When East Meets West
East coast psychologist Peter Economou, Ph.D. and West coast psychologist Nikki Rubin, Psy.D. discuss the relationship between ancient Eastern spiritual practices and modern Western behavioral science with practical takeaways for everyone. Learn more at www.wheneastmeetswest.com
When East Meets West
S4E26 OCD Awareness: Beyond the Stereotypes
Unlock the true complexities of Obsessive-Compulsive Disorder with us as we shatter common stereotypes and misconceptions. Have you ever wondered if OCD is more than meticulous hand-washing or repetitive checking? Discover the hidden layers of this disorder, including the intriguing "pure O" subtypes where compulsions are mental rather than physical. We'll share our personal journeys through the evolving landscape of OCD treatment and training, emphasizing the critical need for specialized knowledge to manage severe cases effectively.
This episode offers valuable insights into the world of OCD treatment, spotlighting powerful methods like Acceptance and Commitment Therapy (ACT) and Exposure and Response Prevention (ERP). Learn how these therapies are making a significant impact, especially for high-performing individuals like athletes. We also highlight essential resources like intrusivethoughts.org and Chad Lejeune's book "Pure O: OCD Letting Go of Obsessive Thoughts with Acceptance and Commitment Therapy," which are invaluable for anyone dealing with OCD. Join us in understanding why recognizing and accepting one's challenges is a vital step towards managing symptoms, with OCD affecting a notable portion of the global population.
pete, I'm so excited to talk about one of my favorite clinical topics that I cannot believe we haven't discussed yet ocd here we are obsessive, compulsive disorder folks listening are probably like why is nikki excited to talk about ocd? That's a really it's. And if you have ocd and you're listening, brilliant and the expert, and so you all listeners tune in, grab some popcorn, maybe you're listening.
Speaker 2:Brilliant and the expert in OCD. And so you all listeners, tune in, grab some popcorn. Maybe you know a little blanket and whatever you enjoy.
Speaker 1:Well, I hope so. Well, I gotta say so. I'm going to start by talking about, like, some of the misconceptions of OCD, because, you know, one thing I'll let listeners know is the reason why this is such a favorite area of mine clinically is that it's so common and it's also often wildly misunderstood by clinicians. So I do a lot of work training clinicians on how to better identify it, especially. We'll talk in a moment of what are called the quote unquote, pure O variety. But I guess I want to start by asking you, like, like what's your experience been with been like as a clinician, like in training? Like did you have a similar experience where you like there were only certain you know symptoms or types that you were taught about as a as a student or early in your career? Like, what's you know? What was it like?
Speaker 2:for you. I don't know if I was taught it at all. Interesting.
Speaker 1:Oh, interesting. Well, it's telling right yeah.
Speaker 2:Probably in psychopathology or some core, you know abnormal psychology, where they would just put it in and like DSM-5, I guess now it's all the anxiety disorders and you know like they would just group them in that way. But I will say that I was probably never it's more like post-graduate that I did some advanced training, especially in our cognitive behavioral therapy world on how to treat well so.
Speaker 1:So, speaking to that, when you're saying, like I don't even know if I had a lot of training, it, like I guess I would ask you, um, what? But when you weren't as knowledgeable about it, like what were some of the things that you believed like signaled the presence of OCD? Like maybe this is even before you were studying to become a psychologist? Like what, what? Like when you somebody's, like that's someone, has OCD, what do you imagine?
Speaker 2:Well, we need, like a listener to call in and we would ask them that.
Speaker 1:Well, kind of except.
Speaker 2:Well, I would say because I also know where you're going.
Speaker 1:You're directing well, yeah, I know, but people, but yes, socratic questioning is very you know um, but yes, but I would say, like, because the reason I'm going there is because, uh, this is common for clinicians and non-clinicians outside always think it's like behaviors that you can observe, and so it's things like washing hands or things of that nature yeah, yeah.
Speaker 2:Except that, dr Rubin, what really happens?
