Transcript for The Truth of OCD: Therapist Alegra Kastens on Living with Obsessive Compulsive Disorder

Thank you for having me. I'm so excited and honored.

Absolutely. So what I always like to say is OCD is a noun. It's not an adjective. A lot of the time we hear people say I'm so OCD. I'm so quirky. I'm organized. I really like to clean. And that's not what OCD is. So it's a noun. It's a mental health condition. And there's kind of two pieces of it. There's the obsessions component. which is repetitive, unwanted, intrusive thoughts and images, and then the compulsions component, which is repetitive, physical, or mental acts that a person feels compelled to carry out in response to the obsession. When we think about obsessions, we commonly think about contamination obsessions. That is the most publicized, the media talks about it the most, but that is actually the smallest sliver of obsessional content when it comes to OCD. The lot of people with OCD have obsessions surrounding sex, violence, blasphemy, sensory motor obsessions, like hyper awareness of automatic bodily functions, existential obsessions, so contamination concerns really makes up this smallest portion, but that tends to be what we hear about the most. And so what happens is the person has a obsession, this doubt. It's kind of like pathological doubt. They're getting relentless intrusive thoughts that are ego-destonic. That's a really important word when it comes to OCD. If ego-destonic means the thoughts are opposite to your values, yourself concept, your beliefs, you do not align with the thoughts. but you just can't stop thinking it all day long. Your brain has been barting you with it, causes a lot of anxiety and discomfort, guilt, shame, and then you feel the urge to do something, whether it's a physical acts like compulsive sanitizing or a mental act like ruminating to neutralize the obsession, to reassure yourself of something, to solve this obsession, to get rid of it, and while that might work temporarily, you might get five to ten minutes of relief. It ultimately just reinforces that obsession to the brain. It tells your brain this obsession is actually very dangerous. We must pay attention to it. And then it also tells your brain the only way that you are going to cope with this is to keep performing compulsions and you are stuck in that endless cycle of obsession, anxiety, compulsion back to the obsession and it just gets bigger and bigger and bigger.

Absolutely, you're trying to resolve doubt or alleviate discomfort or grit rid of the thoughts and like the locks and the doors are really just the tip of the iceberg when it comes to compulsions. Like one of the reasons that I didn't know I had OCD for so long is because none of my compulsions were physical. Nobody would ever look at me in a soon that I have OCD because all of the obsessions and compulsions. happened in my mind. So that's another misconception is that we'll always see someone with OCD. They'll be checking the lock 15 times, they'll be sanitizing and that just is very inaccurate.

Yes.

That's exactly it. Yeah, everything is mental. So Piero is really just a nickname for obsessions without observable compulsions, so their mental compulsions. It's still OCD at the end of the day, but so many people don't understand that. And that's why so many people get misdiagnosed or just live huge chunks of their life, not knowing that they have OCD.

Yes. So technically would be helpful. Now I still say sometimes I'm obsessed with my dogs or whatever it might be. Not good. I'm gonna get publicly canceled for this. But technically speaking, in psychological terms, an obsession is unwanted. It's distressing. So when we hear people say things like, I'm obsessed with my dogs, if I then go out and say like, I have unwanted sexual obsessions, people who don't understand OCD might think, wow, she's really obsessed with sex with dogs. That is not at all the case. Obsession psychologically are like unwanted repetitive thoughts.

Yes. So we all get intrusive thoughts first and foremost. I love that exercise you did Amanda. Everybody has had an odd thought where you just think to yourself like what the fuck was that? Why am I capable of like it's like Could I fuck my dog or could I push someone in front of the subway it's just like what but most people are able to move on from that thought for people with OCD what tends to happen for a variety of different reasons and we don't know the exact cause that thought gets stuck. And the person experiences it repetitively, like over and over and over again. And then that often leads to what is known as obsessional doubt. So it's, it's really like pathological doubt. Like you get the thought so much that it can contribute to you doubting what you know about yourself, which is exactly what happened for me. I had a rapid onset at age 19. I had this one thought that I say like broke my brain. And after that, it was literally like 24-7 intrusive thoughts that then made me doubt who I was because of that. And that's where that like obsessional doubt comes into play and the compulsions performed to try to resolve the doubts. But an intrusive thought is really just like a thought that pops in that is scary and unwanted.

