I'm Jeff Szymanski, PhD - Executive Director of the International OCD Foundation. Today is the first day of OCD Awareness Week. AMA!

Hi Dr. Szymanski!

OCD sufferer here, thanks for taking the time to do this AMA. A couple of questions:

1) It seems my biggest struggle is uncertainty, and my brain feels like it can't handle any hint of it. My obsessions lead into compulsions that search for that brief feeling of certainty. Why is uncertainty so acceptable for some and so difficult for others?

2) It took me several attempts to find a therapist that actually seemed to know what they were doing with treatment (ERP). Why do you think so few therapists are taught more about OCD in school/training?

3) What's your most memorable "obsession" that a client has told you about? Watching the documentary Unstuck, I thought the little boy talking about his biggest fear of becoming a body builder was adorable, but I can appreciate that it was his worst nightmare.

1) When you truly accept that uncertainty is a part of living then it will become easier. I'm not particularly certain of anything I do, but I choose to do it anyway. My value is to move forward and engage in the world despite my uncertainty. Now, when you have OCD the volume on your uncertainty channel is even louder. Which is why practicing behaving in the world even when you are uncertain can be one of the most important lessons you can learn (and is the core of any effective treatment for OCD). 2) Estimates are that the time between onset of OCD symptoms and effective treatment is 14-17 years! That is completely unacceptable. We currently have over 1,400 self described OCD therapists on our website. But even then you have to sift through and look at their backgrounds to ensure that they understand how to do exposure and response prevention therapy or properly prescribe OCD medication. We have an entire training program devoted to getting more therapists trained: https://iocdf.org/professionals/training-institute/

3) The obsessions aren't memorable. The intense suffering and the lengths to which people lose their lives to this disorder are. Many people think their obsession is more bizarre or rare than others. This misses the point. The core of the treatment is that we all have "weird" or "strange" thoughts. But thoughts are just thoughts. Again, this is a core of effective treatment.

Hi Dr. Szymanski! Are there any common myths about OCD you'd like to dispel?

We have a great blog on this topic here: https://iocdf.org/blog/2017/10/03/help-seperate-ocd-myths-from-the-facts/

That said, the most problematic myth faced by those in the OCD community is that anyone can be a "little OCD". This is perpetuated by media representations of OCD, but also the general misunderstanding of OCD as a personality quirk. The problem lies with our use of the words obsession and compulsive. In general lay language "being obsessed" means something different from experiencing an "obsession". I might be obsessed about my team winning the World Series, but this is very different from experiencing an obsession that myself or someone I care about may get sick and die. Similarly, I might be compulsive about cleaning my office, but that is different that being completely overwhelmed by anxiety and feeling the only way to get relief is to engage in behaviors that are time consuming and get in the way of valued activities.

Thanks! I now have a follow up question. Do you believe changing the words of the diagnosis could be helpful? I suspect people will be ignorant and treat the topic strangely anyway but I wonder if addressing the semantics could broaden the understanding of this disorder? Kind of like how bipolar disorder used to be referred to as manic depression.

I'm not sure what people would think about that. I definitely think it is problematic that "obsession" and "compulsion" have very different meanings in lay language and in the context of OCD. There always seem to be myths and misconceptions about mental illness anyway though. I don't know if the community of those with bipolar illness experienced anything fundamentally different when the name was changed from manic depression. I think the larger issue is that people are not well educated about what mental illness is in general. The better we are at fighting stigma, educating and raising awareness, the better off the whole community will be.

Hi Dr. Jeff! My boyfriend has pure O OCD. His intrusive thoughts sometimes just break him down beyond functioning. What can I do to help him get through these times? It's very hard to find material made specifically for Pure O and I've done a lot of research but I'm having a very difficult time finding anything. Do you have any suggestions? Is there any right or wrong things to say? Thank you! And thank you for the work you do!

For those in our audience who may not be familiar with this term, Pure O refers to individuals who primarily experience unwanted and intrusive thoughts of violence, sex, or blasphemy. For many with these types of obsessions they way they respond is with an internal (unseen) compulsion like praying, counting, or "neutralizing".

To respond specifically to your request the most important thing you can do is to be supportive, get yourself educated and encourage him to get educated also. We have a lot of information on our website about intrusive violent and sexual thoughts and we have a lot of information at our Annual OCD Conference about these topics. I always recommend the book, "Imp of the Mind" by Lee Baer. For someone to see and read that others are experiencing something similar can be very helpful. I would encourage you both to try to become more involved in the IOCDF (if you aren't already!) as this community is very welcoming and supportive and can cut down the isolation experienced by so many people affected by OCD.

Thank you so much!

Another question I had is this- I've read that accepting and acknowledging the thoughts they suffer from can help ease the torment. I can imagine it would be incredibly difficult to do so, but have you found that to be true? Would you say that it would be helpful?

ACT or Acceptance and Commitment Therapy is really good at explaining the skills involved in doing this: https://www.amazon.com/ACT-Made-Simple-Easy-Read/dp/1572247053

The goal of this treatment is to begin to help people recognize that just because a thought or feeling shows up, they can choose how they want to respond to it. And that noticing that if we decide to struggle, control or change these thoughts and feelings, we likely end up doing only that and not behaving in the world.

are there "degress" or "levels" of this? I'm almost crying because for so many years I get this violent images in my head and I've never understood why. That's why I don't like watching horror movies and I try to avoid any gore images. I function in my life just fine (well I do have depression and I've hurt myself before but it's relatively bearable) but sometimes I get worried about this, it makes me feel like a psychopath

This is a very common response to having these thoughts! The good news is that they are just thoughts. There is no "reason" these images showed up. However, now that you are trying to push them away or avoid situations that trigger them, your mind has responded by giving them to you more. Not fair, but that is unfortunately what happens. Check out Lee Baer's book about this: "The Imp of the Mind". We also have several good articles about this on our website: https://iocdf.org/expert-opinions/subtypes-of-ocd/

Hi Dr. Jeff! I recently just started seeing a new therapist who specializes in OCD and last week she started exposure therapy which definitely exacerbated my OCD. Do you have any tips on how to successfully engage in ERP and not let your OCD stop you from recovery?

Thank you.

First, you need to tell your therapist this. You should always feel that your treatment is collaborative and your choice. You should never feel bullied or pushed into anything. The treatment should go at a pace you are willing to go at. And yes, sometimes in the short term your symptoms may get worse. Your job is to watch how your obsessions and anxiety go up and down as you engage in behaviors designed to give you your life back. What are you willing to do in order to have the life you want? It will involved a lot of hard and difficult work. So make sure you are in touch with why you are doing this. And make sure to have an open and direct conversation with your therapist!

Hey! I just want to say, as someone who went through 6-ish months of ERP to turn some of my biggest fears (9s or 10s on the hierarchy) into little nuisances (2s or 3s), it's really hard work, but SO worth it. I'm not avoiding situations that I would have six months ago, and am really enjoying larger portions of my day/week now.

