Understanding OCD (and the Overlap Between OCD & Anxiety Disorders) With Lauren Rosen



Obsessive-Compulsive Disorder (OCD) is a diagnosis that is often incredibly misunderstood. And a big part of that is due to how OCD is spoken about. It’s a term that is often thrown around in relation to talking about cleanliness or tidiness, but OCD is a disorder that causes significant distress or impairment in the life of someone who is struggling with it.


I sat down with Lauren Rosen, a licensed marriage and family therapist, whose focus is treating OCD, anxiety disorders, and eating disorders, because she has a wealth of knowledge surrounding OCD and evidence-based treatment of OCD. And Lauren used to struggle with OCD herself. In our conversation, Lauren dives into what OCD is, the overlap between OCD and anxiety disorders, her personal experience with OCD, and she shares lots of helpful tips, tools, and insights for healing.


WHAT IS OCD?


Lauren explains that when we define what OCD is, we have to define what obsessions and compulsions are because OCD is the presence of obsessions and compulsions.


Obsessions are thoughts, images, or urges, and are intrusive and unwanted, and they tend to cause doubt, anxiety, and discomfort in the mind and body. There are many different variations of obsessions. For example, there are obsessions related to contamination, or to something bad happening (e.g. If I step on that crack people are going to die). And there is often a what-if component to obsessions.


Compulsions are the things that people do to try to get rid of the anxiety, and uncertainty, and the doubt, and discomfort. They are safety behaviors. Compulsions are broken down into four categories: Behavioral (e.g. handwashing, door checking), mental (rumination), reassurance seeking, and avoidance.


Lauren shares an example of how obsessions and compulsions can show up. Someone may have an image come into their mind of stabbing someone, and then have a thought like, “What does it mean that I just had this image of hurting that person? Does it mean that I want to do that?” And as a compulsion, someone may repeatedly ask, “Is it normal to have thoughts about whether or not you want to kill someone?” Asking it once would be natural, but someone who struggles with OCD would ask this question repeatedly in an effort to gain reassurance.


OCD is a term that is thrown around casually, but Lauren explains that what you’re struggling with has to cause distress or impairment in your life in order to be diagnosed as a disorder. Lauren encourages people to stop using OCD as a term to describe a love of cleanliness because it can prevent people from getting treatment.


THE OVERLAP BETWEEN OCD AND ANXIETY DISORDERS


Lauren explains that as a society, we are keen to put things into buckets, but things such as OCD and anxiety disorders are much too complex to put into buckets. The connecting theme between all of the disorders is an intolerance of uncertainty. It’s the wanting to know for certain versus the discomfort of not knowing. For anxiety it often looks like wanting to know that you won’t feel uncomfortable, and for panic disorder it often looks like wanting to know that you won’t have a panic attack. It’s the desire to manage and control every aspect of life because of the fear that you won’t be okay if you don’t.


The line that anxiety disorders and OCD sell us is… If you could just control this one aspect of your life, everything would be okay. But as Lauren shares, there is no end point or point in which we’ve resolved everything.


Part of what therapy and recovery is about is saying... I get to change this and I get to change my relationship to this. And although it doesn’t seem like a choice because it’s a hard one, we choose our behaviors and we have the power and ability to get out of the prison of OCD and anxiety disorders.


LAUREN’S PERSONAL EXPERIENCE WITH OCD


Lauren got sober when she was 19-years-old after having an issue with substances. A year or so after she got sober, she ate a piece of tiramisu and was pretty sure that the alcohol hadn’t cooked out of it. She then developed an obsession which stemmed from thinking that maybe she had relapsed. After the event she called her sponsor and asked, “Did I relapse?” And her sponsors said, “Don’t be ridiculous, you didn’t relapse!” She accepted this and went on with her life. And then a couple of years later, she had the thought again. And she was worried that her sobriety wasn’t actually real and that she had been lying to herself.


Lauren says that anxiety and OCD tends to latch onto what matters most to you. And Lauren’s sobriety was one of the most important things in her life. She began to worry that she wasn’t being honest, and she started to compulse. She would replay thoughts over and over and she’d ask herself things like… What was my intention? If my intention was this, what does this mean about me? Does that mean I’m not actually sober? Do I need to change my sobriety date?