Amanda, you know so much about OCD. It is so refreshing. I have to say, but that's exactly it. That is the compulsion. And I like that Glenn and asked about like, well, does obsession mean, sorry, my dogs are like, knowing at the door. Can you hear that? Or obsessive dogs don't worry. There's a little piece. And I can't let them out because they should do bad things.

Um, so like with obsession, no, it's unwanted for sure. But when people think like, oh, you're having obsessions, do you want to push that person in front of the bus? People then misunderstand OCD when really the person with OCD is doing every single thing in the world to make sure that that obsession never comes true. I'm not going to the translation anymore. I'm not using knives. I'm no longer changing my baby's diaper. New moms will lock themselves in their room for four hours because they're so afraid to get near their newborn. It is the exact opposite of someone who wants to do that thing. Compulsive avoidance is so common for people with OCD because the thought scares them so much.

Glennon, yes. The way I used to describe it when I was like deep in it was like I had a pair of headphones glued to my head. Then it was literally like playing all day long and I could not take the headphones off. I couldn't.

Yeah, so the one that really messed me up the most and like definitely trigger warning. This is going to be taboo, but the first interest of thought for me that broke my brain was really like what if you have sex with a child's like it just popped into my mind one day and it was like game over for me. And that was to me when I talked to my clients about it and when I talked to anybody about it, that is like the most stigmatized, the most taboo obsession, the absolute last thing that I would ever want to do and that anybody with OCD would ever want to do. But you like a lot of new moms with OCD experience that would if I sexually violate my child while I'm changing their diaper. So I have clients who do not spend time with their children, make their partners change the diaper, make their partners, do everything with the baby because they are so so afraid that this thought means something about them that they're going to snap and do it. It might look like people like with suicidal obsession. So unwanted thoughts about suicide never being alone. They always require someone to be with them because they're so afraid that they're going to snap and do something. They stop driving because they're afraid that if they drive, they're going to swarm into traffic. Like it really impacts people's lives in huge ways. And it can lead to living a really, really small life. You're so afraid of yourself and what you might do that your world becomes so small.

Honestly, for me, that was the worst part. I didn't Google it. I didn't tell anybody for I think it was like 15 months because I was so afraid of what I would find on the internet. I was so afraid that I would tell a doctor. I remember. driving I think it was like a couple of months into like that first interest of thought that derailed me and I remember driving to the doctor's office thinking like I just have to say it like that whole car ride. It was like hyping myself up like just say it just teller what's happening and I couldn't like I walked into that doctor's office and I was so afraid that she would call the police yeah that I would get arrested that they would think that I'm a pedophile And I never wanted to access therapy for that same reason. How am I going to go to a clinician and tell them that I'm having scary intrusive thoughts about sex with children and animals? Like it just is unfathomable. And so people stay stuck, suffering in silence for so long, and that contributes to lack of a diagnosis, lack of care, and just even a lack of understanding about OCD.

It took a while to get here because the shame, Abby, like you said, I mean, there is no shame like having those kinds of thoughts. You know, it doesn't mean anything about anybody listening who's having them. It doesn't anything about your character, but we have to live in the reality of the world. And if I go say that to someone who doesn't understand OCD, like I get comments on my Instagram all the time, I don't care anymore. I got some last week, like, oh, this woman promoting beastiality. And I was like, okay, like, just take like one look at my content. That's obviously not what it is. But it doesn't bother me anymore because I know who I am. when I was in the throws of my OCD that would have absolutely destroyed man.

