I decided to start this OCD blog as a resource for clinicians who want to understand more about clients they are struggling with. As a former OCD sufferer myself, I want to say “thank you” for your interest! My own interest in educating people about OCD comes out of many years of trying to seek adequate support for my formerly chaotic mind, and not even knowing I had OCD in the first place.
It was only because a younger family member was diagnosed with OCD that I figured out I had OCD on my own after 25 plus years of believing I had a uniquely intractable type of anxiety. I had seen plenty of therapists, but no one pinpointed the correct diagnosis. In fact, I had also completed my masters in Art Therapy and my certificate in Marriage and Family Therapy, I had studied (albeit superficially) OCD and still didn’t know I had it. This is because I, like many, don’t have physical compulsions and I don’t have themes traditionally associated with OCD, such as contamination.
Many of us have this presentation of OCD (sometimes termed “Pure O”, because it was once thought to be only obsessions) in which compulsions are mainly in thought form. Commonly presenting themes can range from: compulsive questioning of one’s sexual orientation, questioning one’s relationship, fear of harming another, or social concerns such as offending others.
The following example of a typical thought process/inner dialogue would be in the absence of any true desire to cause harm:
“What if I run over that pedestrian? (Intense anxiety) Why would I do that, I know I don’t want to do that! But what if I do? OK, I don’t want to run anyone over, I’m just going to stop thinking about that! But what if I’m in denial? This could be important, I might need to take some steps to keep myself from hurting that person! What if I lost control and ran them over!? And then I ended up in jail and had to go to court! How would I live with it, my family would hate me! It would be so humiliating and terrifying! OK, stop doing this, you’re not going to run anyone over, you’ve never wanted to and you’re not going to now. But what about that time my friend told me I was impulsive!? That must mean something!”
And all of this occurring with strong emotions and physical sensations that make it feel real. Some people even describe a sensation in their arms that can feel like they are going to turn their car into the pedestrian.
A tricky part of OCD is that clients often keep these terrifying thoughts to themselves out of fear of being misunderstood by their therapist or others. So, in the absence of straight forward disclosure, how might this look in your clients? For one, it can be very puzzling for clinicians when it seems like a client has resolved a highly distressing issue only for it to reemerge at the next session. It can also (and frequently does) show up in a different theme. Some refer to this as similar to “Whack-A-Mole”.
As you may gather, people with OCD can suffer greatly and needlessly. While the level of suffering that people with OCD experience can be extreme, when given the correct treatment the “recovery” is far greater for my OCD clients than any other I’ve worked with.
My hope is to help more people access therapy that truly helps, which is why I’ve devoted my career to OCD and educating clinicians. I’ll be continuing this blog with more information for clinicians to understand OCD with greater depth.