So you think you have OCD... Now what?

by Jacob Weissman, LPC, specialist in OCD, Anxiety, and Men’s Mental Health

Something has felt “off” for a while now. Maybe it’s felt “off” for as long as you can remember. You stumbled across a YouTube video, or maybe a Reddit post about something called obsessive compulsive disorder- aka OCD. Suddenly it all makes sense. All of the bizarre thoughts, the impulses, the feelings of “I have to do this… or else”. You’re now convinced you have OCD. The natural question is, of course, now what? What do you do about it? What does treatment look like? What’s the first step? The goal of this article is to serve as something of a reference for treatment and a how-to guide for what comes next.

Step 1: Double-check your understanding

The first step is to make sure your hypothesis is actually sound! Lots of things may seem like OCD that actually aren’t, and vice versa. I can’t tell you whether or not you have OCD (that’s where step 2 comes in), but I can tell you a little about what it tends to look like.

Let’s start by breaking down OCD into its constituent parts- obsessions and compulsions.

Obsessions:

Obsessions are intrusive, unwanted thoughts, feelings and/or urges that the individual experiences as distressing. Individuals with OCD often describe these thoughts/urges as “sticky” (they become easily “stuck” in their mind) and tend to experience these thoughts, urges, etc as urgently needing resolution.

Compulsions:

Compulsions are what individuals with OCD do to try and resolve their obsessions. Compulsions are mental or physical acts, and are almost always repeated. Individuals with OCD usually experience their compulsions as “urgently” needing to be done, and find only temporary relief from them.

The overall experience:

The obsessions and compulsions that make up OCD form a cycle. The cycle starts with an intrusive thought (the obsession). This obsession distresses the individual with OCD, who then desperately finds a way to make it go away. This is where the compulsion comes in. The individual experiences a little, short-term relief from the compulsion, but… then the obsession/distress comes raging back. So, they do the compulsion again. And again. And again. Often, both the obsessions and compulsions grow over time, as the individual makes their life smaller and smaller, in an attempt to avoid distress.

Example:

For example, an individual with religious-based OCD (religious scrupulosity) might have experienced an intrusive thought like, “What if I committed an unpardonable sin, and my soul will not be saved?” To resolve this, they then start doing extensive internet research, repeatedly asking their local faith leader questions, and engaging in elaborate, compulsive prayer. This causes them to worry about their relationship with faith more and more, as they begin focusing more and more on their potential “wrongness”. Nearly anyone in their religious community would recognize their concerns — and the extensive religious rituals they compulsively engage in — as beyond the pale. It is not a passing concern they are able to shrug off after a conversation with their pastor. It is a massive knot of distress, obsession, and compulsion centered around their faith.

Step 2: Find a Professional

The second, and perhaps important step, is to reach out to someone who treats OCD. If you’re in Houston, I’m happy to help. You can reach out to me for a free consultation using this link here. Otherwise, the best way to do this is by going to this site run by the IOCDF. The International OCD Foundation is the premier non-profit dedicated to helping people through their OCD journey. Here you’ll find a search bar where you can enter your zipcode. This will populate a list of OCD therapists in your area.

But, how do I know if my therapist is good?

Finding a therapist who says they treat OCD is relatively easy. Finding a therapist who treats OCD well- that’s the hard part. OCD treatment is highly specialized — meaning generalists, who tend to have lots of experience treating “run-of-the-mill” anxiety — may struggle to effectively treat OCD. The most popular, effective treatment modality for OCD is called ERP: Exposure and Response Prevention Therapy. There’s a comprehensive overview of ERP therapy on my blog here. My general advice is to look for a therapist who says they use ERP when seeking out OCD treatment. This is not a guarantee of a good therapist, but it’s a good sign at the very least. Knowing a little about the basics of ERP may help you suss out whether or not your therapist knows what they are talking about.

I hope this is a helpful starting point for those beginning their OCD journey. It can be daunting, but there is help available. Simply starting the journey is the hardest part. If you have questions about OCD treatment or would like to work with me, you can contact me here. I am always happy to help.