So like I can use myself as an example. I knew when I had that first thought that that was not at all. Like I knew that it wasn't what I wanted. I knew I was not capable of it. I've known like this might sound odd. But since I was three years old, like the thing that I knew most about myself is that I was born to be a mom. And that's why these things like the thoughts destroyed me the most. But like I just tend to happen is the person with OCD has a sense of knowing. And then there's the onset of OCD that leads to the doubting. So I always like to ask clients, what was it like before the onset of this? What did you know about yourself? Now what gets tricky is sometimes people have a childhood onset where some people will say, I've never known myself without a CD and so that can be a little bit more difficult. But like what did you know about yourself before this? Most people unless the insight is zero, which can happen with a CD. Most people have some insight that this is not what they want. Now when you're living with OCD, it does feel very real. That's the thing that gets talked about the most. Like, I was not only having that thought, but it was also like an internal feeling. think about that like fighter flight that just runs through your body and because it felt so real that also contributed to me not trusting myself over time it just chipped away at what I knew about myself. So when we say like people will say like just trust your gut, just trust your feelings, trust your inner knowing. Well that often can't happen for someone with OCD whose brain is misfiring. And you're getting all of these false alarm feelings in your gut. Like, trust or gut is the scariest thing to say to someone with OCD because it's like, my gut is telling me I could murder 18 people right now. So that is tricky. And that's something that gets worked through in treatment. You know, like, once you stop performing compulsions, once you learn about OCD and why you're so hooked into the obsession. And I mean, we aren't our thoughts. I think that we're a lot more than that. We're our values, we're our character, we're our actions, caveat, all of us have done bad things. You know, I think when I say we're our actions, people get really scared about that. But we're so much more than the thoughts and the words that like run through our mind. And I think society places such a large emphasis on like you are your thoughts and your thoughts create things and your thoughts are the most important things they just aren't. Thoughts are important to a certain extent like if I tell myself that I hate myself all day long that's going to impact me but I can have a million and one intrusive thoughts and still go out and be an amazing person and live a very values-based life.

Right, because we're not in control of our thoughts a lot of the time. Even just passing thoughts about like what I'm going to eat for lunch, like we're just not in control of our thoughts so much of the time. So to place who we are, like to place that emphasis on our thoughts, just doesn't make a whole lot of sense.

Yeah, so I think it was about 15 months of me, like literally not telling a soul. And I was working as a publicist in LA at the time. I remember the exact night that I googled for the first time, like, why am I having these scary sexual thoughts? Like, I was at the end of my rope. Like, I remember thinking to myself something has to change or like, I am going to kill myself. And it just is a really sad reality for a lot of people with OCD because there wasn't an escape from my brain. The only escape to me was suicide. So I was at rock bottom of like something either has to change or I will die from this. And I was at a movie premiere. I can't even believe him saying this, but I was at a movie premiere for a friend of mine whose son had unfortunately passed away from cancer, like a four or five year old son. And I remember having like intrusive sexual thoughts about the dead son. I like don't want to cry but that was just like that was the point where it was like I can't do this anymore. Not only a kid but like a dead kid who died of cancer, of course my brain went there because my brain went to every which place that it could. So that night I went home and I like pulled out my phone and I just googled why am I having these thoughts? Like I wanted something. And I found online like intrusive.org and like these different websites. I found a website for the OCD Center of Los Angeles, but I still didn't believe that it was OCD. I looked at the website and I was thinking, like, why would I reach out for a treatment at this treatment center where people around me are going to be sanitizing their hands 100 times and like tapping the door? And that's not me. So I like put my phone away. It helps to have that like little bit of okay I'm seeing people online. You were also experiencing this. But I put my phone away and I didn't do anything about it. And then I really had a friend who kind of saved my life. It was at the office really high functioning, which I think masked a lot of the pain that I was experiencing. And because the obsessions and compulsions were mental like nobody saw it. but I was crying outside of the office one day and my friend saw me and she just grabbed my hand and pulled me inside and she said like you need a therapist, like you really just need a therapist. So she called her therapist who then called me and gave me a referral to a therapist, Lori, I still see her, I've seen her for like nine years. And I went to that first session. I don't know what came over me, but I told her like what was happening. She's not even an OCD specialist and she diagnosed me with OCD that first day, which was wild to me. Now the diagnosis didn't help. I mean, like OCD is the doubting disorder. So I got the diagnosis and was like, wait, what if it's not, what if he just doesn't know me, what if he's lying? This was like three years of me being like, wait, like, what if I just like tricked everyone? Yeah, let's own this such a good time. It's so fun. It's so fun. I've been here. And so even then like she wasn't in OCD special since you told me that, but I wanted to work with her because I like like turf from the beginning. And then I think it was like two years into our work together. She was like, oh, I can't see you go through this anymore. Like you really have to find in OCD specialist. So I did, I think I was 22 at the time. And that specialized OCD treatment changed my whole life. Like saved my life, getting on prosack, God bless prosack. I will never live a day in my life without prosack. Also changed my life. It like really quieted down the thoughts. And I decided because therapy had been so helpful because I'd been through so much because people don't talk openly about this like that really ignited me to pursue a careers at therapist and I just like totally changed course. I was don't worry. I was still fucked up. Yeah, we'll go again. You Glennon was like literally someone recommended carry on warrior. After I had unfortunately been hospitalized one night, like put in handcuffs at my West Hollywood apartment, taken to a county hospital. I woke up the next morning and was like, I feel the most shame I've ever felt to my life. And I asked my friend Kimberly, like, what do I do? And she was like, read Glennon right now. And she sent carry on warrior. And I like started reading it and I was like, I'm going to be okay. Amanda's like, we need AAA over here. And I was like, I'm going to be okay. So don't worry. When I went back to school to be at therapist, still lots of problems.

