“The GAP” of OCD: Part 3
In part one and two, we have begun to look at the diagnosis of OCD through the lens of “the Gap” as a disarming way for both sufferers and helpers to learn about the experience of an often-misunderstood diagnosis from a holistic, clinical, and Biblical lens. Defining and using the term OCD is as important as the use of other medical terminology in order to properly assess and treat it as the unique diagnosis that it is. If the Gap of OCD is treated like other kinds of anxieties or struggles, this can causeincredible damage (both in mental health circles and in spiritual circles-more on this topic to come in the future!).
I remember as a young 20-year-old starting to process with my pastor my worst fears that had started a few years prior— the nightmarish thoughts and doubts around if I was a pedophile or not. Pastor Darwin was a gentle, safe place to process these fears that were attacking my mind. He continually pointed me to God’s love and grace as demonstrated in the Gospel. But I’ll never forget the day that he paused and gently told me that he believed that I was experiencing some OCD tendencies. Me? OCD? Isn’t that supposed to be about keeping everything clean and orderly or making sure your door is locked? As it turns out- no! (Check out part one and two blog posts for more details on more “hidden” types of OCD!)
So—what exactly is OCD? Why should we consider this term in our experience of our felt sense of “the Gap”? Clinically speaking, “…obsessive-compulsive disorder (OCD) is a disorder in which people have recurring, unwanted thoughts, ideas, or sensations (obsessions). To get rid of the thoughts, they feel driven to do something repetitively (compulsions). The repetitive behaviors, such as hand washing/ cleaning, checking on things, and mental acts like (counting) or other activities, can significantly interfere with a person’s daily activities and social interactions. Many people without OCD have distressing thoughts or repetitive behaviors. However, these do not typically disrupt daily life. For people with OCD, thoughts are persistent and intrusive, and behaviors are rigid.Not performing the behaviors commonly causes great distress, often attached to a specific fear of dire consequences (to self or loved ones) if the behaviors are not completed. Many people with OCD know or suspect their obsessional thoughts are not realistic; others may think they could be true. Even if they know their intrusive thoughts are not realistic, people with OCD have difficulty disengaging from the obsessive thoughts or stopping the compulsive actions.” (Check out this article from the American Psychiatric Association: https://www.psychiatry.org/patients-families/obsessive-compulsive-disorder/what-is-obsessive-compulsive-disorder).
OCD is often described as the fourth most common mental health disorder. According to the IOCDF (International OCD Foundation), “1 in 40 adults have OCD or will develop it at some point in their lives…” and “1 in 100 kids and teens have OCD….” (Check out this article from IOCDF: https://iocdf.org/about-ocd/).
Notice that OCD is described as involving internal or externalcompulsions—this can involve more “hidden” actions like analyzing, checking for absolute certainty, seeking reassurance (from yourself or others), confessing, neutralizing or trying to get rid of a distressing thought, etc.
In my personal and professional journey with experiencing and treating OCD, I have found that there are two basic themes of OCD suffering that drive the various obsessions or compulsions: 1) We want to make sure that we are who we think we are or ought to be (i.e. we want to be sure that we are not that or wouldn’t do that); 2) We want to prepare for or protect ourselves from our worst-case scenarios (aka we want to have certainty that a worst-case scenario will never happen to us in the first place!). As described in the other two blog posts, there are various experiences of “the Gap” that will focus on different topics. As OCD latches onto what is most important to you, sufferers experience a variety of “subtypes” of OCD such as cleanliness OCD, religious OCD (also called spiritual scrupulosity), pedophilia OCD, false memory OCD, responsibility OCD, harm OCD, and relationship OCD, to name a few. No matter the subtype of OCD, it all works the same basic way as described earlier with an obsession and a compulsion. The experiences of OCD with mental compulsions are often termed “Pure O” (there is discussion in clinical circles around the inaccuracy of this term because technically there is still a compulsion going on- albeit internally). Pure O OCD is an umbrella under which and these other more hidden forms of OCD can hide. The “silent battle” of Pure O is incredibly isolating, shameful, and misunderstood, and I have seen this both in my own story as well as with clients I serve.