Speaker 1:Well, let me, before I get into that, no, I'm not there yet Right, yeah, it's like most of us, and as a student I thought this too like we think of, like, probably the most common type that people are familiar with is contamination, ocd, right, so it's like you know, folks that are afraid of, you know, becoming ill. Like touching a door handle, they're imagining they're going to contract an illness or that there's toxicity in the environment. Maybe they've put a sandwich on the counter that they just cleaned and they're afraid of poisoning. So they might do a lot of hand-washing or a lot of cleaning. People also might be familiar, um, ocd, compulsions that are around, like checking, like checking the locks many, many times, right, counting, you know, is another one. People are familiar with somebody, like going through a certain number, like counting five things, or they can go together, touching, um, you know, touching, going back to door handles, touching a door handle five times, that kind of thing.
Speaker 1:And then, lastly, I would say, like most, uh, commonly used out in the world, which is not always accurate, is when someone will say I'm quote, unquote so OCD, they usually mean they're highly organized or they like things really clean.
Speaker 1:So obviously these are not incorrect identifiers of OCD. They all are representative of types of OCD, but what's really really fascinating to me is that, at least anecdotally so for both Pete and I's practice and loads of colleagues I've consulted with those are not the dominant types of OCD or OCD symptoms that present, at least in outpatient private practice. So for listeners and now there's a little bit more awareness about this that what's more common are subtypes that are called quote unquote pure O subtypes. So pure O is a misnomer, it means pure obsessional type, and so it used to be that people thought that an OCD which is made up of obsessions, really intense, scary, catastrophic thoughts and anxiety symptoms, that that's all there was. But that's not true. There are actually compulsions that people are doing, but they are compulsions they're doing inside their body, right. So is this what you see a lot of too, pete in?
Speaker 2:your practice. Yeah, yeah, and I, I, I'm glad that we are educating our listeners because OCD type A, those are things that people would kind of put together for those like really rigid folks, you know, and and yeah, this is an important thing to recognize. I was actually just teaching this week, maybe I don't remember what day it is.
Speaker 2:At some point sometime in your life when I was talking about OCD because you know, one of the things that for like a budding psychologist, is knowing what to treat and what not to treat. And OCD is an example I give because I say I will not treat severe OCD because we're not equipped to do so. And I give some examples of cases that I presented that I would refer out to specialists that are really like yourself.
Speaker 1:Like me.
Speaker 2:Like you refer to and that's one example. And then always major depression. Those are like my two that I'm very mindful of. That I would refer out amongst other disorders as well, but those are one.
Speaker 1:And so thinking about the severe OCD and how difficult it is to treat and how they need someone really, really skilled to do so, Well, and I think that what's hard is that when OCD is really severe and it falls under this pure O category, which I'm going to give some more details about here in a moment what can be so honestly awful for patients that have suffered from it for a long time is that they're not overtly that impaired, meaning like if somebody who is checking the locks has a routine of checking the locks for like an hour.
Speaker 1:That person is getting in the way of living their life day to day and they know that something's not right. But somebody that's doing what are called covert compulsions. So they're they're doing behaviors inside their body that are about trying to get rid of the anxiety that their obsessions cause. They can do those throughout the day and nobody knows they're doing them and in fact, patients that struggle with that often tend to think that the type of behaviors they're doing they're just they'll. They'll think this is just regular thinking. I'm just thinking through something, so I can't even tell you how many folks come to my practice that they may have, um suffered with this for I don't know, most of their life, 10 years, something like that, and again, that's not the like it's not diagnosed with.
Speaker 1:I mean yeah, yeah, I see a lot of times they're misdiagnosed as having generalized anxiety disorder. Like they think that they're um. They're worrying lazy diagnosis. You know it's funny, I actually just generally disagree. I think um because it's a real yeah, no, I think, like cause.
Speaker 1:There is a sort of that's for another episode. There there is a particular picture of generalized anxiety disorder. But I think people confuse between themselves, between worries and obsessions, and I also see people being misdiagnosed because sometimes OCD can the content, area of obsessions can overlap with actually regular therapeutic content. So a great example is relationships. So there's a subtype called relationship OCD that I even have a hard time diagnosing and this is a specialty of mine. So I think maybe I should probably define the difference between these overt and covert compulsions. Would that be helpful, do you think? Okay?