Yes, so OCD tends to attack what people value and there's nothing in the world, even still that like I want them to be a mom, so it makes perfect sense. I think back then at 19, I would have said this is just random, but now that I've been through this for nine years and I treat it and it's my specialty. I don't think obsessions are all that random. I really do think that it targets people where it would hurt most. Like a lot of people who are really religious will get religious scrupulousity obsessions and that's like their main thing. I'm not religious. I've never cared about contamination. Like those obsessions were just never going to stick for me. And Abby, unfortunately, we don't know the cause of those CD. I wish we did. I think it would make life a lot easier for a lot of people. What we know from researchers that there are brain regions or brain circuits that are implicated. So it is a brain disorder to a certain extent. There's a biological predisposition. So we've seen like stuff with genetics playing a role and then environmental stuff as well can exacerbate the onset. So I think because the year before my OCD got really bad, I think because I was anorexic that not eating and not having nutrition and like the obsessive compulsive cycle there, I think really probably pushed me into OCD a lot harder than I probably would have suffered if I wasn't struggling with an eating disorder.

So harm obsessions like harm to self or others. What if I intentionally kill someone? What if I want to kill myself? What if I'm a murderer? We have like pedophile obsessions. So what if I am a pedophile? What if someone close to me is a pedophile? sexual orientation and gender identity of sessions. So what if I'm not actually a lesbian and I've just been lying to everyone my whole life and now I'm going to ruin my partner's life? It could be religious curiosity like you said could look like what if I've offended God? What if I don't love God enough? And then we tend to see a lot of like compulsive prayer where you're not just praying once you're praying 20 times until it feels right internally. There's relationship obsessions like what if I don't actually love my partner can get that thought out of your mind or constantly checking in on your feelings. postpartum obsession, so that could be an obsession about you actively harming your child or harm kind of like befalling your kid, like what if my baby doesn't wake up in the morning. And like you said, on paper, some of these things seem logical or rational, but it's not logical or rational given the context of it. Right, like yes, pedophiles do exist. Yes, there are people who harm children, but the client is coming in and saying, I'm not that person. I don't want to. I have no desire to do this thing. So it's kind of a relevance, the fact that pedophiles exist, like it's irrelevant to me, because that's not who I am. And that's a big thing we see for people with OCD. It's that obsessional doubt, where a person confuses like an imagined possibility with what's actually happening in reality.

Yes, that's exactly it. And it's crazy because and maybe I shouldn't use the word of crazy, but when I talk about myself listen, there are a couple things happening up here. I totally agree. Yes.