If I could describe it simply, ERP for me was like a graph mostly going up, with dips along the way, but towards the end, I'm in a much better place. My symptoms aren't gone, OCD doesn't get "cured," but you can turn it into an annoying little bug, and less of a big, terrible monster. I'd say my OCD symptoms have improved at least 70%, and I'm in much more of a maintenance mode to keep my progress intact these days.

A few notes that I found helpful:

Be very upfront with your therapist about how your exposures are going. If they're too hard, there's no shame in stepping back a bit. My therapist told me about a patient who was so afraid of knives that even writing the letter "K" was a compulsion-inducing trigger, so you can appreciate that some ERP starts way down the ladder.

While you want to avoid the trap of "needing to do ERP perfectly," it is important to check in to make sure that it doesn't turn into "exposures with compulsions." This is probably a sign that the exposure is too hard if you can't stop the compulsions. I fell into this trap a number of times throughout treatment. Our brains are very sneaky when anxiety is on the line. When my therapist or I caught that behavior, we'd take one step back and work on some easier exposures to make sure the "response prevention" part was happening.

Give yourself a lot of grace! This is a very hard treatment, and there will be a lot of stumbling, there will be days where you're convinced it's not working, or that you're back at square one, but that's not the case, you'll be surprised how much better you're doing in even a few months.

Good luck!

These are all great notes. Thank you for sharing!

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I answered this question to someone else. I don't know of medical marijuana being researched and/or helpful. Have you seen an OCD specialist? You said you were diagnosed, have you tried treatment? If you are curious, please call our office and ask to talk with Alex who can assist you: 617-973-5801

"Today is the first day of OCD Awareness Week."

Starting at what time today?

We just started!

Hi Dr. Jeff! I have well controlled OCD but find that noises really, really bother me. I've read a bit that OCD is similar to autism spectrum disorders in that both have some sensory issues for some people. Is that true? I'm finding it hard to work in an office environment with others who eat, talk on the phone, etc.

While it is true that this is the case for some individuals with autistm, you are more likely referring to misophonia. We are finding that there are a group of individuals with OCD who also have strong negative responses to certain noises. Here is a great article on it: https://iocdf.org/expert-opinions/misophonia/

Hi Dr. Szymanski!

I've had a couple different psychiatrists say I have scrupulosity. Just by living with it for years and learning (mostly on my own), I feel like I mostly have it under control. Yet, I still live with a pretty consistent anxiety with the occasional bad day. What should be my next steps to taking control of my life and really feeling like myself again? I haven't used any meds and have had a hard time finding good care in my area.

I mentioned ACT or Acceptance and Commitment Therapy earlier. Here is a good primer on it: https://www.amazon.com/ACT-Made-Simple-Easy-Read/dp/1572247053 I think this would suit you as what you are describing is the right path. Continue engaging in valued behavior while letting the OCD symptoms become noise in the background but not barriers to behavior.

Hi Dr. Jeff. I am new to discovering that what I have been suffering with is actually OCD and BDD. Mirror checking, weight checking, BMI measuring etc are all a part of my routine but I would really like to know if there are any gentle ERP methods that I might try in order to reduce the need for for obsessing and "compulsing." Any suggestions?

Please go to our site here: https://bdd.iocdf.org/

There is a lot of helpful information about BDD here. Also I would recommend you find a BDD specialist if possible (search our resource director). There are also some great books out there. Kathy Phillips, Sabine Wilhelm and Fugen Neziroglu are people you could start with.

What are your thoughts on the compulsive hair-pulling disorder, trichotillomania? Do you see this as an expression of OCD?

The Diagnostic and Statistical Manual, or DSM, is what mental health professionals use to "diagnose" someone with a mental illness. An updated version of this manual came out a few years ago and when it did there was a new category: Obsessive Compulsive and Related Disorders. In this category we have OCD, Body Dysmorphic Disorder, Hoarding Disorder (used to be a subtype of OCD and now is its own group), hair pulling disorder (also known as trichotillomania) and skin picking disorder (also known as excoriation disorder). The reason these disorders are in the same "category" is that they share many things, but are also distinct from each other. Here is a quick overview of how they are similar and different: https://iocdf.org/about-ocd/related-disorders/

If you have more questions about hair pulling or skin picking disorder (now grouped together as body focused repetitive disorders) visit this site here: http://www.bfrb.org/learn-about-bfrbs

What's the most common misconception about OCD?

People believe that individuals with OCD want to engage in these behaviors. This couldn't be the furthest from the truth. Individuals with OCD feel they have no choice but to engage in these behaviors as a way to reduce their anxiety. People who are "compulsive" like and enjoy the time they spend organizing and rearranging things. It is the difference between wanting to do something and feeling that you have to do it "or else".

Hi Dr. Jeff! What is the major difference between having OCD and having just obsessive-compulsive tendencies? Like where is the line really drawn?

Hello Eastwood! Actually I wrote a blog about this a few years ago. You can read it in full here: https://iocdf.org/blog/2012/06/01/the-d-in-ocd/ But the short answer is that the "D" in OCD refers to disorder. This means that the person is not only experiencing obsessions (intrusive thoughts and images that trigger anxiety), and also compulsions (behaviors the individual engages in to try to make the obsession and/or anxiety go away), but also the obsessions and compulsions are very time consuming and get in the way of the person doing what he or she would really want to do.

Thanks Dr. Jeff! As someone who has battled the O portion, one of the intrusive thoughts is inevitably, "what if I develop the full on disorder?"

And you can continue to notice that as "just a thought". Maybe its the case, maybe not. But while your mind wants to continue to consider it, you might want to consider continuing to live your life as you would like.

Hello Jeff! I've been battling OCD for a while, and although I've made great progress with some obsessions, another one seems to pop up where the other left.

So my question is, is that a common thing with OCD? To "conquer" one obsession(what i mean is learning to not let the thoughts bother you) and see another take it's place?

Also, thanks for being passionate about OCD. As someone who has been driven to suicidal thinking because my fear and anxiety was so great, it makes me happy knowing there are people like you out there passionate about helping others with OCD.

This is very common! And the strategy you have used works the best: note it as an "OCD thought" and move on. Think of it like a headache. While painful a headache doesn't need to keep you from continuing to do things in your life that matter. Painful, annoying, bothersome, but we can all practice the skill of moving forward with what matters to us while also experiencing discomfort. I am writing this as though this is easy and simple. It is not. I do not have OCD, but I have to practice this same skill in my life over and over again.

So, new obsessions are common. Bottom line: respond the same way (ie, don't respond). Also, know that OCD symptoms are more likely to increase in times of significant stress, when in notable life transitions, or when physically ill.

Hi Dr. Szymanski. My 15 year old daughter was diagnosed with severe OCD last June and has just come out of 3 1\2 months of in-patient treatment at the Mental Health Centre. She has many of the main components of OCD, perfectionism, counting, evening out, hording, etc. She has made so much progress over the past few months but can get down on herself pretty quickly as we continue ERP therapy with the out patient team. Do you have any recommendations for us as parents to help support her while transitioning to home and to help prevent relapse?

Talk with the outpatient therapist about being involved in the treatment. Go on our website and look for online support groups on in person support groups for parents. You need support along with her. The more you are all plugged into the OCD community the better. Also encourage her to find online or in person support groups. The transition home can be very stressful as she was used to day to day support and treatment. Using the OCD community at large can help fill in the gap. Also, if possible, see if the outpatient therapist can increase frequency of sessions for a while during the transition.

