Episode 56: Managing Multiple OCD Themes

Episode 56

Managing Multiple OCD Themes

In this week’s episode of Purely OCD, Lauren Rosen, LMFT, and Kelley Franke, LMFT, explore the subject of managing multiple OCD themes.

It isn’t uncommon for those living with OCD to wonder whether or not they are dealing with multiple themes, how to manage them, and whether it is likely they will experience multiple themes (if they aren’t already).

This is what we explore in today’s episode…

Everyone deals with multiple subtypes


Kelley: Today on Purely OCD, we’re going to be talking about how to manage multiple subtypes which is kind of a trick question I put out there for everybody. Because a lot of people, if not everybody, deals with multiple subtypes of OCD.

Lauren: As Kelly likes to say, Taste the rainbow. 

Kelley: I would much prefer Skittles to OCD.

How do I deal with multiple themes?


Kelley: …it’s a great insight if you’re able to distinguish the content and subtypes. But in reality, they’re all the same. And for all of them, we’re accepting uncertainty.


Lauren:  I think people wonder how to do treatment ‘right’. They wonder if they should be doing things or approaching each one in a certain way and a certain order. That’s handling treatment and recovery a little bit too delicately. We have kid gloves on as though we have to do it perfectly or that there is even a perfect way to do it, which I don’t think that there is. 


Lauren: …if we look at it as uncertainty, and needing to learn how to live with uncertainty, then you start to see all of these different themes pop up, and you realize that it’s just another manifestation of uncertainty. That’s just another thing that is brought about by this underlying feeling that you’re experiencing. 

Navigating Uncertainty (Does the average person struggle with uncertainty?)


Lauren: Uncertainty is everywhere. It’s everything. Everything is uncertain. And there are differing degrees of awareness around uncertainty. And a lot of that is circumstantial. And we had this huge moment as a human race two years ago, when this huge element of uncertainty was dropped onto all of us, which was COVID. 

So we’re all wondering; what’s going to happen? How are we going to navigate this? Am I going to be okay, am I gonna get it? Am I not going to get it? Everyone experienced that universally, not just the OCD community.


Lauren: …I think a lot of the time, it’s a matter of awareness of uncertainty rather than whether or not it’s present, and whether or not people are bothered by it. Because I think when people are aware of it, oftentimes, they will become bothered by it. But it depends too, on the individual and on the content.

Accepting uncertainty in OCD & other areas of life


Kelley: I have conversations with my clients all the time where there’s this epiphany moment of realizing they have more generalized anxiety over other facets of life that are unrelated to OCD. And they feel they notice they have actually been accepting uncertainty everywhere, and feel like they have an advantage over those who don’t live with OCD.


Kelley: Other people will zoom out and notice all of the other areas in life where they aren’t accepting uncertainty. And they may frame it if the anxiety has ‘jumped’. But it hasn’t. We’re always dealing with uncertainty.  

There’s always that undercurrent of the unknown. My own therapist a long time ago said to me, when you stop answering and when you stop engaging, it starts hopping around from content area to content area, like it’s trying to get you to respond.

Lauren Rosen, LMFT

Treating the core of the problem


Lauren: I have a good analogy.. So as some of you may not be aware, I had back surgery two months ago. And before I got the surgery, I experienced sciatica for the first time in my life. For those of you who haven’t had sciatica, what happens is, there’s this nerve bundle in your back and sometimes a disc will punch out or herniate. Then the disc in your back will hit this nerve bundle, and all of a sudden, you’re experiencing pain in your calf, which is very weird. 

…But one of the interesting things that I learned in the process is that some of the exercises are intended to bring the pain back to a local centralized area in the back. So the idea is that you try to floss the nerve by doing certain exercises. The idea is to be with what’s actually happening instead of having all of these Phantom pains throughout your leg. 

…So all of that to say, I kind of think what we’re talking about here with OCD is that we’re taking it back down to what it actually is, which is uncertainty. And it’s going to have all of these phantom experiences of, what if I’m a bad person, what if I’m a child molester, etc But actually no, this is uncertainty. 

…The more we can come back to that, the more we’re actually supporting recovery from the actual issue, which is in the back or in the uncertainty.

Exposure to one theme helps with other themes


Kelley: If we’re so fixated on one subtype, we get tunnel vision and stop paying attention to the bigger picture. Which is that we’re just not accepting uncertainty yet and it happens to translate and present in multiple ways, but it’s the same issue.

Lauren:… when you start doing exposure to one thing, and you learn how to tolerate uncertainty in one area, that translates into other areas. And that’s the beauty of viewing treatment from this perspective; it generalizes more easily. 

Is there any way to stop one theme from morphing into another?


Kelley: No. So it’s hard to say this, try not to get too freaked out about the fact that it likely will and you’re going to respond to it exactly how you’ve learned to respond to everything else. By tolerating uncertainty.

It’s likely going to jump.  And when it does, you’ll be ready because you’ve already dealt with this before. Take this take-it-on exposure mindset of being ready for it and welcoming it so you can show your mind how capable you are of handling those thoughts and feelings. 

Kelley Franke, LMFT

Lauren: Anything is possible. People get scared by the fact that there’s new content, and they think that they’re starting from ground zero. And that amps up their anxiety. When in reality, it’s nothing new and it need not be starting from scratch.

Detaching yourself from the content


Kelley: We can’t take these thoughts as seriously. It takes a long time for people to take a step back and unstick themselves from the content. But when they do, they realize that it’s all centered around the same thing, which is a fear of uncertainty. And what it’s going to take is being really present with these feelings and thoughts.

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