 Hi, everyone. Welcome to Ask an Expert, an interview series where we chat about topics around mental health with experts, ranging from clinicians to those with lived expertise. My name is Monica, and I'm a medical student with a special interest in psychiatry. During my studies, I've come across a lot of different things that people have said about obsessive-compulsive disorder known as OCD. You've probably heard of it too, like OCD is all about cleanliness that it's caused by things like stress and that there's no treatments available. Well, today we're going to be separating a fact from fiction with a licensed clinician and OCD specialist, Nathan Peterson. Welcome, Nathan. Hi. Yeah. So I'm, yeah, Nathan Peterson. Yeah, welcome. Yes. And would you like to talk a bit about yourself? For sure. I feel so honored to be here. I'm a licensed clinician. I have a practice in Texas. I actually specialize in OCD and anxiety, and other, you know, disorders such as ticks and Tourettes as well. And it's all I do because I love it. I love this work so much to share what actually OCD is and what the treatment is as well, because it's, it is very treatable. And just getting that information out there is super important. Yeah, there's so much information about OCD. A lot of things are true and a lot of things are not quite true. So essentially what we're going to be doing today is to really tackle the most common misconceptions about OCD. So to those who are watching, put some thoughts about what you think OCD is. And in just a moment, we'll talk exactly about what is OCD, what is the diagnosis like, and what are some of the symptoms of OCD. So yeah, take a few moments to people watching to type in your thoughts about OCD. And yeah, should we just dive in actually and talk about what exactly it is? Yeah. So you've probably seen on TV, OCD usually is portrayed as somebody who is very cleanly. They like things to be clean or they like to organize. And it seems like those are the two categories that are shown. And so most people go around and they might be thinking, Oh, well, I have OCD because I like things to be clean too, or I like to organize. And so I must be OCD. It's really easy to also throw that term around as well. I often when I tell people what I do for a living, they're like, Oh, yeah, I totally have OCD. I love to organize my shoes the right way or I hate it when people do this. And usually what I find is the person that says, Oh, I have OCD about this or I'm so OCD usually don't actually have OCD. It's because OCD is not something that somebody actually wants. And it's not a happy thing. It's actually a pretty debilitating disorder. It's actually ranked in the top 10 most debilitating disorders in the world. And so when we see it on TV, and it looks so like quirky, and it looks kind of like fun and exciting, it really isn't like that at all. OCD looks very, very different. And I don't know if you want me to go into that right now or not. Yeah. So in the chat, people are mentioning terms like obsessions and compulsions. Should we have a chat about what exactly those are? And because they essentially make up obsessive-falsive disorder, right? So yeah, perhaps it might be useful to yeah, have a chat about that. Totally. So what I look for when I'm looking for OCD, it tends to follow a pattern. So I think of like a wheel. And it starts usually with what's called an intrusive thought. For most people, it's a thought that we don't really want. It's going to keep coming back anyway. And it can be about anything. It can be, and usually what it does is it attacks our values. So something we actually really, really care about. So it could be about religion. It could be about our kids. It could be about work. It could be about contamination, really anything. And it's usually a threat. It says, you are in danger because of this. And that's whatever that thought is. And so kind of as an example, I might use the thought, you know, I had the thought come to my brain that I'm a bad person because I imagined myself pushing my child over on their bike, which I know sounds silly, right? But my brain had that thought. And then it says, Oh, there must be something wrong now, you just had that thought. And it comes up with some meaning to it. And because it says, Oh, you're a bad person, I can't believe you do that. Some anxiety comes from that. And anxiety is supposed to warn us that we're in danger. So if we're feeling anxiety, we kind of fall for the trap that, Whoa, this must mean something really important. And so the brain says, Well, okay, get rid of this anxiety. This is what you can do. You can do a compulsion. And compulsions are those things that people do to remove the threat or anxiety. And so those things might be, I'm going to run inside as fast as I can. So I don't push my child off their bike, or I'm going to pray really quick and ask for forgiveness, or I'm going to make sure my child's okay by asking them certain questions. And you know, we're confessing that when people do compulsions, they get that temporary relief. And their brain says, Oh, you're good. This is this is great. This is what you're supposed to do to stay safe. And so they feel good. But then what happens is it goes right back to the top of that cycle. And it says, But are you sure you're not a bad person? Are you sure you didn't actually want to push them over? And it just kind of continues that cycle over