Alegra Kastens (OCD Specialist)

Welcome, welcome, welcome to Armchair Expert, experts on expert. I'm Buck Rogers and I'm joined by John Lightyear.

Hi there. Hi. Hi, Buck.

Hey, how are you, John?

Doing great. Doing good.

Do you ever go by Jack? Because that's a common nickname for Jonathan.

Too presidential.

Oh, I guess that makes sense, but I don't know why you would want to be presidential. You're already going by John.

I do not want to be president.

Well, not president, but presidential.

Ooh, fine line.

Okay. Today, we have Allegra Kastens. She is a licensed therapist and an OCD specialist, a mental health advocate, and a writer. And this is great because, as people may remember if they heard the fact check, I had apologized for perhaps misrepresenting OCD in general. It was recommended we get an expert and Allegra is the consequence of that recommendation.

We learned a lot.

And it was awesome.

Yes, yes, it was.

Oh, such a good episode. She has a podcast called Books, Looks, and Lobotomies, and that is everywhere you would get your podcasts. Recommend that. Allegra was just a fountain of information and I learned a ton. Me too.

He's an armchair experimenter.

He's an armchair experimenter.

He's an armchair experimenter.

Do you have everything? you need? Water and everything?

Yes. Okay, cool.

We've got three coffees. We've got water.

We like to make sure everyone's prepared.

Yes.

Caffeinated. I've been dabbling with different types of caffeine drinks. Last week, I asked for Cortado. What's that? It's different levels of milk.

Oh, okay, but still tea-based?

No, coffee-based.

Oh, coffee-based.

Yeah, but I didn't like that.

Okay. As you'll see, Allegra, I've got Herba Mate tea mixed with some Perrier. This is a straight-up chai tea. That's an old-fashioned black cup of coffee.

Chai?

Did I say chai? You did matcha. I did. Matcha, sorry.

But I was scared. You never drink chai.

Chai's too much. I love chai! I could have a sip or two of it, but 10, 12 ounces? Don't you think it's a little...

No, it's very sugary.

It can be. It's an Indian tea.

I love the color of your hair.

Thank you.

I used to dye my hair a very similar color for years. Mine was Outrageous Cherry Revlon. That was my mix.

Okay. I used to do L'Oreal High Color, but now it's The Salon.

And Allegra, you're the first Allegra I've ever met. Really?

Yes! That's so interesting.

Tell me about this name.

It's actually a wild story. I was supposed to be a boy. The umbilical cord was in the way. So when I came out and I was a girl, they had no idea what to name me. Okay.

Meaning they literally were taking a sonogram of the umbilical cord, thinking it was a penis. It was a penis, yeah. And quite a long one. You would have been stabbed.

I would have been in doubt.

You'd have a different profession. Literally.

And then I came out and they didn't know what to name me, since I was supposed to be James III. So they heard the nurse at the hospital call her daughter Allegra and they were like, fuck it.

Wow. That's funny. Wow, wow, wow.

They could have stuck with James III, because I love James for a girl.

That's controversial, but I like it. I like it. Yeah.

Well, that tells me a lot about your parents, though, I think, in a capsule. Like, that's pretty loosey-goosey, willy-nilly. Like, that's a chill set of folks. if they're like, they hear a name on the fly and they're like, fuck it, let's go with that.

For the rest of her life.

Chill would be one word. Yeah.

It'd be a euphemism.

There are a lot of other words that are used.

Have you met another Allegra? There's famously Allegra buses. They're a great manufacturer of motorhomes.

Interesting. I've met another, Allegra. I was a publicist. So there was, I'm going to forget her last name. She's married to, and I'm going to forget this guy's name.

And I think maybe the bus has two L's. But this is a ding, ding, ding, because you guys both presumably have a PR degree? Yes. And so does Monica.

I also have a PR degree.

You were employed as a publicist.

Oh, yeah. I was a talent publicist for years. Here? Yeah. I lived in LA for six years.

Oh, my God. Were you working mostly with actors?

I had a few actors. Like I had Andrea Barber from Full House. Okay. I'm not allowed to say that I have a favorite, but she was my favorite. Okay.

And I'm like-.

You just can't say who you hated.

I would never.

Oh, my God. But you can say who you love.

Yes. She was just lovely to work with.

So where are you from originally?

Orange County. I grew up there. Oh, you did? Yeah. So, like totally Southern California my whole life, until four years ago when I moved to New York.

Okay. So Orange County. What city specifically?

Orange.

Orange? Yeah. The city of Orange. Where did you go to school?

I went to school in Ohio for two years because I played soccer. And then I quit after my freshman year. So I moved back to California and went to Cal State Fullerton. But then I dropped out to work in the industry and then my OCD, I just couldn't do school because of it.

Okay. So, as I was learning about your story, I know what your specific version is, but I guess it sounded like you were phrasing it in at least one of the documents. I read that it was onset late?

I had an onset at 19 and it was in .

Really? So? you didn't have any as a child?

I definitely had some symptoms when I look back, but it wouldn't have been enough to diagnose me. During soccer, I had weird stuff where I would stand in the soccer store for an hour and I'd have to feel out every jersey until it felt right. And it was distressing to me. Of course. In eighth grade, I had two weeks where I was picturing my math teacher naked, and she wasn't cute to me.

And was there an inciting incident? I'm not sure of what order we should go in, but I'm definitely curious. the physiological components of this and then also the nurture components, if something could trigger it, all this stuff.

I will say I was anorexic at the time and it was untreated. So I do think an untreated eating disorder, with malnutrition and everything else it did to my brain contributed. Sometimes I wonder, if I wasn't anorexic, would I have suffered so badly with OCD? I don't have the answer to that question and obviously it's too late to know, but that 100% played a role in something that probably would have manifested anyways.

Right. Okay. So, as you already know, I'm going to botch a lot of this. I'm cobbling together what I've been told over the years and then my own personal experience with these different things. One thing that made a lot of sense was, okay, so I think I even told you in an email.

