317. The psychology of OCD

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Speaker 1: Hello everybody, and welcome back to the Psychology of Your Twenties, the podcast where we talk through some of the big life changes and transitions of our twenties and what they mean for our psychology. Hello everybody, Welcome back to the show. Welcome back to the podcast. New listeners, old listeners. Wherever you are in the world, it is so great to have you here back for another episode as we of cause breakdown the Psychology of our twenties. Before we begin, I wanted to let you guys know, those of you who lived in the US, that we are going on a mini podcast tour in the kind of middle to end of August. I will be going to Seattle, Boston, Chicago, and there are tickets still available. Each night slash afternoon, we'll be doing a small live podcast recording, plus a Q and A. Then they'll be a chance for you to get your book signed if you have a copy of my book Person in Progress, and then just really mingle with me and other listeners of the show, make new friends, have a glass of wine, have some snacks, and just kind of get to know each other. So if that is something that interests you, if you are ready to meet some like minded people and myself. There are a couple of tickets still available for some select cities. I'm going to leave a link in this episode description. Hopefully I can see as many of you there as possible. Okay, let's get into the episode. Today. We are tackling a topic that feels very personal to me, very recently personal to me. We are talking about OCD. If you guys don't know, and you probably don't because I've actually never talked about it before, so this is probably new information to everyone. I was recently diagnosed with OCD, and it is a diagnosis that, in retrospect and in hindsight, has been a long time coming. For so long, I thought I just had anxiety, and I thought I had a panic disorder. I thought I just have panic attacks. And this is where all my issues with thoughts spiraling, repetitive thoughts, rumination, this is where it all comes back to you. I'm an anxious person. But at the end of last year, I began to kind of realize, wait a second, I actually don't really have panic attacks. You know, probably only had like three or four in my lifetime, and I'm actually not an anxious person. I don't get anxious meeting new people. I don't get anxious trying new things. I don't get randomly anxious throughout my day. I don't even get anxious when my life is really busy. The only time I'm really anxious or I would say, you know, distressed, is when it comes to this very specific loop of thoughts that I can't get out of about very specific things for me, primarily my health and like this grand philosophical concept of like death and existence. But other than that, I don't really have anxiety. And at the end of the end of last year, I kind of had a mental health player up, which I talk about on the podcast, and that kind of caused me to go and see a new therapist, someone i'd never spoken to before. And when I walked in, I was like, I'm not going to put any label on my symptoms. I'm not gonna say, oh, I have depression, I have anxiety. I'm just gonna describe how I am feeling, and I'm gonna see what she has to say. And after a while she kind of said to me, have you considered the fact that you may have OCD? And it just kind of clicked for me. I definitely didn't go in thinking that, I was just like, Oh, this is a theory I want to test out. Something doesn't seem right around the diagnosiss I've been given. And in that moment, I was like, Wow, do you know what, Yeah, you're probably right. I've spent my whole life talking about psychology, talking about mental health, and I kind of got it wrong. How was this never apparent to me? How come I didn't realize all along that this is what was really going on? And throughout the episode you'll hear some things around specific symptom patterns and obsessive obsessive patterns that were very indicative from an early age that just kind of were missed. And I think the reason that they were never apparent to me or to anyone else, is that no one ever talked to me about OCD in a way that related to my experiences or that I could understand when we talk about OCD. It was and it has always been, even when I was at UNI and I was studying psychology, it was so surface level. It was so surface level, and I could never really see myself in the descriptions, the descriptions of cleanliness and organization and neatness and tardiness. But that is really just the tip of the psychological iceberg here. OCD is so multi dimensional, and the reality of it is far more intricate, far more debilitating, and frankly, a lot more deep than the tidy, neat, clean, freak stereotypes really suggest. Also, you know, for so long, OCD has just been a punchline of so many jokes. I don't think any mental health disorder has been as trivialized as OCD. But if you're living with it, it's so complex and it's pretty freaking relentless, if I do say so myself, And I think our society is really lacking in an understanding of this, and lacking in how many people are actually walking around with thoughts, really serious scary thoughts they can't get out of their head, and how many people are suffering because of that. And it really sometimes has nothing to do with the tidy with the tidy kitchen or hand sanitizer or whatever like order in their life. It goes so much deeper. So today, you know, given my diagnosis was almost six months ago, now I really want to do a bit of a deep dive into what OCD actually is. Now that I feel like I know more, I want to dissect some of its core components, the obsessions, the repetitive behaviors, both visible and hidden, and also the vast and very varied ways that OCD can show up in our lives, why it's often confused with other mental health disorders, why it's made fun of, and also what is happening in our brains. I also really want to discuss some of the treatment options, the ways in which you can find relief if you are suffering from OCD. I feel like there will never be a time on this podcast where we don't finish on a high note. I try not to make it or make it seem like it's toxic positivity, but I do think with things like OCD, with any mental health disorder, with anything that we're going through, there is actually a lot more hope than there is despair. And there are really smart people who have come up with really amazing ways to deal with this and to address the things that are going on in our brains and in our minds and in our bodies. So that's really where I want to leave the end of