What even is OCD? Hint: it's not Obsessive Christmas Disorder
(Part 1 of a 3 part series on the similarities and differences between OCD, Autism and/or ADHD)
Disclaimers:
Language: There is a sordid history of the DSM. I may use direct language from the DSM, this is for educational purposes. The language in the DSM, including the use of the word disorder (D in acronym) is harmful. When this language is used, it is either because I am quoting the DSM, or because there is unfortunately a lack of different terminology out there (i.e. leaving the “d” in OCD or the “D” in ADHD). Because I leave this, does not mean that I agree with the wording.
Educational Purposes: The information presented here is for educational purposes, and not meant to diagnose, treat or cure medical conditions or challenges, including neurodivergence (including mental health challenges), or physical health.
Welcome to a special blog post from our newest therapist, Alex McLaughlin! Alex is working with clients ranging from early childhood to adults in Minnesota, both virtually and in person in Edina! They currently have openings and would love to chat to see if they are a good fit for you!
OCD, you’ve probably heard of it. What comes to mind when you hear that word?
OCD, you’ve probably heard of it. What comes to mind when you hear that word?
If you are not someone with lived experience of OCD, or know someone who lives with it, you might think of the most commonly portrayed manifestation of OCD; someone who enjoys things that are neat, tidy and organized; or perhaps someone who needs to flick the light switch on and off 10 times before exiting a room. While these are ways that OCD can manifest, there are actually so many other symptoms that a person living with OCD may experience.
First, let’s explore what OCD stands for.
It does not stand for obsessive christmas disorder, or obsessive cup disorder. These terms are poking fun, or making light of a debilitating condition.
OCD stands for Obsessive Compulsive Disorder, it is a mental health condition in the diagnostic and statistical manual for mental disorder by the American Psychiatric Association.(1) Unless you feel called to look up the full criteria, I’ll provide you the Cliff’s Notes: OCD is characterized by obsessions and compulsions that cause distress, and impact a person’s life significantly. Obsessions are recurrent and persistent thoughts, urges or images that intrude on a person’s mind, are unwanted and cause distress. Compulsions are acts (physical, mental, etc.) that a person does in response to their obsessions, in an effort to reduce their distress, or prevent a feared outcome from happening.
OCD affects about 1-3% of the global population,(2) per one study, another source estimates about 1 in 100 adults, or between 2-3 million adults in the U.S.A; and 1 in 200 kids and teens, or around 500,000 in the U.S.A.. (3) OCD can be incredibly debilitating, in fact, according to digging that the OCD-UK did, “OCD was once ranked by the World Health Organization in the top 10 of the most disabling illnesses by lost income and decreased quality of life.”
Each person with OCD will have a different experience from another person with OCD. People who live with OCD have different content of their intrusive thoughts / obsessional doubt, sometimes referred to as “themes,” One theme of OCD is commonly referred to “harm OCD,” in which a person has intrusive thoughts / obsessional doubts about harming others and/or themselves, which is not consistent with who they are and their values in life.
Remember that everyone has worries, and everyone experiences intrusive thoughts. The difference between worries that exist outside of OCD and OCD is the worries happen continuously, tend to revolve around the same or similar topics, cause a great deal of distress, and a person makes efforts to ignore or suppress thoughts, or neutralize them with another thought or action.
The type of worries within OCD are repetitive. Like throughout the day, throughout the week, etc.
Some examples of obsessions include:
Worry that you might hurt yourself or someone else, on impulse, without a desire to do so, for example; “what if I stab my loved one,” “what if I accidentally drive off that bridge?” or “what if I harm someone because I wasn’t careful enough.” (harm OCD)
Worry that you are actually a p*dophile, for example; “what if I get a groinal response when I’m babysitting,” “what if I (P*dophilia OCD, or POCD)
Continuous doubt and worry about your romantic relationship, for example, “is this person right for me,” “what if there is someone better out there,” or “do I really love them?” (Relationship OCD).
