OCD Without Shame

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In today's episode, OCD Without Shame, OCD feels like a nonstop demand for certainty, even when you know the fear does not make sense. I break down why intrusive thoughts are symptoms not character warnings, and how evidence-based treatment helps you reclaim your life.
• the “oversensitive smoke alarm” metaphor for OCD and why the brain’s done signal gets stuck 
• the obsession anxiety compulsion relief loop and how relief reinforces the cycle 
• why OCD is not tidiness and how compulsions can be invisible and mental 
• what research suggests about genetics, trauma correlation, stress and age of onset 
• why searching for the one cause can become its own compulsion 
• intrusive thoughts in motherhood and the shame that keeps people silent 
• ERP as the gold-standard treatment and how it retrains tolerance for uncertainty 
• SSRIs as a first-line medication option and why support is not failure 
• a small at-home practice to delay one compulsion for five minutes and observe the anxiety shift 

Transcript

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When A Thought Won’t Let Go

Speaker 0:00

Welcome to Couch 10 with Cat, mental wellness with a friendly voice. I'm Cat, your friendly neighborhood marriage and family therapist, best-selling author, and TEDx speaker. But most of all, I'm a proud wife and mama, endurance athlete, and wholehearted coffee lover, and I'm truly delighted to be your host. Each week we gather for thoughtful conversations about relationships, resilience, healing, and yes, sometimes we laugh along the way. Let's begin. Have you ever checked the stove three times, gotten in the car, and had to turn around anyway? Have you ever had a thought so unwanted, so out of character that it scared you or terrified you? What if I told you that that thought isn't a warning about who you are? Rather, it's a symptom, and that symptoms can heal. Today we're going into the brain, the body, and the heart of OCD, obsessive compulsive disorder. Welcome back to Couch Time with Cat. I'm Cat. I want to start today with a scene, not a client story, but maybe something you identify with or something you've seen someone experience. It's 1147 and you're lying in bed. You've already checked that the door is locked. You know it's locked. You watched your own hand turn the deadbolt. And yet a thought slides in, quiet and certain. But what if you really didn't check it? What if you only think you did? So you get up, you check again. Relief floods in for exactly four minutes. Oh. Then the thought returns a little louder this time. But what if you really didn't check it? What if you only think you did? And it's wearing a slightly different disguise. That loop, that exhausting 2 a.m. just let me be sure loop is one of a thousand faces of obsessive-compulsive disorder. And if you've lived it, you already know it isn't about being tidy or particular. It's about a brain that has learned to treat uncertainty like a five alarm fire. You're listening to Couch Time with Cat. I'm Cat. Hi, friends.

OCD Is Not A Quirk

Speaker 2:40

And today we're talking about where OCD actually comes from: the biology, the psychology, and the whole tangled ecosystem of it. And more importantly, what actually helps? As we begin this episode, I want to share some statistics because data helps us take the shame out of discussing. According to the National Institute of Mental Health, an estimated 2.3% of U.S. adults will experience OCD at some point in their life. That's roughly 1 in 40 people. I actually think it's higher, but I'm not a scientist, so I don't have any. But anecdotally, I believe it's probably one in 20. In any given year, it affects about 1.2% of adults, and it shows up more than three times as often in women than it does in men. Globally, research from the World Mental Health Survey says it studied over 26,000 adults across 10 countries, and it found a prevalence closer to 4%. Here's the number that stops me every time. Among adults with OCD, over half report serious functional impairment, and another third report moderate impairment. This isn't a quirky personality trait. This isn't needing to line up your salt and pepper shaker just right. It's a condition that reshapes people's daily lives. For the next half hour, there will be no shame, no oversimplified answers, and no pretending that there's a magic supplement that'll just fix it. I want to talk in science, data, compassion, and help us carve a real path forward. Okay, shall we?

