OCD: It’s not just in your head

Anxiety or OCD?

We see clients all the time who struggle with general anxiety, and sometimes, as we look deeper and ask more detailed questions, we come to discover that, in fact, the individual has OCD. What is OCD? OCD is defined by obsessions (intrusive, unwanted thoughts or images) and compulsions (behaviors or mental rituals to neutralize anxiety). While not all people who have anxiety have OCD,  all people who have OCD have anxiety. 

Sometimes the OCD patterns are challenging to pick up and accurately diagnose since they are normal behavior patterns for our clients. They don’t know life any other way. It can be hard for clinicians to diagnose, too. A study noted that OCD can be misdiagnosed by primary care doctors in about 50% of cases, which means that patients struggle with symptoms far longer than necessary and aren’t able to get the best types of treatments from OCD trained professionals. However, with specific training and diagnostic testing, we can rule out if it’s something more. Once OCD has been determined, we take a very specific approach to reduce symptoms, the first of which is educating the client on WHY they struggle with OCD. It’s not just in their head! Below is a picture of a brain without OCD and a brain with OCD. Notice the yellow and red areas that show parts of the brain that are overactive in trying to detect harm and error.

“It’s not me, it’s the OCD.”

So why does the OCD brain respond differently than someone without OCD? Well, first, we have to understand what the brain does with someone who doesn’t have OCD.  Let’s use the coffee maker, for example. If you don’t have OCD, after making coffee, you’d turn the machine off and leave the house without another thought. But those with OCD will be riddled with a process like this:

• Turn on the coffee, coffee brews, pour coffee, and turn off the coffee maker.
• Goes to change into work clothes and comes back to check if the coffee maker is unplugged. Says out loud, “It’s unplugged.”
• Doubt creeps in again, and a thought pops up that says, “Was it really unplugged or did you just think it was unplugged?”
• Recheck the coffee maker again to confirm that it’s unplugged. Fear sparks again, and you think, maybe I accidentally bumped into it and plugged it back in without noticing. I’ll check one more time.  
• Checks again, gets in the car to go to work, and as you leave, the image of the house burning comes to mind. You are already out of the neighborhood, but you take a U-turn, go back home, and check again. 

The OCD Brain Gets Stuck

All of our brains have an error or threat detection system, the Cingulate Gyrus. This is really helpful when it sends out signals that danger is ahead, and this part of our brain is mainly in the anterior cingulate cortex. For the non OCD brain, this part of the brain will alert, and when the problem is resolved, it quiets down, but not for the OCD brain. So, what is going on in the brain, and why is it happening? The picture below shows a simplified version of what goes on when there is a misfiring in the brain.

Picture from this source

For the coffee machine scenarios, the orbital cortex will detect that something might be wrong. “What if the coffee pot causes a fire?”

• The Cingulate Gyrus, error detection center, will tell us that “This is not safe.  Fix it!”
• The Caudate Nucleus, the part that filters and shifts to another thought, gets stuck. So the anxious thought simply loops over and over. The brain cannot go to another task yet. 
• The thalamus relays signals and keeps the loop going, which reinforces the urge to check and do compulsions. It says, “You need to check again. You might not have done it right.”

This all happens without the person even knowing it, since many people struggle with OCD without knowing they have it. In fact, one article notes that many patients struggle with OCD for 13 years before being accurately diagnosed and treated. Simply put, some people think that the way their brains work is normal and don’t realize that the shift is stuck since it’s been this way for so long. And even when someone knows that their fears are irrational, they feel compelled to respond to them since the misfiring and incorrect messages from the brain require such strong reinforcements. The neurological glitch can cause people to be paralyzed and struggle to do simple, everyday tasks. 

Best type of therapy for OCD

Sometimes OCD can disguise itself as general anxiety, and while therapy for anxiety will be helpful on some level, it won’t help the person find relief and make significant progress. This is why it’s important to ensure you are properly diagnosed and working with a therapist who specializes in OCD. Exposure and Response Prevention (ERP), which helps reduce the obsessions and the compulsions, is considered the gold standard for treating OCD. When utilizing ERP, people experience significant improvements in their daily lives, so they aren’t just managing life but enjoying it. ERP has been proven to be significantly more effective than using medications alone. 

It’s time to simplify OCD!

Understanding the brain’s role in OCD helps us shift from a shame-based strategy to one of understanding, compassion, and empowerment. If this article resonates with you or someone you love, we hope it’s been helpful. Though OCD doesn’t go away, with proper education and the correct forms of treatment, symptoms can be significantly reduced. If you’d like to learn more about OCD or if OCD is a part of your story, we would love to connect! We encourage you to reach out to us to discuss how you can find relief and more freedom. Reach out to us to get started.