Well, I will say we don't know the exact cause of OCD, but environment can absolutely contribute to the onset. So I would never say that having a lack of control would not be a cause or a correlation. I don't think it would be the thing alone, because research points to genetics and also what is it called? The brain. So yes, that thing that's responsible for fucking my life up.

Well, there's like addiction as well. It's like a combination.

It's a combination of a lot. But that does make a lot of sense, because for some people, OCD can be the brain's way of trying to protect you, even though it's doing a really fucked up job at it.

Yeah. Again, only because I'm writing about it right now. I'm also putting together pieces that I wouldn't have thought of, because when I'm writing about it, I'm kind of forced to try to explain the experience of it. And the easiest way I could think to articulate it is I would start the day with neutral luck. Like I woke up anew.

Like magical thinking, maybe, or compulsions to prevent that bad thing from happening. Yeah.

It's just like really trying to understand why is this so unpredictable and where's this all going? And it's very tenuous and I've got to be on it. And then also, so the first one really starts with, I scuffed one foot on the way to school, and that's a failure. on my end. I'm supposed to be walking without scuffing my feet.

Right. Or like a neutralization or a punishment.

Yep. And then this just would ratchet up all day long with the amount of things I was juggling. But then I heard, I was watching a 60 minutes on people with super memory and they pointed out this correlation between people with super memory and OCD that they over index in OCD if they have super memory. So then I thought, well, maybe there's a physiological component that there's a part of the brain that's maybe a little more developed than it should be.

I don't doubt that for a second, because if it were just environmental, wouldn't everyone who had the environment that you had, or I had growing up, have OCD? And they don't. There are people who have really traumatic childhoods and don't develop OCD.

Yeah. Is it rare that someone would have an onset at 19? or is there nothing normal? Is there anything, any trends that we could say?

19 is actually a really common age. I found out from a lot of my clients, it's usually young kids. So it starts in childhood or young adults, like 19 to sometime in your twenties. I have seen older adults, like even at the age of 65 have an onset, but that's definitely not the norm. And I don't mean norm as in.

The same with schizophrenia, which is interesting. It can come on.

It has a window.

Yeah. But it can often come on later in twenties or late teens, showing no symptoms before.

I feel like there's two camps with OCD. Some who will say, I don't know what it's like to live a different, like I've always had OCD. And then there are the people like me who I had a before, so I knew what it was like before. And there's always the argument of which is worse.

Well, I could easily see one blessing of that. And as I've read what you've written, I recognize that for a lot of people, they don't know they have OCD, which prevents them from seeking treatment. They think they're just goofy or wrong, or a pedophile, or a murderer, or a rapist. So in some way, your version does seem at least like minimally, you would know there was a period of your life where you didn't experience it versus, if you have no memory, where you haven't, I think it would be easier to make the argument. I am a killer.

It definitely was helpful to have that before, because I knew it wasn't me. But then in my brain, I thought, did I just turn into a pedophile? Does that happen? It really did help, but it didn't help enough for me to set the thoughts aside.

Okay, so this has been happening while you get your degree in PR and you start working.

Yeah. And then I had to drop out of school because I couldn't read books because of OCD. I would read a word and it would get turned into a sexual thought. I couldn't watch TV, so the films for my film classes I couldn't watch because it sounds like I'm seeing things. I'm not, but my brain would turn something on the screen into something sexual in my mind.

Okay. So it was having a big impact, and then you leave and then you get this job and then does it escalate to, we would say in recovery, like a bottom, even though that's obviously not very clear. People have multiple bottoms. That's kind of a stereotype as well. But did it reach a nadir where you were like, oh fuck, I have to seek some kind of treatment for this.

Yeah. So trigger warning, suicide. I think it was about a year into not knowing what was happening. I wanted to kill myself, not because I wanted to die, but because I saw that as the only way out. And so I remember thinking, I need to either figure this out or I'm going to kill myself soon.

Yeah, right. And is it hard to find someone that specializes in OCD? Is it a pretty small field of people that are qualified for it?

Yeah, there just aren't enough OCD specialists. And then even people who say that they specialize sometimes don't. You'll look at their Psychology Today page and there's 40 different diagnoses. And you don't specialize in schizophrenia, OCD, bipolar. Right.

Right. Okay. So at what age do you start a course of treatment that you feel like is effective or on the right path?

I want to say it was 22.

And then you, I'm presuming, decide then you want to go get your degree in psychology. Yes.

I didn't want to specialize in OCD treatment. at first. I thought that everybody else's thoughts and obsessions were going to stick in my brain. I didn't want the murder thoughts. I had enough OCD.

That makes total sense. I'm not going to try to get sober in a crack house.

Yeah.

It might look good one day. Right.

Yeah. Yeah. Yeah.

Totally. So. I was worried that I would pick up obsessions or compulsions, and then I realized this is my passion. This is what I want to do.

Yes. Okay. Sorry. And not to keep making it about me, but it was contagious for me. So I would randomly bump into a kid who also had an eye blinking thing and I was hiding mine.

No, that makes sense. And I know people will say compulsions aren't contagious, but my brain was so sticky that they did feel contagious to me. I remember reading the man who couldn't stop. I don't know if you've read that. No, it's a book about OCD.

This might veer out of OCD. Correct me. But one aspect of it for me is simply knowing what the worst thing I could have or do is, is, in itself, sticky. Giving myself something to worry about is almost irresistible. So yes, if I heard like, oh my God, this happened.

Literally, especially when your nervous system is hyperactive and the fear center of your brain is misfiring.

This is just so tricky. Cause as soon as you're saying it, I'm like, I feel like that's hypochondria. Cause people say I have hypochondria, which feels like that. Now I learned about this. So now this is going to happen to me.

Right. And hypochondriasis or health anxiety or even health OCD, they can appear similarly, but OCD is different than health. Anxiety is different than even tics or Tourette's is different than trichotillomania, like hair pulling.

