Podcast: OCD Isn’t What We Think It Is

Inside Mental Health Podcast Guest and Host Bio

Shala Nicely, LPC, is the author of Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life and coauthor with Jon Hershfield, MFT of Everyday Mindfulness for OCD: Tips, Tricks & Skills for Living Joyfully. She is a counselor and cognitive behavioral therapist in metro Atlanta, specializing in the treatment of OCD & related disorders and anxiety disorders. Shala produces the Shoulders Back! Tips & Resources for Taming OCD newsletter and blogs for Psychology Today, offering an inside perspective on life with OCD. She is currently working on her third book, a murder mystery called In Neptune’s Orbit, about the true price of secrets we keep from ourselves.

Links Provided By Guest:

· Shala’s Website: https://www.shalanicely.com/

· Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life:https://www.amazon.com/dp/B07CQ66T6F

· Everyday Mindfulness for OCD: Tips, Tricks & Skills for Living Joyfully:https://www.amazon.com/Everyday-Mindfulness-OCD-Tricks-Joyfully-ebook/dp/B06XGRB72W

· Shoulders Back! Tips & Resources for Taming OCD:https://mailchi.mp/12d08d3ee5bd/vi318kjn2j

· Psychology Today Beyond the Doubt blog: https://www.psychologytoday.com/us/blog/beyond-the-doubt

· OCD Blog Post Library: https://www.shalanicely.com/all-ocd-blog-posts-by-category/

· Twitter: https://twitter.com/ShalaNicelyLPC

· Facebook: https://www.facebook.com/shalanicelylpc/

Our host, Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without.

To book Gabe for your next event or learn more about him, please visit gabehoward.com.

Episode Transcript

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.

Gabe Howard: Welcome to the show, everyone. I’m your host Gabe Howard, and calling in today we have Shala Nicely, LPC. Shala is the author of “Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life.” And she’s also a cognitive behavioral therapist specializing in the treatment of OCD and related disorders. Shala also lives with OCD herself and has made it her mission to help the public understand obsessive compulsive disorder. Shala, welcome to the podcast.

Shala Nicely, LPC: Thank you so much, Gabe. I’m excited to be here.

Gabe Howard: We are very excited to have you here. Now, I want to ask you about the number one thing that I hear when I bring up OCD, and that’s the statement, that everyone is a little OCD. And I want to first ask you as a therapist, is that true? Is everyone, in fact, a little OCD?

Shala Nicely, LPC: That is such a great question to start with because, no, everyone is not a little OCD. There are specific diagnostic criteria that we use to determine whether somebody has OCD. And the only time that we would ever say someone has a little OCD is if they actually meet the diagnostic criteria, but they’re in the mild range of having the disorder. So, no, everyone doesn’t have a little OCD, and that’s actually really good for everyone because they don’t want to have a little OCD.

Gabe Howard: All right. I want to ask you the exact same question, but as someone living with OCD, what does that statement everyone’s a little OCD conjure up in you?

Shala Nicely, LPC: And I’m glad you asked this question as a follow-up, because I think there are different answers between people answering that as a therapist and answering that as a person with OCD. Because as a person with OCD, even though we try not to be overly sensitive about this because nobody means any harm, they mean I’m neat and tidy, I have attention to detail, I’m organized. But what people with OCD who’ve actually suffered with the disorder hear is something that’s quite invalidating that everybody has a little of this. And therefore, what I have probably doesn’t matter all that much, isn’t that big of a deal. And gosh, if it’s not that big of a deal, why can’t I. Why can’t I stop? Why can’t I stop doing these compulsions? And if it’s not that big of a deal, well, then maybe I don’t even need to go get treatment? And I just need to sort of get it together. So, I think, unfortunately, even though people don’t mean harm with this, is that people with OCD, especially untreated OCD, take it as an invalidation of their own experience and it can keep them or make them hesitant to go get therapy.