and over and over again. And it's so debilitating for the individual that's going through that. So the sessions are the things that people are really worried about those value systems in their life that are seem like they're getting destroyed. And those compulsions are the things they're doing to make sure their values aren't getting destroyed. And it's it's very difficult. Yes, for sure. And it sounds like such a stressful experience. And that's why I when I read online, people are saying like stress can cause OCD. And that's, I think leads to the second myth that we could potentially talk about, which is kind of the etiology of OCD, like what are the causes of OCD? And do we even know the causes of OCD and what they are? Totally. So what are your thoughts on that? As a super great question, what we know is that OCD tends to be genetic. So we can find down the line, somebody has OCD, but you know, these older generations didn't talk about it very often. And so it's hard to gain that data. But they actually don't even have to have OCD. It can be on the tree, which I call the tree, where it can be someone might have ticks and Tourette's or they have body dysborphic disorder or they have hair pulling or skin picking. And we kind of see just different patterns and anxiety is obviously a really big one. And so what I find is when people are older, you know, maybe in their teens or older and they're like, I just found out I have OCD. What we find out is that you actually probably have had OCD. It just didn't come out maybe until the specific moment. And so life experiences can play a part into why someone's OCD comes out of the blue. But it doesn't that isn't the cause for it. If somebody has OCD, they kind of had OCD. And so, you know, having a new child, for example, a lot of people realize, I have OCD, that's a huge value in someone's life. I just have a new child and I've got to make sure they are safe and they're okay. And all of a sudden all these symptoms start arising. And usually what I find is I can look back in someone's history and we can find other patterns that they just had no idea. Because like I said, all we see on TV is cleanliness and orderliness. And if they're not doing that, then, you know, we're not even thinking about OCD. It actually takes, I don't want to get the wrong statistic, but I know it takes many years for someone to actually get diagnosed with OCD correctly, because it can be so misunderstood. And speaking about the whole diagnosis process of it, people often also read that you can just do some tests and then you get OCD and that's it. Whereas it's so much more like as we alluded to. So maybe it'd be a good time to also have a chat about what like that diagnosis kind of process is like, if someone suspects that they might have OCD, what are the next steps that they could take, especially if they're extremely, extremely distressed from it. It's good to give them sort of like an idea of what they can expect to towards treatment. Yeah, absolutely. You know, one of the bigger things that I look for is everybody has intrusive thoughts. So whether we really know it or not, everyone has an intrusive thought and it can be weird things that we're like, well, that just came out of the blue. That was kind of a strange thought. But our brain moves on and it says, that was strange, but then it moves on. When it comes to OCD, an individual might have this intrusive thought, but their brain doesn't move on. It says this is valuable. And it starts interfering in their life. That's the second part that I look for. How much interference is this having? How much is it on your brain? And how many behaviors are you doing to make sure that this fear doesn't actually come true? And so some people, if they're not absolutely sure, is this OCD? Is it not? I say write down some on a piece of paper or on your phone. Write down every time this thought comes to your brain. And it might be a lot. You might put a little check mark next to that thought every single time it comes up. Write down all the things you're trying to do to avoid or ask for reassurance. Just to make sure that you're okay. And sometimes if they come back and they've got this big list of things, we can know pretty quick that this isn't just a life experience. This is something else. And it's usually OCD related. Obviously, individuals can get in little funks in their life where it's a lot of anxiety, some trauma moments that have happened, and it can feel like OCD for a little short amount of time. But to actually have a diagnosis of OCD, usually we see it when someone's younger and it follows when they get older. Not always that way. But I have seen individuals who are older who all of a sudden, like, wow, have OCD out of the blue. And it came from a big life experience, but they probably had that genetic component with OCD as well. It's really interesting that you bring up this genetic component because like many other psychiatric disorders, it's more than just like the environment. It's more than just genetics entirely. It's really that interaction. And this is actually interesting because someone in the chat just asked a question as well. Thank you for your donation also. Sats asks, can OCD actually change your personality? What are your thoughts on that? That's a good question. So I think it can change someone's behaviors. So it will change the way that you live your life, where you might not