The Smoke Alarm Model

Speaker 4:29

Picture OCD. Less like a broken part and more like an oversensitive smoke alarm. A typical brain smells a little smoke, checks the toaster, and moves on. The OCD brain smells the faintest tint of something, and the alarm doesn't just go off, it won't shut off. Researchers have found this connects to circuitry in the brain that links areas responsible for noticing danger, weighing information, and signaling, okay, we're done, let's move on. In OCD, that we're done signal gets stuck. And here's the loop underneath every obsession. No matter what it's about, a trigger sparks a distressing thought. The anxiety spikes, and you perform some kind of compulsion, checking, reassurance, mental review, and then the person gets relief. But that relief is a trap. So our brain doesn't learn, oh, there was never any danger. It learns checking is what's keeping me safe. So the next intrusive thought hits even harder because now it has evidence on its side. Now, where does this come from in the first place?

Genes Set The Stage

Speaker 5:53

So many places, friends. Diagnoses can be so very nuanced. And some people think, oh, you're born this way. Some people think you have it's hereditary, your brain has a predisposition to it. Some people believe it's trauma. I believe it's a combination, and more than believe, research says it's a combination of things. We don't always know exactly what the trigger is, like why somebody's brain just goes into it. But most of the time, a clinician that specializes in OCD, which I specialize in OCD, they can trace it back to what happened. Was there a trauma? Is there a nutritional deficiency? Is there a genetic component? So most people who specialize in OCD can kind of figure out why, and then give the person tools to help bring them some relief. So genetics play a measurable role. And a major genetic meta-analysis published in Transitional Psychiatry. So it pulled data and it found that OCD is roughly 7.2 times more common among close relatives of someone with OCD, so hereditary. In twin studies comparing identical twins who essentially share all their DNA, they consistently land on a heritable estimate of around 50%. Some studies of childhood onset OCD put that number even higher in 45 to 65% range. So the 50% heritable number that gets misunderstood. It doesn't mean you have a 50% chance of getting OCD if a parent has it, but it means that across a population, about half of the variation who develops OCD symptoms can be traced to genetic differences. So researchers have found that some of the genetic variability connects to serotonin, dopamine, and glutamate systems. But, and this matters so much, the saying is that genes load the gun, but they don't pull the trigger. There isn't a single OCD gene. And having the vulnerability doesn't guarantee the outcome. So some of us can be predisposed, and then the experiences that we experience as we grow up, or maybe there's nutritional deficiencies or um an just an underlying base of anxiety, sometimes all these things can work together and push us into OCD. I think I say, I tell my clients that OCD is anxiety times a thousand. So some of us have anxiety. Oh, you know what? I think I told you guys I was going to share this with you, but maybe I didn't. So recently I got a brain map done of my brain. And oh my God, I cannot wait to tell you all about it. So they put these little electrodes on my brain. And I went to Mary Parker's clinic. She's from Infinite Potential Counseling, and she has been a guest right here on Couch Time with Cat. So go back and listen to that episode. She was um, she helped us talk about perimenopause. It was an awesome episode. So go check that out. So I went to Mary's clinic, Infinite Potential, and they did a brain map of my brain. And um, I got to see how my brain functions. It was so cool. And so they don't go off of symptoms. I don't tell her I have anxiety, and then she says, okay, here's medication. She can see whether I have depression or see whether I have anxiety or ADHD or autism or any of these, any number of things. So my brain map says I have anxiety. That's it. I have anxiety and a predisposition to obsession. And she was like, Does that uh does that track for you? I was like, Yes, ma'am. Yes, it does. She said, When you are awake, your brain is very high functioning. And then when you sleep, it's like your brain falls off a clip of a cliff. I was like, Yes, ma'am, that does track. That absolutely does track. You know what else I learned is that when I close my eyes, my brain functions better. What? Isn't that cool? I have better, better brain function when my eyes are closed. So if I'm having a conversation and I can't quite get the thought out, if I close my eyes, I've always done this. I just didn't know why I was doing it. So if I close my eyes, I can complete and process that thought. And I never knew why. And now I know that's just how my brain works. I thought that was really cool. So there's a little, a little sneak peek behind um my brain and a brain map, and it was really cool. So I may have a predisposition to something to OCD, but it doesn't necessarily mean that I'm going to develop