Gabe Howard: One of the things that I learned in preparation for this show and a statistic that many people don’t know and many of our listeners probably don’t know either, is that OCD is the 10th most disabling illness in the world now, not the 10th most disabling mental illness, but the 10th most disabling illness. And there’s also this phrase, well, I’m a little OCD. Well, I’m a little OCD. And it seems like the people who are saying that they’re not asking for help, they’re bragging. They really see this as like this very, very positive thing. So, I’m curious, how can something both be so disabling, so destructive and negative and dangerous and scary, but also this really positive thing that we brag about at work?

Shala Nicely, LPC: I think what happens here is there is a confusion between some terminology like perfectionism and meticulous and attentive to detail and what OCD actually is, because OCD is none of those things. It is not being attentive to detail. It is not being meticulous. What OCD is, is OCD is a process that captures those traits, if you have them, and co-opts them and warps them so you’re not even functional anymore. The example I give in one of the blogs that I’ve written about the fact that people with OCD should never keep their try to keep their OCD because, gosh, if I don’t keep my OCD, I’m not going to be organized anymore and things are going to fall apart. And a blog I wrote to help people understand that we don’t want to look at it that way. I described a situation where you have a caveman and let’s say in prehistoric times and let’s say he has OCD and he’s sitting at the front of his cave and he refuses to leave because he’s so scared and he’s looking out into the savanna and looking for tigers. And he just focuses on the tigers all day long to make sure there are no tigers. And he misses the cobra that slithers up right beside him and is about to strike. That’s what OCD is like.

Gabe Howard: One of the examples that I heard, and please correct the example if it’s wrong, is that if you have this obsession to do something and the example that always comes up is open and close the door three times, right? So, before you can leave your house, you have to open and close the door three times. That a true person with OCD would do that even if their life was in danger. So, if the example that I was given is even if the house was on fire, that door would have to be opened and closed three times before they could escape the fire. Is that a better example of what OCD is versus just a quirk or a personality trait?

Shala Nicely, LPC: Yes, because that gets at the disabling nature of the disorder. So, what you need to do if the house is on fire is leave as fast as you can. If your OCD is making you stop at the door and go through it three times, that’s threatening your life. So that’s a great way to think about it because, again, the OCD is getting in the way of what you need and want to do to live your life.

Gabe Howard: Shala, let’s switch gears a little bit and talk about your life with OCD. What does your OCD look like?

Shala Nicely, LPC: It depends on how it’s acting. I actually personify my OCD as various forms of monsters, depending on how badly it’s behaving. Most of the time, because I’ve been in recovery for about 13 years now, mostly my OCD is very quiet and doesn’t bother me very much at all. I’ll personify it as this benign orange ball that sits in the corner. It’s actually got knitting needles and it’s just knitting away, knitting, knitting, knitting and leaving me alone. That’s how my OCD is most of the time. But if I get triggered in a big way and I don’t use my skills, then my OCD can rise up and be what I call the triad of hell, where it’s bigger than I am. It’s scary. It’s looming over me. It’s holding a gun to my head is how it feels as it’s demanding that I do all these things because it’s scared and it wants me to make it safe by doing these compulsions. My OCD has taken almost every form you can have over the years from being obsessed that I have a dread disease to worrying about contamination, to needing things to be just right to thinking I’m running over people, to worrying that I’m a sexual predator, to worrying that I’m murdering people, all sorts of things. And OCD tends to do that. OCD tends to morph over time if it is not treated and go from obsession to obsession to obsession. And what it’s doing is it is playing off of the things that you hold the most dear. So, if your relationships with people are the things that matter the most to you, you might end up with relationship OCD. If your relationship with God is what matters most to you, you might end up with scrupulosity and thinking that you’re going to end up in hell. So, OCD can morph and move around as your values move around.