this episode with a bit of a brightness on the horizon, a bit of a silver lining, I will say before we begin small caveat. This episode is not for diagnostic purposes. If you think you may be suffering from OCD, please go and see a registered psychologist or a psychiatrist in your local area to get help. My real aim for this episode is just to kind of provide a bit more information about my own story, why it's actually not a rare story, and also, yeah, just kind of provide you with some information general information around what this disorder of really means for people who are enduring it, because I think we could all really benefit from knowing more about the lived experience of people with OCD, whether you have it or whether you don't. So, without further ado, I don't want to say excited for this episode. I'm very invested in this episode and it was a real pleasure and really personal, personally motivating to research it. So I hope you get something out of it. Let's go into the complex origins, symptoms, and experience, but also treatments for OCD. Stay with us. Let's kick things off by firstly just busting some myths, because honestly, the popular image of OCD wildly off the mark. It is not about being unique freak. It's not about being particular about details. Whilst some individuals with OCD do experience symptoms related to order and cleanliness, that is just one faset and it doesn't do justice to what is really happening under the surface. So what is OCD A very basic perspective. At its core, OCD is actually one of the most revalent mental health conditions in the world. And every time I tell people that, they're always surprised, but it's true. About one to three percent of the population has OCD. And if that doesn't sound like a big amount, I will say that makes it the fourth most diagnosed mental health condition in the world, coming under depression, generalized anxiety disorder, and panic disorder. And if we translate one to three percent into a number, that's around seventy eight to two hundred and thirty four million people worldwide. And let's also be clear, that's just the number of people who are diagnosed, so it's not including the people that havn't yet been able to access a diagnosis for various reasons because of health inequality, because they don't even recognize the symptoms in themselves, because of stigma, any number of reasons. So if you want to understand ocd's are more. You basically have to understand as a starting point how it is described in the DSM five. So the DSM is basically the reference point for all mental health or brain related conditions, OCD being one of those, and OCD is characterized in this book by two main components, obsessions and compulsions. You have to have both to have a diagnosis of OCD. Let's break down these components. So obsessions these unwanted, intrusive and often very distressing thoughts, images or urgers that just pop into someone's head seemingly out of nowhere. They are persistent, they typically cause a lot of anxiety and stress, and they are frequent. They're frequent visitors in our minds. Here's the key point. These aren't just excessive worries about real life problems. If you are going broke and you are worried about money, you are obviously going to be thinking about money all the time because it is a present day issue for you that is very, very stressful. That doesn't make it an obsession in OCD terms. Obsessions as a part of OCD are very different. They're what we call ego dystonic, meaning they clash with a person's true values, realities, beliefs, desires. They also are not always particularly relevant to what that individual is experiencing in that moment. So, for example, you may have intrusive thoughts about hurting someone even though you're not hurting someone at that point. You can have intrusive thoughts that you're a bad person, even though you know that doesn't match reality. You're not a bad person. You can have intrusive thoughts about the meaning of life that go against your beliefs about your purpose. Here, you can have false beliefs that someone in your family may be ill or that you may get ill, that are totally unreasonable when we actually pair them up with reality, but which your brain thinks one hundred percent factual, true information. It's the fact that these thoughts are so counter to who we are, what's going on in our lives, how we wish to see ourselves, that they cause so much fear and such intense anxiety or stress at times. Here's the other crucial thing. We can't help it. Of course, you know, if your life is falling apart, if your world is crumbling like, you're going to be anxious about what's happening in your environment and your circumstances. But with obsessive thoughts, they just come out of nowhere. There's no typically, there's no real reason that they're there. They just are. How I like to explain it is that these thoughts are kind of like a smoke alarm going off on your head, and no matter how many times you push the button, it won't turn off. So you just have this alarm going on and on and on. Someone without OCD can easily turn off the button, but if you have OCD, you can't. So that's the first component these obsessions. Then we have compulsions. These are the repetitive behaviors or mental acts that an individual feels driven kind of to perform in response to the obsessive thought. So you think something that's scarer, you think something that's causing you panic, you think something that feels terrible in your body, and so the only way to stop that thought is to go and do a repetitive behavior, to perform a compulsion that makes that thought feel less sharp. The goal of the compulsion is to prevent or reduce the feeling of distress that is caused by the obsession or it's kind of this weird, this weird thing that we do that we think is going to stop something terrible from happening. We think that it's like protective either way, we kind of do see it as a good thing that we are doing these and that we are performing these compulsions because they are somehow neutralizing a threat or somehow saving us. You know, for example, you may have this fear that something's going to happen to your family, But if you flick a light switch on and off twelve times arbitrary number, well then it's not gonna happen. How could you not do that if you genuinely think that your family will perish in a car accident if you don't flick the light switch on twelve times exactly, Like, of course you're going to do that. Of course you're going to perform the compulsion. It's the only thing that in your mind is preventing this terrible thing from happening. It's