Trauma Stress And Early Onset

Speaker 11:44

it. Now let's go to life experience. So trauma doesn't cause OCD in some simple direct line. So there's not causation, but there's correlation. And research has found real association between traumatic experiences and then how severely OCD shows up, and sometimes even how it's expressed. So if our nervous system learns that the world is unpredictable and we need to stay one step ahead of disaster, and we also carry a biological vulnerability toward OCD, you can see how that hypervigilance, so that fire alarm, and compulsive certainty seeking might start talking to each other. And then if you add in stress, sleep deprivation, hormonal shifts, illness, major life transitions, none of these create OCD out of nothing, but they absolutely turn up the volume on a system that's already sensitive. One more data point that matters here is that OCD tends to start young. Research places the average age of onset around 19 to 20, and the condition often follows a pattern. One wave of onset, ages 8 to 12, and then another one in the late teens, and then early in the 20s. So if your OCD started in childhood or adolescence, that's not unusual. That's actually the most common pattern researchers see. I've also seen a statistic that says average onset is at 11 years old. So the study that I'm referring to right now falls right in that category. Who loves Eddie Murphy? Raise your hand. Dun dun dun me. I love Eddie Murphy. He is, he's so divine. I adore him. We are not friends or anything, but um, I just think he's the beast knees, right? Also, guys, I'm drinking a Diet Coke.

unknown 13:56

Don't tell anybody.

Speaker 13:57

Okay, for my locals, for my Wimperly locals, once a week I go to Marco's and I adore the Marco staff. I just adore them. Equally, like I adore writing Murphy, but I know the Marco staff. And I order pizza and there's shrimp and avocado, and I always get a Diet Coke to go with extra ice. And Christine, shout out to Christine, shout out to Haley. These are these women are my heroes. And so, right now, even though a real radio show host would be drinking water, I'm drinking Diet Coke. Don't tell anybody. So I was watching the Eddie Murphy documentary on Netflix, and he's just incredible. I highly recommend. But he shares in there OCD hit him as an adolescent. And he really wrestled it with it for a long time. And sometimes people grow out of it. And then sometimes it gets really louder for people. So if that's you, there is no shame. Um, there are people that I love dearly with OCD. I treat this population because I just have such a soft spot for them in my heart. Because OCD is exhausting. You have to do so much mental work to get through the day when you have OCD. And so I really love bringing clients who carry this with them. I really love bringing them some relief. If you have OCD or love someone who does, I want you to notice is there a part of you that has been searching for the one cause, the one explanation, the one thing to blame? You don't need a perfect origin story to begin healing. You don't need to know exactly why. That search for certainty about the cause can ironically become its own kind of compulsion. We can hold curiosity about where this came from without ever needing a verdict. Let me tell you a little bit about why this topic means so much to me.

