How OCD Works

While it sounds like something out of a movie, some POWs in WWII really held an Olympics. And it happened more than once. 

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Dopamine is perhaps the most talked-about, most misunderstood biochemical in our bodies. It’s linked to not only addiction and depravity, but also focus, motivation, and living a productive life. How can one molecule be so many things to so many people?

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If you've ever worked in a restaurant, you know the feeling that occurs when the health inspector pays a visit. While nerve wracking, it's the best insurance patrons have that their food will be prepared and served in a proper environment. Learn all about how these inspections work, from their past history to current incarnation, in this classic episode.

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When paperboys stopped delivering a couple of very big newspapers in 1899 it was a big deal. Big enough that the two biggest publishers in the world got pretty scared. But did it actually accomplish anything? 

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The story of what happened to the car that James Dean crashed.

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Whistling is pretty cool when you think about it because it can mean many things, from simple happy tunes to legit communication. Learn all about this ubiquitous skill today. 

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Long before slide rulers and pocket protectors, civilizations across the world used their noggins to build some impressive structures. Almost all have crumbled to ruins over the millennium, but thanks to the earliest tourists, we admire them still today. Explore some of them with Josh and Chuck in this classic episode.

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Wikipedia changed the world. Before it came along, you had to go to the library to get the answers you sought. And you and your friends had to just agree to disagree on facts. And as the internet grew and commercialized, Wikipedia remains free and open.

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Those armrests in the middle of benches aren’t just for your comfort, they’re intended to keep the homeless from laying on them. Cities are filled with these mean-spirited inconveniences. But who’s to say how a person should use a bench?

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In almost every part of the world, in some form or fashion, widows have things harder than they did when their spouses were alive. In some places it means they pay higher taxes, in others it means they’re ostracized to live on the margins of society.

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Kimberley Quinlan is a sought-after therapist with an expertise in Cognitive Behavioral Therapy. She shares her education and advice about Obsessive Compulsive Disorders, Body Dysmorphic Disorder and how she's using science-based treatments to get results with her clients. Most importantly, with this interview, she offers encouragement & hope to anyone who may be suffering with OCD or Body Dysmorphia!

Tag us with your takeaways @LoriStreator and @KimberleyQuinlan

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DISCLAIMER: This podcast is not intended for treatment purposes and is for educational use only. It is not to be used in place of therapy. If you or someone you know is struggling with mental health issues, please reach out to the nearest appropriate professional.

Welcome to another episode of Your Anxiety Toolkit Podcast.  There has been a lot of talk lately in the OCD Community surrounding this big question “Does Khloe Kardashian have OCD?” I know a lot of you are really struggling with this topic, feeling unseen, unheard and misunderstood. 

In a recent episode of Keeping Up with the Kardashians, Khloe’s mom, Kris Jenner discussed her daughter Khloe’s overwhelming need to be organized. She shared, “Khloe is the most organized, cleanest, most obsessive person I know in her own home. But lately, she’s on another level.”

In response, Khloe explained: "Being the control freak that I am, this experience is torture”. However, she also has been known to explain her need to be organized as “a good thing” and something that “helps” her in her life. 

This brings us to the big question: Does Khloe Kardashian have OCD? 

Well, the most important thing to remember in this podcast episode is that we cannot diagnose someone we haven’t met. Please keep this in mind as we address this very important topic. 

In an effort to do my due diligence, I consulted with an attorney on this and he confirmed that it is not appropriate to diagnose someone you haven’t met. He reported that this is an ethical issue, not a legal issue. 

One of the big questions that arose after this recent Kardashian episode was, “Can you treat someone you haven’t diagnosed?”

Again, when consulting with an attorney, we revealed that a therapist technically can in situations where it is not necessary to diagnose someone. However, in order to implement a treatment tool, it is a good standard of care to do a full assessment to be sure the treatment modality and related tools are appropriate for the person we are meeting with. 

In an effort to discuss if Khloe Kardashian has OCD and if her description of symptoms and presentation of symptoms meets criteria to be OCD, we would first need to have a good understanding of what OCD is diagnostically. 

In the episode, we discuss in depth the Diagnostic Criteria for Obsessive Compulsive Disorder, in an effort to thoroughly educate and advocate for those who have OCD and who are struggling to ask for help. 

Diagnostic Criteria (Directly from the DMS 5)
A. Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2):
Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).
Compulsions are defined by (1) and (2):
Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
Note: Young children may not be able to articulate the aims of these behaviors or mental acts.
B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
It is important that we specify if the symptoms are accompanied by good, fair or poor insight, as this can help us differentiate between the diagnosis of OCD and other mental illnesses that may look the same.
With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.
With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true.
With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true.
D. The disturbance is not better explained by the symptoms of another mental disorder, differential diagnosis or set of symptoms

In an effort to really give you a good understanding of other diagnostic possibilities for someone showing similar, but not exact symptoms, I wanted to address some symptoms and disorders that would need to be RULED OUT before treatment. The reason for this is that small differences in the symptoms may drastically change the course of correct treatment. This is a crucial part of the assessment process, done by a therapist, psychiatrist, medical doctor or psychiatric nurse. 

The first is perfectionism which can be divided into two categories, adaptive and maladaptive. Adaptive perfectionism is a type of perfectionism that improves the quality of someone’s life while
maladaptive perfectionism negatively impacts a person's life. Research has shown that both adaptive and maladaptive perfectionists have high personal standards, but failing to meet those standards can have a negative impact. 