the only thing that is cooling off the obsessive thought. It's not about pleasure, it's not about avoiding reality. It's about escaping the terror of the thought in your mind. It's about escaping what you think is going to happen if you don't address this thought with this compulsion just to nail this home. Think about it like this. An obsession is screaming at you something terrible is going to happen if you don't do X, and the compulsion is the desperate, often illogical attempt to silence that scream and avert the perceived disaster by performing X. And both of these components, like I said before, are essential. There is actually something called purely obsessional OCD. They call it pure o OCD, where the obsession is obviously the distressing thought, but the compulsion is just to think about that distressing thought more. And sometimes people can look at that and think, well, that's not OCD. There's no compulsion. This person isn't acting in a certain way to prevent the negative, distressing thought. It is still OCD because the act of thinking is actually the compulsion is actually the compulsion. You can understand how frickin' frustrating that can be, but in some ways it is soothing. Thinking about something constantly over and over again until it feels safe is actually, in some ways a form of OCD. It's a way that we try and try to turn the smoke alarm off, and that brings us to the OCD cycle, which is really what defines this disorder. So the OCD cycle starts with an intrusive thought. Now here's a crucial piece of understanding that we can't miss out on. Intrusive thoughts are actually really common. Around eighty to ninety percent of the general population experiences intrusive thoughts on a regular basis. That's why intrusive thoughts alone are not enough to be diagnosed with OCD. Intrusive thoughts are basically just like random, unwanted, bizarre things, sometimes disturbing that just like pop into your head. You know. The best example, you're standing on the train platform and you're like if I just jumped, Or you're driving your car and you're like, what if I just crash my car? You're holding a baby, You're like, you just have this image of yourself like throwing the baby on the ground, and then it disappears. You know, for most people, those thoughts are quickly dismissed. You might think that's really weird. Obviously I'm not going to do that, like that's crazy, and your brain just filters it out, recognizes it as just like a random brain blip. But for someone with OCD, those thoughts don't just pass by, They become sticky. Their brain doesn't filter it out. It flags it as really important, really important information. It flags those thoughts as dangerous. It flags those thoughts as something that they have to pay attention to. And so when that thought enters the part of our brain that filters our thoughts that are are useful in those that aren't, grabs onto it and holds onto it tight. So like, let's say you are spending time with your family and for like a split second, you think, what if I end up hurting my family member? What if I stab my family something bizarre like that. Someone without OCD might think, like, think that, and be like, that is so weird that I just thought that. What a random thought, What a horrible thought. I'd obviously never do that when you could refocus. For someone with OCD, though, instead of just being able to dismiss it, the brain immediately interprets this thought as highly significant and threatening, thinking, oh my god, but why did I think that? Obviously, if I thought that, it means some part of me really wants to do that, And if some part of me really wants to do that, that I'm a monster. And if I'm a monster, I shouldn't be around my family because if I'm having those thoughts and obviously I'm going to act on them. You can see how this creates a lot of anxiety a lot of dread. Individuals with OCD often have an inflated sense of responsibility. Inflated responsibility basically means that they have this exaggerated belief that they as individuals, have the power to cause or prevent negative outcomes, even when objectively they don't. This feeling of being excessively responsible for preventing bad things from happening, even if it sounds delusional to people who don't have OCD, what it means is that the thoughts that they're having around family members being hurt, them hurting family members, terrible things happening really difficult to shake. But this is where the compulsion comes in. The compulsion is introduced as this behavior that can make all of that go away. There is some behavior they believe they can do that will shield them from the bad thing happening, that will shield the people they love from bad things happening, And so of course they're gonna do it. They're gonna wash their hands as many times as they need, They're going to ask for reassurance until the cows come home. They're going to check every single lock twelve times, because that's how many times they need to do it to assure ensure that they haven't been anything. You can kind of see where this is going. One of my compulsions when I was a child, And again I don't know how anyone freaking missed this, but I guess I never told anyone. But when I was a kid, every single night, before I went to bed, I would pray, and I would have to pray for exactly one minute and forty five seconds, and my prayer would have to be very very specific. I would have to mention every single member of my family. I'd have to say all of these certain things. I'd have to thank God for five different things every single night, although something bad was going to happen. My family was not religious at this stage. I had never stepped foot in a church. I think I started doing this when I was like four. I had I'd like I had no. I didn't go to a religious school. I lived in like a part of Australia where, you know, religion wasn't really a huge thing. But I'd gotten in my mind that you know if I didn't do this, people would be hurt. Here's the cruel irony of that. Though performing the compulsion only provides a very temporary brief sense of relief before the anxiety comes racing back, but this just momentary relief actually reinforces the compulsion. Of course, you're so distressed by these thoughts you're having. Any sense of calm is one that you are going to pursue. But what that means is that your brain learns, Okay, when I have the scary thought that a family member is going to die, I'm going to get a disease, something terrible is going to happen. If I do X, the bad feeling goes away. Well, then of course I'm going to keep doing X. And this