Speaker 1:So, as I mentioned, so OCD consists of three components. It consists of anxiety symptoms, sometimes also anger and disgust. Those emotions can be present too. Anxiety is always present. But those other two can also show up Obsessions or intrusive thoughts or images. So obsessions or intrusive thoughts or images are think of them as automatic thoughts or pictures in your mind that when you have them they are disturbing, catastrophic or like extremely terrifying to you. So your anxiety, on a scale of zero to 10, is probably going to be like a seven plus. So other like worry thoughts don't usually tend to activate anxiety that intensely. Maybe it's like a four.
Speaker 1:And then the last component of OCD is there's a compulsion, so a behavior that your brain wants to use to try to neutralize the anxiety by getting rid of, or neutralize the obsession by getting rid of the anxiety. So this is where someone touches a door handle and they're concerned that they contracted COVID, for example. Let's say they have an obsession oh no, I got COVID from touching the door handle. They might then wash their hands for 20 minutes until they feel like, okay, I think I'm safe now, right, but it doesn't really go away because the obsession keeps coming back. Those are overt compulsions. So overt behaviors are behaviors we can see other people doing overt compulsion. So overt behaviors are behaviors we can see other people doing.
Speaker 1:Covert behaviors, which we've talked a lot about on this podcast, are behaviors happening inside the body we can't see you doing. So covert compulsions are things like trying to problem solve, figure out an answer, trying to reassure yourself I'm okay, it's probably safe, I probably didn't get COVID. I call it mining for data, going over something in your mind, looking for evidence whether something is true or not, doubting oneself Is this what happened? There's actually tons. I'm just giving a couple common examples and I don't know any you would add here?
Speaker 2:No, what's important at least I wanted to say when you were speaking that came to mind was any disorder is you talk about like interfering with life is very treatable and so you know. So, to your point, it's like it could be interfering like an hour of the lock checking. I had a roommate that actually before I knew what any of this stuff was, he would check his alarm incessantly for about 20 minutes before he went to bed.
Speaker 2:So, even if it's like psychosis, like something that we haven't also talked about that much, no matter what the diagnosis is, it's very treatable, and so, with the right treatment, the right treatment that's the key. With the right treatment, people will live very normal lives. But no, thank you for breaking that down.
Speaker 1:Yeah, yeah, well, and, pete, I'm so glad you're saying that because, again, one reason it's helpful to have more understanding and awareness of the symptoms of OCD in general. So that includes these pure O symptoms. So pure O symptoms best way to describe it are basically the covert compulsions means you're doing a lot of mental checking, right? A mental um, or internal covert behaviors Um, that's going to get you to the right treatment and OCD very treatable, right? So we have standardized treatments, um, very, very, uh, uh effective, which are exposure and response prevention, known as ERP, um, and also act, acceptance and commitment therapy, and that's actually how I treat OCD is usually a mixture of the two.
Speaker 1:Um, yeah, any, I mean I want to recommend a book and a website here in a moment for folks listening, but, yeah, I mean like, yeah, awesome, me too. I also want to talk about a book, um, but yeah, I don't know, like, I guess I'd say like I feel I guess one reason I'm so excited about talking about is is because it's so treatable and when people are suffering and they don't know, they go on for long periods of time without getting the help that they need and it's like the good news is actually um, we have really great treatments for this, in addition to medication, which is often also a component of treatment for OCD.
Speaker 2:Yeah, it could be a part of the treatment.
Speaker 1:And I like that.
Speaker 2:You said the combination, and this is where, just for listeners, the world of psychology gets a little complicated because, like you said, some people might come to you after they've been to therapy for a long time. There's different types of therapy. You don't go to an orthopedic doctor if you have an issue with your heart, you know, and so that's the thing about this. You want to go to a behaviorist, an OCD specialist, if you're having, you know, some of these types of behaviors. And, hey, you want to break down the difference between OCPD and OCD. Do you think that would be helpful?
Speaker 1:I think that's going to be a little confusing for folks actually, because, yeah, well, yeah, because a little confusing for folks actually, because yeah, well, yeah, Cause I was like we could do an episode on OCPD I, I will. Just the one thing I will say is I think I don't like the name OCPD, which is obsessive, compulsive personality disorder.
Speaker 2:I actually tell I work with a lot with OCPD as well and I tell folks I say I think it's, I think it's better named as, like perfectionism disorder, yeah, totally eliminate. In the same kind of way, like so that nikki said about medicine or act or erp to help to reduce the symptoms. Uh, people with ocpd or any personality disorder, really their behavior changes in a very small way, if at all. Um, but you learn to accept depends, depends on the, the severe.