Yes. I'm crazy. We get to use that word because it's not happening and I will own that. We earned it. We earned it. Yes, we did. We certainly did. So even I will have a lapse. Like every six months, it's so weird. It's like blockwork. I think it's probably related to trauma at this point, but I will have a lapse. I literally am an OCD specialist. I've gone through treatment. I know I'm not this person, but when my brain gets sticky, I fall back into compulsions and it's like, and then I wake up and I'm like, what are you doing? Like, this doesn't exist. What are you doing? But it feels so real and that urge to perform the compulsions is so like strong that all day long I'm in my head compulsing about this thing that isn't actually a problem. Like God does not hate the person. They are a lesbian. They definitely are not a serial killer, but you spend all day like trying to solve this problem that just isn't even there.

It's like so mental compulsions can be like rumenating, so analyzing and obsession. You're just going over and over and over the obsession in your mind. And that's different than an obsession because that rumination is an active choice. It's like a behavior, but it's a mental behavior. You are checking it on your feelings. That's a really big one for people with sexual obsession. So you have that thought like what if I'm attracted to my dad and then you check your coronal area to see if you're feeling something. That's the compulsion. But what tends to happen is when you're checking down there, you're probably going to feel something. And that then feels like evidence. So then you're caught in that. Let me check again. Let me make sure that I'm not feeling this thing could look like mentally reviewing the past. So going over and over and over past experiences in your mind. Thought neutralization is a big one. And that's why like typical CBT doesn't tend to work for OCD treatment because Thought neutralization happens when you replace like a bad thought with a good thought. So let's say you have the thought like fuck God pops into your mind and then the person immediately has to neutralize it with I love God. That's not a solution. That's not going to help. You're just reinforcing that unwanted thought and you're caught in that obsessive compulsive cycle. I mean, it could be like purposely bringing on the thoughts to see if they still bother you like all kinds of mental acts that people perform and you would never know that someone's doing it. Like I could be sitting at my desk. I don't know writing an article and everybody around me could have no idea that I'm like simultaneously compulsing.

It's devastating.

That's a really great question and that's what breaks my heart when it comes to like parents of children with OCD because the thing that you want most is to reassure your child is to make them feel better. But that reassurance just doesn't say she ate. So what happens is when a person performs a compulsion, it might help in the short term, but again, it just signals to the brain that the obsession is important. It's something that we should pay attention to. And then the brain sticks to that thing further. And then it also tells the person that the way out is to perform that compulsion. And that one compulsion is never going to be enough. It's two, three, four, five, six, seven until the person is in the shower for seven hours sanitizing until they've asked their mom 80 times if they're a serial killer or not. And it just doesn't say she it's never going to be enough. So when you're accommodating your kid or your partner of whoever it is with those CD, You're essentially eating the OCD. You're making the OCD bigger. You're giving it importance when that's not what we want to do. We want to starve the obsession to show the brain this doesn't matter. It's not dangerous. It's not important. We don't need to do anything about it. It's hard because it often means a little bit of short-term discomfort for the long-term gain. Whereas when a parent wants to help a child, you really want to help them in the short-term. I just want them to feel better right now. But that compulsion while you might reassure your kid and they feel better for two minutes, it just exacerbates their suffering and the long run. Because it's giving meaning and importance to that obsession.

We're a lot of cutting out compulsions. There's a whole like treatment process and what is effective for OCD, but psycho education first and foremost, like really understanding what OCD is and why you keep getting hooked into it. And then when you stop performing compulsions, you are no longer reinforcing to your brain that that obsession is important. So really cutting out compulsions is such a big piece of treatment. It's hard. It's not always automatic. So I don't want anyone listening to think that they need to like never reassure their child again. It's often done with the help of a therapist. It can be done gradually. But ultimately, it is cutting out compulsions and then also continuing to live your life like facing your fears head on. So instead of throwing away the knives, I'm going to cook with knives tonight. And I'm going to let those thoughts exist. And I'm going to do nothing about them. That tells the brain. This is not meaningful. This is not dangerous.