Hey Dr. Szymanski,

I've made great progress with ERP. Mostly in social situations, but when it comes to driving I give in to my anxiety. I can ride shotgun and easily face any thought of jerking the steering wheel or pulling the ebrake. When I'm behind the wheel, it's a different story. I think of how a car can be deadly and how I'll purposely hit people. Logically I know I won't act on my intrusive thoughts, but that doesn't help combat my anxiety. Even the combination of meds and exposure hasn't helped. I think I just need to find medication that works better for me and keep trying with ERP, but I'd like to hear your opinion on this. Do you think that it's best that I keep trying what I'm doing?

All of this makes sense to me in terms of being the driver is actually the trigger because then you would be the responsible one. I would be curious however to hear how your ERP exercises went. Has your ERP therapist been in the car with you? Have they talked with you about any subtle avoidance or safety behaviors you have maybe been engaging in? Are you doing 100% response prevention? I would strongly recommend evaluating the quality of the ERPs you are doing for sure. I think if they are tweaked in certain ways they may have a better pay off.

Hi Jeff, Today is also PANDAS Awareness Day - is that part of OCD Awareness Week? Does the OCD Foundation help families understand PANDAS?

Today is PANDAS Awareness Day! Thank you for bringing this up. This is absolutely part of OCD Awareness week as PANDAS and PANS are subtypes of OCD. We have information on our site here: https://kids.iocdf.org/what-is-ocd/pandas/

But we also refer people to the PANDAS Physician Network (https://www.pandasppn.org/) and the PANDAS Network (http://www.pandasnetwork.org/) for more information and resources.

PANDAS/PANS is part of our broader education and awareness campaigns. We go to conferences to exhibit and educate other professionals about it as well as making sure we highlight these conditions at our Annual OCD Conference.

Has anyone with OCD been prescribed medicinal marijuana to help ease anxiety associated with OCD? My father has OCD very badly, and I began having obsessive behavior around the age of 16. I self medicated with marijuana and am proud to say I do not have OCD!!!! Of course, the thoughts are still there, and I can be compulsive at times, but I fully believe marijuana saved me from misery of living a life controlled by OCD. Sure, im a lazy pot head, but I'm happy and I'm not controlled by it. My father is going to be 70 and his OCD completely runs his life....it's sad to watch.

While this isn't my area of expertise, I also believe that no one is prescribing medical marijuana to treat OCD. That said, if your response to obsessions are to do nothing about them (and to not respond to them with compulsive behavior) you have already figured out what to do! Educate your father about what OCD is and what treatments are available. We have a lot of education and information on our website: www.iocdf.org

I will thanks! I think a lot of my fathers OCD stems from sexual abuse - he is deathly afraid of coming into contact with "penis germs". Any other similar patients with genitalia fears?

There are individuals with OCD that have obsessions and anxiety about genitalia. Sometimes it is purely OCD related and sometimes exacerbated by past trauma. In either case, an OCD specialist could likely be of help to him.

Do you know of any OCD specialist psychiatrists in the U.S. who are open to doing online consults with people in Canada? I have a friend who could really benefit from specialized help but the wait for a psychiatrist is over a year here. On top of that, many of the GP's and psychiatrists around here are not well-versed in treating OCD.

Please call our office and talk with Alex our community support specialist and he can walk your through the resource directory. We do have therapists who list "teletherapy" as an option.

Hey Dr Jeff! What is the best thing to do to help relieve the stress of a family member or friend dealing with OCD?

What everyone wants to do is to help. And to try to help we might end up accommodating (see here for information about family accommodating behaviors in ocd: https://iocdf.org/families/). The best thing you can do is to be supportive, listen, ask questions, educate yourself, but don't participate in the symptomatic behavior. Encourage them to consider treatment. The right treatment for OCD can be quite effective!

Hey, there has been recent studies lately about how using psychedelics could be a possible treatment option for ocd. As someone who has been struggling with it a lot and running out of options, what do you think about it, and where would someone like me go to seek treatment in a non-regulation way like that?

I don't believe this has been widely studied (though not my area). We do have a couple of articles we are planning to post on our website about updates on medication and natural supplements. Please contact our office and ask for a copy of these: [email protected]. Have you tried residential treatment? Also, there are also some newer (in some cases) more invasive options for treatment resistant OCD as well including neurosurgery options, deep brain stimulation, gamma knife, and transcranial magnetic stimulation. Again, we have recent articles on these options and are in the process of posting on our website in the next couple of weeks. But you can access them through our info account in the meantime.

In terms of public education and outreach, are there plans for any coordinated educational effort to dispel the use of "OCD" for everything that has little to do with the condition?

I'm referring to the tendency to use "I'm OCD about X" for something like a line being out of place, the kind of social media posts of "People will OCD will go bonkers over this", etc.

Similar campaigns have had some impact on other conditions like schizophrenia, Tourette's, functional deficiency, etc

About two to three years ago we moved our primary messaging to: "No, your not sooo OCD". Our aim is to educate the public about what OCD really is. Throughout this thread you will see the messaging we use on our website and when we intersect with (social) media.

This is the most common myth and most damaging for the OCD community: that OCD is just a personality quirk. So this has become our central focus.

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There were a couple of other inquiries about this. But, I don't know of any research showing this to be a viable option.

I was diagnosed with OCD as a kid and still struggle with intrusive thoughts. I was taught to conceptualize my intrusive thoughts as a bully or a belligerent person who just doesn't want me to be happy. Think "I can beat this," argue with it up to a point, but if the thoughts persist (persistent doubting), then recognize when I've spent too much time arguing with something that won't give up and distract myself. Any other tips for dealing with intrusive thoughts and fears like "I'm/someone I love is about to die?" (for no good reason)

I think for the most part you are on the right track. It is helpful to think of your OCD mind as "not you". As such, you can allow a thought or image to come into your mind and you don't actually need to argue with it or distract from it. You can simply let it be and just move on with your life. You are caught in the OCD trap of thinking you have to respond to the thought rather than just letting it float in and float out. Thoughts left alone come and go on there own. I've mentioned Acceptance and Commitment Therapy a couple of times so far and again think some of the skills taught from that perspective might be helpful (https://www.amazon.com/ACT-Made-Simple-Easy-Read/dp/1572247053)

Hi Jeff,

I have contamination OCD, and my family has a very hard time understanding it. What resources can I give them to help them educate themselves? My family is mostly in the medical field but still have no knowledge of mental health. I’ve made a lot of progress but sometimes I have my relapses and they get angry with me.

Thanks for doing this, glad we have this week!

We have a section on our website for families: https://iocdf.org/families/ But I also think just asking them to spend some time on our site in general (iocdf.org) would be beneficial. If possible, they could also accompany you to our Annual OCD Conference (https://www.ocd2017.org/index.cfm?do=cus.ocd2017Home). At our conference we have people with OCD, hoarding disorder, bdd, body focused repetitive disorders; their family members; and mental health professionals/researchers. It is a great experience to see everyone in the OCD and related disorders community in the same space at the same time. Here is a cool video from one of our past attendees. Maybe consider sharing this with them as well: https://iocdf.org/blog/2017/04/19/annual-ocd-conference-guest-post-by-morgan-rondinelli/

Are you sure this is the first day? Check. Check again. And again. And again.

