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Episode 22

Q&A on OCD

April 26, 2021

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Question: I heard there’s OCD related to wanting to hurt others. Is that true? 

Many subtypes revolve around the potential for harming others, including Emotional Harm OCD and Physical Harm OCD. The treatment for OCD is Exposure and Response Prevention (ERP), regardless of the theme.

Question: I’ve been using medicine for half a year but everything is the same.

Kelley and Lauren can’t give medical advice generally and can’t give direct advice on social media. 

Medications are often used in OCD treatment, though they aren’t necessarily effective for everyone. People can achieve recovery without medication though many find support with meds.

Lauren: We joke a lot on here because that’s who we are and I think it’s important to bring a sense of levity to what can be a difficult topic. But… it’s tough.

Kelley: And believe me… we’ve been there. In crying states for days… sometimes weeks.

Lauren: And it is something that passes ultimately… especially if you’re doing the work.

Kelley: Anxiety and depression… are both convincing you that “this is how it’s always going to be” – or it’ll get worse. Well, that may or may not be true. What we know is that if you do the work and you keep moving forward despite the pain you can get better.

Lauren: And you can live a very, very full life.

Question: OCD intrusive thoughts occur in dreams. Why does it happen? They are very graphic, detailed and real.

I mean, I think I had some last night.

Kelley Franke, LMFT

There’s not a clear-cut answer as to why. Anyone who dreams has weird dreams. 

Question: I literally got diagnosed with OCD today and found out that there are 38 subtypes. Is there any way to define which type I am?

Lauren: I think there are probably more than 38 to be honest

Kelley: It’s infinite, right?

Lauren It’s only as creative as the mind that it comes from. And there are, what, 7 billion people?

Regardless of the subtype, OCD wants certainty and the treatment approach is the same. The topic, in many ways, is irrelevant. The only reason the subtypes exist is to help normalize people’s experience.

Question: My wife passed recently… OCD flared severely, first time in ten years. Is that common?

Yes, absolutely. OCD preys on any life change or life event or huge stressor and there’s no doubt that a flare can happen around a huge stressor like that.

Kelley Franke, LMFT

And life transitions don’t have to be painful in order to be stressful and to aggravate OCD. For example, if you are going to college, this is often an exciting transition, and, at the same time, it’s likely to still be stressful.

Question: Can you talk about accommodations at work from a therapist’s perspective?

Generally, making accommodations in treatment time limited is wise. 

Lauren: If I’m working with somebody my goal is to support them in not using accommodations. We do not want OCD to get to dictate any part of your life ultimately.

Kelley: What Lauren’s saying is that… the goal is to slowly wean them off [of accommodations].

Lauren: Giving accommodations when somebody is not actively working toward getting better is actually likely to make them worse… We don’t want to give people the wrong impression that you’re somehow incapable of doing these things that are challenging as a result of OCD.

Question: I tend to hold onto things for fear of “what if I need it?” At work I hoard emails.

There’s not a question but Kelley gives some thoughts on that – specifically about how this relates to a desire for certainty.

Side note given a question that Kelley and Lauren don’t fully comprehend: Sometimes people hear compulsive and think about compulsive eating or compulsive gambling, but these are different from OCD and are treated differently.

Question: Should we find someone who has specialty in OCD to treat it? Also psychologist or psychiatrist?

If a person has OCD it is really important to get treatment from somebody who uses evidence-based protocols – so protocols that have been researched and are peer-reviewed – to get help… I’m very passionate about this because I personally didn’t get the correct treatment for many, many years because I was never properly diagnosed and because I was in talk therapy.

And not that there’s anything inherently wrong with talk therapy but talk therapy for OCD is a problem, especially if you do a lot of reassurance seeking because what happens is then therapy becomes a compulsion… I would certainly recommend finding someone who specializes if you can.

And if you are working with somebody and you can’t afford to see somebody then at least having somebody get a book on OCD or work through a treatment manual together so that it is informed by what we know because the research is pretty clear about what is effective for OCD and what is not.

Lauren Rosen, LMFT

By the time our clients come to us they’ve already gone through this process so:

1. They’ve wasted a ton of money

2. They’ve wasted a ton of time, and

3. Their OCD has gotten worse

Kelley Franke, LMFT

Also, for clarification purposes:

Psychiatrists are medical doctors who prescribe medications.

Psychologists are high grade marriage and family therapists. They went to several more years of school and did more research. They are doctors but they are not MDs.  

There are also Licensed Marriage and Family Therapists, Licensed Clinical Social Workers and Licensed Professional Counsellors. 

Lauren and Kelley give book recommendations: 

The OCD Workbook by Dr. Bruce Hyman

Freedom from OCD by Dr. Jonathan Grayson

The Mindfulness Workbook for OCD Jon Hershfield, MFT, and Tom Corboy, MFT

Living Beautifully with Uncertainty and Change Pema Chödrön

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Disclaimer: This information is meant to be general information not unique to any individual. Before following any guidance or advice found on this site or in the Purely OCD Podcast a visitor or listener should always consult with their own licensed healthcare practitioner. The Purely OCD Podcast and Website are not therapy or intended as a replacement for therapy. They are for educational purposes only.