What a word, though. Say it again.

Trichotillomania and dermatillomania. So even tic disorders are very comorbid with OCD, but they're not the same thing. Same with hypochondriasis.

And they're like cousins in a way.

Yeah. A lot of similar features.

Yeah. I can imagine where someone had tics, but they didn't have the component. that was the tics were controlling for another feeling, right?

And there is a kind, it's not a diagnosis. But a lot of clinicians use it. It's called Tourette's OCD. So it's a name for a blend of tics and OCD, where it's not just a tic presentation, but it's also not just an OCD presentation, which I'm not diagnosing you, but maybe you had something like that.

Yeah, yeah, yeah, yeah. Okay. So now I think would be a lovely time, because I think a lot of people are upset. really what happened and this was lazy and not meticulous of me, but Camila and I had been talking about many things. I'm talking about addiction.

First and foremost, I'm so grateful that you're having me here doing this. I am not out to cancel you or I'm not the language police. So I just want you to know that I'm very sensitive to describing OCD accurately, just because there is so much misconception around it. Even Khloe Kardashian constantly uses closed CD because I like to organize my cereal pantry, and it leaves people so confused and without a name for the condition. So thank you for doing this and for owning up to that.

Must have been even more upsetting, if you liked it.

I've had to backtrack things that I've said. I totally understand it. With OCPD, so number one, it's egocentronic a lot of the time. And what that means is, if someone has a preoccupation with control, perfectionism, organization, orderliness, they tend to think that that is the right way to be.

That's so key. We've got to triple down on that point. It's very in keeping with their overall value system.

That's exactly it. It could impair other people. I also want to say that I'm not saying that OCPD is a likable condition. And actually someone was upset about my video about you because they thought I was saying OCPD is likable. That's not what I'm saying.

Dismissing that.

What does it stand for? Sorry.

Obsessive, compulsive personality disorder.

This is what you have when we're talking and we use these terms and you'll go, I'll be a little OCD in this thing. Got it.

Yes. Where you might see excessive list making excessive attention to detail. People who say, I really need my spreadsheets to be in this way. They get mad at others often who don't align with the way that they view things. There might be excessive devotion to work.

Well, now I will say this, and this is a time I misuse it. I am so uncomfortable when things that are hanging are not level. And I'll go, Oh, this is my OCD, but that's my OCPD. If I was going to say it, even, because it should be level.

In your head.

I don't disagree. You know, like I don't think I want it level, but it should be crooked. I think I want it level and it should be level. Totally.

And that might not be distressing to you at that time, where if someone had, let's say, just right OCD or perfectionism OCD, that would distress them and they would feel the urge to do that over and over and over again until an internal sense of rightness is achieved. So there is that aspect to OCD, but it's also a very small sliver of how OCD can manifest.

And is it fair to say as well? It's also spectrumy. So it's like, even as you're describing it, like, yeah, I want it level. It should be level. Also, it's deeply unsettling in a bad luck way.

That's a really great question. To be diagnosed with OCD, obsessions and compulsions have to take up at least an hour of your day or cause clinically significant distress or impairment in functioning. So yes, technically speaking, now there are more severe levels of OCD. Some people require residential treatment, whereas others can be treated in an outpatient setting once a week. But if you meet criteria for having OCD, there has to be some kind of impairment in functioning or distress.

That's a great metric too, an hour a day. Yeah. Because right now, not a chance. Yeah. I'm not spending, no, five minutes of my days.

Well, I've been eating this burrito. I stopped, but I was eating a burrito kind of obsessively. It was all I was eating. And then I thought something weird's happening where this is becoming obsessive, but it wasn't causing me any stress. But I also wasn't like, this is the way it should be.

Maybe the word would be just better used. Habitual. Like it became really habitual.

Yeah. But it was a little more.

I want to dissect your brain. So was it a safe food for you? There could be so many reasons that people, I'm not saying you have any disorder, but people with eating disorders have foods. For instance, apples. for me, I had safe foods that I would eat constantly.

We're not leaving here until we figure out why Monica ate that burrito 14 days in a row.

It was weird.

Jack's, just like, please get therapy. It was so weird.

Yeah. I mean, it started out as just tasty and then it became like, well, this is, I really don't know what happened, but I needed to have it every day. And then it became the only thing I was eating every day. And then, honestly, part of it, I was getting so full on it. I think it was like, this is kind of a hack.

Right. Because you need more food than a burrito during the day, for sure.

So, yeah.

And it could be a fixation. I mean, I sometimes will eat Chipotle multiple times a week. You know, it doesn't have anything to do with my OCD. It's just a fixation on what tastes good. Yeah.

Yeah.

Yes, yes, yes. Now, and we're getting along so well, and I like this so much, truly.

Were you worried?

No, not at all. I don't think you would have come if you weren't. Yeah, yeah. I think that said everything about both of us, that we would want to sit down and chat. One part I can't relate to tremendously, but now that I've read a bunch of what you've written, it certainly makes more sense.

So if we're going to go with the addiction and the alcoholism example, I think most people know what addiction is. And I think that there's a difference with OCD. If I could have, from day one, known that that was OCD, I would have saved myself a lot of pain and suffering. And I didn't. It took aspects of my life that I will never be able to get back.

Like, maybe in 20 years, we'll be in a spot where it's like.

Everyone knows what, right. But we don't. right now. Even on Instagram, when I post about sexual intrusive thoughts, it's there's another white woman promoting bestiality. And it's like, that's definitely not what this is, but you know, people just don't know about it.

Well, what I really got a lot of understanding out of was you writing about the five taboo and very common OCD obsessions, because it started to make a lot of sense, which is. If your garden variety knowledge of OCD is checking the locks twice, or, as you say in, in media, what's most commonly presented, and certainly I agree is someone washing their hands a lot. That's like what we like in movies. Well, first of all, it's very visual.

So, yes, right. The internal stuff is a little bit harder.