Absolutely. So exposure and response prevention is the most evidence-based treatment for OCD. And really what it entails is exposing yourself to the feared stimulus. We'll simultaneously cutting out that compulsion. And like I used with the knives example, the exposure could be I'm going to cook with the knives. And then response prevention is after the fact I'm not going to ruminate and mentally review me cooking to see if I did something. And that can facilitate a couple of different things. Number one is something called habituation. So the more that you do something over and over again, the easier it tends to get over time. And then it can also facilitate something called inhibitory learning, where you're essentially learning safety by cutting with the knives, by changing your baby's diaper, by driving the car. You are learning that that thing isn't happening. You're not killing anybody. You're not swirving into the road. So there's a lot of learning that takes place when we change behavior.

I mean, some people can do it without for sure. And I think where it gets hard is like for me, my whole life was an exposure because I was having thoughts about kids and family members and my boss and friends. everywhere I went was an exposure for me and that was so difficult. So yes, there is like that active exposure you can do with a therapist, but a lot of the times people are getting passive exposure as well, or that exposure is just happening because there are some parts of life that we can't avoid.

Absolutely. Now, I think it depends on where the person's at, because when I was in my individual therapy for OCD, my therapist suggested I go to group therapy to like meet other people. Absolutely not. I was so afraid that my brain would stick to somebody else's obsession. I was like, listen, we got a lot going up here. We do not like I didn't want to have thoughts about murder. Like I was so afraid that I would see everybody else with OCD and then my brain would like grasp onto that because that's how sticky it was. So at the beginning of treatment, it really wasn't super helpful for me, but as I moved through treatment and then as I'm a therapist now, like I run OCD groups, I love this community more than anything. Like I never feel more at home than when I'm with someone who has OCD because I just know that like they understand my brain. So community is a massive resource and it helps alleviate that shame, just like knowing that there are other people experiencing this and that you're not alone and that you're not a monster and that's so much of why I do the work that I do.

Yeah, are they?

I have to say yes. I might be biased, but I think yes. And I also think because to me, like I've had a lot of other trauma, OCD was the most traumatic thing that I've ever been through in my entire life. So I think that going through what people do with OCD and coming out on the other end of that also builds so much resilience. that I think that that's also a part of it. Like yes, more enlightened, yes, more like psychologically aware, but also so damn resilience. The strongest people that I know are people who have lived with OCD and who have overcome it. And I never like to compare when it comes to mental health conditions, but I think in terms of the shame and the stigma and the misunderstanding, like OCD is just one of the most misunderstood conditions. And it is just inherently easier for me to walk into a therapist office and say I'm struggling with food restriction than it is to say, I'm like having thoughts that I'm terrified. So I think like because of that as well, like there is just so much resilience and strength that comes out as people with OCD. And like the OCD didn't give that to them. I like to say that to people because they'll say like my OCD really just gave me strength. No, you are strong. We're getting through that OCD and you gave that to yourself.

Great question. I wish I had the answer. I mean, no, I think really is the answer. There's no cure per se. I wish there was, but like what that means is I can never guarantee that I'm not going to have elapsed again. And I do have lapses occasionally. You can get to the point where you no longer meet diagnostic criteria. Like, that's where I'm at right now. My obsessions and compulsions do not take up an hour of my day. I have the occasional interest of thought. I just like let it go and move on with my day. So I'm recovered right now, but there isn't a cure. Like I just know that at some point in my life, I will have a lapse again. Yeah, and eating disorders as well, you know, I'm in recovery. Will I have a lapse at some point? Perhaps.

Yeah. So much, especially between OCD and eating disorders.

That's a really great question. I think it can be helpful for partners to know like generally speaking, this is what I go through. And like there can be that education process at the beginning, if someone feels like it, I always say to people, you do not owe your partner the content of your obsessions, you don't owe your partner diagnosis because you are not your OCD. Great. By not telling them you're not like leaving out this secret self that you're hiding from them. But it can be helpful for them to know so that they know how they might be accommodating the OCD. What we don't want is for like the partner with OCD to be using the partner without as a compulsive mechanism. They confessing to that partner all day long asking for reassurance all day long. And that really is when it can be helpful.

