OCD Myths v Facts
MYTH OR FACT: OCD only involves cleaning and germs
MYTH
OCD themes range throughout many, many different topics! Cleaning and contamination is a prominent theme but there are also themes around hurting others, hurting oneself, religion, sexual orientation, symmetry, personal responsibility, and many more
What does ERP stand for?
Exposure and Response Prevention
What makes a thought "intrusive"?
A thought is intrusive when it is unwanted, distressing, or involuntary
What is a compulsion?
An action done solely to reduce anxiety or discomfort
What part of the brain sends the alarm signal when it thinks there is danger?
The AMYGDALA
Fun fact: The amygdala is the primary center for big feelings like fear, anxiety, and survival
MYTH OR FACT: Having violent or scary intrusive thoughts means a person is dangerous
MYTH
Having violent/scary intrusive thoughts means nothing other than that you had a violent/scary intrusive thought! Thoughts in OCD are often egodystonic, meaning that they directly go against your identity, intentions, and values
In ERP, what is a fear hierarchy?
In ERP, a "fear hierarchy" refers to a list of feared things/situations to engage in as part of therapy. These fears are listed from least to most scary
TRUE OR FALSE: Everyone has intrusive thoughts, not just people with OCD
TRUE
Everyone experiences intrusive thoughts but for those with OCD, those intrusive thoughts can feel super sticky!
TRUE OR FALSE: Compulsions are always physical behaviors
FALSE
Compulsions are physical but they can also happen in your mind. Some examples include: counting, repeating words/phrases in your mind, undoing thoughts, replacing "bad" thoughts with "good" thoughts, praying, mental reviewing, etc.
What is the name of the body's automatic response to danger?
Fight or flight (and freeze!)
MYTH OR FACT: OCD only bothers you about things that don't really matter
MYTH
OCD almost always attacks the things you care about the most - safety, relationships, religion, health, morals
What is the job of anxiety/fear during an exposure?
A) To tell you to stop immediately
B) To show you that the exposure is too hard
C) To show up, peak, and eventually come down on its own
D) To disappear as fast as it can
C) To show up, peak, and eventually come down on its own
What is it called when you experience an intrusive thought and continue to over-analyze it?
Rumination
Fun fact: Rumination is considered a mental compulsion because it often serves to understand or problem solve and reduce discomfort
Paige has OCD related to medical and health anxiety. She is constantly obsessing about having an illness she does not actually have. She goes to the doctor/hospital 3 times per week to confirm whether or not she has the illness.
John also has OCD related to medical and health anxiety. He too constantly obsesses about having an illness he does not actually have. John has been avoiding the doctor/hospital and anything medical-related for months.
Who is engaging in a compulsion?
Both. Paige reduces discomfort by making absolute sure she either has the illness or not and John reduces discomfort through avoidance.
Even though they are two opposite behaviors, both are done to avoid anxiety/fear
Name 5 common sensations that come with anxiety
Heart racing, upset stomach, shaking, hyperventilation, sweating, chills, tight chest, dissociation (derealization/depersonalization), dizziness, weakness, shortness of breath, and many more!
MYTH OR FACT: Two people can do the exact same behavior and for one person it is a compulsion, while for the other it is not
FACT
What makes a behavior a compulsion is the purpose behind it. If it is done to escape or reduce OCD-driven anxiety, it is a compulsion
TRUE OR FALSE: The goal of exposure is to eliminate anxiety
FALSE
This can be tricky but the goal of exposure is to learn to tolerate anxiety/discomfort, not get rid of it. It is okay to experience fear, exposure is there to show us this and help us be brave!
Why does trying to figure out WHY you had an intrusive thought actually feed OCD rather than help it?
Analyzing the thought treats it as something worth investigating which is exactly what OCD wants
Repeated compulsions actually make OCD stronger. OCD will ask for more and more compulsions as long as it gets that temporary relief
Why does the anxiety alarm sometimes go off even though there is no real danger?
Our anxiety alarm really wants to protect us. In order to keep us safe, it is always ready to go and looking for danger. Sometimes it thinks it perceived true danger (even something small may have set it off!) and it triggers the body's automatic response
MYTH OR FACT: If someone's compulsions are invisible or not obvious, their OCD is probably mild
MYTH
Mental compulsions, while less visually obvious, can be just an impactful as physical compulsions
Max has progressed a lot with his OCD. He has been practicing eating lunch at school without texting his mom to make sure she is okay. He has reduced his compulsions to now only texting her once. His therapist says the goal is zero texts but Max says one text isn't hurting anything. Who is right and why?
A) Max because one check-in is totally reasonable for any kid
B) The therapist because even one compulsion maintains the OCD cycle and prevents from fully learning
C) Max because reducing compulsions gradually means stopping at one is fine
D) The therapist because texting parents during school hours is against the rules
B) The therapist because even one compulsion maintains the OCD cycle and prevents from fully learning
Vero has OCD. When she is in the kitchen with her family, she has thoughts that she might hurt them. She often feels an upset stomach, heart racing, and shaking when this happens. In order to make sure she does not hurt them, she only washes the spoons and lets her sibling wash the forks and knives. Every night before bed, she prays and confesses about the thought just in case God is mad at her. What is the intrusive thought?
A) "I should only wash the spoons just in case I hurt them"
B) "I am sorry for having bad thoughts"
C) "I am going to hurt my family"
D) "I feel so anxious"
C) "I am going to hurt my family"
Explanation: Intrusive thoughts are unwanted thoughts. A) and B) are related to compulsions, while D) is an observation of her feelings
Every time Amy touches a doorknob, she washes her hands 5 times and feels completely better. Her therapist tells her the washing is actually making her OCD worse - but Amy says "that can't be right because it works every time!" Why is Amy's therapist correct?
A) Because compulsions only work sometimes, not every time
B) Because feeling better after a compulsion teaches her brain that the doorknob was actually dangerous
C) Because washing your hands too much is bad for your skin
D) Because Amy should be using hand sanitizer instead
B) Because feeling better after a compulsion teaches her brain that the doorknob was actually dangerous
A) Because stomachaches are caused by food and his tests are often after lunchtime
B) Because the brain and body are connected, and his nervous system is treating the test like it is true danger even though it is not
C) Because anxiety only affects the mind, not the body
D) Because he is taking harder classes in high school so it is reasonable to feel sick before every exam
B) Because the brain and body are connected, and his nervous system is treating the test like it is true danger even though it is not