be going out as often, where you are doing behaviors you never did before. Because OCD could be anything. It could be if I don't tap on the wall three times, my loved one's going to pass away. And so I'm spending the day tapping on the wall to make sure my loved one doesn't pass. But that doesn't actually change personality. It kind of changes behaviors. I think it does bring some depression with it because it can feel so overwhelming and hopeless that I am stuck in this loop and I just cannot get out of it. I think over time it just wears on people because it's so intrusive in their life. And I don't like OCD. It's one of those things that is obviously very treatable. It's just getting the right treatment for it. And since we also brought up the idea of treatment, another myth that we think that could be useful to kind of tackle is the idea that OCD is not treatable. It's a myth. Surprise, everyone. Should it be a good opportunity for us to discuss what treatment might look like in the form of psychological treatment and pharmacological treatments? Yeah, totally. So this is the cool part that OCD actually is treatable. But here's the catch, though. You have to do the right treatment. So the average therapist most likely doesn't know the right treatment. The treatment for it is actually called exposure and response prevention. And it's more than just being a therapist and reading a book about it and then trying it out. You actually need a lot of training to do it correctly. And so where somebody might have OCD, they might just go online, find the closest therapist to them. And that therapist is probably going to do talk therapy with you. They're going to say, let's find out what your traumas are and let's go through your whole past experiences. Let's figure out why you're worried about this. And the person might say, like, well, do you think I'm a bad person? And that therapist will probably say, no, you're a great person. Look at this, you're a great family person. You do great things for the community and you're great at work. And guess what? They feel good. And then they leave the session and their brain's like, but am I a bad person? And it just starts all the way over. So we know talk therapy is not the way to go. Logic doesn't seem to work with OCD as much as I wish it would. And so when we use the correct treatment exposure and response prevention, we actually are doing behaviors that are going to teach the brain something brand new. Because right now, all it's saying is that you are in danger. And if you are in danger, you better do a behavior to make sure you're safe. And what we're doing is the brain's going to say you are in danger. And we're going to say, OK, and not do anything about it. And so we actually are exposing to the uncertainties of life, of the fear, whatever it could be. So if it were contamination, as an example, the treatment actually is I'm going to touch the contaminant on purpose. I'm going to keep it in my hand and I might be putting it around and I might be saying the magic, the magic words are maybe, maybe not. And I had that my wall up here. But maybe, maybe not, we have to tell the brain, we are not figuring this thing out anymore. And what ends up happening is that when the threat says this is dangerous and you didn't give into it and you said, yeah, I don't know, we'll see, let's risk it. And nothing ends up happening. The brain learns and it says you like you lied to me, you said I was in danger and nothing happened. And once it learns that experience over and over and over again, eventually those obsessions start slowing down because you've taught it something different. You said you are a false signal and I've proved it to you and not through logic but through experience. And so we are moving closer to fears on purpose. And we're responding differently to them. And so the more we can do that, the better the better individuals get and they their brain just gets stronger. I kind of think of it as really cold swimming pool that somebody jumps into that you probably had that experience or maybe the ocean, you jump in there and your body is cold and all your brain is saying is get out, get out, get out. But if you stayed in long enough, you would your brain would learn something different. It would say, I know I told you this was cold, but guess what? It feels a little bit different now. It feels better. It feels a little bit warmer. But the cool part is the pool is the same temperature. It's just that we've adapted to it and we've gotten used to it. And that's kind of what this treatment does is let's get used to the fear and almost feel like we're risking something when really we're not. And people get better. Their brain learns to move forward a lot quicker from these things. And do you normally kind of do this in conjunction with other pharmacological drugs? Or do you think that exposure response therapy is the primary driver of positive change in a person's life? Yeah, absolutely. When I used to work generally with all diagnosises, is that a word? I, medications, I was like, you know what, I don't think medications is a thing that maybe you should probably explore. But when it comes to OCD, it's one of those things that I see somebody get onto an SSRI, those are the ones that tend to be the ones that work for OCD. And here's the kicker though. The information and research shows that it's often has to be a higher dose than