OCD For Dummies

387 Pages·2022·5.047 MB·English

by  Laura L. Smith

OCD
2nd Edition
by Laura L. Smith, PhD
OCD For Dummies®, 2nd Edition
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Library of Congress Control Number: 2022943430
ISBN 978-1-119-90314-7 (pbk); ISBN 978-1-119-90315-4 (ebk); ISBN 978-1-119-90316-1 (ebk)
Contents at a Glance
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Part 1: The Ins and Outs of OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
CHAPTER 1: Facing Obsessive-Compulsive Disorder (OCD) . . . . . . . . . . . . . . . . . . . . . . 7
CHAPTER 2: Understanding What OCD Is All About . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
CHAPTER 3: Meeting the Associates and Relatives of OCD . . . . . . . . . . . . . . . . . . . . . .43
CHAPTER 4: Blaming the Brain for OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
CHAPTER 5: Developing and Living with OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Part 2: Starting Down the Treatment Path . . . . . . . . . . . . . . . . . . 85
CHAPTER 6: Overcoming OCD Obstacles to Change . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
CHAPTER 7: Getting Help for OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Part 3: Overcoming OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
CHAPTER 8: Cleaning Up OCD Thinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
CHAPTER 9: Meta-Mindfulness for OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
CHAPTER 10: Tackling OCD Behavior with ERP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
CHAPTER 11: Considering Medications or Brain Stimulation for OCD . . . . . . . . . . . . 181
CHAPTER 12: Responding to and Recovering from Relapse . . . . . . . . . . . . . . . . . . . . . 193
Part 4: Targeting Specific Symptoms of OCD . . . . . . . . . . . . . . . 205
CHAPTER 13: Sanitizing Risk: Contamination OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
CHAPTER 14: Dealing with Doubting and Checking OCD . . . . . . . . . . . . . . . . . . . . . . . . 219
CHAPTER 15: Subduing OCD-Driven Shame . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 .35
CHAPTER 16: Messing with “Just So” OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
CHAPTER 17: Shrinking Superstitious OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
CHAPTER 18: Uncovering OCD Accomplices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
CHAPTER 19: Dealing with OCD-Related Impulsive Problems . . . . . . . . . . . . . . . . . . . 283
Part 5: Assisting Others with OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
CHAPTER 20: Wondering about Children and OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
CHAPTER 21: Helping Your Child Conquer OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
CHAPTER 22: Helping Family and Friends Cope with OCD . . . . . . . . . . . . . . . . . . . . . . 319
Part 6: The Part of Tens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
CHAPTER 23: Ten Quick OCD Tricks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
CHAPTER 24: Ten Steps for After You Get Better . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 .37
CHAPTER 25: Ten Dirty Little Secrets about Dirt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347

