06:49 AM

OCD isn’t what you think it is. Just ask this former quarterback.



A sudden onset of obsessive-compulsive disorder derailed Stephen Smith’s college football career. Now the CEO of an OCD treatment program, he shares what he wished he knew about this debilitating yet treatable condition.

Let’s get this straight: When your friend, who has started washing her hands a few extra times per day, tells you she’s “so OCD” about personal hygiene, the odds are she doesn’t really have OCD, or obsessive-compulsive disorder. The odds are that she’s being responsible in a time when handwashing can prevent her from getting sick.

True OCD could look more like this: Your friend is so worried about contamination that she may wash her hands 30 times a day. If she touches anything outside the home, she’ll wash with bleach. Grocery shopping or riding the subway provoke extreme anxiety. Spending hours a day on her handwashing routine prevents her from leaving her apartment or engaging in social relationships.

This example may seem extreme, but it’s not to the 1 in 40 U.S. adults who experience OCD over their lifetimes. A serious mental health condition, OCD has been named one of the top 10 leading causes of disability according to the World Health Organization. Research shows that 25 to 40 percent of people with OCD develop substance use disorders. And people with OCD are 10 times more likely to die by suicide when their condition is left untreated.

“OCD is one of the most misunderstood conditions,” said Stephen Smith, the founder and CEO of NOCD, a telehealth company that specializes in identifying and treating people with OCD.

Smith ought to know. In college, a sudden onset of OCD nearly ended his football career and education. He learned how destructive OCD could be – but also that there’s hope.

“Fortunately, OCD is one of the most manageable conditions. People with OCD can and do get better,” Smith said.

Here’s what you need to know to help you, or your family members get the right care for OCD.

How to recognize OCD before it’s too late

People with OCD experience two main symptoms: obsessions and compulsions.

Obsessions are repeated, intrusive thoughts, urges or mental images that cause anxiety or distress. According to the National Institute of Mental Health, common symptoms include:

  • Fear of germs or contamination
  • Unwanted forbidden or taboo thoughts involving sex, religion or harm
  • Aggressive thoughts towards yourself or others
  • Desire to have things in a perfect order

Compulsions are the actions that a person with OCD takes in response to an obsessive thought. These behaviors are repetitive and, like obsessions, feel like they’re out of a person’s control. Common compulsions include:

  • Excessive cleaning and/or handwashing
  • Ordering and arranging things in a particular, precise way
  • Repeatedly checking on things, like seeing if the door is locked or that the oven is off
  • Compulsive counting

“People with OCD perform their compulsions to try to alleviate their distress,” said Smith. “While it may make them feel better temporarily, compulsive behaviors don’t stop the obsessions. In fact, they make them worse.”

This destructive cycle can lead to serious consequences. Research shows that 25 to 40 percent of people with OCD develop substance use disorders. And people with OCD are 10 times more likely to die by suicide when their condition is left untreated.

“If people get misdiagnosed and go without treatment for years, their problems can cause them to lose their job and their family and they can find themselves out on the streets alone,” said Smith. “It’s really a tragic thing.”

Effective treatment now easier to access

As with other mental health conditions, OCD can be treated with psychotherapy, medication, or a combination of the two.

The gold standard form of psychotherapy for people with OCD is called Exposure and Response Prevention (ERP). First, people are gradually exposed to the situations that bring on their obsessions and anxiety. Then, people are prevented from performing the compulsions they’d normally do. Over time, the intrusive thoughts stop coming.

It was ERP that helped Smith take back control of his own life. But finding help wasn’t easy, which led him to found NOCD.

Through live video appointments online, NOCD therapists offer ERP therapy to people with OCD. People using this platform begin to get better in about eight weeks and are taught techniques to help them self-manage their condition for the long run.

“We often ask people to fit within the health care system,” said Smith. “With NOCD, we bring the health care system to you.”

Recently, a peer-reviewed study by the Journal of Medical Internet Research (JMIR), one of the most respected journals in health care research, validated the effectiveness of virtual ERP at NOCD. The study, the largest of its kind for OCD treatment, documented the outcomes of over 3,500 people over the course of their virtual ERP at NOCD therapy, which averaged 11.5 weeks.

Improvements included a median reduction of over 43% in OCD symptoms, as well as dramatic improvements in depression, anxiety, stress, and overall quality of life. This is significant because it shows that effective treatment often starts with treating the root issue of OCD; treating only the anxiety and depression likely wouldn’t have the same effect.

Virtual, evidence-based ERP therapy services at NOCD are covered for eligible businesses that are members of Horizon Blue Cross Blue Shield of New Jersey. NOCD provides treatment to adults, adolescents, and children (down to age 5).

In addition to NOCD, Horizon has expanded options for people with OCD so they can get quality, affordable care. Visit the Horizon behavioral care website or call us at 1-800-626-2212 (TTY 711).

Horizon Health News is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

NOCD is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey.