Living is a form of not being sure, not knowing what next or how. The moment you know how, you begin to die a little. The artist never entirely knows. We guess. We may be wrong, but we take leap after leap in the dark.
-Agnes De Mille
Obsessive-compulsive Disorder (OCD) is a neurological, habit propelled system to counter extreme difficulty with uncertainty and the experience of not being in control. It is imaginal absorption, getting lost in a bunch of “what if’s”. There is basically a false alarm or sense of threat that is very hard to resist acting on. It can be a struggle with perfectionism, self-judgment or feeling overly responsible for the well being of others. It is characterized by obsessions, which are unwanted, repetitive, disturbing thoughts, and compulsions, which are behaviors that are intended to decrease the discomfort caused by these thoughts. Compulsions (a.k.a. rituals) can be physical, such as washing or cleaning, checking, repeating behaviors or they can be mental or covert, such as excessive analysis, mental review, ‘figuring out loops’, reassurance seeking, or ‘thought-neutralizing’ strategies.
A disorder is not a personality defect or character flaw. A disorder is simply something that is at a level of severity that decreases or interferes with the quality of life. All of us have unwanted thoughts from time to time and rituals that are routines that save us time and energy. When this “normal” experience of coping with unwanted thoughts and rituals begins to impair functioning, causes severe anxiety, takes up significant time, and reduces the enjoyment from work, leisure, and relationships, it is then a dis-order. The good news is that this disorder is well understood and research over the years has provided us with safe and effective evidenced-based therapy approaches that can help people find freedom from the oppressive effects of OCD on their lives.
I use evidence-based therapies including exposure-response prevention (ERP), acceptance and commitment therapy (ACT), cognitive-behavioral therapy (CBT), and Inferential-based cognitive behavioral therapy (I-CBT), all within a framework of mindfulness to help clients interrupt the automatic, repetitive thoughts and behavioral cycles of OCD. ERP has been the treatment of choice for many years and now I-CBT is offering hope for a more complete recovery and in some cases a significant mitigation of symptoms without the need for extreme levels of ERP that can be overly challenging and uncomfortable for some.
Ketamine-assisted psychotherapy (KAP) for OCD and severe anxiety
I work in collaboration with a medical doctor to provide this effective support for people struggling with OCD and severe Anxiety. It is showing very promising research results and I am finding it can help clients to make progress faster than with psychotherapy alone. The medicine experiences combined with psychotherapy can create more distance from disturbing thoughts so that the work of changing behaviors and gaining back your life and self becomes easier. I honestly feel this tool is a game-changer and will become more utilized as people become more familiar with its benefits. See my section on Ketamine-assisted Psychotherapy (KAP) for more information.
Common OCD and Related Concerns That I work with:
Contamination OCD
Common obsessions: fear of germs, repulsion to uncleanliness, chemicals, or other “contaminants”
Common compulsions: excessive washing, cleaning, reassurance-seeking and avoiding related to risks of contamination.
Hyper-responsibility OCD and Harm OCD
Common obsessions: fear of making a mistake or causing a tragedy, fear of committing violence against self or others, fear of “snapping” (going crazy) and causing harm, intrusive violent thoughts.
Common compulsions: excessive checking of light switches, stove, appliances, repetitive thoughts about whether one is a good or safe person, avoidance of situations or objects that could result in harm, avoidance of triggering media, mental review/checking of violent thoughts, reassurance.
Pedophile Obsessions
Common obsessions: fear of being sexually attracted to children or fear of being a sexual predator, intrusive thoughts about children with sexual content .
Common compulsions: checking for arousal in triggering situations, avoidance of triggering situations, excessive mental review of behavior around children, constant mental review of personality characteristics to reassure that one isn’t a pedophile.
Just Right OCD
Common obsessions: fear of not being able to tolerate specific feelings often related to perfection or order
Common compulsions: repeating routine behaviors, arranging/ordering, checking/repeating writing and reading, homework, or work tasks.
Hypochondria / Health Anxiety
Common obsessions: fear of having or catching illnesses, perfectionism in relation to health or well being
Common compulsions: checking body for symptoms, excessive googling/researching symptoms, excessive reassurance seeking, avoidance of or over-reliance on medical professionals/procedures, excessive focus on maintaining healthy life practices.