Speaker 1:But I'm thinking, yeah, yeah, ocp, does I mean ocpd? I think I is more.
Speaker 2:That's where I don't.
Speaker 1:Obviously this is just my own clinical opinion, but I wouldn't characterize it as a personality. Yeah, yeah, OCP. Does that mean? Ocp, I think, is more. That's where I don't. Obviously it's just my own clinical opinion, but I wouldn't characterize it as a personality disorder. I characterize it as just like a very, very rigid way of thinking, which, by the way, I'm sure there's people out there that would say that's actually what personality disorders are in general. But anyway, yes, I think that's maybe best for another episode.
Speaker 2:Well before I share my resources here. What's the book that you wanted to recommend? No, my same was. I Treat with Actin ERP as well.
Speaker 1:I thought you were like oh yeah, I also have some.
Speaker 2:No yeah.
Speaker 1:You also do ERP and Act as well. Yeah, yeah, yeah, and isn't it's I mean as a clinician? It's just I find it so rewarding it just is because it's so helpful for folks.
Speaker 2:Yeah, yeah Again. I mean I think for me it's like mild to moderate, and I see it a lot with athletes.
Speaker 1:Yes.
Speaker 2:High performers.
Speaker 1:And so I feel comfortable in that regard. But when it goes to moderate to severe is when I start to refer to a specialist. Yeah, yeah, well. So some resources for folks listening. There are two of my favorite resources that I have almost all my patients that have OCD I have them read. So the first is a really awesome website. It's called intrusivethoughtsorg. I sometimes actually go through this website with patients in session because it does a really nice job at outlining some of the really common content areas of OCD. So when I say content areas, I mean, um the content of the obsessions or intrusive thoughts um that a person may struggle with. It's not an exhaustive list. Actually, ocd can be really sticky. There's in slippery, it can. It's a shape shifter. So even there's even some sometimes we can diagnose OCD if it's not in this content area. But these are some of the most common ones. So, um, highly, highly recommend that website intrusivethoughtsorg uh, intrusivethoughtsorg Um.
Speaker 1:So that is an amazing website, amazing resource. And the other recommendation I have is for a fantastic book that came out in 2023 called Pure O, ocd Letting Go of Obsessive Thoughts with Acceptance and Commitment Therapy um by Chad Lejeune I hope I'm pronouncing his last name correctly Um, I hope I did Um. Anyway, it a fantastic book. It is designed for the patient to read, so it's not like a clinician manual.
Speaker 2:When's your book going to come out?
Speaker 1:I don't know. I'm never going to write a book Never. I defer to wonderful resources like Dr Lejeune has. So it is one of the best books I have ever read on OCD, so I highly recommend it.
Speaker 2:I don't, I don't, I never read it.
Speaker 1:It is like you will tear through it. It's very. It's also very small. It's like less than 200 pages. It's got a lot of great tools in there, so I would recommend that as well.
Speaker 2:So I'm we've talked, I'm a recovering perfectionist and so you know we certainly identify with some of these behaviors and so you know I hope this sounds like this was helpful. I mean, I know I always love you and I hope some listeners and if anyone you know, if you have a loved one out there with it it's not about shame or stigma around it, I mean it's really about just owning, and the only way you grow is by acknowledging what is, and that's where our act work comes in, like acknowledge what's there and then you know committed action towards where you want to go.
Speaker 1:Exactly right and, and I'll just, you know, leave listeners with actually some statistics here that, um you know, worldwide the percentage of people diagnosed with a lifetime prevalence OCD is, uh, currently um assessed to be about 2.3%, but that but that at some point in a person's life, about one in four people will experience obsessions or compulsions. I would guess that's probably been maybe a little higher, but that's what the research shows. Yeah, so it's. I know 2% sounds low, but it's actually one of the more common things that we see, and so hopefully this information is a good jumping off point for you to maybe get curious about some of your own types of thoughts and behaviors, uh, maybe people that you know, and if you or somebody you know is struggling with um OCD, just to feel hopeful that, um, there is a way to work with it and live with it and have um a fulfilling, contented life.