normal for it to actually touch the OCD. And so but when somebody gets on this medication, all of a sudden all these treatment skills that we've planned out and like, you're going to face this and you're going to do this and you're going to do this, they come back and they're like, that's not hard. And it's like, well, their brain, you know, kind of figured it out for them because this medication helped kind of jumpstart their treatment. Obviously, not everybody needs to take medication. For me, someone comes in my office, I do the treatment first, let's do it and let's work really, really hard and let's face these fears and let's respond differently to them. And if you're still struggling and you're working as hard as you can, that might be a good indication to go ask a psychiatrist or or a physician if medications right for you. Because a lot of people can do it without medications as well. But we've shown that it can help. Ones that I that I don't like are kind of the benzos are very quick. You know, take it and my anxiety goes away because that ends up being a compulsion. And and then people get stuck in that, oh, I can't tolerate this anxiety, I better go take this this pill. And so those are the ones I kind of shy away from. Yes, that's definitely super interesting that you bring it up for anyone who's interested. You mentioned selective serotonin reuptake inhibitors SSRIs benzodiazepines, exposure in restaurant and response therapies. So those three things are really interesting. And I definitely recommend people watching this to also do some further reading on this, the literature on OCD treatment is huge. It's very interesting. So that's that with that respect. There's also a really important question that came up with the whole regard of treatments. Many people unfortunately, don't have access to receiving professional support for whatever reason. And they're they're suffering. So what are your thoughts on what they can do in terms of maybe reading papers or finding out more information to help them through through this challenge? Yeah, absolutely. I so realistically, to find a real OCD therapist, there are not many, not many. And even in my area, there are only a few. And we all have waiting lists months, months months. And so and I can only imagine just, you know, I'm here in the United States, but in other countries as well, like the treatment to try to find good treatments going to be really difficult. One of the things that I did for myself is I started creating a lot of YouTube videos about OCD and treatment specifically for those who don't have access to say, here's all the knowledge that I have, I want to push it out to the world and actually help you just jump start your own treatment, if that's what you want to do. Obviously, things like Reddit and these other platforms and forums, like is going to have people's opinions, but getting something from a real therapist is going to make a difference. I do have, if I can plug that, I do have my online program that I specifically created for that as well, that I thought about, what do I do every session with my clients? And I created the self-directed like, here's what we do, we're going to track symptoms and we're going to go through, I think it's 42 videos, little videos that in worksheets are just like, this is how you do treatment. This is how you write scripts. This is how you do exposures that I created for people to actually just learn how to do it, who don't have access. And even those who do have access to just have that extra support as well. And so that that's definitely an option. Amazing. Yes, having accessible resources is really important. And so I definitely urge the person who asked the question and also to anyone out there really, to find a resource that just clicks that's something that you understand, something that you can refer back to and read and perhaps reach out to maybe school counselors to supportive friends, because it's really like a group effort when it comes to mental health challenges, I think. And with that, I thought it'd be good to just summarize some of the myths that we tackle today. And if there are any other questions, you can leave in the chat for the last few minutes of the stream. But otherwise, we talked about how OCD is not all about cleanliness. It is so much more. We mentioned how stress is not the only cause of OCD. It's not the cause of OCD. We mentioned genetics, playing a big factor, environmental factors, perhaps the whole gene environment interaction. OCD is not just a personality trait when you hear people say things like, oh, I'm so OCD. Again, it's very complex psychiatric disorder. We also tackle the myth that OCD is not treatable. It's a myth because we know there are several treatment options from pharmacological treatments. We mentioned SSRIs, benzodiazepines, not so favorable, but that is something out there. The thing that's more favorable is exposure and response therapy. And then finally, we mentioned some resources that you could also visit, such as Nathan's very old YouTube channel and his special online OCD program, which we'll leave in the link. So if there's any other questions or comments you can leave in the chat. Otherwise, please comment what you'd like to see next in the series. And thank you so much for your time. Thank you, Nathan, and thank you to all those like to goers for tuning in. I appreciate it. Thanks so much. Bye. Bye bye.