Andrew Butler-Pothast, LCSW

What Is OCD?

OCD stands for Obsessive-Compulsive Disorder. Despite how it may be portrayed in media and pop culture, OCD is not an adjective to refer to character traits nor is it solely about being neat and tidy. It is a diagnosable condition that is characterized by either obsessions or compulsions or both.

Obsessions are intrusive thoughts, images or urges that are unwanted and cause a certain level of distress. Obsessions can include things that we fear others will find out about us or that will get us in trouble. There can be shame surrounding these thoughts as they might go against your morals or beliefs. It’s important to remember that these thoughts are unwanted and enter our minds against our will. Because of this, there might be a strong urge to suppress or contain these thoughts for fear of them getting out or coming true.

What we do in response to these thoughts or urges or the behaviors we engage in to neutralize these experiences are called compulsions. More specifically, compulsions are done to prevent a feared outcome or to decrease distress. These behaviors can include checking, seeking reassurance, repeating routines, or even mental compulsions like ruminating or mentally reviewing (for instance, listing all the reasons you’re not a bad person). Avoiding feared outcomes or triggers can also be a compulsion. We can think of these behaviors as certain rituals we engage in to satisfy certain thoughts or feelings. They may not be what we want to be doing but it’s what we’ve learned to do in order to manage the distress.

The cycle of OCD can be a vicious one.

As we engage in compulsions to ‘scratch the itch’, there might be some temporary relief. However, with time, OCD can get bigger as we train our threat response that these experiences are not safe. Life may become about getting away from discomfort and seeking relief as the obsessions get bigger and scarier. It’s not unusual for OCD to get in the way of more important things in life like relationships and meaningful engagement.

People might say that you should just get over it or cut it out. However, OCD can feel like an itch that you have no choice but to scratch. There can come a point where it can feel as if there is no other way but to follow the commands of the OCD monster.

Do I Have OCD?

It’s estimated that 2% of the population meets the criteria for OCD. However, studies indicate that pretty much everyone has intrusive thoughts. Behavioral rituals are also not so unusual. For instance, you might have a morning routine that you follow or a certain way that you like to do daily tasks. What differentiates OCD is that the thoughts and behaviors are out of line with who you are and how you want to behave. What’s more, rituals and intrusive thoughts can get in the way of your life and you might spend a greater amount of time than you would like engaging with these behaviors.

The best way to determine if you have OCD is to speak with a professional. A professional trained in identifying and treating OCD can best make a determination as OCD can be misdiagnosed as others conditions by someone without relevant training. OCD can be tricky and it’s not uncommon to have the thought, “what if this isn’t OCD?”

How is OCD Treated?

The gold standard and first line treatment for treating OCD is Exposure and Response Prevention (ERP) in conjunction with psychiatric medications. ERP is an exposure-based CBT treatment that works to disrupt the OCD cycle. With a trained therapist, you’ll gradually work towards freedom from OCD by confronting obsessions while disengaging from compulsions. Though the practice may sound scary, working with a therapist allows for focus on alleviating what’s getting in the way of what really matters to you.

You can think about ERP as if you are retraining your brain to better respond to what it’s telling you. It’s possible to step out of the OCD cycle and see the wealth of opportunity around you. With treatment, you may find yourself better able to make decisions and interact with your surroundings.

My approach in particular is guided by compassion. I combine elements of Acceptance and Commitment Therapy (ACT) with ERP to tailor treatment towards what matters to you with an increased sense of flexibility and openness. We will never move beyond what you are willing to try to work through your struggles. We will slowly test assumptions and discover together what is working for you and what might change in order to live the life you really want.