Perfectionism can also be categorized by orientation. Self-oriented perfectionism is perfectionism that is pushed by the individual person. Self-oriented perfectionists are very hard on themselves, set very high standards for themselves and have rules and expectations that are often unreasonable. Socially prescribed perfectionism is perfectionism that occurs due to societal expectations. This might include the expectation to get good grades in order to have a good life or having to have the “perfect” body to be loved. 

It is also important that we address the similarities and differences between OCD and OCPD. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), OCPD is explained as "a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency." People with OCPD have an unhealthy expectation of achieving perfection and have an excessive devotion to work at the expense of leisure time and close personal relationships. They are often inflexible with issues related to ethics and morality and can be seen as judgmental and expect others to live to the same standard. 

So, when answering the question, “Does Khloe Kardashian have OCD?” I encourage us all to do our best to continue to educate others on the differences between OCD, levels of insight related to OCD, perfectionism, and OCPD.

I strongly encourage you all to read Shala Nicely's amazing blog post about this exact issue, mostly addressing the misuse of the term, “I am so OCD”
https://www.shalanicely.com/aha-moments/ocd-is-not-what-you-think/

References used in this podcast
https://www.apa.org/monitor/nov03/manyfaces
https://www.anxiety.org/what-is-the-difference-between-ocpd-and-ocd-and-how-are-they-treated

My guest this week is Dr. Joel Minden. He’s back for our series finale in this 4-part series on effective ways to manage anxiety. This time we applied his 3-step program from his book Show Your Anxiety Who’s Boss (affiliate link) to managing fear and anxiety in OCD, panic, and worry, including examples from my own life in these areas.

As I try to make clear in our discussion, many people experience more severe versions of what I describe, and there’s no quick and easy fix for overwhelming anxiety. At the same time, the same types of techniques tend to be really helpful, regardless of severity. Joel and I also talked about what it’s like to deal with anxiety as someone who specializes in treating anxiety, which I found super helpful. 

Are you struggling with gratitude this holiday season?  If so, this episode is exactly what you might need to hear.  In today’s episode of Your Anxiety Toolkit, I spoke with Shala Nicely about struggling with gratitude.  Together, we address why some people might be struggling with gratitude or being grateful, especially if they are also struggling with mental health.  

In this episode, Shala Nicely addresses the personal struggles she has had in the past with gratitude and some incredible tools to manage this. 

Shala so beautifully articulates three common reasons why people struggle with gratitude. The first two struggles fall under the category, that Shala calls, gratitude by comparison. This often occurs when you are supposed to be doing “better” than someone else, but you do not feel very grateful. Shala explains that gratitude by comparison can fall into two separate categories: relief-induced gratitude and guilt-induced gratitude.

The third common struggle is forced gratitude.  An example of this might be, “I should be grateful and I’m not. What’s wrong with me?” or, “You have everything going for you. Why can’t you just be thankful for what you have instead of focusing on the negative?” 

I love that Shala addresses how forced gratitude quickly becomes what we know clinically as toxic positivity. 

Some great tips if you are struggling with gratitude might be: 

            • Mindfulness 

• Practicing wonder, curiosity or beginners mind

            • Non-Judgment 

            • Give yourself permission to not practice gratitude over the holidays

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Check out these other fantastic episodes featuring Shala Nicely!

Executive Editor Michael Roy speaks with Luke J. Norman, Ph.D., and Kate D. Fitzgerald, M.D., about their article examining whether brain activity is associated with treatment response to cognitive-behavioral therapy (CBT) in adolescents and adults with obsessive-compulsive disorder (OCD), and whether any associations are treatment specific relative to an active control psychotherapy (stress management therapy; SMT).

Dr. Luke Norman was recently a neuroscience postdoctoral fellow at the University of Michigan. He is now affiliated with the National Institutes of Health. His research has looked at treatment for obsessive-compulsive disorder and attention deficit hyperactivity disorder.

Dr. Kate Fitzgerald is the Phil F. Jenkins Research Professor of Depression and associate professor in the Department of Psychiatry at the University of Michigan. She is the academic director for child and adolescent psychiatry and co-director of the Pediatric Anxiety Disorders Clinic. She is also an adjunct associate professor in the Department of Psychology. Her work has examined pediatric anxiety and obsessive-compulsive disorders, and currently, she is interested in looking for biomarkers of pediatric anxiety disorders that may represent options for novel, targeted treatments. She also has done work focusing on the use of cognitive-behavioral therapy in schools.

• How the authors became interested in this area of research [2:42]
• How prevalent obsessive-compulsive disorder (OCD) is among the general population, and its conventional treatment approaches [5:50]
• Comparing cognitive-behavioral therapy (CBT) with a control psychotherapy called stress management therapy (SMT) [8:42]
• Details about two neural networks that have been implicated in OCD (the cingulo-opercular network and the orbito-striato-thalamic network) [12:04]
• Makeup of study participants, and methods the authors used to analyze the data [14:07]
• Comparison of symptom change between the group who received CBT relative to the group who received SMT [17:39]
• Details from functional MRI scans [18:23]
• Differences by age [20:40]
• Other notable study results [21:25]
• Limitations of the study [22:21]
• Implications that this work has for the understanding and treatment of OCD [23:30]
• Key points for researchers, clinicians, and other mental health professionals [24:50]
• Recommendations for further research [26:07]

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