Sexual Orientation OCD
Common obsessions: fear of changing sexual orientation or of being in denial of sexual orientation, intrusive sexual thoughts related to orientation
Common compulsions: checking for arousal in triggering situations, avoidance of triggering situations, excessive mental review of sexual themes.
Relationship OCD
Common obsessions: fear of being in the wrong or imperfect relationship, fear of not being in love with partner or feeling attracted enough, choosing the wrong partner, fear of not being faithful to partner.
Common compulsions: checking for feelings of love or attraction, avoiding triggering situations, excessive mental review of qualities of relationship, excessive rumination about whether a relationship or partner is right.
Religious and Moral Scrupulosity OCD
Common obsessions: fear of religious blasphemy or of exercising faith inadequately, fear of being morally imperfect.
Common compulsions: compulsive prayer, excessive review of religious concepts, avoidance of triggering situations, excessive attention to issues of honesty or morality, excessive mental review of perceived mistakes, excessive scrutiny of one’s moral character. Often this shows up as a repetitive figuring out loop to prove whether one is a good or bad person.
Hyper-awareness OCD
Common obsessions: fear of not being able to stop attending to breathing, blinking, swallowing, thinking, or other semi-voluntary behaviors/bodily processes .
Common compulsions: checking for awareness, excessive distracting, reassurance seeking about symptoms or about what is normal, avoidance of body-awareness
Phobias
Common obsessions: focused fear of specific triggers, such as throwing up (emetophobia), small spaces (claustrophobia), open spaces (agoraphobia), specific animals or environments, needles or medical procedures.
Common compulsions: avoiding triggers directly or indirectly, various rituals designed to feel certain that triggers will not occur.
Social Anxiety
Common obsessions: fear of being evaluated negatively by others, fear of public speaking, being humiliated in public, fear of not being able to connect with others socially .
Common compulsions: avoidance of social situations, mental review of social interactions, excessive comparison of self to others.
Body Dysmorphic Disorder
Common obsessions: fear of being unattractive or of having a physical deformity, imperfection or perceived pathology.
Common compulsions: excessive weighing, mirror checking, ritualized eating, checking of specific body parts, comparison of self to others.
Orthorexia
Common obsessions: Excessive worry about the effect of diet on health.
Common Compulsions: Avoidance of certain foods perceived to be harmful, overly strict dietary rules
Orthorexia is a relatively newly recognized disorder not yet included in the DSM. It is thought to be an eating disorder that has overlap or is possibly within the category of OCD. Below is a link to further information on Orthorexia
https://www.nationaleatingdisorders.org/orthorexia-nervosa
Panic Disorder
Common obsessions: presence of panic attacks and fear of having panic attacks.
Common compulsions: avoiding situations that could trigger attacks, avoiding environments that do not have easy escapes.
Generalized Anxiety Disorder
Common obsessions: excessive and impairing fear/worry associated with everyday issues such as work, finance, relationships and responsibilities, fear of becoming anxious.
Common compulsions: mental review, reassurance seeking, over-preparing, perfectionism, avoiding situations that may produce anxiety, attempted avoidance of thoughts related to worry areas.
Below is a link to the website of one of my teachers who is a renowned expert in treatment, training and education on reversing the negative effects of anxiety in its many forms. You can also watch videos of his work to get an idea of how I work with these issues.
It is difficult to find professionals who are truly skilled in working with OCD, even though many will advertise that they do. Don’t go to anyone who doesn’t use evidence-based practices of ERP, ACT and/or I-CBT in the forefront of their approach. Make sure that anyone you consider working with has specific training in OCD therapy.
Below is a link to the International OCD Foundation website where you can find professionals in other geographic areas who specialize in work with this issue and related disorders. You can also find more information on OCD, events and ways to connect with others who struggle with it too.
There is hope for re-gaining your mind and life so that you can experience the things in your life that are most important to you, rather than being distracted and controlled by OCD’s constant commands. I can support you in moving from a place of being a victim at the mercy of OCD to being empowered and in control of your own life.