People with OCD see between 14 and 17 years, on average, between the onset of OCD symptoms and the time they receive a correct diagnosis. Here are four steps as a guide to get better results.
Step 1 – “My room is messy. Could this still be OCD?”
You may have chuckled at the rack of “Christmas Obsessive Disorder (OCD)”-themed sweatshirts on sale this past holiday season. Unfortunately, jokes like this downplay a painful disorder and contribute to widespread misconceptions about OCD. Popular media also perpetuates misinformation about OCD. Germphobic TV detective “Monk” is a stereotype. In fact, a minority of people with OCD are worried about germs or cleanliness. OCD is unwanted and distressing obsessive thoughts, images, and impulses. For people with OCD, compulsions (e.g., avoidance, rumination, controlling, reassurance seeking, cleaning) reduce distress or prevent something bad from happening. Common but lesser-known themes of OCD include, but are not limited to: harm (“I could lose control and murder my partner”), pedophilia (“What if I could abuse my niece?”), false memories (“Maybe I Were you charged with a DUI in the past and don’t remember?”), hit-and-run (“What if I hit someone while driving earlier?”), and metaphysical/existential (“Maybe I’m in a computer simulation.”) .
For more information, see:
- Anxiety and Depression Association of America
- OCD International Foundation
Step 2 – “I’m so embarrassed. How could I talk to anyone about this?”
People with OCD often fear that they are immoral, sinful, dangerous, or evil. Put yourself in the shoes of a new mother who dreamed of being a mother her entire life. However, she is now faced with recurring images of herself strangling her baby. Her violent thoughts conflict with her values or her ideal image of herself. Mental health professionals label these unwanted thoughts as “egodystonic.” OCD-related thoughts are often the worst things a person with OCD can imagine. However, OCD tricks sufferers into believing that these beliefs will come true unless they comply with their compulsions. This experience can cause intense shame, which prevents people from seeking help.
Shame and avoidance of treatment can be intensified for people of color and/or queer people. People who worry about harm-based or sexually related OCD may fear that mental health providers will reflexively view them through the lens of racial/queer stereotypes and view the person as dangerous or sexually deviant rather than taking themselves seriously. the time to understand the egodystonic nature of OCD. . For example, a gay African-American lawyer’s OCD may make him fear that he is a pedophile or a murderer. You avoid seeking help because you fear that your symptoms will be misinterpreted as a threat.
An intermediate step to help prepare someone for contacting an OCD specialist is to connect with others with lived experiences. Learning that you are not alone and that there is a name for what you or a loved one is experiencing can decrease shame and increase hope. A small but strong representation of queer, black and brown people is growing in the online OCD community.
See:
- Podcasts from OCD specialists and/or people with lived experience
- Social media influencers with lived experiences share real stories.
Step 3 – “I’m ready to talk. Is this treatable?
Yes, OCD can be treated with evidence-based therapies. The optimal duration and intensity of therapy depends on the severity of symptoms, the presence of additional mental health problems (e.g., depression, substance abuse), and other factors. For many, a few months of weekly 1-hour sessions should provide great relief and hope. Here are proven treatments:
- Exposure response prevention (ERP): often combined with acceptance and commitment therapy (ACT)
- ERP emphasizes behavior change with actions “to face your fears.” ERP activates obsessive thinking and negative emotions and then prevents compulsive responses to break the cycle of OCD. ACT prioritizes one’s values in goal setting and treatment planning. Teaches mindfulness and other skills that change your relationship with difficult thoughts and feelings.
- Inference-Based Cognitive Behavioral Therapy (I-CBT)
- I-CBT is an evidence-based 12-module program that incorporates psychoeducation and thinking and narrative exercises to demystify the obsessive doubts that occur early in the OCD process. One goal is to stop the sequence of OCD by acquiring information about the reasoning errors that cause OCD.
Autistic people and others under the neurodivergent umbrella may be particularly reluctant to engage in behavioral treatment for OCD. There are OCD specialists experienced in selecting and tailoring evidence-based treatment approaches to meet individual needs.
Stage 4 – “How do I know if a therapist has the appropriate training?”
For proper diagnosis and treatment, trust an OCD specialist. An OCD specialist is a licensed mental health provider with training in ERP and/or I-CBT whose clinical work focuses on working with clients with OCD. Most mental health providers are not OCD specialists, so finding someone in your geographic area can be difficult. However, virtual options are increasingly available. Research suggests that online therapy is as effective as in-person therapy.
There are strategies for finding OCD specialists who respect you and affirm your individual experience and identity. Many therapists are gaining experience working with diverse populations and life experiences.
See:
- OCD Specialists (ERP, ACT, I-CBT) – https://findyourtherapy.adaa.org
- OCD specialists – https://iocdf.org/providers/
- Inference-Based CBT Providers – https://icbt.online/find-treatment
- Use trusted sources to locate providers properly trained in evidence-based OCD treatments. Ask potential providers about the therapies they offer. Ask them to describe their training, experience, and process.
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Look for direct statements on provider websites about identity issues that are important to you (e.g., LGBTQ+ affirming, neurodivergent affirming, anti-racism, cultural humility).
This publication is brought to you in collaboration with the ADAA OCD and Related Disorders SIG.Learn more about GIS.
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