So if the common colloquial understanding of OCD is that then when you're wrestling with these five taboo OCDs, any one of them are a combination of them. You think you're uniquely broken, not that you have this thing, because this thing is checking your door locks, which you don't do, so you don't even know. And then I was like, yeah, that makes a ton of sense. That's very, very valid.

Right. The locks and the washing and the sanitizing, such a small portion, not necessarily small in terms of not a lot of people have it, but if we're looking at just writer contamination obsessions, there's also violent obsessions, postpartum obsessions, sexual obsessions, OCD spans so much more than that. But that's all we hear about, as if that's a hundred percent of the condition.

Right now. Okay. I'm going to go through the five taboos, cause, yeah, this must be so distressing to be trying to evaluate what you are in spite of all these intrusive thoughts. And I also think just really quick, cause I found myself figuring out the difference as I was reading obsessive and compulsive, these are kind of two pieces of something. It's an order.

Yes. So obsession is repetitive, unwanted thoughts, images, or urges that are intrusive and often distressing for the person. So it's recurrent. It's not just one thought that pops in. Like, I think I heard you say, well, I have intrusive thoughts from time to time.

Yeah. So that's great. So I guess when I was thinking about it, it was like the compulsivity is what you're observing, but that might not even be reflective of the obsession.

They might not be connected, you're saying, right?

Well, just like, yeah, if you were observing someone from the outside and you notice that they have some of these compulsivities, it's not so intuitive. It's like how they're choosing to regulate and address and fix and nullify. the obsession isn't so direct. It can be, but also it might not be.

Right. Some people with sexual obsessions will wash, let's say, their vagina or penis after having an unwanted thought, because they think that that's the thing that neutralizes it. To the outsider, it would be like, why are you washing that during the middle of your workday 18 times?

You would think they were a germaphobe.

There we go. So you can't always tell, or it could be, if I don't tap this wood, then I'm going to snap in my sleep and kill my child. Right. And people wouldn't think that the tapping of the wood has something to do with that. And you also don't always see people's compulsions.

Did you know, so when I said I have intrusive thoughts, I do. And at this point I do think they go away. But I did have a period of time after a major family incident where I was having intrusive thoughts. I could not stop. And the thought was, what if I kill myself?

Absolutely.

But I don't think I had any compulsions to neutralize it that I know of.

Okay. Were you ruminating? Were you analyzing? For sure. Boom.

Congratulations. Wow. Thank you. I did it.

We all three. And I didn't know when I was struggling that I was doing mental compulsions. I thought it was all obsessions, but I was trying to solve it in my head, trying to get rid of the thought, even if you're trying to suppress it and push it away, mental compulsion. But it's tough because there are also intrusive thoughts with PTSD. So I see why your brain went there.

Maybe it is that. I don't know.

And intrusive thoughts with PTSD tend to be more so about the trauma that occurred. And the person might be avoiding things cause they don't want to relive that trauma, where OCD is more of this irrational fear that is popping up.

Seems like a weird combo.

Maybe I was going to say, I see both in yours. Not that I'm diagnosing.

No, no. You're allowed to, by the way, we're happy to take any.

I mean, your license is your issue, not ours. So feel free to let the diagnoses fly.

I feel like I want to know more.

Stay tuned for more armchair experts. If you dare.

There are a couple of moving parts to this. The first is the egodistonic nature of OCD. And what that means is the obsessions are opposite to the person's values, desires, self-concept, what they know about themselves. So they're having all of these unwanted thoughts that don't line up with who they are. Could be, what if I'm a pedophile?

Well, I was going to say, even if they don't act on it, they're masturbating to it.

Often masturbating to it, or they still know I am attracted to children. And that's not the person with OCD. The person is doubting what they know. when they have OCD. It's what if I'm a pedophile, even though I know that I'm not.

Like this abstract fear based in nothing.

Based in literally nothing. But then I'm sitting there all day long. Like, am I a pedophile? Even though I know I'm not, it seems like the biggest waste of your time, but I just couldn't get it out of my mind.

Yeah. And you would, although this could be part of the compulsion, I was going to say you would never go. search for images like a pedophile would, but also I could see a part of the compulsion where it says, I actually need to look at those to prove to myself. I don't like it.

I'm so glad that you said that. And there was actually a battle in one of my videos in the comment section the other day. So most people with POCD don't, that is a huge fear of theirs. Even so much so that when they're watching porn, if the word teen is in, I'll have clients come in and say, Oh my God, am I a pedophile? Because I watched one that said teen.

I would even argue like that is the perversive nature of suppression. almost. There's something really interesting about suppression and fear that it's all together somehow.

For sure. There are people with OCD who, unfortunately, have looked at that compulsively. That does not mean that they are a pedophile. They don't align with it. Even if they're having a groan or response, again, trigger warning, rape, people who have been assaulted, they might orgasm because the body responds.

Yeah. Or whatever, want to experience that in your real life.

Oh God. Yeah.

So yeah, we went through some of them, but I wrote down some that I think are interesting. Well, also, could you explain to us the difference between these two very common things? There's the what if, and then there's the command obsession. So there's like two different columns of this.

I think that some people think that to have an obsession, it has to start with what, if, or to have an intrusive thought, it has to start with what, if, like, what if I'm a pedophile? People also get intrusive thoughts like you are a pedophile, or people with harm obsessions might get intrusive thoughts like kill them or rape them. where you feel like it's your brain telling you to do something or that you want to do something that you absolutely don't. It's still an intrusive thought and it doesn't mean that you're any more likely to act on it. And I think those scare people more, because it's like, if my brain is telling me you are a pedophile, then I really must be.

Your brain's telling you all the things, so how do you know what's real and what's not real?

Right. So it might not show up as neatly as what if I'm a pedophile, it might be you are a pedophile or sexual images of children or sexual phrases, or even like noises in people's minds. Very graphic. It's not a fun time.

