Maybe the bravest thing I've ever done

Lessons from OCD treatment

In early May, I sought out OCD treatment for the first time. I’d been aware that I likely had OCD for several years, but I hadn’t sought out help for it beyond normal therapy. I thought I was managing it fine on my own.

Until I faced reality and realized I wasn’t.

As it turns out, OCD infiltrates my life in so many more ways than I previously understood. Now I’m doing twice-a-week OCD therapy and in a way, it feels like I’m starting from scratch in understanding my brain and what it needs from me.

OCD is one of those disorders that most people know little about beyond what they see in dramatized TV shows and movies (and what they see is often inaccurate). And a lot of people might joke that they’re “so OCD” when they just like to be organized (please don’t do this)! Even though I’m in early in my OCD treatment, I want to share what I’m learning since OCD is so widely misunderstood.

Here are some lessons learned from my OCD treatment so far, some new and some deeper understood:

1. What OCD actually is

I imagine most people think OCD is being really intense about organization, cleanliness, or germs. That’s not what it is at all, although it does manifest in those ways for some people with OCD. OCD stands for Obsessive Compulsive Disorder, and what sets it apart from other mental disorders is an ongoing cycle of the following:

1. You have an unwanted intrusive thought or obsession come into your mind. The healthy thing to do would be to acknowledge the thought and move on without attaching meaning to it. But OCD does attach meaning to it, dwelling on the intrusive thought and falling into a state of distress. This is the “obsessive” in OCD.

2. Nobody likes distress, and OCD tells you that you need to do something in order to feel better and push the intrusive thought out. This part is the “compulsive” in OCD. When you give into OCD and perform a compulsion to feel better, it only provides temporary relief.

3. What performing the compulsion actually does is tell your brain that the original distressing thought you had is bad and you are bad and you need to perform a compulsion every time the thought comes back. The more you do this, the stronger the thoughts become and the stronger the urge to perform the compulsions. And then it starts to consume your life. This is the “disorder” in OCD.

Last year, I wrote about my experience with religious OCD. As a teenager, I had intrusive thoughts that felt impure and against my beliefs. Here’s an excerpt about how OCD played out for me at that point in my life:

The church teaches that you must keep your thoughts clean and pure, and all of a sudden my mind seemed to be turning against me. I didn’t know what was happening to me. I thought I was being overtaken by the devil.

Thankfully the church’s website had advice for keeping your thoughts holy, namely to shut out any unwanted thoughts by singing hymns or reciting scriptures in your mind. So that’s what I did. Obsessively. Only it didn’t actually work. It made things worse.

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2. There are a lot of different themes, or subtypes, of OCD

I knew I had experienced religious OCD before, but I didn’t realize just how many other subtypes of OCD there are — and how many of them I’ve experienced. Each subtype of OCD has its own themes of intrusive thoughts or obsessions. Some subtypes are much more obvious than others. For me, not fully knowing about the other subtypes meant I didn’t realize how much of a role OCD plays in my life.

Here’s a short list of just some of the OCD subtypes that exist, taken from the NOCD website, all of which I’ve experienced at some point:

• Existential OCD: intrusive thoughts around impossible questions

• Harm OCD: unwanted thoughts about harming yourself or others

• Health and Contamination OCD: intrusive thoughts associated with germs, sickness, or contagion

• Perfectionistic OCD: reliance on things to feel perfect

• Relationship OCD: intrusive thoughts associated with friendships or romantic relationships

• Religious OCD: intrusive thoughts about violating a religious, moral, or ethical belief

• Responsibility OCD: obsession with responsibility for other people and the environment

• Sensorimotor OCD: obsession with one’s movements or physical sensations

• Sexuality and Gender OCD: obsession over one’s own sexual orientation

It’s extremely validating and empowering to have names for these, and slightly overwhelming to realize how much OCD colors my life through a variety of themes. Hence the need for treatment!

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3. Exposure Response Prevention is the gold standard of OCD treatment and it’s really effective and also really hard

Starting OCD treatment meant starting twice-a-week Exposure Response Prevention therapy (ERP for short). ERP’s goal is to expose you to your OCD’s fears, train you to not respond with compulsions, and instead sit with the distress until it passes on its own. Basically, ERP is facing your deepest fears and letting go of trying to protect yourself from them. It’s hard work.

I’m only a few weeks into ERP, but so far it’s looked like making a catalog of my fears, what triggers them, and what my typical compulsions are. Then I brainstorm with my therapist about how to expose myself to my fears in our sessions. ERP looks different for everyone, but so far we’ve done things like consuming triggering videos or articles that I might come across in my regular routine, as well as something particularly effective called worry scripting.

You know how you can use journaling and affirmations to reassure and ground yourself? Worry scripting is kind of the opposite of that, where you explicitly write out triggering thoughts and intentionally push yourself further until you’re writing out your deepest, most distressing fears on repeat. In writing them out and facing them, you force yourself to sit with your fears until the distress subsides.

Is exposure therapy maybe the bravest thing I’ve done to date? Maybe.

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There’s so much I’m learning and unlearning, and a lot more I could share. I might share more in the coming months. But I will say that I’m really proud of myself for getting help (made less scary thanks to NOCD). It’s only been a few weeks and it’s already radically transforming my relationship with my mind and my life as a whole.

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A book! And now movie!

If you’re interested in learning more about the OCD experience, Turtles All The Way Down by John Green is a great read. John Green has OCD himself and made sure OCD was accurately represented in it. And it was recently made into a movie!

Ironically, I tried reading the book back in 2022 and didn’t care for it. Fast forward to a few weeks ago when my friend

Kimberlee

reminded me of it and I decided to give it another try. This time, I couldn’t put it down. The character’s obsessions are different from my own, but I still felt so seen.

If you made it this far, thanks for being here. As always, I’d love to know your thoughts. Feel free to comment below, or reply directly from your inbox.

Love,

(and Monet, the fluff ball obscuring half of this picture)