Providers: test your OCD knowledge.

While in graduate school, I applied for and got my dream internship at a university counseling college students. I was ecstatic and slightly terrified. When I look back on my experience what stands out the most is how little I knew about the many ways obsessive-compulsive disorder (OCD) manifests and presents. 

It turns out I was not the only one. I now specialize in treating OCD and have heard endless stories from clients who have been misdiagnosed or underdiagnosed. Mental and healthcare providers have the best intentions, but OCD is complex. 

Individuals with OCD are said to go untreated for a decade or longer, partially for fear of sharing their experience but also opportunities to diagnose are missed, which only prolongs one’s suffering. I hope to bridge the gap and increase awareness of the bewildering presentations of OCD so individuals get help and treatment sooner rather than later. 

Ready to test your OCD knowledge?

What diagnosis would you give each of these? If you think one is OCD what subtype/theme? 

1. A man worries he’s a pedophile because he keeps having “impure” thoughts of children no matter how much he tries to push them away. These thoughts cause him significant anxiety, shame, and disgust. He no longer sees his nieces and nephews whom he loves and avoids driving by schools and playgrounds. He’s never acted inappropriately with a child nor does he want to but fears he might because of these thoughts.  

2. A new mom believes her infant is a doll even though loved ones keep telling her it’s her baby. She is not acting normal and wants to throw the “doll” out. She is fine with this.   

3. A patient confides that they have vivid images of harming themself with a knife. They are scared they will act on this, which is terrifying because they don’t want to get hurt or die. They now avoid sharp objects whenever possible.

4. A new mother had a sensation in her genitals when changing her newborn and now keeps thinking: “What if I’m sexually attracted to my baby?” She’s distraught and no longer feels comfortable/safe changing her infant’s diaper alone. 

5. A client worries they were inappropriate with a partner from years ago and keeps replaying one sexual encounter over and over, wondering if it was consent, even though the partner said it was and they “really enjoyed themselves.”

Before you check your answers…What exactly is OCD?

Individuals with OCD have obsessions, which are unwanted thoughts, images, sensations, and urges that come against one’s will and cause significant anxiety, fear, and even shame or disgust. To reduce these unpleasant symptoms, they start engaging in physical (e.g. avoidance) and mental (e.g. replacing a “bad” thought with a good one, replaying a memory) compulsions.

OCD has many different subtypes (harm, pedophilia, perinatal, false memory, real event, emotional/contamination, scrupulosity, health, etc.) and they present with the same cycle: obsession>anxiety>compulsion>temporary relief>cycle repeats.

Individuals with OCD are egodystonic; the obsessions they are experiencing go against their values and beliefs, which is why they cause them significant distress. They do not act on their obsessions. OCD targets what one values most like family, vulnerable populations such as children, religion, one’s health, etc.

OCD is complicated. 

Luckily, there are an amazing amount of resources and effective treatments (exposure and response prevention therapy & medication/SSRI anti-depressants) for OCD.

Here are some of my favorite resources:

The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is an OCD assessment that I prefer to use to tease out OCD and determine its severity.   

NOCD Academy offers excellent and free continuing education (CE) webinars (60-120 minutes) that provide a good overview of OCD, diagnosing, and first-line treatments.  I highly recommend taking one of these to gain a deeper insight from specialists. 

The International OCD Foundation (IOCDF) has an abundance of resources including videos and articles. 

The Periscope Project is a great resource for healthcare workers, in Wisconsin, providing care to perinatal women who are struggling with mental health.  

My website Inside Out Counseling LLC has recommended reading and podcasts for those with OCD and their loved ones. I also have blogs on OCD and exposure and response prevention therapy. 

How’d you do? Quiz answers.

1. OCD. Pedophilia subtype.

2. Perinatal psychosis. 

3. OCD. Harm subtype. 

4. Perinatal OCD. 

5. OCD. False memory/real event subtype.