Seriously though, does it annoy you that people equate simple little habits with OCD that actually compels behavior and makes a person uncomfortable if he doesn't do the behavior?

I've talked about this some over the past couple of days and yes I think this is in part a language problem. That obsessive and compulsive mean something very different in day to day conversation and that because they are the same "words" that when people hear about obsessive compulsive disorder they think they are hearing about the same thing. But they aren't. Which is why we try to raise awareness and educate. I also think this has been exacerbated by the media who seems to play into these myths rather than helping to correct them. Another front we have been working on for the last decade.

Hello Dr. Szymanski I was wondering why

A) some medications (such as adderall) increase OCD symptoms?

B) why stress causes OCD symptoms to flare up?

And

C) why is my OCD worse on some days than others?

A) I'm not a psychiatrist so I typically don't give specific answers about medication questions. But I can respond to this broadly. OCD is a disorder of both behavior and the brain. The reason some medications work for some individuals with OCD is because it is affecting the levels of certain chemicals in the brain. Some medication, that aren't meant to treat OCD, might be altering these brain chemicals in the wrong direction making OCD symptoms worse. B) Compulsions are a coping mechanism. They are in part intended to reduce discomfort. So when other life stressors show up, individuals typically move to the behavior that they feel works the best: in this case compulsive behavior. C) Most individuals with OCD report that their symptoms wax and wane. We know from research that exercise, sleep and diet habits both affect the body, the brain and your moods and behavior. On some days you might have been taking better care of your physical self and as a result your OCD symptoms might be better. On days where you are physically ill, or had bad sleep or drank too much caffeine your symptoms will increase. Your emotions are tied to your brain and physical body. When you treat your brain and body better it is good for a general reduction in OCD symptoms.

When do you know its time to pull the 16 year old out of high school for homeschooling? Do you recommend home schooling for OCD teenagers?

I would do this in consultation with an existing outpatient OCD specialist who is seeing your 16 year old. You, your teen and the therapist should have a plan in place for what the treatment plan should look like and whether being in school right now is making the follow through on the treatment plan the right move. If your teen is not in outpatient therapy for OCD treatment that would be my first step.

Hi Dr. Szymanski,

Since today's topic is about PANDAS/PANS, I would like to ask a question about pediatric OCD. Unlike PANDAS, my symptoms were gradual. Beginning with motor tics at age 3 that subsided and morphed into obsessions and rituals by age 7. Is the prognosis worse for early onset OCD? I ask because despite extensive ERP therapy, my struggles have continued.

So one of the defining features between pediatric OCD and PANDAS/PANS is the onset of the symptoms. PANDAS/PANS typically has a younger onset and also a very rapid (and in many cases intense) onset.

From what I know about the genetics research on OCD, if you have pediatric onset of OCD at a younger age and it isn't PANDAS/PANS, there might be more a of genetic contribution. I am not aware of research (though it may be out there) that earlier onset predicts worse outcomes. That may or may not be the case. But the bottom line is that this does not mean that treatments won't work for you. It may mean that traditional outpatient, 1-2 times a week ERP and/or an SSRI might not be enough. It may be that you have to try some different kinds and in different combinations. For example, there are several different combinations of medications that can be used to treat "treatment resistant" OCD, some people have found residential treatment helpful, others are turning to procedures like Transcranial Magnetic Stimulation or Deep Brain Stimulation.

If you are currently in treatment with an OCD specialist(s) I would address this directly with them. Maybe do some research on our website and/or call us here for more resources. Sometimes its a matter of finding the right treatment with the right person that works for you.

I have a 16 year old who was in hospital outpatient treatment program (he suffered treatment fatigue at week 10 and came home) in Tampa this summer. He is sliding back towards compulsions and anxiety keeps him from attending school. How do I know encouraging him to return to the same place (of course he knows how difficult ERP is) and if it will work? He is currently on medication and doing CBT weekly but no exposures? This mom needs help!

Were you involved in the treatment process while he was there? Did the treatment team give you recommendations? Is he attending any support groups? Are you? Are you involved in his treatment now? If he is in therapy and not doing exposure and response prevention he isn't really in CBT for OCD. It looks like maybe they have moved into working on his motivation. In either case I would strongly recommend you get more actively involved in his treatment. You don't have to attend all of his sessions and be there the whole time but his providers should be keeping you involved in some way, providing support and guidance to you, and giving you some helpful tips about how to encourage him at home. If his existing treatment team won't involve you, I would question why not. You should also ask your son directly if he is finding the outpatient therapy helpful. And if so, how can you support his efforts better. And if not, what are your options. You could also consider getting into treatment yourself for parental guidance and support around a family member with OCD. Many OCD specialists are open to this. You should also consider coming to our Annual OCD Conference where you (and he) would find a lot of support and ideas.

I was 100% involved in his daily treatment in HOP and the parent who makes sure his meds are taken daily and he goes to therapy weekly. We live right outside of Charlotte. Even with the help of Rogers clinical staff looking and searching before we came home ERP therapy is almost non existent here, there are a few therapists who were recommended (private pay only) and only one support group on the other side of town. We had planned on making the SFO conference but we were in the middle of HOP treatment :) One of the biggest challenges I face is the other parent that suffers from bi -polar who won't set boundaries or rules around treatment. When my son goes to his house its like an all weekend vacation with no rules, no exposure work, no medication adherence rules - sounds crazy but this parent is so afraid to say no and be a parent!!! This makes it very hard to set healthy boundaries and expect a 16 year old to adhere when he could just ignore the hard stuff.

One more thing - the one ERP Dr I found in Charlotte who will remain name less who knew about HOP at Rogers, knew about ERP and knew that this need to be in the treatment plan only did talk therapy with my son for 3 visits. We found another therapists but desperately trying to find ERP therapists doesn't exist here so send us some good therapists!!!!! So excited that https://hopewayfoundation.org/ has opened but once again no adolescent care.

Ashley, call the office 617-973-5801. Charlotte, NC? We have an affiliate there: https://iocdf.org/organizations/ocd-north-carolina/ and one of our board members is there. They may know of additional resources. I know of a couple ERP therapists in/near Charlotte. See if Alex, our community support specialist can help you.

Have you talked with this other parent directly about how upending this is for your son? Have you spoken directly with him about it? If you both contracted with each other about what his behavior needs to look like when he returns from that house, otherwise restrictions will be put on visiting there, would that be helpful?