An example of how the “loop” of OCD works: You have a distressing thought or image about something that you really care about (Did I hurt someone? Would I harm myself? Am I a Christian? Have I married the “right” person? etc.). Because of the distress of this thought or question (combined with what you may have been told about “bad” vs “good” thoughts), you understandably try to analyze or get rid of this thought or seek an answer in order to gain certainty about the thing that you really care about. That may look like analyzing your actions or thoughts, reassuring yourself that you did not do something wrong, confessing any potential “sin”, etc.). As you can probably see, this becomes a loop because there is no 100 % certain answer, the topic is not actually “solvable,” or it involves faith and trust in something outside of your analysis.
So—how do we treat this “loop” of OCD, to get unstuck?
ERP (exposure response prevention therapy) is the most researched and proven way of clinically treating OCD, exposing someone to their fears (the obsessions) and then empowering the sufferer to not give into their compulsions (whether external or internal). This clinically helps to re-train the brain’s threat response (from the amygdala) as the fear “habituates.” (For more information, checkout: (https://www.treatmyocd.com/blog/what-is-exposure-and-response-prevention-therapy )
If you are a helper or supporter of someone suffering from OCD, learning more about ERP will shape how you interact with them (you might help them find a locally trained therapist in ERP, encourage them in their ERP homework, and watch out for not reassuring them or feeding into their OCD loop).
Other types of treatment for OCD involve ACT (Acceptance Commitment Therapy), I-CBT (Inference based CBT), TMS (transcranial Brain stimulation), neurofeedback, and other options. Medication (specifically SSRIs), functional psychiatry (treating the root of mental health through a functional medicine model), and metabolic psychiatry(addressing potential metabolic issues through ketogenic diet for example) are all options which can provide symptom relief to those suffering from the often-hidden experience of the Gap of OCD. (For more information, check out: https://iocdf.org/ocd-treatment-guide/;https://www.psychiatryredefined.org/category/ocd/; https://www.metabolicpsychiatry.com/research
I personally have been treated and helped by ERP, ACT, functional psychiatry, and a ketogenic diet. Professionally I have received training to treat sufferers of OCD with ERP, and I also incorporate aspects of ACT and educating people on their options with both traditional and functional psychiatry. Upon educating people on the mental illness of OCD and as people express openness, I will then gently incorporate aspects of the Christian faith, pointing to how Jesus can meet us in our shame and fill our Gaps even as we take leaps of faith to engage in needed clinical treatment.
In my story, I was both helped by my pastors who had sensitivity and awareness to OCD and could point me to the Gospel in ways that I specifically needed to hear as a sufferer of OCD as well as by my clinical counselor who treated me with ERP. Through exposures of ERP, I learned that on the cross, Jesus became gross and took on a punishment that alone could atone for any grossness or shame that I could ever feel about being a pedophile or any other fear (whether perceived or real!).The only One Who could ultimately be with me in those waves of shame was Him. In my worst-case scenario, Jesus would not abandon me but instead hold me in my imperfections. He was never repulsed by me but always embraced me, asking that I bring nothing— not even perfect knowledge of the thing—but my need. He bore every pain and every sin (whether real sin or OCD’s twisted version of “potential sin”) and every broken thought and every part of the badness I was feeling. I learned that only Jesus could fill a Gap that I never could, that no compulsion (even spiritual- like confession!) ever could, and that He alone was my certainty.
Whether you are a sufferer of OCD or a helper to someone who is, I invite you to have curiosity about this complex mental health struggle and ways to experience freedom from it through becoming educated on OCD, seeking clinical and holistic treatment options, and perhaps even experiencing Jesus as your Gap Filler along the journey.
On the Bridge:
Grab a cup of your favorite drink and get ready for personal reflection or gracious conversation! This can be done in a personal or group context. At the end of each blog, there will be a few questions for reflection designed to help you grow as a sufferer or helper as well as to “build bridges” between the two groups around a topic. I invite you to use these questions in a way that works for you whether that be for personal reflection or gracious conversation with other sufferers or helpers (or both!). Consider others in your life that may need to be educated on a topic and consider ways that you too may also be called to be a “bridge-builder.”
1) What is the definition of OCD? Why is it important to use this term in describing “the Gap”?
2) What is the difference between internal vs external compulsions of OCD?
3) What is the “loop” of OCD?
4) What is a top treatment for a sufferer of OCD? If you are a helper of someone suffering from OCD, what might your role be with them?
5) What do you think about the concept of Jesus as your Gap Filler?