Gabe Howard: Something I was surprised to learn about OCD is that the content of the obsessive thoughts can be very socially unacceptable. I think that television and movies have always taught us that the obsessions are, well, just kind of quirky or annoying, but people obsessively worry about things like breaking the law or that they’re a bad person deserving of going to hell, or even on the extremes, that they could be a sexual predator or a violent person. And I can only imagine that if these are the types of things that are running through your head that you’re obsessing about, that someone would want to hide that because after all, you wouldn’t want the people around you to know that these are the kinds of things that you are thinking about. Is that common? That the content of someone’s obsessive thoughts is what keeps them from discussing it with their friends or family?

Shala Nicely, LPC: Very common. Most people who have OCD for any period of time end up with some sort of obsession compulsion duo that they feel very shameful about, that they feel like the content is not something they could share with even their closest family members or even a therapist. And this contributes to people not wanting to seek treatment because they’re afraid that if they go to treatment, that they’re going to end up in jail or a psychiatric institution for a long period of time. And so, they hold all this in. They hold all this in silence. In fact, in my own experience what my OCD did to me, since I’ve had OCD since I was a little child, is my OCD came up with what it called rule number one. And rule number one was that we never told about all the things that we thought, thought and saw in our head, because if we did, we would make it happen. And if we did, we’d have to explain ourselves and no one would be able to understand. And I think many people with OCD have their own version, unfortunately, of rule number one.

Gabe Howard: I know, Shala, that you just mentioned that people are uncomfortable sharing this, but you were able to get over that discomfort and share them. Would you mind sharing with our audience a couple examples of what you had to fight through to share in order to get the help that you needed?

Shala Nicely, LPC: And are you asking like, like in the past what they were?

Gabe Howard: Yes. Yes. It’s an awkward question to ask because you just said many people don’t want to share it because they’re embarrassed. And then I immediately say, hey, what was yours? So?

Shala Nicely, LPC: Ah, gotcha. When I was a kid, I hit my head on the bottom of a swimming pool and then was convinced that I’d given myself head cancer. Also, as a child, I used to, when I was going to sleep, close my eyes and see images of my parents being decapitated by a guillotine. And then I would

Gabe Howard: Oh, wow.

Shala Nicely, LPC: Would have to do a very complicated ritual that involved pushing my hands up in a particular way. Like I was pushing the guillotine up away from my parents while creating this very elaborate mental movie in my head where I was saving my parents from the guillotine. And just before the blades fell, I was able to rip them away so they were safe. So that was an example of these violent images that people with OCD will get.

Sponsor Break

Gabe Howard: And we’re back with Shala Nicely, author of the book “Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life.”

Shala Nicely, LPC: Sometimes I would feel like I had to before bed as a kid, pray repeatedly over and over the same prayer for 20 or more minutes until I got it absolutely perfect because I felt as a child that it was my job to be the protector of my parents, my family, my pet, everybody in my world. I was responsible for keeping them safe and alive. And these very intricate prayers that had a very specific order had to be done in a particular way and had to be done every night or else something bad could happen. And those are just some examples. And I have many, many, many examples from my life. Those are just some examples of the types of things that people with OCD end up feeling saddled with. Like they have the weight of the world on their shoulders.

Gabe Howard: One of the examples that I heard is that as things that hit critical mass in the media, like, for example, the #MeToo movement where everybody was talking about sexual harassment in the workplace and people with OCD start becoming concerned, well, what if I’m the problem? What if I’m the cause? Now, they don’t want to go to somebody and say, hey, I’m worried that I have sexually harassed somebody because that ends careers, that that is very, very problematic. But then they start to obsess about it and they have no place to put those concerns. Is this the reality of life with OCD that you can become obsessed with something that if you bring it up, the consequences literally are dire?