Can ocd twist what actually happens? I have dealt with intrusive thoughts and I think it's my ocd that twists when I can be in the middle of doing something and have an intrusive thought at the same time. However, I still can't make the uncertainty go away. I wouldnt analyze if it actually happened. I feel like a horrible person. Any suggestions

Bad news: uncertainty never goes away. Good news: that is true for everyone with and without OCD! The skill to learn is how to allow yourself to have the unwanted thoughts, to not judge them, categorize them or analyze them. Then to ask yourself the question: whether my mind gives me these thoughts or not, and whether my body is feeling what it is feeling, what would I truly like to be doing with my time right now? The skill of moving forward with valued activity despite what is going on inside AND letting go of the battle with your mind and feelings. Arguing with them to go away before you can have a life. Consider looking into some OCD self help books and/or consider accessing an OCD specialist to help you think through your options.

Hey Dr. Szymanski,

Is it possible for OCD to manifest itself in different ways over a lifetime? For example, when I was child, I would feel a compulsion to blow on my fingers to "blow away" germs, or run my fingers along walls, and make sure the lock on the front door was oriented the perfect way before going to sleep. Now I don't get any of that, but I get a lot of anxiety related to scrupulosity, as well as making sure that I'm performing ritual purifications and prayers perfectly, which then take up a lot of time, and get in the way of others things I could do.

Although I'm not professionally diagnosed, I think there's a good chance it's OCD, because one of my parents was professionally diagnosed with it. I'm really normal in other aspects of my life, but this scrupulosity and purification thing makes my life really difficult. How do I manage it?

It is very common for people to experience a shift in their OCD symptoms over time. With treatment or without. This is more the norm than the exception. If you suspect you have OCD, I would recommend you consider meeting with an OCD specialist to talk this through more. Do some investigating on our website and print out materials that resonate with you. You can use our resource directory or call our office (617-973-5801) if you need help finding someone. OCD treatments can be very effective for many. Here is the link to read more about the treatment: https://iocdf.org/about-ocd/treatment/

Hi Dr. Szymanski, I've had OCD (primarily intrusive thoughts) for more than 22 years (basically all of my adult life), so I am very grateful for all you and the rest of the IOCDF do for us sufferers. One question I have been struggling with is the role of ACT in recovery from OCD. For about two years, I worked with an ACT therapist and very hard to use ACT to overcome my symptoms, but my OCD simply overpowered me. I have now found a new therapist who is very experienced with ERP, and I think he may be a better fit for me. Do you think ACT alone--without ERP--can be an effective treatment for OCD? I couldn't seem to make it work. Thanks again for doing this!

I have talked with a lot of ACT therapists about this and they all agree that you should use what works! Which is very ACT of them to begin with. ACT still needs more research to show that it is as effective as ERP for the treatment of OCD. That said some people report ACT helps them more, some say ERP helps them more, and some have reported that they pull from both traditions and that this has been helpful. I have responded to a few other inquiries on this AMA and have recommended in some cases they consider learning more about ACT if they aren't familiar with it. But the bottom line still remains the same: do what works for you!

How do you differentiate between those who actually have OCD and those who just say they have OCD for the attention? Does sorting out the "fakers" hurt the legitimacy of those who actually struggle with OCD?

I have not come across this (ie, faking having OCD to get attention). What I have very commonly come across is people using OCD lightly to say that because they are "obsessed" about something or they are "compulsive" about keeping their house clean they have OCD. I don't see it as faking as much as using the term inaccurately (and inappropriately). The response we have taken at the Foundation is to use these instances to in fact educate people about what OCD really is. I agree that individuals affected by OCD do feel that their suffering is diminished when people talk about OCD in this way. Research has shown however that if we take the time to educate and share stories about what the experience of an individual with OCD is really like, that this is the most effective way over time to change perceptions.

Dr. Jeff,

I'm hoping this hasn't been asked already, but this mornings a bit rushed so I only have time to post, not read right now.

I've personally been dealing with OCD that I believe to be triggered by a minor PTSD event for a few years now. I will admit that while my personal symptoms are more minor than many other sufferers, I haven't ever felt the need for prescription medication (yet). I was just curious if you believe that many symptoms can be treated without anxiety medications, or eventually taken off after some time?

2) As someone who started experiencing sudden symptoms at the age of 21, it's become a sort of passion of mine to educate and help others in a similar situation to mine. For someone without a medical background or education, how would you recommend being able to directly help those who suffer from OCD?

3) Personally I've found good results dealing with contamination and checking obsessions by doing a form of personal exposure therapy through outdoor activities, climbing, backpacking, etc. Do you think these activities have a place in modern therapy?

1) Many people have significant reductions in OCD symptoms with exposure and response prevention therapy. Without medication. Use our resource directory to see if you can find someone in your area (https://iocdf.org/about-ocd/finding-help/) or call our office 617-973-5801. 2) Attend one of our events! https://iocdf.org/programs/ Become an OCDvocate: https://iocdf.org/get-involved/ocdvocate/ Definitely get more involved with the IOCDF. We have plenty of projects and need help in disseminating resources and information. 3) A number of intensive programs around the US are involving these types of activities in their programs. The NeuroBehavioral Institute in Florida is a great example of this.

10 years of SSRI did almost nothing for me. I got a "genesight" test which said I should try Gabapentin and SNRI-Pristiq.

Just tapered off SSRI but SNRI is similar and I am not comfortable with the risk factors and have had little success from any medication.

I have managed to eliminate any but the most disturbing anxieties but these are of course actually more difficult to address mentally.

What can you suggest?

P.S. Unfortunately due to my disability I am forced to live with a father who simply does not comprehend OCD, continually minimizes my experiences, acts like I cognitively am crazy, frequently talks like I should just ignore this and asks why I can not use my brain, etc, while simultaneously treating me like an ingrate for his finances. We recently learned he has ADD and despite his diagnosis he still is willfully ignorant how OCD influences me. This is a torturous situation where we have diametrically opposed mental conditions. He can not comprehend germs most of the time and constantly triggers my phobias. On occasion his frustration has led him to intentionally contaminate followed by dramatic setbacks for me.

Please check out our resource directory and/or call our office to see if you can locate an OCD specialist near you. Exposure and Response Prevention (along with medication) are the first line treatments for OCD. More about OCD treatment here: https://iocdf.org/expert-opinions/ocd-treatment/

Tips about family issues are here: https://iocdf.org/expert-opinions/family-issues/

In ERP cognitive enhancers facilitate learning. Any suggestions on alternatives to D-cycloserine?

Also your thoughts on inhibitory learning theory vs habituation models? See Abramowitz work

Sorry for briefness - OCD patient fear reasons. Trying to expose just a little at the time by even asking.

Good for you for doing something that challenges your OCD! The research on D-cycloserine started out very promising but doesn't look like it is going to be of much help. The two areas of research I am keeping my eye on are the glutamate based drugs (like namenda - contact us for a recent article in our newsletter about this) and transcranial magnetic stimulation (again we have an article about this you can access by calling or emailing).

I am convinced by convincing data and so Michelle Craske's work on Inhibitory Learning is very compelling. It has changed how I (and many others) do ERP. Dr. Craske herself has said however, that more work needs to be done before we do a full paradigm shift over to inhibitory learning. What I found most compelling about her research is that in my work with "treatment resistant" cases of OCD her guidelines were much more helpful and impactful than the traditional habituation model.

I'd be interested in that newsletter for both Namenda and TMS.

Are you familiar with Rodriguez is work out of Standiford on OCD and her data on glutamate and Gaba?