Concern with morality. For example, “what If I offended God / Allah / Universe, and I’m going to hell / purgatory?” or “I think I committed blasphemy, what if God hates me?” (scrupulosity / religious OCD)
Worry about making mistakes, or if things are not “just right.” For example, “what if I make a typo in this email, and people think I’m incompetent and I get fired for it?” or “I don’t feel right the way I’m cutting this apple, that must mean that I’m doing it wrong, and something awful could happen if I don’t cut it another way.” (Perfectionism OCD or “just right OCD”).
As mentioned earlier, compulsions can be overt, subtle or mental acts that a person does in an attempt to reduce their distress, or prevent the feared outcome from happening.
Compulsions can be:
Physical acts or cover acts, such as: switching a light switch on and off until it feels right, excessively washing your hands.
Reassurance seeking: asking someone to reassure you that a feared outcome will not happen. For example: asking people repeatedly if they think you’re straight, or a bad person.
Subtle Acts: re-writing or rereading something to check for mistakes
Mental compulsions (4): reassuring yourself (for example, repeatedly asking yourself if you want to push that person in front a train), mental review (replaying conversations in your head to answer a question, gain certainty, or reassure yourself), worry (for example, thinking over and over again about something that might happen, and making a plan for a hypothetical situation), and rumination (thinking about something over and over again to gain certainty or answer an unanswerable question).
Avoidance of situations, people, places, things that may trigger obsessions, or avoidance of situations, people, places, things, behaviors because OCD tells you avoiding it is the only way to prevent the bad outcome. For example: avoiding using sharp objects (harm OCD), avoiding children (POCD), avoiding touching surfaces for fear of germs (contamination OCD).
So now that you understand a bit more about OCD…
You might be wondering, why we, a clinic that specializes in assessing and working alongside Autistic, ADHD, dyslexia, learning disabilities and/or other folks under the neurodivergent umbrella (including OCD).
The reason we are talking about it, is because OCD co-occurs with Autistic and/or ADHDers. In the blog post, next week, we’ll dive into the similarities and differences between OCD and Autism. The week after that, we’ll explore the similarities and differences between OCD, and ADHD; and all three (OCD, Autism and/or ADHD).
Are you working with a provider who already supports you with managing OCD? It is vital they be aware of the ways in which ADHD and/or Autism may present as OCD; and as such, it’s important that they do not encourage / assign exposures that are solely related to Autism and/or ADHD, because they could cause unnecessary discomfort and harm. If you’re feeling called to self-advocate, you might consider sending them this blog post, or the next few that we publish. If you feel that you want to find a better fit, see below….
Do you live on Wahpekute land (colonized as MN) (8), and have, or suspect you might have OCD, ADHD or are Autistic ? Alex is an AuDHD therapist with lived experience of OCD, who is trained in treating OCD and committed to providing ND-affirming therapy, reach out to schedule a free consultation. Live on either Wahpekute land, or Chumash land (colonized as Los Angeles, CA), and wanting an assessment to understand what might be going on (Autism, ADHD and/or OCD, among other things), then reach out to see about scheduling an assessment!
Live on Chumash land and wanting referrals for an ND-affirming therapist who treats OCD, we may be able to help!
We live and work on the unseated territories of the Wahpekute and Chumash land, we pay respects to their elders past and present. We encourage folks to explore the ancestral lands they live and work on, and to learn about the Native communities that live there, the treaties that have been broken. If folks feel called, we encourage them to consider taking actions to support (9) Native communities, reparations, and land back movements.
Footnotes:
1 DSM; we’re currently on the DSM-5-TR
2 Obsessive-compulsive disorder
4 Here is a list of more mental compulsions.
9 Support starts with educating yourself about history, and being willing to sit with uncomfortable truths. It can then include things like: learning about cultural appropriation, and commit to not engaging in and perpetuating cultural appropriation; committing to calling people in to conversations; educating others, honoring Native folks on holidays such as Indigenous People’s Day, considering the implications of celebrating holidays such as Thanksgiving, or the Fourth of July; making land acknowledgements, having conversations with people about what you learn; financial support; uplifting and amplifying Native voices and stories; understanding and supporting Land Back efforts; researching and supporting Native causes, including supporting and advocating Native-led for legislation changes. Some options for financial support of Native communities on Wahpekute land are here, here, here, here, here or here; Chumash land here; National.