Shala Nicely, LPC: Yes, I think sometimes people will get triggered by stories in the media of violence, of assault, of murder, of other things. And then they’ll think, oh my gosh, have I done that? And then they’ll get lost in that story in their head. I think it’s really important to emphasize that people with OCD are worried about being sexual predators or hurting people or harming people. But that is the absolute opposite of who they are as people, and this is why they worry about it. They’re worried about it because they value relationships. They value their loved ones and their colleagues so much. And the thought that they might be doing something like this is horrific to them. And so, it is a situation where they hear something in the media, they see the public reaction to it, and they think, oh my gosh, that can’t be me. But what if that is me? The majority of the time, people with OCD, regardless of the content of their obsessions, are going to be trying to process this internally. They might ask for some reassurance, but people with OCD would be super anxious about asking for reassurance in a way that would trigger any red flags because they’d be worried about potential consequences. If somebody thought that they were doing these things when they actually are not. So, when there’s something happening in the media that’s receiving a very negative public backlash, people with OCD can often start worrying about, well, gosh, what if that’s me? What if I did something like that? And then oftentimes they will take that internally and try to figure it out and get further and further and further stuck in that OCD hellish loop.

Gabe Howard: As you were talking, I was thinking about my own life and my own family. And my full-time job is to publicly share my story of living with bipolar disorder. So, I think I’m a pretty open person, especially when it comes to living with mental illness. But, wow, if I was having reoccurring thoughts about my parents’ death or about my parents being killed in some horrible way, I don’t know that I could bring that up to them or anyone. I don’t know that I could talk about that because, well, I mean, it would hurt my mom and dad. It would upset them and it would just be an incredibly uncomfortable conversation. And I’m saying that as a 46-year-old adult, I am married, I own a house, I own a dog. And I’m very uncomfortable just talking about this with you. And as I heard your story, you weren’t an adult. You were a child. So, you would have just had to walk up to your mom and dad one morning and say, hey, I wanted to let you know I’m having these reoccurring visions that you die by a guillotine. All right. Off to school. I just I see that as just being absolutely impossible. It would be a barrier to anyone. Hard stop, but especially young adults. It would just be such a barrier to getting help.

Gabe Howard: But what can parents do? I mean, should your parents have said, hey, any chance you couldn’t fall asleep last night because you were too focused on us being decapitated? Their parents aren’t going to say that. I’m just I’m genuinely trying to figure out the intervention strategy for this because it seems impossible. It just seems impossible to figure out how to help somebody or how to encourage somebody to share these deeply disturbing and scary obsessions.

Shala Nicely, LPC: And it’s doubly hard because a lot of people with OCD are excellent actors and actresses, and we hide that all this is going on and we don’t say anything for the exact reasons that you mentioned, is we don’t want to tell family members that we’re having these violent images about them. We don’t want to admit that we feel so out of control that we feel like monsters. So, if you’re a parent or a family member and you’re wondering if something like this is going on, sometimes you just have to look for subtle clues. Does the person seem really anxious, withdrawn, preoccupied, tired, not sleeping well? And if you suspect something like this is, especially if it’s a child, getting the child to somebody who has expertise in something like OCD or other anxiety disorders so that they can be evaluated by somebody who knows how to ask the right questions, who knows how to give the right assessments to pull this information gently out. So that we can understand if those things are going on. Because a lot of times if you’re talking to somebody with OCD in a therapeutic setting and you’re able to say to them, Yeah, what you’re experiencing is completely normal for somebody with OCD, you just see their whole body posture relaxed, like, oh my gosh, I’m not losing my mind. I’m not a monster. This is part of the disorder. This is not me. So, if you think somebody that you love is having these issues, trying to help them get into a situation where they can be evaluated, can be an exceptionally helpful and relieving thing for them because they’re carrying all this around inside thinking that it’s really them, that there’s something fundamentally wrong with them when really, it’s that they have OCD.