Please call the office and ask to speak with Alex our community support specialist. He can forward you those articles. I love Carolyn Rodriguez. She wrote an article for us on Ketamine. I follow her and Chris Pittenger from Yale in terms of their research on glutamate based drugs. Chris wrote the article on meds that you can access from Alex

OCD and video gaming / technology. It seems to fall right in line with the biggest obsession for my 16 year old. With technology being such a huge piece in our current world and so many of our schools and jobs how do we treat this? If you take it away completely the obsession is still there when you give technology back. What have you seen to help in this area of treatment?

Is your 16 year old in treatment? This is a perfect topic for a session with an outpatient therapist about how to both address the obsessions triggered by the technology but also setting appropriate limits regarding the use of technology. If you aren't in treatment, see if you can find an OCD specialist near you.

Hi Dr. Szymanski! Thank you for doing this AMA!

What are some things that I (or anyone) can do to raise awareness of OCD, or otherwise help support things such as research of new treatments?

As this week is OCD Awareness Week it would be great if you wanted to get more involved. You can do that by checking out to see if there are any awareness week events in your area (https://iocdf.org/calendar/) and attend. You could post information about OCD Awareness Week on your social media channels. You could sign up to become an OCDvocate (https://iocdf.org/get-involved/ocdvocate/) and/or you could promote our fundraising endeavors to help fund research! https://iocdf.org/professionals/research-grants/

We are trying to do a better job of engaging those in the OCD and related disorders community who want to get more involved, to advocate, and to give back. I hope you will get more involved!

Do you have any suggestions for finding a good therapist who has significant experience with treating OCD?

On this page of our website https://iocdf.org/find-help/ we provide more background you might want to know about when looking for a therapist. On this page we provide some tips to keep in mind: https://iocdf.org/about-ocd/finding-help/

When you do find providers in your area pay close attention to how they describe their background, experience and training. Look for comments that talk about how many individuals with OCD they have worked with, specific training they have gotten, and how long they have been working with individuals with OCD. And grill them on their knowledge and experience with ERP!

Why don't researchers generally accept Pandas in Adult? Ex - https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2631893

PANDAS and now PANS (for more information about both of these subtypes of OCD please visit: https://kids.iocdf.org/what-is-ocd/pandas/ https://www.pandasppn.org/ http://www.pandasnetwork.org/) has been a strangely controversial diagnosis. In the past couple of years this has changed and there is increasing consensus on what this is and better ideas about how to treat it. Because this condition begins in childhood/adolescence the primary research efforts have been aimed at this population. As our understanding about PANDAS and PANS increases I believe there will be a shift to trying to understand better what happens to these individuals as adults. Given the scarce resources for funding on this topic at the moment though, the focus is on the younger population. Others may have additional points of view on this. Leaders in the field of PANDAS and PANS include Drs. Sue Swedo and Tanya Murphy.

Hey Dr. Szymanski - what are some of your favorite books to recommend to those suffering with OCD?

Thanks!

I've recommended Imp of the Mind by Lee Baer a few times as I still think this is the best book on the topic. For OCD in general I typically refer back to books by Jon Abramowitz, Bruce Hyman, Jon Grayson and Fred Penzel to name just a few.

Do I need to be licensed to practice erp with clients ? are there any facilities out there that hire people without degrees?

Many intensive treatment programs utilize "ERP coaches" who work under the supervision of a licensed clinician. This is common at the OCD Institute at McLean Hospital and the OCD programs Rogers Behavioral Health. Reach out to either of these groups (or any others listed on our "programs and clinics" page) to see if they are utilizing this strategy: https://iocdf.org/clinics/

Hi Dr.Szymanski, I always have intrusive and disturbing thoughts which are either unmoral (hurting someone) or sex related. I always have the thought coming up in the mind if I tried to stop myself to think about it I will be tempted to think of it and makes me nervous and anxious and annoyed, if I think the bad thought I will feel a bit relief but as I know the thought is bad and I lost to the temptation of thinking those 'thoughts and ideas' I will feel sad and disgust to myself and question myself if I am a evil person.

I have been taking Cymbalta 60mg for like 4 years, although it helps quite a bit (not really feel that nervous anymore when thought comes up, just tell myself 'this is just thoughts and I dont really mean it'), I just wondering do I need to take this forever? The side effect isnt great and I would like to stop it soon.

anyway thanks so much for the AMA

I think some additional coaching by a trained ERP therapist will help you in your endeavors to label "thoughts as thoughts" rather than as "good" or "bad" or "evil". You are on the right track. Many people, in consultation with their existing prescriber, will try ERP and if it is helpful will then consider tapering off their medication. As long as you and your treatment team are all in agreement about how to do that. Also consider reading "Imp of the Mind" by Lee Baer

Thank you for this AMA!

I'm a little confused about what to expect from ERP, with contamination OCD. Will the things I feel are disgusting eventually stop feeling disgusting and risky when I encounter them, or even feel just less disgusting? Thanks!

So this is connected to an earlier question about two overlapping but also different models about how to do exposure and response prevention and how it works. In the original model (ie, the habituation model) the idea is that when you expose yourself to obsessions and the feelings that go along with them and you don't engage in the compulsive or avoidant behavior (this is the RP part of ERP), then your brain and experience realize that you don't have to do the compulsive behaviors and your anxiety/disgust will habituate (ie, go down) on its own. You learned something new (this isn't dangerous) and if you repeat this over and over again then your "new" learning will "over write" your old learning.

The Inhibitory Learning model found that habituation doesn't really predict long term out all that well. In this research Dr. Craske has found that new learning and old learning compete with each other. New learning doesn't over write or make you "forget".

So the trick is to continue to challenge obsessions, anxiety and disgust by not giving in to the temptation to engage in compulsive behavior as a way of controlling or managing the unwanted feelings and thoughts. In this model the more you practice tolerating and allowing the feelings and thoughts to be there the less intense they end up being. But the course waxes and wanes. This matches the experience of many people who have reported success with ERP. That staying committed to the ERP model can really keep their OCD symptoms at a minimum but few people have said they completely go away.

Hello Jeff; thank you very much for doing this!

TLDR: I get serious panic attacks, have phobias of medical procedures, and bite my nails (a ton) when I'm anxious. Should I talk to my doctor about OCD or just general anxiety? How should I start the conversation, and make it clear I'm not just trying to fake it for a Xanax prescription?

Context:

I've been phobic of most medical procedures since I was about 15. I'm 28 now. At 15, I passed out in the middle of a biopsy, and I've noticed from that point on - I get extremely anxious when people talk about medical side effects or injury. I've avoided those conversations for the most part, but I do have panic attacks and lose balance/vision for a few minutes in extreme cases. My mind seems to loop horrible side effects or feelings repeatedly until I fall into panic.

I've been trying to stay healthy with eating, exercise, and less caffeine, but lately the panics have been more frequent and worse. I was reading about anxiety medication, and have avoided asking about Xanax (or similar) because they mention OCD in addition to general anxiety. A bit of light reading years ago made me think it was highly unlikely I had OCD due to the severity of most symptoms.