This was excruciating for Lauren because it was all consuming. She felt like she had to figure it out or she couldn't live her life. And for two years, she worried, obsessed, and sought out reassurance. And at the time, Lauren didn’t understand that she had a choice in changing her behavior. And then recovery showed her that she did have a choice. She says, “I get to live the life that I want to live regardless of my thoughts and feelings.”


HELPFUL TOOLS FOR COMPULSIONS


Sometimes you can do compulsions without even realizing it, and as Lauren explains, you’re not always going to recognize that it’s a compulsion until after the fact, but this will support you in better recognizing them moving forward. It can look like, “Oh, I was just trying to get certainty there. Ah, ok. Well, that’s interesting information. How did I feel at that moment? Well, I felt this pull in my chest and my throat was starting to tense.” Doing this (acknowledging), will key you in so that the next time that you feel on edge, you might take a step back and respond differently. But this takes practice, and you get better at seeing it and recognizing it and as you are willing to be aware in a nonjudgmental way. They are truly learning opportunities.


Delaying or limiting can be really helpful tools. Instead of saying… We’re going to stop doing this (compulsion) altogether, it’s saying… Are you willing to limit your handwashing to one minute instead of ten minutes? Are you willing to limit checking the door to three times instead of ten times? Are you willing to limit the amount of times you’re asking somebody if they’re upset with you? Making incremental shifts and tolerating uncertainty for certain amounts of time can be really helpful.


An example of delaying can look like... For 24 hours, I’m putting that aside and I’m not touching that or answering that. And what’s interesting is that the more time and space that you get between the initial occurrence and making a decision to compulse, the more objectivity you tend to have around it.


A benefit of delaying is that it can help to show you that you can put your focus elsewhere and become absorbed in something, and when you do, the compulsion can lose its importance and have you not returning to it at all. The other benefit is that it’s giving you the practice of tolerating uncertainty and discomfort, which is building a really helpful and necessary muscle that will help you significantly throughout your recovery.


MORE HELPFUL INSIGHTS & TIPS


  • The goal isn’t to stop all compulsions. And it’s not about never doing a compulsion. It’s about seeing when you are doing a compulsion, and saying, let’s practice accepting anxiety, uncertainty, and discomfort.


  • The thoughts and feelings aren’t going away, so it’s truly about… How do I view every time they come up, as an opportunity for me to practice having a better relationship with them?


  • It’s so helpful to recognize when you’re in compulsive behaviors and making the choice to disengage, especially with mental compulsions.


  • Meditation in general can be really helpful because it helps to remind you of when you aren’t in the present moment and helps to bring you back into it.


  • You’re not doing it wrong because you have to keep practicing.


  • If you’re working to discuss or analyze a certain content area that brings about distress or anxiety, it’s probably best done supervised by somebody who understands and specializes in treating OCD.


MINDFULNESS MEDITATION


Mindfulness meditation is an amazing tool! It helps to bring about awareness to your thoughts, feelings, and behaviors. Because as Lauren explains, in order to disrupt the process and make healthy changes, you have to first have awareness. Mindfulness meditation really helps you to slow down and practice nonjudgmental noticing. It’s also one of the most effective tools for practicing disengaging from mental behaviors.


In practice, mindfulness meditation looks like choosing an object in the present moment that you can put your attention on, like your breath, or sounds, or physical sensations. And then you rest your attention on that until your mind wanders. And when you realize that you’ve wondered, you gently notice it, and then you bring your attention back to your breath, or the sounds, or the sensations. And this is all very similar to the process of what happens when you’re anxious and experiencing anxious thoughts or feelings or when you have an intrusive thought. You notice that you’ve gotten lost in your thoughts and in trying to figure something out, and then you make the choice to come back to the present moment.


Make sure to listen to the full episode for all of the amazing tips, tools, and insights!


HOW TO CONNECT WITH LAUREN:

Podcast, videos, resources, all the things: theobsessivemind.com

On Instagram: @theobsessivemind

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