Okay. And now, at the risk of perpetuating another stereotype, I can't help but resist the overlap between that and the call of the void, which is something I think people are very familiar with. And I'm wondering how you think about that. So a lot of people experience standing on a skyscraper and the voice is telling them jump off the building, jump off the building, jump. But now that I get that a ton, I can almost not stand on a tall building because my brain's screaming jump.

I'm so glad you described that, because when you said the call of the void, I had no idea we were talking about. I was like, Oh my God, this is going to be the one question I can't answer. Okay.

They call that the call of the void.

I have new language. That's wonderful. So that is exactly it for people with OCD. And I don't necessarily like that. we describe OCD, or obsession sometimes as urges, because I think that implies that a person desires it.

And all the time, and a myriad of different things, not just a tall building. Yeah. Yeah. But I like call the void and I often use it to explain how I'm feeling in certain other situations. It's like I identify the thing I don't want to happen the most, which is fall off this building.

Or like shouting out a slur in public.

Yes, exactly.

I get it on airplanes. I've gotten it at weddings, where it's like, just yell this word out. And I'm sitting there like, don't do it, don't do it. And now I know what it is. So it doesn't bother me as much.

And again, there's the version of that, that most people can touch, which is like you walk into a room, there's four people, one person has no legs and you're like, Oh, don't say anything about legs. Don't and don't talk about running. All these things like. you're just completely consumed with what you shouldn't do.

And then you feel like you're doing it more because you're thinking about it. Yes, totally. And that's why thought suppression doesn't work. When we tell our brain, don't have that thought, don't have that thought. We're thinking it more, which is why people with OCD, they try to suppress them, and then it just gets worse and worse.

How does Tourette's fit into this?

Really great question. So Tourette's or tic disorders, they are a separate diagnosis, but very comorbid. with OCD. With Tourette's, there tends to be what is called a premonitory urge that precedes the tic. So it's this kind of buildup of tension in the body.

Go full throttle.

Poor you. That is so awful. But then there can also be that Tourette's OCD where there's kind of a mix, where the person has that premonitory urge. So they feel the somatic buildup or tension and then they perform compulsive tic like behaviors over and over and over and over again until it feels just right. So it doesn't always fall neatly with Tourette's or OCD.

Yeah. The reason I asked is I was assigned this documentary in a psychology class and it was like a two hour documentary on Tourette's and this convention that the people in the stock all met at and they showed the check-in process at the hotel and they had worn the staff like, Hey, this is a Tourette's convention. You know, you're going to see a lot of things come. And sure enough, once they identified in these workers, whatever it was that could be called out that they knew they shouldn't, that was very common. That's why I was wondering how much of it it's like, so they've assessed the same thing, like, don't talk about this right now, but then they talk about it.

Oh, for sure. And that's part of why I didn't want to be an OCD specialist because I didn't want to pick up on that, or sensory motor obsessions. Have you heard of that?

No. Tell me.

Okay. So that is when you have a hyper awareness of automatic bodily functions and then you obsess about what if I never stopped thinking about this? So, blinking as you were talking and you were talking about tics, I noticed my blinking.

The worst thing you can do is become aware of anything in your body.

And that can look like tics too, where the person is aware of their blinking and then they're blinking their eyes multiple times to try to stop having that awareness of the blinking. It is OCD, but it can appear tic-like. There's a lot of overlap between a lot of these conditions.

Oh God. Now I can't stop thinking about it.

I'm going to make more of that. I had a client once with that and I was like, what you do is just if I think about it, I think about it.

Right. Okay. That's helpful.

If I think about my blinking, if I blink a million times today, I do. That's how I get through it. It's just like, whatever. You don't give energy to it.

You just accept it. Okay.

Exactly.

My only one I still have a touch of is I'll get acutely aware of my bladder.

Oh, peeing?

Yeah. It's when I start obsessing. I'll be on an airplane. If it fucking kicks off on a flight, I'm so sorry if you're seated next to me, but I'll have to go every 12 minutes. I'm just like, oh fuck.

And that is a compulsion, right? And sometimes it can almost feel psychosomatic, where you probably don't even have to pee, but you're thinking about it.

Well, the proof is in the bowl. Like, I'll pee three ounces. I'm like, well, that wasn't worth a trip to the fucking head. Oh man. I think that one started on talk shows.

I think a lot of people can relate to it before sleep. Oh, for sure. I think there's more, like, I got to go back. Oh wait, one more time before.

I wish I could reach in and squeeze my bladder and wring it out.

It probably wouldn't work because it's not related to the pee. It's more of a, I have to do this so that I can, right? Or not. Yeah.

No, totally.

I'm hoping that by peeing I'll be disconnected from my surveying. I'll get this pee out and then I'll finally unplug from focusing on the sensation. Like right now, all I can feel is my bladder. Well, Angie, if you think about bladder blinking,

but if you're getting up and you're constantly going to the bathroom, that's kind of reinforcing that awareness. So that's the other thing. That's why response prevention, cutting out compulsions, is really helpful. So it's not the getting up and going to the bathroom. probably that's going to help you.

that awareness. That's a tall order. That scared me. That's like a sponsor telling me I got to pray every morning. Like, Oh, we got to do that.

Don't you feel like it's gotten better since you've been meditating?

Well, unfortunately it's just so far away from when I meditated in the day. It's like the end of the day. I'm starting to obsess that I'm not going to get a perfect night's sleep. All the things that are going to fall apart cause I don't get the good night. And then all of a sudden it all gets hung on this bladder.

The present moment awareness, the more you strengthen. that, for me, anyway, helps with some of this, where I can be like, whatever. I feel, I might have to pee, but I'm not going.

I'm going to come back to the present moment. Yeah. Mindfulness was huge in my own recovery. It helped me so much.