That is such a brilliant question and yes. I think that OCD commonly gets misdiagnosed as generalized anxiety when they just aren't the same disorder. I would say find an OCD specialist if you're listening and you're thinking like this is really what I'm going through. I have these obsessions. I perform these compulsions finding an OCD specialist who's able to do that differential diagnosis can be really helpful. A lot of clinicians sadly don't understand OCD and they just throw on a label of generalized anxiety and that's not effective because the treatment for the two things are different. And then even in grad school programs when I was training to be a therapist, I did a presentation on OCD, and I had my professor stop me in front of the entire class and say, this is wrong. Like, rumination would be the obsession. It's not the compulsion. No idea what he was talking about, but like even in grad programs, we learned so little about it. So we have therapists, misdiagnosing all the time. And OCD is just not the same thing as generalized anxiety. And then also like you said with comorbid conditions, people living with OCD who have substance use conditions and people don't understand perhaps that the OCD is really contributing to that. There's just missed diagnosis everywhere.

Right. And then what's sad is a lot of the time treatment programs are not set up to treat both at the same time. So we fail someone who's struggling with substance use and it's like we just have to go get sober. Okay, but a lot of the reason that I'm drinking is to escape what's happening in my mind. So how is that going to work for me?

Well, absolutely, and even with OCD, I'll have clients come in and they'll say, I have contamination of sessions. And then like five sessions later, the other stuff comes out. So even when people see me as an OCD specialist and very vocal about living with OCD, I really talk about the taboo stuff, I will still have clients come in who only talk about one thing and then gradually open up about another. And that's with an OCD specialist. So unfortunately, people go and get misdiagnosed. People get hospitalized wrongly or get like reported to the police by therapists who don't understand OCD. I firmly believe OCD should be the one diagnosis that every single clinician understands.

I think that with social media, we've seen our rise in OCD advocacy and education. So I'm hoping that that continues. There is like quite a bit of research about OCD, but for whatever reason, perhaps because a lot of it is so taboo, the media only highlights one particular part of it. So I think there is hope in seeing how many advocates and educators are really trying to push for. like the world understanding what OCD actually looks like. We have a long way to go though. We sadly have a really, really long way to go.

that it can get so much better. That is one thing I never believed. It's like I thought because the onset was so rapid and because my brain changed so quickly that this was gonna be me for the rest of my life, but it gets so much better. I described myself as being 95% better than when I had the onset at 19 and I get like 97% less intrusive thoughts than I did at 19 when it was 24, 7. So it really can get better. You can change the brain. You can rewire the brain. And there is so much hope for living a really beautiful, meaningful life, even while you have OCD.

Yeah. So when let's say if we're going to look at suicidal obsessions compared to someone who is actively suicidal, the person with suicidal obsessions will come in and they'll say, I don't want to be having these thoughts. I'm not suicidal. I really like my life. I'm so afraid of my brain. I stopped driving. I'm not going to be alone. I threw away all my knives. Like this is terrorizing me. It's very ego-distanic. Whereas with something like, let's say someone is actively suicidal, they might come in and say, they might not like that they're having thoughts about suicide, but they probably are lining with it. You might see them planning, getting means to harm themselves, creating a plan to do something. They probably have intent to do something if they're in really severe suicidal ideation. And that's a huge difference. One is actively planning to do something. Or they could be where is the person with those CDs doing everything in their power to make sure that that thing doesn't happen. Yeah. Same with homicidality. I would easily be able to tell if someone comes in and says, I want to kill my boss. I've bought a gun. And this is my plan versus someone who literally is like, afraid to even come near me because they're so afraid of their brain. I just can very easily tell the difference, but unfortunately a lot of clinicians who don't have training can't. They hear suicidal thought, they hear violent thought, and the alarm bells start going off. Like, is are they homicidal or are they suicidal?

Wow, absolutely had them do that for clients who are willing by the way, and it can be an effective exercise for them to learn like Yeah, I mean, like, their hands are literally like shaking. Like, this is not a person who would ever do that. I can always tell. So yeah, like, for me, it's clear as day. Huh. Yeah.

Pretty wild.

Thank you. I'm grateful for you Amanda. You knew everything. I guess honestly, so wonderful. The questions that you asked, I am so thoroughly shocked in the best way.

That's amazing.