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Six things you should know about OCD—from a therapist with OCD


Important insight on this misunderstood condition, from a therapist who has struggled with it.

By NOCD Therapist, Stacy Quick, LPC

I'm a therapist who treats people with obsessive-compulsive disorder, or OCD. I also have OCD myself. It’s safe to say I know a lot about it. And we need to clear a few things up.

Here are six things you should know.

1. OCD is not what most people think

Folding the laundry as soon as it comes out of the dryer, knowing a lot of statistics about a favorite sports team, or following recipes to the letter does not mean that a person has OCD.

The term obsessive-compulsive disorder is familiar to most people, but it is also highly misunderstood. Because “OCD” is used so freely in everyday conversation, as a euphemism for, say, “hyper-organized,” we hear it a lot without considering its true meaning. Obsessive-compulsive disorder is, in fact, a chronic mental illness, and should be considered with the same seriousness we afford bipolar affective disorder or major depression.

Those who suffer from OCD are unlikely to describe any benefitsin fact, the condition can attack someone’s very values, identity, and sense of safety. In fact, research shows a significant link between OCD and suicidal thoughts and attempts.

2. OCD is characterized by a cycle of obsessions and compulsions

Obsessions are recurrent, unwanted, intrusive thoughts, images, feelings, or urges. They cause significant distress, anxiety and a strong urge to engage in compulsions, sometimes called rituals. Compulsions are any physical or mental action that people take to try to reduce anxiety, “undo” an obsession, or prevent a feared outcome.

When a person is diagnosed with OCD, their functioning is typically significantly impaired. They may struggle with relationships, socializing, working, and carrying out daily activities. They may spend at least an hour of each day engaged in obsessions or compulsions—or far more.

That’s why, unlike its pop culture portrayal, OCD is not cute, funny, quirky, or beneficial; it is painful, all-consuming, and terrorizing. The toll that OCD takes on daily living can vary from person to person, but often the condition impacts many areas of functioning. People with OCD frequently report having relationship issues, trouble attending school or work, struggling with self-care, difficulty engaging in meaningful activities, and so on. Their physical health can even be impaired.

3. The compulsive behavior may seem trivial; the obsessions that cause it often are not

Even people with some understanding of OCD may not grasp its breadth. They have likely been exposed only to a couple of ways that OCD appears, such as people knocking on things several times, repeating certain phrases out loud multiple times, or washing their hands repeatedly.

Often overlooked or ignored are the obsessions that frequently happen inside a person’s mind—the unwanted, intrusive thoughts and doubts that cause the compulsions. Some may experience taboo intrusive thoughts, which can be sexual or violent in nature. Others may obsess about whether they have done something terrible in the past, acted in a way that was inappropriate, said the “wrong” thing, lied, or cheated—the list is endless.

There are hundreds of different ways OCD can manifest, and the condition can attach itself to just about anything. It is as unique as the mind it invades. For example, OCD may tell the most faithful believer that God is disappointed in them and that they cannot be forgiven. OCD can whisper to a new mother who would do anything for her child that she could harm her baby, even though she does not want to do so. OCD may try to convince a partner that they have been unfaithful and need to leave. Many people will also report that their fears change from time to time, or that they experience several manifestations of OCD at once.

4. OCD diagnoses are often delayed for years

One of the most sobering things I hear in treating people with OCD is that they had no idea that their intrusive thoughts were part of a mental health problem. They had always heard that OCD was nothing more than performing specific actions, like lining things up a certain way.

In many cases, people I worked with had delayed seeking much-needed treatment for this very reason, suffering in silence for many, many years. In fact, research suggests it takes people with OCD 14-17 years on average to receive a formal diagnosis and evidence-based treatment.

5. OCD can lead to other mental issues

People who struggle with OCD are at greater risk of developing substance use disorders or other unhealthy coping mechanisms in an attempt to combat the intense feelings that OCD causes. It’s also not uncommon for people with OCD to suffer from other mental health issues like depression. People with OCD may isolate themselves and prefer to be alone. They may make excuses not to engage in activities that could cause them discomfort.

By understanding and getting proper treatment for the root cause—OCD— quality of life can increase, while symptoms of depression, stress, and anxiety can decrease.

6. OCD is highly treatable

The good news is that today, we know a lot about OCD—far more than ever before. As we continue to educate others about what OCD is—and what it isn’t—more and more people who desperately need treatment are able to get it. Exposure and Response Prevention (ERP) therapy is the most effective treatment for OCD, backed by decades of clinical research. For some, a combination of ERP and medication may be optimal.

ERP treatment involves teaching people to respond to their fears without trying to cancel out or neutralize a thought, image, urge, or feeling by performing compulsions. In ERP, a therapist guides an individual through exposures that trigger their fear and anxiety and helps them learn to weather the discomfort that it causes. Over time the person begins to recognize that they can handle the distress and accept uncertainty about their fears, even though they may not like it. They learn that anxiety is just a feeling that will pass on its own. ERP helped me—and it can help you too.

ERP is most effective when the therapist conducting the treatment is an OCD specialist with training in ERP. They provide a personalized and structured plan for treatment that’s tailored to unique needs and goals.

I am a therapist at NOCD Therapy, created by a former quarterback with OCD, that helps make ERP treatment accessible. It offers convenient, effective, and affordable OCD treatment through live, face-to-face video ERP therapy sessions, as well as always-on support between sessions on the NOCD platform through peer communities, therapist messaging, therapy tools, online support groups, and more. Like me, all NOCD therapists are licensed, specialize in treating OCD, receive ERP-specific training from world-renowned OCD experts and researchers, and deeply understand all themes of OCD.

NOCD services are covered for eligible commercial members of Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ). If you or a loved one are struggling with OCD and think that you may benefit from ERP therapy, schedule a free 15-minute call to speak to someone on the NOCD Care Team. They can answer all your questions about starting treatment, getting matched with a qualified and licensed OCD specialist, using your Horizon BSBCNJ insurance for therapy, and more.

In addition to providing the convenience of NOCD, Horizon BCBSNJ has expanded mental health care options for people with OCD so they can get quality, affordable care. Find a behavioral health professional.

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.