really strengthens the link between the obsession and the compulsion, making it more likely that the cycle will repeat the next time the obsession appears. The child will continue to pray, the person will continue to wash their hands, they will continue to check the lock twelve times. And because the compulsion momentarily feels like it prevents the feared outcome, probably because the feared outcome was never going to happen anyway, You never get to test whether the fear was realistic in the first place. The cycle gets stronger, the anxiety returns, the compulsion becomes more rigid and frequent. I think something that's really key to highlight when talking about OCD is actually how vast this condition really is. Like we said at the beginning, it's not just tidiness. There are all these different categories of OCD symptoms that I think is really important that we know of. So we are going to take a short break here, but when we return, I want to talk through these very important categories and how they are very very distinctive and different. Stay with us. So researchers and people in the clinical mental health space often categorize OCD symptoms into various common themes or dimensions, just to kind of make it easier to label people and to choose what treatment would work best for them. I'm going to share some of these with you guys. Now, this is actually, by no means an exhaustive list. It's just the most common ones. So the first is the classic, it's the most recognized type of OCD. Contamination and cleaning obsessions to do with this might involve intense fears of germs, dirt, bodily fluids, chemicals, chemicals in your food, or even mental contamination, feeling dirty from a negative thought or an interaction. The underlying fear is not of the dirt, not of the germs. It's of illness. It's of death, it's of moral impurity. It's of something being in your body that you can't control. Compulsions around this might involve excessive hand washing, showering, cleaning objects, avoiding perceived contaminants, or asking others to clean things because you trust them more, all driven by that desperate need to alleviate that fear. I actually read a really fascinating article about a group of people, well, there weren't really a group, but people individually who would not get the COVID vaccine because they were so scared of obviously, of having something in their body that they couldn't control. It's not that they thought the vaccine was bad, it's not that they didn't even believe in vaccines. They were just so fearful of chemicals or things they didn't understand being in their body. And so you can see how this goes very very deep and has a real societal impact. The next kind of category is around symmetry around symmetry, ordering, and feeling that things need to be just right, perfectly aligned, balanced, exact. This fear can be rather vague, but it can also be really intense, and really what it's coming down to is this sense that something bad might happen if the world doesn't have order, and that there is an impending sense of doom or terror that will afflict the person if their environment isn't ordered just so. Compulsions around this might involve arranging objects repeatedly, repeating actions until they feel perfect, so reentering a doorway until it feels just right, because if it doesn't feel right, maybe that's a sign that something's off. Doing counting rituals is another one. The sheer distress and fear comes from things feeling out of place, and this like very unbearable internal tension that doesn't settle on its own. It needs to be settled by things in the environment or certain sensations. Another really common dimension of osity centers around harm and responsibility, something that we've kind of alluded to already in today's episode. This is where it can get quite dark and distressing for the individual. These obsessions often involve really terrifying fears of harming oneself, harming others accidentally harming them, or being violent or aggressive towards people without really wanting to be. For example, a new parent might have a terrifying, intrusive image in their brain of harming their child, even though they have absolutely no desire to do that, and that creates really immense guilt and shame, and some psychologists and researchers have even suggested that it's the very fact that they know they won't do it, and that it is so terrible that their brain feels like continuously drawn to it like a magnet, like, wow, this thing is so intense and so dark. When we have to sit with this even longer to store really make sure, but in sitting with it, the lines kind of get blurry. You don't actually want to do it. That's something we really have to be clear of here. You don't want to hurt someone, you don't want to hurt yourself. But the fact that the thought is there confusing to you because you think, well, why would I be thinking of it if I didn't want to do it. Compulsions to do with this involve extreme avoidance of sharp objects of children of certain people, but also constantly seeking reassurance that you haven't harmed anyone, constantly confessing perceived bad thoughts, or just constantly mentally reviewing past events to check for any wrongdoing. You can see why this is sometimes confused with anxiety. Right. This overthinking element, this rumination element, is something that OCD and anxiety have in common. There's also religious or moral OCD. This is sometimes referred to as scrupulosity. Scrupulosity you know when you see a word written down but you've never like actually said it before. Like scrupulosity, Yeah, basically involves obsessions and compulsions centered around religious, moral, or ethical beliefs. I was actually listening to a podcast about this the other day that was interviewing priests, new priests who were dealing with these people who just like wouldn't stop calling them members of their church, who would confess every single little thing that they'd done, even when it wasn't bad. And the priests were having to deal with this fact that they were like this. One guy was like, oh, you know, I went to vacuum my carpet and I missed a bit, and is God going to be mad at me about that? And the priest had to be like, oh no, and this woman who was like, oh, you know, I cooked dinner for my husband, but I was gonna cook something else. But what if he wanted the other thing more than he wanted the thing that I gave him, I've displeased him. I'm evil? Does this mean I'm going to Hell? And the priests had to be like no, it's these fears of sinning, of being immoral, and really it's a deeper fear of divine punishment, of hell, of eternal damnation. So these people might pray excessively, repeat religious rituals, obviously, seek constant forgiveness from members of the church, or really avoid situations that they think could lead to immoral thoughts. The final one I want to mention is relationship OCDA. I feel like some of you probably saw this coming. We actually have an entire episode on this from earlier this year with an expert. All she does is talk about relationship Osiday. She is amazing. She knows every single dimension on this. If this is something that you feel particularly drawn to understanding more, you can go and listen to that episode. But relationship OCDY really involves intrusive doubts and obsessions about your romantic or close personal relationships. These obsessions might really focus on a partner's flaws, the rightness of the relationship, any doubts you have in your mind about how much you love them, about your attraction to them, whether other people feel this way about their partner, whether your relationship is wrong, whether it's right, whether you're doing the right things. The core fear here is off and around making the wrong decision, around hurting someone by not loving them enough and leaving them, of wasting your time, of wasting their time. Compulsions really often include excessive comparison, constantly comparing your relationship to others, mentally reviewing the relationship history, constantly seeking reassurance about the relationship's validity, constantly asking other people about their relationship, what was their timeline, how were they feeling at this point in their relationship, to kind of compare your own. This intense doubt and fear can really damage almost every single relationship that you're in, even the ones that are almost perfect, even the ones that there is absolutely nothing wrong. If you look for something wrong in a relationship, you will find You will find it. You will absolutely find it, because no relationship is perfect, right, So if you have OCD and your brain is real hell bent on hunting for that hunting for that thing that's wrong, you are going to find at least something that you can cling onto. So with these categories, it might be that someone has just one type of OCD, but it is also possible for OCD to change and attach itself onto different themes because the core underlying mechanism is the same, it just might have a different expression. The sheer variety of themes as well, means that true people with OCD might present completely differently, yet they will both be battling the same underlying mechanisms of intrusive thoughts and compulsive responses. The issue that comes with this is that sometimes they don't get the proper treatment or diagnosis because people don't understand where OCD came from, even some you know, professionals, even some people who are meant to specialize in mental health disorders, because this disorder is so varied, they just might not recognize a new permitation. So before we get into that part of this story and that part of why this happens, let's actually talk about what causes OCD. Where does this come from? Obviously, our brains play a very significant, if not the most important role, hence why this is called a mental health disorder. But it's not that you have a broken brain by no means. It's that it's that there are just specific differences in how certain brain circuits function versus how they function in someone else. And these differences, which no one can really control, no one's in charge of, they do predispose someone to developing OCD compared to someone else, and they contribute to profound feelings of being trapped by thoughts and compulsions. The crucial structure we need to understand and bear with me. It's a long name, but it's called the cordico striato thalamo cortical loop CSTC loop. I know you're probably thinking, what the heck is that? That sounds like you just made that up. I didn't. It's a real thing. It's a real structure. It's basically a brain circuit that acts like the best way I can describe it is like it's a busy highway in your brain for information and it connects all these areas that are involved in decision making, error detection, habit formation, reassurance, checking, observation, all these things. It's a very important structure, and when part of this highway doesn't work or it's closed down, the loop obviously can't function, and that is where a disorder like OCD emerges. So the first area that we need to understand as part of this loop is the part that's responsible for decision making. It's called the orbitofrontal cortex. In OCD, research has shown that that cortex, that part of the cortex I should say, is hyperactive. It's like an overly sensitive alarm bell, constantly flagging thoughts as critical threats, feeding that fear that something terrible is going to happen even when it's not. The way I describe it as like a really anxious parent who sees everything as something that's going to harm their child. So that is the first part of the brain that's quite hyperactive or something's going wrong. The second area is the area responsible for error detection. It's called the anterior singulate cortex. It's located very deep inside the brain. When it's not working right, it keeps again sending this something is wrong signals. So that orbitofrontal part of your brain is saying that it's wrong, as saying that something is wrong. And then the second part of your brain is interpreting that and sending these alarm bells that it doesn't really need to. That is what's creating this fear response or this distress that you can't turn off. And then we also have the basal ganglia, which is responsible for habit formation. So errors or issues with this area mean that you are going to start performing these compulsive, ritualistic actions and falsely associating those actions with a positive outcome. So you know, you think something bad's gonna happen, you perform an action, the bad thing doesn't happen. You know that. Logically you can kind of see that, well dah, like maybe the bad thing wasn't gonna happen anyways, But this part of your brain thinks, oh no, like, actually this action has been reinforced by something bad not happening. Obviously I saved myself. Obviously I did something right. This is the cure. So basically, when this part isn't working, it makes it really hard to stop performing your competitive action in response to an unwanted thought. So you can kind of see when the communication between these brain areas is a little bit off. This is what creates that loop that we were describing before. Basically, what I'm trying