For years, the acronym ‘OCD’ has been widely misused by people to describe their organizational skills or how neat they keep all of their belongings. To be technical, Obsessive Compulsive Disorder (OCD) should be defined as the presence of obsessions as well as compulsions. Obsessions being characterized by “recurrent & persistent thoughts, urges, or images that are experienced as intrusive or unwanted..” and compulsions being characterized by “repetitive behaviors or mental acts that that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly,” (APA, 2022). What I hope to voice is that OCD is not something that is a personality trait, it is a mental health disorder as it states in its name. 

History of OCD

It is actually believed that OCD can be dated back to the 14th century. Researchers believe that some religious depictions and works depicted signs of OCD-like behaviors. Of course, the term OCD was not around during this time and it was referenced as scrupulosity (a term to reference fear of sins and compulsions to be devoted). During the 19th century, a time when psychology as well as medical advances were being made, French psychologists attempted to understand what they came to know as compulsions and obsessions by separating them into different categories. These conditions include that of phobias, panic disorders, as well as manic behaviors. 

What we have come to know now within the world of psychology, is that there really is no particular cause for OCD. There are current theories that state that biological, environmental, as well as learned behaviors can trigger the onset of OCD behaviors. However, what we do know is that those who have OCD have a larger sense of responsibility to tend to their intrusive thoughts as well as may misinterpret these intrusive thoughts. This sense of responsibility and repetitive behaviors lead to the obsessive thoughts regarding the stressor, leading the individual to engage in compulsive behaviors to rid themselves of the intrusive thoughts. 

OCD Breakdown

Obsessive-compulsive and related disorders is now its own section within the DSM. OCD used to be categorized as an anxiety disorder, however with the recent DSM-V edition it has been separated into its own section for obsessive-compulsive and related disorders. There are several disorders that fall under this category: Obsessive Compulsive Disorder, Body Dysmorphic Disorder, Hoarding Disorder, Trichotillomania, Substance/Medication Induced OCD, Excoriation Disorder, as well as Other/Unspecified Obsessive-Compulsive disorders. 

Body Dysmorphic Disorder occurs when an individual has a preoccupation with perceived flaws or defects in their appearance. Any part of the body can be the area of concern for the individual; even if these flaws are not observable to anyone else. Because of the obsession over these perceived flaws, the individual likely will engage in compulsive behaviors in order to keep themselves in check.

Hoarding Disorder is probably one that you may know well due to TV shows like Hoarding: Buried Alive, I came to know it because of my grandparents. My grandparents were excessive hoarders, with their house being filled with countless knick-knacks, books, clothes, and even hundreds of mason jars. After my grandparents passed, it was up to my family to clean out their house and that was a project! After, most likely, 10 full dumpsters and a week of work we were able to clean out the house that they once lived in. Hoarding is the characteristic that an individual has a hard time letting go of items, regardless of their perceived and actual value. The difficulty that comes with letting go and releasing these items is the aesthetic and/or sentimental value that the item may have. Even though my grandparents were victims of hoarding, we were able to donate many things from the house we were able to salvage. 

Trichotillomania is a disorder where the individual compulsively pulls hair out from any part of the body. The distress that can be experienced by those with a hair-pulling disorder is one that can be described as shame, embarrassment, or even just feeling as though they have lost control. Hair-pulling may bring one gratification and satisfaction with each pull of a hair. Whereas, excoriation is the picking of the skin. Individuals who actively pick at their skin throughout the day, may experience similar emotions and feelings; feeling embarrassed, ashamed, as well as loss of control. The preoccupation with the intrusive thoughts of wanting to pick at your skin, or the struggle to fight the urge to not pick off a healing scab can leads to the compulsive behavior of removing that part of their skin. 

Still think that OCD is just a cliche personality trait?

OCD Treatment Methods

There are ways to live with symptoms falling under the umbrella of obsessive-compulsive related disorders. A common modality that is used is Cognitive Behavioral Therapy, which is oftentimes used for many mental health concerns in therapy today. For a brief explanation of CBT, it essentially involves regular talk therapy about problems causing distress in the here and now. One of the key targets for CBT are intrusive thoughts, which we can also call OCD obsessive thoughts and need to act on compulsions as intrusive thoughts. Unfortunately, intrusive thoughts are something that cannot be completely eliminated because intrusive thoughts are simply unwanted or distressing thoughts, urges, or impulses.

Additionally, there is an approach termed Exposure & Response Prevention that is specifically geared towards challenging one's fears, obsessions, and compulsions. The idea of ERP is not to scare the individual, but to allow the individual to confront their fears in a comfortable setting that does not cause further distress. A major part of ERP is for the individual to be confronting these fears, but minus the act of the compulsions to “make it right.” Similar to regular talk therapy, with ERP the initial targets are small and are ones that don’t cause too much distress. This is because it is easier to challenge minute fears and be able to comprehend your ability to overcome them when first starting out.

