of the hierarchy is.
Speaker 3 (22:10):
Okay, you can look at someone of the same sex
and if that thought comes up, that's okay.
Speaker 4 (22:14):
It's just a thought, it's just words.
Speaker 3 (22:16):
In your head, but prevents yourself from engaging in that
compulsive behavior.
Speaker 4 (22:20):
To break that cycle.
Speaker 5 (22:26):
Bierb bierb bib impowving a serious crisis, BRB having a crisis.
Speaker 1 (22:33):
We've reached that time in our episode where we answer
a question or dilemma from one of you. But are
you happy listeners, Anastasia, This one's from Sandy.
Speaker 5 (22:42):
One of my closest friends recently opened up to me
about having OCD. I knew they had anxiety, but I
didn't realize the extent of it until they shared more
about the intrusive thoughts and compulsions they deal with daily.
I really want to support them, but I don't always
know how, Like do I challenge the compulsions do I
just go along with them? I want to be there
(23:02):
for them, but then I also don't want to our
friendship to revolve around managing their mental health either, If
that makes sense. I guess my question is what's actually
helpful when someone you love is dealing with OCD, and
how do I show up for them in a way
that's supportive but also healthy for both of us.
Speaker 1 (23:18):
Oh, Sandy's a good friend.
Speaker 3 (23:20):
I know.
Speaker 4 (23:20):
I was just thinking.
Speaker 3 (23:21):
I was like, I love that Sandy has asked this question,
because they're obviously a very thoughtful person.
Speaker 1 (23:26):
Yeah.
Speaker 3 (23:27):
My biggest piece of advice here would be when in doubt,
ask your friends. There's not going to be a one
size fits all answer here. I think it's very much
going to be individual and dependent on the kind of
friendship and relationship that Sandy has with their friend. And
so I want to say, have this conversation with your friend,
ask them. You know, when you do have these compulsions
(23:48):
come about, do you want me to help you challenge them,
or do you want me to be a kind of
neutral bystander, or do you want me to just sort
of provide encouragement to you? You know, how can I
best show up for you and how can I help
you given what's happening with the OCD. We want to
prevent falling into the role of the therapist. I think
sometimes friends, you know, ride in with these questions with
(24:10):
really good intentions, But I would say, don't feel like
you have to take the responsibility on of being the
therapist for your friends when she's in these moments of
having these obsessive and compulsive thoughts and behaviors. Sometimes the
best way you can be a friend is to just
be there for someone. I know sometimes when we're working
with people who have OCD, we do sort of recommend
(24:33):
to family and friends not to enable the compulsions. But
this can come with risks, right risks to the friendship
as well. So depending on whether we actually are involving
sort of family and close friends in the treatment process,
don't feel like you need to necessarily challenge. Ask your
friend what's going to be most helpful for them, and
then also celebrate their wins. You know, if they are
(24:55):
able to kind of combat certain compulsive behaviors or have
intrusive thoughts and not sort of act out the compulsions,
celebrate those wins with them. I think that's one of
the best things as a friend you can do to
help and support someone through this journey.
Speaker 1 (25:07):
You gave some really good solid advice. Good luck, Sandy,
You've got this, Anastasia, Can you reiterate the main takeaways
from today's episode?
Speaker 3 (25:16):
Absolutely, First of all OCD comes in all sorts of
shapes and sizes, well beyond the stereotypes of what we
see on TV. Second, OCD can be incredibly distressing and
debilitating for individuals who have it. Third, there are a
range of different types of themes that both the obsessions
and the compulsions can take. And Lastly, exposure response prevention
(25:39):
or ERP can be a very effective gold standard treatment approach.
Speaker 1 (25:43):
If you have a burnie question for us, there are
a few ways to get in touch with us. Links
are in the show notes.
Speaker 3 (25:48):
And remember, while I am a psychologist, this podcast isn't
a diagnostic tool, and the advice and ideas that we
present here should always take into account your personal medical history.
Speaker 1 (25:59):
If you missed our mythbusting episode on ADHD, feel free
to scroll back through our feed to listen to it.
Next week, we're talking about procrastination, a relatable topic.
Speaker 3 (26:10):
The senior producer of But Are You Happy?
Speaker 1 (26:13):
Is Tylie Blackman, Executive producer is Naima Brown, and social
producer is Jemma Donaho.
Speaker 3 (26:19):
Sound design and editing by Tina Mattalov.
Speaker 1 (26:22):
You can find us on Instagram and TikTok search but
Are You Happy? Pot, I'm a Shani Dante.
Speaker 3 (26:28):
And I'm doctor Anaesthetia Heronus. The names and stories of
clients discussed have been changed for the purpose of maintaining anonymity.
If this conversation brought up any difficult feelings for you,
we have links for more resources in the show notes
around the topics we discussed today. You can also reach
out to organizations like Beyond Blue or Lifeline if you're
(26:49):
wanting more immediate support.
Speaker 1 (26:51):
Thanks for listening, See you next time you're listening to
Amma Mia podcast.
Speaker 3 (27:03):
Mamma Mia acknowledges the traditional owners of the land and
waters that this podcast is recorded on. Mamma Mia acknowledges
the traditional owners of the land and waters that this
podcast is recorded on.
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