Intrusive Thoughts And New Mother Fear

Speaker 16:03

I've spent hundreds of hours training specifically in exposure and response prevention, which is the gold standard. It's the most heavily evidence-based treatment we have for OCD. I didn't fall into it by accident. I was drawn to it because I've watched over and over how much silent suffering happens when someone's brain convinces them that their intrusive thoughts mean something dangerous about their character. Let's let me define intrusive thoughts for a second. So an intrusive thought is a thought that seemingly comes out of nowhere. So it can just be, and it's terrifying. So brace yourself. Sometimes they are more benign intrusive thoughts, and sometimes they are really, really scary. So I started to have intrusive thoughts after I had a baby. I had never had them before. Um, but after I became a mother, it completely changed my brain chemistry. And I know a lot of mothers out there, a lot of new mothers out there have intrusive thoughts. It's really scary. It's really, really scary. So my babies are healthy now and they're not babies anymore. One is taller than me. But when my eldest was a baby, you know, I'd think, what if I drop her? Or even worse, I'd think, I'm going to hit her head on the hallway wall. Now, I didn't think I want to hit her head. I would think, what if when I'm walking, I hit her head on the corner? But sometimes it wasn't even the what if. It's like, this is going to happen. And it was so terrifying because I thought, what is happening? What kind of a mother am I? This is horrifying. Like, and and it took me years to admit that I was having those thoughts. I certainly wasn't going to tell a doctor because I thought, oh my God, like they're going to take my baby away. I'm a bad mom. It was just, so you're suffering in silence. It's terrible, terrible, terrible. So I've experienced intrusive thoughts. So an intrusive thought is a thought that comes out of nowhere and that is very unlikely to happen. And really, what your brain is doing is your brain is trying to make sure that that thought doesn't happen. But it comes kind of, not kind of, it comes in a different form. So sometimes people who have, there's so many types of OCD, but there's like contamination OCD. So what does that mean? It means you start to get really scared that something is going to give get you sick or something is dirty. Um, and so you start, your life starts getting smaller and smaller and smaller because you're afraid to touch different things, because you're afraid to get sick, because ultimately you're afraid to get your family sick. So when you learn to help relieve OCD as a clinician, eventually, and I'm and I'm doing, guys, I'm doing really, really broad strokes here. So please understand that. And as a clinician, you're taught that those fears really show that what you want to do is protect your family the most. And your brain is getting, the wires are getting crossed and it's coming in different, but your real fear is that you, your real goal rather, is that you want to protect your family, but you're doing it in a way that's hurting you and causing you a lot of exhaustion and pain. So that can get a little confusing, but intrusive thoughts do not mean you want to do the thing. That is not what they mean. It means you're afraid of that thing happening. I've also watched over and over what it looks like when someone learns that they can sit with uncertainty and keep living their life anyway. Uncertainty, that's so hard for so many of us. We want to know what is gonna happen. Who's gonna come to the party? Are they gonna say yes? Are they gonna say no? Am I gonna be healthy? Are my kids gonna be safe? This possibility of uncertainty can be paralyzing for a lot of us. But the truth is, there's no other option, friends. There's no other option than to be uncertain. We just never ever know. And life proves that to us every single day. And yet, we reach for certainty over and over and over because it helps us feel good. And that's what people with OCD are doing. They're trying to reach for certainty. My approach is holistic and grounded. I care about nutrition, sleep, nervous system, relationships, trauma history, all of it. But I will never let wellness trend replace what the research says actually works. So there are a lot of fly-by-night type treatments. That's not my vibe. I want something that's evidence-based. When a client knocks on my door and they say, I need help with OCD, I don't think, oh, I've never struggled. Let me fix you. Or hi, I'm on this pedestal. No, no, no, no, never once, I can honestly say. But I think most of us, if we're honest, have had at least one loop that we couldn't seem to think our way out of. I sure have. A worry we replayed, a text we reread six times. And sometimes those thoughts hijack our brain. And we've all had versions of that. And that's why I just don't do shame. I don't do it here on couch time, I don't do it at bright light.

unknown 21:59

I

Speaker 22:00

Want to foster a sense of compassion and awareness and support. Okay, before we get into what actually helps, I want to give you a few numbers that I think about in a we really have to think about how this is affecting us kind of way.