Gabe Howard: It occurred to me that pretty much every example of OCD symptoms that you have given on this podcast I have never heard before. I thought OCD was not wanting to shake hands or opening the door multiple times or obsessive counting or frequent hand-washing, that kind of thing. You know, the kind of things that you see on television and in movies. And the example that you’re giving are, well, they’re very, very scary and not anything that I personally would have associated with OCD. And I don’t think that most people would think something like being consumed with violent thoughts could be a symptom of OCD. This is just not what the general public understands the disorder to be. This must be a huge problem for people because how are they going to recognize these symptoms as OCD and get help?

Shala Nicely, LPC: I think you’ve hit on the key issue here in that OCD, it’s like the typical iceberg, right? There’s the little tip of it, and that’s the stuff that people can see, the hand washing, the going through doors multiple times, all of that. But the majority of the iceberg is under the sea and you can’t see it. The majority of OCD is in people’s minds. And it’s exactly what you said, is that there is a core fear of what if I’m a bad person? What if I’m going around hurting people? What if I’ve hurt myself? What if I’ve ruined my life? What if I’ve ruined other people’s lives? And that’s the majority of what the disorder feels like? I describe it in my memoir as someone holding a loaded pistol against my temple all the time and telling me if I didn’t do these things, if I didn’t do these rituals, then I was going to die. Or somebody I love was going to die. And it’s that feeling of being held hostage that every move that you make is being watched by your mind to make sure you’re doing the right thing. You’re getting criticized all the time. It’s this feeling of having no control over your own life. That’s what it feels like to have OCD and what pushes most people to the point where they get therapy is they just can’t take that anymore. Where the OCD has become so disabling that they’re having trouble functioning in life. Most people who see me as a therapist are coming to me with severe OCD because it takes severe OCD to really push somebody to be willing to say, hey, I’m having these images about my family I don’t want to have or I think I’m hurting people or I just can’t let go of the thought that maybe I’m going to hell. That’s what pushes somebody. The desperation to get away from the situation where they feel like they’re being held hostage. That’s what typically pushes somebody to get therapy.

Gabe Howard: If someone listening believes that they might have OCD, who should they follow up with? Who should they ask? How should they begin to seek help?

Shala Nicely, LPC: I think the go to place to look for information about OCD is the International OCD Foundation. So IOCDF.org. That’s a great place to begin your journey. Reading about OCD and reading about the appropriate treatment. Again, exposure and response prevention therapy or ERP is the evidence-based therapy for OCD, and it works exceptionally well for the majority of people who do it. We also have medications that can work for people as well, and sometimes the combination of the two works exceptionally well. So going to the IOCDF website, learning about the disorder, learning about the symptoms and then using their treatment provider database to find somebody who’s trained in exposure and response prevention, or to find a psychiatrist who can help provide medicine so that you can begin your recovery journey. The IOCDF also has on their website support groups and ways to connect with others so that you don’t feel alone. Because part of the problem with OCD is the isolation that it creates. And when you’re able to talk to somebody else who can hear the thoughts in your head and go, I get that. I’ve had those same kinds of thoughts, too. That reduces the shame. That makes it feel easier to go out in the world to find a therapist and talk about this and reclaim your life.

Gabe Howard: Shala, thank you so much for being here. I know that your book is available wherever books are sold, but where can folks find you online?

Shala Nicely, LPC: They can find me at ShalaNicely.com.

Gabe Howard: Beautiful. Thank you again.

Shala Nicely, LPC: Thanks so much for having me on, Gabe. It was a real pleasure.

Gabe Howard: You are very welcome. It was my pleasure. And I want to give a big thank you to all of our listeners. My name is Gabe Howard and I am an award-winning public speaker who could be available for your next event. I also wrote the book “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon. However, you can grab a signed copy with free show swag or learn more about me by heading over to gabehoward.com. Wherever you downloaded this episode, please follow or subscribe to the show. It is 100% free and you don’t want to miss a thing. And hey, do me a favor. Recommend the show, share us in a support group, share us on social media. Hell, send somebody a text, because sharing the show is how we grow. I will see everybody next Thursday on Inside Mental Health.

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