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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.

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.

We'll explore what OCD.

Actually is, how it shows up in real life, and what evidence based treatments are available.

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 are unpacking OCD because it's a term that gets thrown around in conversations.

Right.

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 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.

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?

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 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 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?

So this might be.

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 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 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.

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?

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 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 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.

They may be.

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 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 someone might engage with to stop themselves from acting out that feed behavior.

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?

They're different, but they're connected.

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, can often cause a lot of anxiety for someone.

So what are the other types that are out there with OCD?

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 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 thoughts relating to sexuality.

So am I straight, am I gay?

Am I by?

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.

You know.

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 worry about them.

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 were mentioning that earlier.

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 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 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 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 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, 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 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.

Feels just right.

And then one other example I want to provide around themes of compulsive behaviors is mental compulsions.

So compulsion doesn't have.

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.

So what is the cause of OCD.

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 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.

So I was reading something online the other day and they were talking about r OCD.

What's that all about?

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, 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 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.

As opposed to certain other kind.

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 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.

Wow, that's so interesting, like knowing that OCD can be in the context of relationships too.

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 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 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 form of OCD is.

More moral or pure or better than the other.

It's simply the same manifestation but different types of obsessions and compulsions.

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 have OCD, what's the best way to treat it?

Yeah?

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.

It's causing you.

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 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 a general member of the public and you want to access them.

There is a fee.

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 by the university.

So highly recommend this way up.

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?

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.

That sounds that sounds very clinical.

Yes, yes, it's quite.

It does sound a bit clinical, a bit scary.

Sometimes when we say to people, okay, exposure response prevention, they're like, oh, what is that?

Yes, what are you about to do?

Yeah?

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 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.

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, 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 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.

Wow, that's so effective.

I mean, I really love how individualized and specific it is as well.

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 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 comes with those thoughts.

So have you done this with clients as well?

Absolutely, absolutely so.

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 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 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.

Part of the hierarchy is.

Okay, you can look at someone of the same sex and if that thought comes up, that's okay.

It's just a thought, it's just words.

In your head, but prevents yourself from engaging in that compulsive behavior.

To break that cycle.

Bierb bierb bib impowving a serious crisis, BRB having a crisis.

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.

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 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.

Oh, Sandy's a good friend.

I know.

I was just thinking.

I was like, I love that Sandy has asked this question, because they're obviously a very thoughtful person.

Yeah.

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 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 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 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 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.

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?

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 or ERP can be a very effective gold standard treatment approach.

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.

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.

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.

The senior producer of But Are You Happy?

Is Tylie Blackman, Executive producer is Naima Brown, and social producer is Jemma Donaho.

Sound design and editing by Tina Mattalov.

You can find us on Instagram and TikTok search but Are You Happy?

Pot, I'm a Shani Dante.

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 wanting more immediate support.

Thanks for listening, See you next time you're listening to Amma Mia podcast.

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.