OCD & ERP Example

Let’s say that your fear is that everything around you is covered in germs and you are fearful that these germs will cause you to become infected or die. Here is an example of what can be done to challenge and confront these fears over the course of treatment. Also notice that these steps are broken down into simple achievable steps, as to not be pushing the fear too far.

  1. Touch stair railing in a public place
  2. Use both hands to open doors to public buildings
  3. Touch toilet seat at home, without washing hands afterwards
  4. Be around an animal of some sort 
  5. Use a public toilet
  6. Showing physical signs of affection with loved ones (spouse, children, parents, etc.)
  7. Use a fitting room at a store to try on new clothes

With each step being broken down and with each step gradually working up the fear ladder, an individual can become confident with facing their fears. However, it should also be stated that the person seeking treatment determines their hierarchy of fears and what they feel comfortable confronting and in what order.

OCD can be a debilitating illness, although it doesn’t have to stay that way. OCD is not making sure your desk is organized, or your kitchen is always clean. It’s more so about what these obsessions and compulsions do to you and how they impact you. Also, OCD is not the only disorder that comes with this family sized pack of obsessions and compulsions. If you feel like you're struggling with any of these, there is a way to regain control. Obsessions and compulsions will not write your life story.

- Conor Ohland, MHC-LP

Perfectionism is a defense mechanism many anxious people tend to struggle with. Many of our perfectionist clients struggle with the negative thoughts that they are not good enough unless they do everything 100% right 100&% of the time. Perfectionists tend to down play their accomplishments, have difficulty with minor changes in their desired outcome and struggle with constantly not living up to expectations, usually expectations that are not always very realistic in nature.

Where does perfectionism come from?

Perfectionism is rooted in shame. Perfectionism is driven by  “what people think of you”, versus “staying true to yourself”, or ignoring the opinions of others. Research shows that shame is highly associated with perfectionism, depression, anxiety, addiction, aggression and much more.  Perfectionism is often a cover for feelings of shame, stemming from the belief that what we do – or fail to do – is a direct reflection of who we are. Shame is a reaction that at times occurs when we interpret our actions, our standing, our very selves in the context of what is expected by friends, family and society at large. If we do not meet the expectations posed on us by others we can begin to blame ourselves and internalize that shame. When we don’t meet those expectations we feel anxious, vulnerable, and judged as “different”. This results in negative self-talk like: “I’m stupid,” “I’m unworthy,” or “I’m unlovable.” And if we believe these to be true, then surely other people will judge us just as harshly as we judge ourselves.

In order to combat this feeling of shame, we develop ways to subdue it, or mask it. Perfectionism is one such method; by shielding our imperfections and our insecurities from ourselves as well as those who might look down on us, we can keep the shame hidden. By achieving impossible standards, producing exceptional work, saying the most intelligent phrases, or by having an immaculate, beautiful home and/or personal appearance, we push away any opportunities for shame.   We eliminate the chance for vulnerability or connection, thus lessening the opportunity for scrutiny or judgment. We are isolated.

How Do we Begin to Combat the Shame?

One essential process is that a person must talk about the shame to someone they can trust, like a therapist, so that they can experience safe vulnerability. The three essential steps in healing are:

  1. Understanding the exact nature of such shame by taking ownership of the problem behavior.
  2. Learning shame-resilience.
  3. Self-compassion. 
  4. Embrace imperfection.
Step 1 Take Ownership:

The first step is to allow yourself to develop a relationship with a trusted therapist so you can allow yourself to truly be vulnerable and explore how shame is feeding your perfectionism. You could try a family member or trusted friend, but for many people, finding and speaking with a person bound to hold all your secrets and problem by confidentiality is the first step in truly putting your issues on the table. 

Step 2 Shame-Resilience:

How does one become shame resilient? Well you start by identifying you shame triggers- what exactly is causing you to feel shameful? What are the beliefs about yourself and the world that are relating to this? 

Step 3 Self-Compassion:

Self-compassion is essential in the healing process of working through shame.  Learning to speak about yourself in reaction to it, as if you were speaking to someone you care about- you know without all the labeling and name-calling. Your therapist will be there to help you work through it and empathize with what you are feeling and experiencing. 

Step 4 Embrace Imperfection:

Embracing imperfection is allowing yourself to just be, rather than expecting to be something better, someone who fits in. It is opening up to being vulnerable, first with yourself as you build up resiliency, then with others while you practice loving yourself despite how you are perceived. You can do this in small steps, selecting a small stone in your façade that will not reveal you to the world just yet but willallow you to practice having compassion for yourself. Maybe you let the dishes pile up for a few more hours than usual, wear mismatched socks, or let yourself be 5 minutes late to a social engagement. These small practices give you the chance to become enamored with your quirks and imperfections, using them as positive, somewhat silly, intentional reflections of your true self. 

As always, if you would need help working through your struggles, our office is here to help. Please call us at 631-503-1539 to set up your first appointment and discuss how we can help you live a life you are proud of.

Stay Shining,

Jamie Vollmoeller, LCSW

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