Well, earmarked. X, I want you to walk us through the kind of course of action, but in effort to destigmatize this stuff and let people know that what they're dealing with is common and has a solution. I think we should go through a few more of the taboo ones. And you point out at the beginning of this piece, I read that the stakes seem incredibly high and they are in that the fear of I'm going to go talk to somebody and tell them I'm thinking about killing my baby. You're immediately thinking you're going to have the police called on you.

Yeah. That's why I didn't want to seek help. I knew I was having these sexual thoughts about kids, but I wasn't going to go tell a stranger that and then risk them saying, you're a pedophile. I'm calling the police. And unfortunately it does happen where doctors and clinicians who don't understand OCD treat someone with suicidal obsessions as if they actually are suicidal, violent obsessions, as if they are homicidal.

Right. So you're saying one feared outcome would be getting the police called on you, but then another one would be a 51 50..

That's happened for people who have suicidal obsessions and they're not suicidal. Their brain is going kind of like you were talking about. What if I kill myself, even though they don't want to?

My heart and compassion goes out to the doctor sitting on the other side of that. They're like, Oh my God, if I don't do so, I mean, that's a very hard call to make on the other end. I'd rather be wrong in there alive. I'm sympathetic to.

Of course. Yeah. And that's why this is so important because more doctors need awareness about OCD. and what's ego dystonic versus ego syntonic.

Right. So if someone who has suicidal ideations also is thinking in the world would be better off without me, my family would be better off without me. Like things would be better. Like this is in accord with my principles. Would that symbolize the difference?

Yeah. For instance, people with suicidal obsessions, they're hiding their knives. They're throwing away sharp objects. They're doing whatever they can to not die because they don't want to die. I've had clients stop driving because they're afraid that they're going to open the door on the freeway or turn their car into the median.

This is Monica. Yeah. I think you've probably gotten close to removing knives from here.

Oh, a hundred percent. There's definitely moments of like. that needs to be far away for no real,

like, but it feels so real. It's so scary.

Okay. So violent obsessions is one. This is to harm themselves or others.

What if I kill someone? What if I stabbed someone? What if I'm Jeffrey Dahmer and I'm lying to everyone and I just don't know it. Jeffrey Dahmer got enjoyment out of killing people. He wanted to do those things.

You can really take over your entire life.

Yes. This is not someone who desires hurting other people in that way.

I feel so bad for those people because he has, how are you to know? that's not how Jeffrey Dahmer felt before he snapped and did it?

You know, it's wild too. And I should not be saying this. Cause I'm going to trigger everyone. There's a Jeffrey Dahmer interview where he talks about obsessions and compulsions. And I'm like, babe, no, you're a serial killer.

Doesn't have to be either or though.

If it's OCD, if it were harm obsessions, he would not be killing people. So in that case, it would have to be either. Or now he could have, he talked about it as the compulsion to kill and his obsessions about killing. And it's like, but you align with that. That's egosyntonic.

I more meant he could have had separately OCD about one thing. And then over in this quadrant.

No, he was talking about his obsessions and compulsions to kill. I'm like, babe, you like to cut people up and eat them. This is not OCD.

In fact, thank you for giving us the worst example. It's like him, Hitler. There's a handful of people. They really did us a service in talking about things or set the bar over here.

Pedophiles. to me. I always tell my clients, POCD, I think, is the most stigmatizing and shameful, because even murder, sometimes you can explain away. There's justified murders. There we go.

It's the number one. And look, I have on here many times said like, I have enormous compassion with pedophiles. I don't have to fight the urge to do that. That's not what I desire. I know one pick that.

I'd rather be a murderer. Oh, a million percent. I don't think they have the week. So I agree with that.

I think even if they want it, and they desire it societally, they're aware, there's still gotta be enormous shame on the backside of all of it.

It's disturbing. It's awful. It should not happen. And I have so much compassion, for you can have compassion.

I still want people to be put in jail. That's my take.

And it would be so hard to be born that way. That's my point. I don't think anyone picked it out, and we don't have compassion for them, and they deserve treatment and care too. And to be put somewhere safe. Yeah.

Postpartum obsessions. Yeah. I don't know why. I'm just arbitrarily saying I feel like this one would be the most common of these five you've listed. Is it more or less common than the others?

Probably about the same. And it tends to be a mix of sexual and violent obsessions for people. So what if I throw my baby down the stairs? What if I want to microwave my baby? And a lot of new moms can get these kinds of intrusive thoughts.

I hate to say it, Monica, but I can see that happening to you.

Me too. I already live like that a little bit anyway, not having any kids. I do feel a lot like what if that falls right on your head? Yeah, it's not great.

Yeah, I worry about family members all the time. Yeah. I think I'm going to die all the time.

Yeah, and it's so painful because it really robs new parents from having that experience that they want to have with their newborn.

The compulsions that you listed are really heartbreaking. to think that there are a lot of parents that don't want to be alone with their baby.

Oh no, they have people come over like their parents, compulsively. They're afraid that if they're alone, they'll snap and do something. They don't want to spend time with the baby because ultimately they want their baby to be safe. This is so opposite to their values. I work with a lot of moms who have had to grieve that postpartum period that they didn't get and that they watch other people get with their baby, that euphoria, that bliss, don't have it.

So that's postpartum OCD. Is there postpartum chemical stuff that's going on that would cause you to actually act on it, or is that separate? Not with OCD.

There could be postpartum psychosis. I'm not a psychosis specialist, but from what I know, the person is experiencing delusions or hallucinations. So that's what we commonly hear of when it's this new mom drowned her babies in the tub. It's psychosis. That is very different than OCD.

the hallucination. The baby's spirit possessed.

Exactly. That's not OCD. But people worry that they are experiencing psychosis and that if they tell a doctor, their baby will be taken away. So it's a painful spot to be in.

Oh, oh, I would be terrified if I said all this about child protective services. I mean, everyone has a heightened fear of that. Out of nowhere, Delta was maybe three. at this point. A babysitter came over, friend of ours daughter, and she gets there and she's right in the kitchen, but Delta's only three.

No, I'd be worried about that.