Why Help Takes So Long

Speaker 22:19

So on average, research shows that it takes somewhere between 14 and 17 years from the first appearance of OCD symptoms to actually receive evidence-based treatment. Good golly. That is too long. And some studies put the closer diagnosis or the years rather to seven years. I've also seen 10 years. Either way, that is a long time to be carrying something alone, often because of stigma, and not recognizing the symptoms as OCD. Sometimes we just think we're quirky. Sometimes we think I'm controlling. Sometimes we think I have anxiety. So because we see on TV, we see people say, Oh, I have OCD. And that just means you want your bed made a certain way. That's not what OCD is. Just like a quick tiny reference. There is OCD, obsessive-compulsive disorder. That is what I'm talking about here. The client has an obsession, and to break that obsession, they do a compulsion. The compulsion brings relief from the obsession, and it's this loop. There's also something called OCDP, obsessive compulsive or PD, rather, personality disorder. So what that is, is that it's like um it just doesn't have a strong hold on the person. It's not as detrimental. Also, shout out to Alexandra Grace. She is my eldest, and she is standing in the production room staring at me. Hi, baby. Can you hear me? She's standing at the production room waving at me, and um I'm very proud of her. And now she's dancing. So wow, she's doing the worm. This is a real mom and pop show here. Now she's pretending to be a narwhal. Oh my god. Oh, that's so fun. What a what a blessed life I live. What a blessed life I live. You know what? Let me do a quick shout-out to the KWVH 94.3 team because they allow me to have this airtime. They allow me to kind of set up shop and talk about things that are really important to me that I think that will help benefit you, the listener. And they allow my kiddos to come and act like narwhals. So I think that's just a really, really, I'm just so grateful for it. So thank you to everybody at KWVH94.3 for supporting Couch Time with Cat and for making this just um a real highlight of my life and my week. A massive world mental health survey study found that fewer 20% of people with OCD receive any kind of mental health treatment. So wow, there are so many people out there who are suffering that may not even know what to call it. So, how can they find the treatment that they actually need? So OCD is not liking to clean things, it's not being quirky, like we talked about. Obsessions are intrusive thoughts, images, or urges, and they cause real distress. And then compulsions are anything physical or mental. And those are done to neutralize the distress, to prevent something from happening. Here's where it gets really tricky: compulsions can be invisible. I'm bilingual, just kidding. I mean, I am bilingual, but I it's not Spanish. So compulsions can be invisible, mentally replaying a conversation, googling symptoms, chat GPTing things, silently reassuring yourself, confessing, confessing, confessing something to a partner or avoiding a person or place. So you can have significant OCD, and nobody around you would ever guess. You're listening to Couch Time with Cat. I'm Cat, and today we're unpacking OCD, where it comes from, and how real recovery actually happens.

ERP Practice For Real Recovery

Speaker 26:46

So here's the tool I want to talk about today: ERP, exposure response prevention. So instead of asking, how do I make this thought go away? We learn to ask a different question. How can I stop organizing my life around this thought? Because here's the truth: everyone has a strange, unwanted thought. Everyone experiences uncertainty. And the issue was never really the thought. It's the meaning that we attach to it and the behavior that follows. ERP works by intentionally and gradually approaching the OCD, the things that OCDs say that you have to avoid, and then practicing not doing the compulsion. So it's not to punish yourself, it's to teach your brain something new. And here's the big one that you can tolerate discomfort. I mean, that's the name of the game, friends. Almost all therapy is learning that we can tolerate discomfort, that the anxiety will rise and fall on its own, and that you don't need the ritual to be okay. And that's genuinely new learning happening at a neutral level. So research on OCD treatment has been found to change the brain activity in the regions involved after people go through this ERP program. So it's not just willpower, we're rewiring