However, I bite my nails excessively when I'm anxious - I mean a lot, and everyday. They are very disgusting. I want to stop, but I've always done it since I was a child. I know this is considered a 'compulsion' based on some articles I've read, but I don't really know if it constitutes OCD. A lot of articles mention you can't be a little OCD, and I've figured I would just be crying wolf.

Thanks again for all you do!

Feel free to print out this response and bring to your doctor!

As we have been talking about when these behaviors are getting in the way of your life then they matter! The treatment for specific phobias (medical procedures) and panic attacks is very similar to the treatment for OCD. It is an exposure based treatment. Resources about these disorders can be found here: https://adaa.org/understanding-anxiety/specific-phobias https://adaa.org/understanding-anxiety/panic-disorder

The Anxiety and Depression Association of America also has a therapist directory. An anxiety disorder specialist will also have ideas for nail biting. More information about nail biting can be found here: http://www.bfrb.org/learn-about-bfrbs/nail-biting

Definitely address with your doctor. And bring in any resources from these websites that you found particularly helpful.

First off, thank you for doing this, my college's OCD group starts tomorrow, and it only makes it better that it's on OCD Awareness Week. In the foundation, is it considered more appropriate to say "someone is OCD" or "someone has OCD"?

I've been dealing with the condition myself and I've grown irritated at the prior, as to me it signifies their life is taken over and is nothing more than a shell to be used by the disase. I'm curious what the leading organization says on this.

We have asked our community about this and their preference is "an individual with OCD" or "an OCD sufferer". Regarding the latter point some people don't like the negative connotation of sufferer and some have recommended OCD Warrior! Which I quite like. But the bottom line of your inquiry is actually quite important and an integral part of the therapy: you are not your OCD. So someone "has" OCD is accurate. Someone "is" OCD is not only inaccurate, but if believed by the person with OCD, it can be very detrimental.

As a high school senior with OCD how am I able to help inform the people at my school about the truths of OCD? My initial idea was to make a power point and ask to show it in my classes, but there's probably no time for that since most of my classes are AP classes.

Contact Stephanie Cogen at our office. She is currently working on developing and Anxiety in the Classroom resource for educating school personnel as well as students about what anxiety and OCD are. She can be reached at [email protected]

Hi! I was diagnosed 4 years ago with OCD. Right now I am struggling with intrusive thoughts while in the middle of doing something. Then after the thought I panic and have anxiety thinking did I do what my thought was? Example: If I was taking care of someone and was helping them in some way, then an intrusive thought popped up as I'm helping (say harm) them. Then I worry that I harmed them. Like if I was helping with a bath and water got on someones face while I was rinsing their hair and the thought had to do with them not breathing or making it difficult to breathe because of the water getting on their face. Then worry that I didnt grab a towel fast enough, like I hesitated before getting the water off. I hope this makes sense. Could use some/tip please and thank you

We have some great articles on these topics. Dr. Fred Penzel has written a few of them and he provides very practical and straightforward ideas about what you can try. Also not a bad idea to consult an OCD specialist to help out! Here are some of the articles: https://iocdf.org/expert-opinions/expert-opinion-violent-obsessions/ https://iocdf.org/expert-opinions/but-i-love-my-kids/ https://iocdf.org/expert-opinions/homosexual-obsessions/

Thank you for doing this.

I am really worried about my mental health in my later years. I have been diagnosed with OCD and been going to therapy and taking my meds. Things are going fine now, but I'm an older parent forty-three with a four-year old. I am so freaked out about the chances of mentally degrading later in life to the point where I will not even research it.

Can you provide any insight on how OCD affects the elderly and when?

I would definitely discuss with your current therapist. Are you engaged in exposure and response prevention therapy? You can also chat with others with OCD in online forums (https://iocdf.org/supportgroups/online-and-phone-ocd-support-groups/). In terms of research, no one in particular comes to mind who is researching OCD in the elderly. Jon Abramowitz is usually up to date on who is researching what though. Contact him via this page if you'd like: http://jonabram.web.unc.edu/

Dr. Szymanski,

My wife is being treated for anxiety linked to OCD. Since beginning therapy and medical treatment several years ago, the day-to-day impact of OCD on her life has decreased dramatically. However, she would like to eventually become non-reliant on her medication. Is this a possibility? If so, what techniques, or treatments would eventually lead to this goal. I understand that you cannot comment on my wife's specific case, but in a broad spectrum.

Thanks.

A similar question asked above and so I am happy to repeat it. If your wife has been stable for a while on her meds and would like to transition off medication she should bring this up with her psychiatrist and work together collaboratively to find and OCD specialist who is skilled in exposure and response prevention therapy. More about OCD treatment here: https://iocdf.org/about-ocd/treatment/

Do you see children being diagnosed with OCD a lot who really aren’t? It seemed like a lot of kids I worked with would have OCD or ADD diagnosis but after working with them in group some of those behaviors disappeared

It seems like a family doctor shouldn’t be giving psychological diagnosis. Shouldn’t that be left to a psychiatrist to prescribe meds?

Across the board we see and hear (and some research has shown) that OCD is commonly misdiagnosed. Either people think it is there when it isn't or don't know to ask the right questions to properly give the diagnosis. This is why we are committed to training the general public, the mental health community, school personnel and the medical community. We have some new initiatives aimed at pediatricians and we are currently developing our Anxiety in the Classroom resource. Family physicians and pediatricians should absolutely refer to a specialist if they suspect OCD. One does need some specialized training and background to both diagnose and treat OCD.

Hey Dr. Jeff. Current residential OCD patient here.

1) Are there any brain imaging techniques that can help with treatment or tracking OCD progress? If so, why don't we use these in residential treatment?

2) Why isn't ERP treatment better understood by psychologists or more widely available? (EDIT: Asked above)

3) Do you have any other advice for maintaining your gains other than doing ERP homework, eating healthy, exercising, and joining a support group?

4) Are hoarding rituals less common than other OCD subtypes? Are people with hoarding disorder less likely to seek help? It seems that I run into more people with contamination, checking, etc

1) From my understanding brain imaging studies show differences between OCD and non-OCD brains only when grouped together. It isn't a diagnostic tool (yet!). 2) I will expand a little on this as well. For a long time training for mental health professionals was largely from a theory called psychodynamic therapy. Unfortunately that style of therapy, while helpful for some things, is not helpful for OCD. It has taken some time for mental health training to catch up and begin training therapists in techniques known as CBT or cognitive behavior therapy. This therapy is helpful in treating OCD (specifically the technique of exposure and response prevention or ERP). We need to get more therapists trained in this model! But is catching on. 3) Get involved as an OCDvocate (https://iocdf.org/get-involved/ocdvocate/), come to one of our Walks (https://iocdf.org/programs/1million4ocdwalk/) come to our conference (https://iocdf.org/programs/conference/). I truly believe that staying connected to the OCD community can be extremely important. Oh! And do some reading in ACT (for example: https://www.amazon.com/ACT-Made-Simple-Easy-Read/dp/1572247053). Some people have found ACT principles helpful in relapse prevention.