Table of Contents
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
About This Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Foolish Assumptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Icons Used in This Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Beyond the Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Where to Go from Here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
PART 1: THE INS AND OUTS OF OCD . . . . . . . . . . . . . . . . . . . . . . . . . . .5
CHAPTER 1: Facing Obsessive-Compulsive Disorder (OCD) . . . . . . . 7
What Is OCD? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Suffering shame . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Wrestling with risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Dealing with doubt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Counting the Costs of OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
OCD and the Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Pandemic panic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Disgusting filth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Exploring Treatment Options for OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Changing the way you think with CBT . . . . . . . . . . . . . . . . . . . . . . . . 14
Thinking about thinking: Metacognitive therapy . . . . . . . . . . . . . . . 14
Approaching OCD mindfully . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Modifying behavior through ERP . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Controlling OCD with medications . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Sending signals deep into the brain . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Helping People with OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
CHAPTER 2: Understanding What OCD Is All About . . . . . . . . . . . . . . 19
Seeing the Two Sides of OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Obsessing about obsessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Considering compulsions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Coming to Terms with OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
The OCD worry cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Thinking and believing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Inspecting impulses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Categorizing the Types of OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Doubts, fears, and uncertainties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Contamination, germs, and dirt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Shame, embarrassment, and inappropriate thoughts
and behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Superstitions and rituals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Table of Contents v
Symmetry and perfectionism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Parenting OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Obsessive feelings and sensations . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Separating OCD from Normal Worries . . . . . . . . . . . . . . . . . . . . . . . . . . .38
OCD and Diversity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Getting to a Diagnosis of OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Avoiding self-diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Avoiding misdiagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
CHAPTER 3: Meeting the Associates and Relatives of OCD . . . . . . 43
Recognizing the Guests or Associates of OCD . . . . . . . . . . . . . . . . . . . . 44
When anxiety and OCD hang out together . . . . . . . . . . . . . . . . . . . . 44
Moods and OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Meeting the Close Relatives of OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Body dysmorphic disorder (BDD): A seriously distorted
self-image . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Hoarding disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Trichotillomania: Pulling your hair out . . . . . . . . . . . . . . . . . . . . . . . . 49
Skin-picking: Excoriation disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Distant Cousins of OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Obsessive-compulsive personality disorder . . . . . . . . . . . . . . . . . . . 51
Smelling bad: Olfactory reference disorder . . . . . . . . . . . . . . . . . . . .52
Tics and Tourette’s syndrome: Involuntary sounds
and movements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Somatic symptom disorder: I think I’m really sick . . . . . . . . . . . . . . 55
Eating disorders: Intense fear of fat . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Impulse control disorders: unstoppable bad habits . . . . . . . . . . . . 57
CHAPTER 4: Blaming the Brain for OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Looking at the Brain’s Role in OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Connecting genetics with OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Getting inside your head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Choosing a Path to OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Taking information in . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Selecting the shortcut . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Picking the high road . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Communication within the Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Electricity and chemicals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Serotonin, dopamine, and glutamate . . . . . . . . . . . . . . . . . . . . . . . . . 67
CHAPTER 5: Developing and Living with OCD . . . . . . . . . . . . . . . . . . . . . . 69
Developing OCD Early . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Good intentions; bad results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
When bad things happen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Learning by seeing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
vi OCD For Dummies
Developing OCD as an Adult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Reinforcing OCD with Positives and Negatives . . . . . . . . . . . . . . . . . . . . 77
Supporting OCD with positive reinforcement . . . . . . . . . . . . . . . . . . 77
Supporting OCD with negative reinforcement . . . . . . . . . . . . . . . . . 77
Combining positive and negative reinforcement:
A double whammy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Worsening OCD with Bad Thinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Exaggerating risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Not accepting uncertainty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Needing everything perfect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Controlling thoughts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Being too responsible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Viewing thoughts as real . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Thinking magically and illogically . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
PART 2: STARTING DOWN THE TREATMENT PATH . . . . . . . . 85
CHAPTER 6: Overcoming OCD Obstacles to Change . . . . . . . . . . . . . . 87
Realizing Resistance Is Futile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Fearing treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Handicapping against treatment success . . . . . . . . . . . . . . . . . . . . . 92
Believing the worst about yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Overcoming Resistance and Changing for the Better . . . . . . . . . . . . . . 97
Embracing the process of change . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Defeating self-handicapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Dismantling change-blocking beliefs . . . . . . . . . . . . . . . . . . . . . . . . 102
Taking one step at a time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
CHAPTER 7: Getting Help for OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Going After the Types of Help You Need . . . . . . . . . . . . . . . . . . . . . . . . 106
Educating yourself about OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Getting support from family, friends, and others . . . . . . . . . . . . . .107
Choosing a professional to help you . . . . . . . . . . . . . . . . . . . . . . . . 108
What to Expect in Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Keeping your therapy private . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Digging deep into an OCD diagnosis . . . . . . . . . . . . . . . . . . . . . . . . 115
Speaking the truth to your therapist . . . . . . . . . . . . . . . . . . . . . . . . 115
Evaluating your therapist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .116
Reviewing the game plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
PART 3: OVERCOMING OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
CHAPTER 8: Cleaning Up OCD Thinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Realigning Interpretations with Reality . . . . . . . . . . . . . . . . . . . . . . . . . 122
Seeing common types of OCD distortions . . . . . . . . . . . . . . . . . . . . 122
Table of Contents vii
Using CBT to correct distorted thinking . . . . . . . . . . . . . . . . . . . . . . 122
Defeating unreasonable doubts . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Ending exaggerating risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Rethinking the idea that thoughts have real power . . . . . . . . . . . .129
Decoupling facts and feelings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Overcoming the need for perfection . . . . . . . . . . . . . . . . . . . . . . . . 132
Sidestepping obsessive thoughts . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Letting go of feeling excessively responsible . . . . . . . . . . . . . . . . . 134
Pushing Out OCD Thinking with New Narratives . . . . . . . . . . . . . . . . . 137
Creating made-up, OCD-like stories . . . . . . . . . . . . . . . . . . . . . . . . . 139
Writing down your OCD narratives . . . . . . . . . . . . . . . . . . . . . . . . . .140
Assessing and rewriting OCD narratives . . . . . . . . . . . . . . . . . . . . . 141
CHAPTER 9: Meta-Mindfulness for OCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Thinking Erroneously . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Separating Your Thoughts from You . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Acquiring the Attitudes of Mindfulness . . . . . . . . . . . . . . . . . . . . . . . . . 150
Making time to be mindful . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Pursuing patience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Letting go of striving for striving’s sake . . . . . . . . . . . . . . . . . . . . . . 151
Discovering acceptance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Suspending judgment about emotions . . . . . . . . . . . . . . . . . . . . . . 153
Living in the now . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Minding Meditation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Breathing meditation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Walking meditation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
CHAPTER 10: Tackling OCD Behavior with ERP . . . . . . . . . . . . . . . . . . . . . 161
Exposing the Basics and Benefits of ERP . . . . . . . . . . . . . . . . . . . . . . . . 162
Understanding why and how ERP works . . . . . . . . . . . . . . . . . . . . . 163
Seeing the upsides and downsides of ERP . . . . . . . . . . . . . . . . . . . 164
Exploring an alternative when ERP isn’t appropriate . . . . . . . . . . . 165
Working through ERP Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Step 1: Determining your OCD theme . . . . . . . . . . . . . . . . . . . . . . . 167
Step 2: Making a list and choosing your challenge . . . . . . . . . . . . . 167
Step 3: Identifying and preventing the response
to compulsions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Step 4: Preparing to engage in ERP . . . . . . . . . . . . . . . . . . . . . . . . . . 172
Step 5: Moving through your triggers with ERP . . . . . . . . . . . . . . . 173
Managing the ERP Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Knowing what’s cheating and what’s not . . . . . . . . . . . . . . . . . . . . .176
Troubleshooting ERP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .177
Rewarding yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Limiting ERP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
viii OCD For Dummies