to say is it's not you, it's your brain. So let's talk about when these symptoms first begin to emerge. So OCD can actually emerge at any age, kind of scary when you think about it, But there are two primary ages where it is most likely to begin, or occur or first be noticed, and that is between the ages of nine to eleven and then again around twenty to twenty one years of age. If we think about those years, they are really significant periods in our lives. The first is basically when puberty begins, and then the second, when we reach out twenties, is where we have this second huge shift in our lives in terms of gaining independence, maybe moving away from home, forming new relationships, this added sense of responsibility, which we know people with OCD really struggle with. It's even what some people call second puberty, that first those first two years of your twenties, like so much is changing. There are monumental shifts, and this can you know, cause a massive impact on our stress levels and our mental health. So some researchers will say that it's not that OCD is more likely to occur that these time periods are significant, is probably what I should say. It's not that these periods of these years are special in any way, like that number doesn't mean anything. Is actually what's happening developmentally, and it's actually what's happening in terms of life stress. So much is changing during those periods of our life. It's the change, and it's the stress that is triggering OCD. Another really critical time when people are more likely to be diagnosed with OCD is right after a child has been born, right after they've given birth, because obviously that's like, that's a huge life change. Your whole center of orbit shifts to be that child. And often when someone develops OCD around this period in their life, the symptoms often focus around the child, around accidentally accidentally harming the child, contaminating the child in some way. So it is really tied to the context, and it really does highlight how stressful significant life changes can act as a trigger, especially if you already have a biological predisposition, especially if a family member, a parent, a sibling has OCD, it's likely that you have some of the same elements of your DNA blueprint that make you more predisposed. Doesn't mean that it's going to happen. Doesn't mean that you are determined to develop OCD. It just means that it may be more likely and that you are more susceptible to triggers. Another explanation also comes down to the role of serotonin. A lot of people think of serotonin as purely like the happy chemical alongside dopamine, but we do know that they are really involved more deeply in motivation and in emotional regulation, being able to have a feeling, have a thought, and not invest in it entirely. So people who are more predisposed to developing OCD might also have some differences in terms of how their brain processes, interprets, stores, releases serotonin, which is why if you go to a doctor, if you're to a psychiatrist, one of the first things that they will often offer you as a solution is SSRIs selective serotonin reuptake inhibitors complicated name, basically just means that there's more serotonin in your brain for your neurons and your synapses to use, so you are less likely to suffer from a deficit in that neurotransmitter that could contribute to OCDA symptoms. Actually, just recently, a really big paper came out talking about whether SSRIs are actually even effective at all. I'm not even going to get into it because I don't even think that I have formed my own opinion about the research, but it's something on the horizon. People are kind of starting to rethink this purely biological approach to mental health out aside. Basically, what we want to understand is that OCD really isn't just caused by one thing. It is a complex interplay of various factors, kind of like a perfect storm of psychological vulnerabilities or patterns to do with biology, predisposition, environmental triggers that all kind of come together and mean that someone ends up in this terrible obsessive compulsive loop. Okay, we're going to take another short break, but when we return, I want to talk about the light at the end of the tunnel. I guess, some of the treatment options, some of the ways that we can better understand our OCD and also just advocate for ourselves in a system that doesn't really understand it. So stay with us. We will be right back after this short break. So, as my story kind of explained at the very beginning, getting an accurate OCD diagnosis isn't always straightforward. In fact, significant delays are incredibly common. You know, I was looking into this, I was like, I cannot be the only one whose experiences and it's not like I'm blaming anyone or saying you know, yeah, I'm not blaming anyone. I'm not blaming my family, I'm not blaming previous mental health professionals. I think it's just because of like the inherent invisibility of many symptoms, the fact that sometimes people don't see the nuances between symptoms, that anxiety and o city are different because of like there's like a five percent difference, but that five percent means everything. And also the shame the fact that sometimes a lot of the compulsions or the obsessions are things we don't really want to admit, and that leads to more severe symptoms and more prolonged suffering. Like I said, I was researching this, I found this study from twenty twenty one from the University of Leipzig which actually found that the average time between the age that symptoms appear in the age that people get diagnosed OCD is on average thirteen years. Thirteen years over a decade. That's the average, the average, and that was just like absolutely shocking, and to break down some of those factors, I think firstly, a lot of people do hide their OCD symptoms. Obsessions can contain really disturbing content, thoughts about violence, sexuality, blasphemy. That's deeply upsetting. And we have been taught to believe that our thoughts reflect who we are and that we have control over our thoughts. So if we think bad things, we must be a bad person. That's actually not how our brains work. A lot of our thoughts occur unconsciously and then flowed up into our conscious mind, and it's not because we genuinely believe them. It's because our brain is just shooting out electricity and seeing where it lands. People are often really terrifying, Like if I reveal these thoughts, people are going to think I'm crazy, which, by the way, I hate that word, but that's what they think. People are going to think I'm crazy. People are going