The psychodynamic therapy treatment my first therapist used was kind of rough for OCD - like "let's question everything about your childhood." Which cast a ton of doubt on what, I believed until that point, was a pretty awesome upbringing/childhood. I feel very fortunate to have had my gut tell me to do a bit more research and find a therapist trained in treating OCD.

Yes, we have heard this a lot. And research on psychodynamic treatment for OCD bears this out as well. Just isn't the right tool to fix the problem.

Good for you for going with your gut. I'm glad that you found someone who was more experienced in OCD. I had a very similar experience and found that it exacerbated my OCD .. sometimes I feel it can lead to questioning/obsessing about other things that aren't the core of the problems.

Exactly... After a few sessions with other therapists, I thought that if these sessions are making things worse, that's probably a bad sign.

No disrespect to alternative therapies, but I had one person I was referred to, fully licensed, having me stare at crystals and stuff. She also told me that my obsessions were "secret, encrypted messages" from my subconscious.

That is probably the single worst thing a therapist can tell a person with OCD. Obsessions are non-sensical and should be treated as such. They are not secret, encrypted messages.

Thanks for your answers, Jeff! I assume ACT is similar to "Radical Acceptance" and will look into it :)

Acceptance and Commitment Therapy or ACT is what is called a "third wave" CBT therapy. Acceptance is definitely part of it as well as mindfulness and others. It is based on relational frame theory, a body of evidence which shows how all of us get stuck in our head trying to follow rules about how things should be rather than how things are. The goal is to encourage people to spend less time trying to control their interior experience and to spend more time engaged in valued activities - even while experiencing the unwanted thoughts and feelings.

Hi Dr. Szymanski,

I suspect that I may possibly have perfectionism. I am pretty rigid about things being done in the "right way" and cannot move on until they are fixed. I can never step outside myself in the moment and realize that I may be acting irrationally. I find myself picking arguments and fights often and never being able to move on until I'm satisfied I came out the winner. Competition and "being right" seems to rule my life and my relationships. For example, I have been working on getting in shape recently. My girlfriend mentioned that she also wanted to start exercising, and I immediately viewed this as a challenge or a competition. I could not move on and asked her to please not try to get in shape at the same time I was. Does this sound like perfectionist behavior and, if so, how is the best way to receive treatment for it?

This does sound like perfectionism to me. And it is a really good thing that you are recognizing how it is getting in the way of your life. While this may or may not qualify as an OCD diagnosis (though it may), it does sound like you are seeing enough harm from it that it might be useful to see if a therapist could help. Here is an article I wrote a few years back: https://iocdf.org/expert-opinions/perfectionism/

See if it resonates.

Hi Dr. Jeff! Thank you so much for doing this! Last year I realized I had OCD, and recently started taking medication that was prescribed my my psychiatrist to help combat it (which is working wonders).

I haven't been officially diagnosed, however, but do you think it's important for people to receive an official diagnosis? Or since I can still get the medication do you think it's not a big deal?

Once again, I really appreciate all you guys do at the IOCDF!

I typically recommend that if you are doing something that works, keep doing it. If at some point you want to stop taking medication and you want to consider doing exposure and response prevention (ERP) then I would do this in consultation with your psychiatrist and find an ERP specialist. However, there are some individuals who tolerate their medication well and are fine taking it. And so, if it ain't broke....

My teenaged boy has been going to therapy for quite awhile now. How long is therapy suppose to last? It is very expensive and wondering how long it is going to take. He does do ERP

I would ask to be more involved in his treatment. It is very common for parents to be involved in their kids treatment whether they are 6 years old, 16 years old, or 36 years old! We know that OCD affects the entire family system. You, the therapist and your son can still "protect" his confidentiality in his treatment but you should also be getting assistance, support and guidance from the therapist. Including asking questions like this (which is very appropriate!).

I'm struggling with a relapse of the Pure O type of OCD. A number of years ago I was in therapy with a leading psychologist in the field, and I would consider my treatment as largely successful, but this time I decided to try another OCD specialist to see if I could get a different perspective. I'm thinking, however, that maybe I should return to my original therapist since there are some discrepancies in their approach. What do you think is a good barometer to gauge if the therapy is successful?

The best barometer of successful treatment is the percentage of your day that you are engaged in behaviors that matter to you as opposed to the amount of time spent on compulsive behavior. The experience of obsessions or anxiety isn't the best marker. Control what you can control: your behavior. A therapist that keeps you focused on that is your best bet!

What is the difference between OCD and Intuition? People often suggest I'm OCD since I have a tendency to point out when things are out of place.

I think this again is that misunderstanding of what an obsession or compulsion is in general language, versus what it means clinically. If you are noticing errors and mistakes you are detail oriented. That is good! If you become so preoccupied with something being out of place that it becomes time consuming to think about and respond to then it is more likely OCD. If you are regularly critiquing others and this is getting in the way of your relationships but you feel intense anxiety when you can't correct them, then it is more likely OCD. It is about 1) do you like to engage in the behavior and 2) does engaging in the behavior get in your way.

Does this shirt bother you? https://www.amazon.com/dp/B075WRY722

The message on the shirt doesn't bother me. The context in which it is being sold does. For example, we have seen an advertisement for "obsessive compulsive" cosmetics. The use of these terms is appropriate. They are referring to the personality traits of obsessive and compulsive. The message on this shirt is saying the same thing. However, when they sell it as an "OCD tshirt" they are changing the meaning. When they invoke the "D" then the meaning of obsessive and compulsive changes. Again, these are all opportunities to engage people with proper education when they inadvertently make light of something they don't understand. Research has shown that telling people to just "stop doing that" doesn't work and in some cases there is a rebound effect. So we typically don't take on groups that do things like this. Instead we try to reach out to educate them about why the D matters.

I wouldn't say I have OCD but anxiety and depression as well as ruminating thoughts. How does one help stop these thoughts (without trying to avoid the elephant in the room, making it worse.)?

Mindfulness techniques can be very helpful in terms of suggesting an alternative to trying to stop these thoughts (which doesn't work for anyone!). Check out the resource I've already posted about Acceptance and Commitment Therapy (ACT) which may be a helpful approach to ruminations: https://www.amazon.com/ACT-Made-Simple-Easy-Read/dp/1572247053

I have CDO, it's a bit like OCD but in alphabetical order. Does everything have to be in even numbers?

The CDO example is an example I hear a lot about as a way of making light of OCD. So I will instead respond to your question. For some individuals with OCD, an obsession is triggered if something is seen or done in a certain number. For some it is even numbers, for some odd numbers, and for some it is a certain number like 4 for example. And then it may be things in multiples of 4. For individuals with OCD symptoms like this is may be connected to a need for feeling "just right", it may be connected to intrusive violent or blasphemous thoughts, or something else. So if the obsession is "when I see the number 4 something bad will happen if I don't respond to it" then the compulsion might be "If I tap 8 times it will undo the number 4 and make things feel better or make the unwanted thought go away". An ERP around this would be to have the individual confront their fears about the number 4 and not respond with compulsive behaviors of doing things in 8s.

However, if you just like certain numbers or prefer certain numbers or like the symmetry of even numbers then it is unlikely you have OCD. Instead you just have preferences and likes.