I'm going to show you my daddy's penis.

Kind of obsessed with your penis. Yeah.

She used to tell me to, I'm going to smack you in the penis. She's mad at me.

What if I'm attracted to my parents? What if I want to have sex with my parents? I definitely had that, and it was so awful. Images, just sickening. Nobody wants to think about their parents having sex.

Yeah. A lot of my worst nightmares, people are like, what's your worst nightmare? And people are all, I got chased by this guy. Oh, the night before. I'm like, no, it's always.

And I was so worried that I would dream about the obsessions that I couldn't sleep. I stopped sleeping for so long because I was afraid that I would have sex with a child in my sleep or have sex with a family member. And sleep evaded me for a really long time,

which probably made it all worse. So, Oh, I was a mess.

No, I don't want to make light of any of these, but I will say bestiality and necrophilia, obsession. I just feel like of all these that it'd be easiest for me to talk myself out of,

it would be these. You think, you would think, but no,

when I tell you the things that I believed, no, I had the dog ones too. I had insight. I knew I wasn't, but I really thought I could want to touch my dog's vagina, or when you're in it and it's feeling so real and your adrenaline is so high and your brain is.

misfiring, you believe it. You're panicked. You're in the amygdala. Like you're not in the frontal lobe. You're in the fear center.

And that's why often, when people say, but just tell yourself that you're not, you know, you're not, well, I can't connect to that when the fear center of my brain is active. Those are two different parts of the brain.

And the one is better at hijacking the other.

That's exactly it. And then, when you're getting images of you touching dogs, Oh God, I would get so many thoughts about my bosses. King Charles Cavalier. Is that what they're called? Never forget.

That's an honest, never very perverted breed.

I don't know exact dates, but from what I've read, exposure and response prevention, which is the treatment with the largest evidence-based, I think, has been around since the eighties. But when I worked at UCLA at their intensive outpatient program, we saw people who were 75 years old, who just had never had treatment or language for it. So it is relatively newer, and there are other treatments that can be effective too.

Is the approach you just said at all similar to immersion therapy? I hear this immersion therapy. It's like if you're afraid of germs, they'll make them stand in a trash can.

Absolutely. But it's more gradual. So exposure is exposing yourself to the feared stimulus. So that might be cooking with a knife if you have violent obsessions. And then response prevention is cutting out the compulsive rituals.

Right. So how does one do that?

Well, here's the thing. We can't stop intrusive thoughts. We can stop mental compulsions. Mental compulsions are active. If you are choosing to solve a math equation, you can stop doing that.

This is a benign example, but I will have arguments with people in my mind that are forthcoming, or I've decided are forthcoming. And so I'm building my case and I have exhibits and I've got like 12 pieces of good evidence. And then, by the time I get to the 12th, I get worried. I forgot the first one. So I go back through and I will find myself on hour three of having an argument with somebody that ultimately will never happen.

Is that similar? Right. So if the obsession is, what? if I'm a pedophile? Let's say that thought pops in, which it did for me.

Would this fall in line with CBT? This sounds very CBT.

Yes. So that's the behavioral portion of cognitive behavioral therapy. There is a cognitive component to OCD treatment too. I think a lot of people, when they think of CBT, they think I'm going to give you a worksheet. You're going to challenge these unwanted thoughts and then you're going to get better.

You just gave me one, but could you give me some examples of steps you took and when you started feeling relief in that timeframe? I know you consider yourself extremely lucky and having gotten your arms around it in like a year and a half of work.

Oh no, it was not a year and a half. Oh yeah, no, no, no.

Or maybe it was that you sought treatment.

Yes, exactly. So I got diagnosed within a year, which is truly a miracle, because a lot of people go 10 to 15 years. That's the average. And that year for me, like I said, I was ready to kill myself. People that go 10 to 15 years, not knowing I have so much respect for.

And this person's approach was.

Psychoeducation at first. So educating about OCD, which sounds ridiculous, but when you don't know.

It doesn't sound ridiculous.

We just learned so much today.

The most liberating part of reading the AA Big Book is going like, this is an illness.

Yes.

Right. Oh, okay. So it's not a moral failing on my end.

That's why I like being diagnosed with it. I respect Camilla not wanting to call it a disorder. And if I have clients who don't, that is fine too. I love calling it a disorder because it's not me. So a lot of education about OCD, then some metacognitive therapy, which is ultimately thinking differently about your thinking, which can be helpful.

But really quick, let's spend one second on that. The stakes are high to acknowledge that what you're thinking is not real, because it then calls into question all the other things you're thinking. You're compositing reality in your head. So once you open the door to the fact that I'm an untrustworthy observer of reality, the whole house of cards feels like it might collapse. That's a big one.

And people with OCD, and even people in general, have to learn which thoughts are worthy of paying attention to, because there are some thoughts that are helpful and true. With OCD, not so much. So that really helped me. learning that feelings are not facts was really helpful too, because it felt so real to me and I couldn't understand why it felt like I could be a pedophile and I wasn't. Learning.

Yeah, no one does.

But it got to a point where I would come into her office. I would just sob on the couch the whole session. She would tell me to chill. That's how activated I was. I probably wouldn't say chill to a client, but I kind of, she was like, you need to chill.

Did she ever say take a chill pill?

No, no. I'm like, don't tell me to fucking chill. Yeah. Yeah.

It's not going to work.

But it was a turning point in my treatment because I came in and I was finally graduating with my bachelor's degree, and that was a big deal for me. And I wanted to go to the graduation and not have intrusive thoughts. That was my whole thing. I kept saying to her, can I just stop these thoughts? I want to have this one day.

Stay tuned. I'm your expert. If you dare.

Have you ever done transcendental meditation by chance? No. Okay. So the big breakthrough in that for me, this is very similar, which is in the past, when I would try to meditate, I would start thinking about things and ruminating on things. And I'm like, well, I can't because of this.