to think I'm dangerous. People are going to think that I should be institutionalized. And this immense shame and fear of misunderstanding really huge barriers. Unfortunately. You know, there have been documented cases where individuals, especially parents, struggling with intrusive thoughts about harming their children, have sought help, have said I don't want to do these things, but I am thinking about them, and I can't control the thought, not the action, the thought. They've disclosed those to a healthcare professional, and they face devastating consequences. Instead of receiving appropriate mental health support for OCD, they have sometimes been met with suspicion, They've faced investigations, they've had their children removed from them. This really deep rooted, I think misunderstanding, this cultural misunderstanding. It creates a really chilling effect where those most in need of help are terrified to seek it, fearing these catastrophic consequences, and so you just suffer in silence, and that actually reinforces the hidden nature of OTDY, especially some of its more taboo subtypes. It's the fact that our society hasn't doesn't understand this, doesn't understand the difference between a thought, a desire, and an action, and so it clumps them all together and shames people who have any of them. Nowadays, clinical guidelines do really strongly advocate for professionals to be trained in differentiating these egodostonic intrusive thoughts from actual intent or risk of harm because there has been a lack of specialized knowledge in the past that has created really severe and damaging misjudgments. You know, the International OCD Foundation explicitly states that thoughts are not indicators of a person's true desire. Someone's actions are more indicative of their desire, their desire to hurt or harm people. And they've really tried to say, like, people are not their thoughts, and if they are infessing their thoughts, they obviously don't want to act on them. So please treat them. Please treat them, not just in general in terms of give them help, but give them respect. But unfortunately, not all practitioners or even mental health clinicians are fully trained in recognizing those many diverse presentations of OCD. And it's not all their fault, you know. They might just be less familiar with certain symptoms. They may just have previous misconceptions or their own beliefs about what kind of person would have these thoughts. It does just end up though, perpetuating suffering due to missed opportunities for health. Another study that I found looked at GP physician like family doctors, their ability to diagnose OCD, and it found that cases were misdiagnosed. Around fifty percent of the time someone comes in with OCD, there's a one and two chance half like a one and two chance that they're going to get the right diagnosis, which is really really scary, and it's really crucial that they know what to look for because they're often the only entry into receive they are the only entry into receiving treatment. So if they miss the ball, if they miss certain symptoms, like, that's it. That's the end of the line. Sometimes it's not all doom and gloom, though, I really want to make that clear. Although the road to accessing support may be tricky, OCD is highly treatable. It is one of the actually one of the easiest disorders to treat. The absolute gold standard actually for OCD treatment is something called exposure and response prevention. It's it's a type of cognitive behavioral therapy, which is a very common type of therapy that is used all over the world. So ERP basically involves gradually exposing people to their biggest fears, their biggest obsessions, whilst preventing the accompanying compulsive behavior. Yeah, they would they would usually kind of turn to reduce anxiety, so response prevention. They're preventing a certain response. And basically, what they're trying to do, and what this technique is trying to do, is give them evidence that the worst case scenario won't happen. Because once they can see that what they're doing isn't actually doing anything, it's not the reason that they're safe, it's not the reason that their family is protected, it's not the reason that something doesn't happen, then they don't have to perform it as often and they can kind of just sit with the discomfort of the thought without the compulsion and see that nothing bad it's going to happen. A thought is not reality, A thought is not an action. Basically, you call your OCDS bluff. I heard an amazing analogy to sum up what this treatment really does and what it teaches people to do. Imagine you have like a snowball in your hand, right and at first the ice is pretty painful, like it's cold, it kind of burns, and you think, what if I get frostbited? What if something my hand falls off? What's gonna happen? So you instinctively want to let go and you want to throw it on the floor. You want to throw it away, maybe throw it at someone. But if you just wait with the snowball in your hand, the ice will gradually start to melt and it will drip away, and eventually it will be gone and your hand can start to warm up again. It's gonna suck having this cold thing in your hand that's freezing, But then you kind of realize, wait, this actually can't hurt me beyond the initial the initial feeling when I first have the thought, when I first hold the snowball, that's when it's gonna hurt the most. But if I can just wait it out, if I can just have a little bit of courage and training mental health training, there is another side to this that perhaps my anxiety and my distress is never let me see. The goal is basically to learn that the feared outcome doesn't happen, and this process really gradually rewires the brain's fear response. It realwires basal ganglia, It rewires parts of your frontal lobe, parts of your interior, parts of your brain that are assessing situations the wrong way. Given the challenges in diagnosis and the misunderstandings we've talked about, I think being your own informed advocate is really crucial here. If this is something you're going through, this means that listening to things like this, gaining more information about your specific OCD subtype is so valuable so that when you do step into the system, you freaking know your stuff. You know what you need. You know how to get to someone who knows more than you, but who will treat you with respect. And this might sound kind of harsh, but the only way to do that is kind of bypass people who actually don't know that much about your OCD, don't know much about OCD in general. So this might include getting to the