SSRIs And Shame Free Support

Speaker 28:16

the brain. Okay, and a quick important note on medication. I hear so much shame around this. SSRIs are the first line medication for OCD. And research shows somewhere between 40 and 60% of people who try them see a meaningful reduction in symptoms. Often equally as high of a change, ERP produces just as good of results for a lot of people. And I think the one-two punch is medication plus ERP. I know there's a lot of bad to be said about medication. I know, I know, but I am a big fan of an SSRI. If you're on an SSRI or any medication your prescriber has recommended for OCD, that's not a failure. For a lot of people, medication and ERP work together, not in competition. Needing support is not the same thing as not being strong enough. Okay, friends, think about one small compulsion you do on autopilot, whether it's checking, reassurance seeking, mental replaying, and as always, no judgment. Awareness is the very first step of ERP. You don't have to change anything about it today. You just have to notice. Here are a few questions you can ask yourselves, all right? What's one thought you've been carrying that you've never said out loud, even to someone you trust? If your OCD or anxiety had a voice, what tone does it use with you? Is it panicked, bossy, a perfectionist? What would your life look like if you needed 10% less certainty than you currently demand of yourself? And who taught you growing up that uncertainty was dangerous? I think probably everybody around us. No shame on them, of course. And then lastly, what's one ritual, big or small, that you do to feel safe that maybe deserves a second look? I have worked with clients doing ERP in my private practice, and I have seen them get so much better. And there's so much hope in that. There's so much hope in knowing that we are not prisoners of the way our brain organizes. Sometimes we can rewire our brain, we can learn to feel safe, we can learn to grow, and that we can learn to have hope in ourselves, not just in people outside of us, but we can have hope for and in our own experience, and we can create a life that feels really good to

Try Delaying One Ritual

Speaker 31:04

us. Okay, before we land this plane, I want you, I want to leave you with something to do, right? To try at home. So let's take an action. Your invitation this week is to pick a small compulsion, just one, and simply delay it for five minutes. Don't eliminate it, don't white knuckle it, just five minutes. Notice what happens in your body. Notice that the anxiety moves even a little without you doing the ritual. So for example, this is gonna sound funny, but when I put on my socks and tennis shoes, guys, I always spill too many beans here on the show. Okay. I'm a bean spiller. So I will tap my foot on the floor. And I used to think it was to kind of just to like grab to get my balance before I go from two feet to one foot to like slide on my sock because I put a I put on my socks and shoes while I'm standing up. But the other day I started thinking, is that a compulsion? Like, am I why am I tapping? It's just something I got in the habit of. And I'm not doing it to avoid something, maybe really to avoid falling, but I don't know, I do it the exact same way every time. So um, that's not OCD, but it's something. It's something that helps me feel safe. So is there something in your world that's kind of like that? If this episode landed for you, think about what's one area of my life where I've been chasing certainty that isn't actually available, maybe. And if you know someone quietly white knuckling their way through intrusive thoughts, send them this episode. You might be the reason they finally feel less alone. Today we talked about OCD, what it really is, not a personality quirk, but a multifactorial condition. So it's roughly shaped by 50% genetics, 50% environment, an experience affecting somewhere in one in 40 adults in this country alone. We talked about the loop of obsession, anxiety, compulsion, and temporary relief. And how that loop, however exhausting, can be unlearned. We also talked about the hard truth that it takes people over a decade on average to get the right help. And the encouraging truth that once you get help, ERP produces real measurable results for most people who try it. And we talked about how medication is legitimate, it's shame-free, and when combined with ERP, it can outperform either approach alone. If any part of today felt like it was describing you, I want you to know that this is treatable. You're not broken, you're not too much, and you're not in this alone. You don't need another year of letting OCD make decisions for you. Wherever you're listening from, your car, your kitchen, your bed, thank you so much for spending this time with me. Every time you listen to this show, you make my dreams come true, and I appreciate you so very much. Be good to yourselves this week. Until next time. Thank you for spending this time with me today. If this episode resonated, I'd love to stay connected with you. You can follow along on Instagram and Facebook at Couchtime with Cat and sign up for my newsletter at CouchTimewithCat.com for reflections and resources delivered straight to you. Listen to Couchtime with Cat on KWVH 94.3 and subscribe on Apple, Spotify, and iHeartRadio. Your support means so much to me. Thank you. Until next time, take good care of yourselves.