I would call my therapist. Do you know what my mantra is? She's like, babe,

you're not supposed to say it. You're like, I know.

That's why I'm definitely telling you. Well,

it's really funny because of the other people I know who do TM, we would never do it. And I have one friend who tells everyone and I'm like, this is crazy. I got to hold on to some of the magic voodoo. I really want to know it.

Well, I'm sure you can get it out of Lincoln. I can't believe. you don't know it.

That's wild. Well, I did make one up that I did tell you. Yeah. Making up is worse. Well, no, I was using it for a while and it worked, but I think, maybe because I told you it stopped.

It's the most counterintuitive, because, of course, I wanted to stop having thoughts about children and animals, but the more that I fought with it, the more of those thoughts that I have,

which you resist, persists. That's exactly it.

That's a big motto, and I say that to clients often. So when you say it's okay to have these thoughts, it doesn't mean I need to engage with them. So I wasn't, at graduation, ruminating about the thoughts. I let them exist and I came back to the present moment, which was graduating.

Yeah. You can almost think about it, as like you're in a room, a fifth person enters. You don't like that person, but it's like, yeah, they're here. Okay. But I'm not going to try to remove them.

That's exactly it. And then you're not bothered as much when you're not attending to the person that's there. It's like, you can be here.

It's not my preference, but I accept it.

There we go. And that's, I think, why a lot of people don't like the word acceptance with OCD. They think I'm saying, except that you're a pedophile. No, I'm not saying except that the thoughts are true. I'm saying except that you're having them.

And that you're likely powerless over having them.

That's exactly it.

Is there anybody trying to pinpoint, like, if you were to look at this from more of a psychoanalytic approach, if Orna were here, like, I do wonder if Orna would be like, you know, Orna, do you want couples therapy?

I can't watch that for my own reasons. This is not OCD that I get really fixated on being single. And so I don't want to watch, I don't want to watch couples therapy because I'm like, I want to be in couples therapy with someone. It sounds nuts.

You won't want to be in a relationship. It might be the antidote.

It might help. I'm sad when I watch things with couples, I just need to get the fixation under control. That's why.

I actually think this would be the antidote. Monica loves it.

I love it. And you feel both, though. You do feel like, oh man, there is this powerful thing happening. There's something special about partnership. But then you're also like, oh my God, it's hard.

You're not seeing their picnic. You're not seeing the day they got married.

And my brain rate always goes to the honeymoon phase. So it might help. I probably need it. Yeah.

No one's in there, cause it's going spectacular. It's like in AA, where we say, it's like, it's the loser's club, not the winner's club. No one's like set out to join AA.

There are a lot of different theories. Psychoanalysis is likely not going to treat OCD first and foremost. And I think a lot of people will say what caused it doesn't necessarily matter because we're treating the symptoms of it. I think a lot of people get triggered by psychoanalysis because they think that the therapist is saying there's meaning to these thoughts and we need to figure out the inherent meaning in them. When.

Yeah. I don't think it would be linear.

Not at all. But some psychoanalysts do think, like I had one when I was getting my hours and I was an intern who said something about. she thought sanitizing represented something. It didn't make sense to me, but I think some psychoanalysts do think there's some kind of meaning behind why someone's doing these things.

I think my most optimistic view of all of it, and we talked about it with Orna, I actually don't like that these two approaches are positioned against each other. or that they're binary, or that you should do one or the other, or that you can't look at yourself from every conceivable angle and have a toolkit. I just don't love that. there would even be any kind of pitting one against another.

Two thoughts about that, because I agree with you. I think that we're treating the whole person and I think sometimes clinicians forget that. I'm a big fan of using different modalities. And I think a lot of the times therapists get really married to one modality. And we also do want to use what's evidence based.

I would imagine there would be a preferable order, even if you're going to do both. I would think you would definitely want to do your approach or a CBT approach and get it in a manageable condition.

And then maybe look at, are there other things, which has been helpful for me? because I do think that even for me, there's this underlying, what if I'm bad? And that definitely stems from childhood, like big one for me. So looking at that has been helpful and looking at just how that shows up in other areas of my life. It wouldn't have helped during my OCD treatment per se, but now that my symptoms are under control, it is helpful for me to look at maybe why I still get stuck on things sometimes.

Yeah. To be fair to Orna, she also said she often refers people to CBT people.

Yeah. Oh yeah. I don't have a problem with it. Listen, I could probably be in psychoanalysis. Is it a treatment for OCD?

Well, for me, like, okay, I started going to AA 20 years ago, almost through the day, and it solved all of the burning rooms on fire in the house issue. And it worked for so long, but then, after those fires are out for a long time, you're like, oh yeah, I can hear a dripping leak. There are other things I want to tackle or explore. And AA actually doesn't have any kind of prescription for that. And so I liked then adding that aspect.

Yeah. And I think even OCD clinicians, I don't want to get canceled for saying this, but I think sometimes can be very narrow and it's like, we're just treating the OCD, which is great. when we're treating OCD, but we have to remember that they could have PTSD. They could have other things that also need to be managed, or just even managing the emotional impact of OCD. There are clinicians who say OCD can't be traumatic.

Yeah. So glad we did this. Oh, me too. Yeah. It's been really fun.

So informative. I definitely didn't know about all this at all.

I'm going to have to clean up my talk a bit.

Sometimes we just talk and say stuff, but it's good.

We get to correct. Like I said, it's amazing that you've done this.

What's really funny is, you know, we interviewed a sociopath. and this is not to compare these things at all, but in learning about sociopaths from a diagnosed sociopath, who's also a clinical psychologist, I'm like, yeah, you're born that way. No one picked it out. Now I kind of have compassion for sociopaths. Now I can't even use the word sociopath the way I want to use it.

And that's what I was thinking too. I was thinking Dax probably thinks that I'm one of those people who says we can't use any kind of word. I'm not. Because I've been suicidal for much of my life. I talk about suicide in a way that sometimes I joke about it and I've dealt with it.