appointment and just telling your GP exactly what you need and what treatment you think is helpful, even if they might dismiss it. Advocate for your desire to try that. It could mean asking for a second opinion or a referral to a specialist when you can tell someone maybe isn't specialized enough. Also keeping up to date with emerging research that an average GP wouldn't have time to look at. It's not that these people are uneducated, it's not that they're cruel, it's not that they're malicious. It's that they see thousands of people a year, with each of them having very specific health problems, very specific maybe even mental health problems. There are hundreds of thousands of articles coming out each year about all those specific conditions. They can't necessarily keep up. But because this is impacting you and it's individual, you can and you can hopefully be able to come into those appointments knowing a little bit more, and not only can this lead the doctor in the right direction, but also it can be really empowering for you to be educated and having psycho education around your symptoms and around what's happening in your brain is actually research has shown a really powerful contributor to healing and to finding relief from OCD. Also, remember, if you do access support and the first professional isn't the right fit, you are actually totally allowed to say this isn't working, and you are allowed to request or find someone new. You know, I did this my first person, my first couple of people when I first got my diagnosis. They didn't really understand what was happening, and they kept trying to guide me back to solutions for someone with a different type of OCD that wouldn't work for me. So I just asked to see someone else. It was really uncomfortable, felt awkward, but I'm glad I did it because my mental health is more important than someone else's feelings, and about someone else's feelings about their job performance. You know, self advocacy it isn't about being confrontational. It's about not wasting your own time. It's about not putting your mental health on the line for someone else to learn from or experiment with if they don't know what they're doing. And it's also about recognizing that you are the expert of your own experience. You literally live with these thoughts every day. You have the right to informed, effective care and taking an active role I think really allows you to say this isn't right, this isn't working for me, and ask for something better because you deserve it. I think something else to say is that OCD is not a one and done condition. Unfortunately, it is something that you have to continue managing and working with. Obviously it gets easier over time, but this might be a long journey for you, So don't settle in with someone who isn't going to be a good companion on that journey. Find someone who's going to be able to really meet you where you're out in terms of a mental health professional, it's going to be able to keep up to date and really care about you and know what's going on so that things do feel less sticky, things do feel easier. Okay, I'm going to quickly finish with some resources that I personally think of really really helpful if you have OCD. These are resources that I have engaged with people that I follow who I think really reduce some of the stigma and just give you more information and help you be informed in like a medical context. The first is Zachary James. He is a UK creator. He runs the I guess handle OCD Stigmatized on Instagram. I really really love what this man does. I love how he talks about his own experience. I love how he talks about upcoming research, about news story mentions of OCD, about elements of it that people don't understand. So would really recommend him. There's also another Instagram handles sush I guess service provider called Treat My OCD. I personally have never used their service, but I really like how they share information in a really succinct way. I also really like how they occasionally share stories of celebrities or public figures who have OCD, who talk about it in interviews, use or talk about it on podcasts because I find hearing what other people are going through with this is such like an Oh, it's so soothing when you're like, oh, thank god, I'm not the only one. And often, you know, celebrities are the ones who have the platform to talk about it. They recently shared some clips from Benny Blanco Pink Panthers about OCD. I did not know Pink Panthers has pure, pure OCD, purely obsessional, and she was talking about it and I was like wow, Wow. It was this weird thing where I was like wow, I've never heard someone talk about it that way. So that was like quite empowering. I never thought Pink Panthers would help me with my mental health, but there we go. And then a podcast, a podcast that I think is exceptional called It's Not What You Think. They share so many stories, they specialize in only talking about OCD. They have such a brilliant approach to it. So I'll link all of these things in the description below. I just think if you're looking for some informed people and some cool stuff, that is where you should go. But thank you so much. For listening. If you have made it this far, leave a little yellow heart below. I don't know, I feel like it's a nice I feel like that's a nice little symbol of OCD awareness. Note that I'm really with you in this. I imagine how hard it is for you to be dealing with this alone. But I have also dealt with it alone, and it's gotten easier. And it's the more I've learned, the more relief I feel. And so I really hope that you find that kind of calmness and that peace and that stillness, and I believe you can. So I'm sending you a lot of love in every single one of your journeys with this very difficult disorder. Oh, I know it's so cliche. No, you're not alone, though it's gonna get better for you. There are people who know a lot out there about this illness and can help you even if the first couple of people don't know anything. Just be your own advocate, be brave, be courageous, and I really am wishing you all the best. I hope this episode has helped share it with someone that you know who might also benefit from it. If you think this was a good resource, make sure you're following me on Instagram as well at that psychology podcast. I'd love to hear your stories or your own experiences with OCD, as I am still a little young and when it comes to this condition and this disorder, and until next time, stay safe, be kind, be gentle to yourself, and sending you so much love. Stay tuned for another episode. We will talk very very soon.