
Loading summary
Dr. Celine Gelgich
With VRBoCare, help is always ready before, during, and after your stay. We've planned for the plot twists, so support is always available because a great trip starts with Peace of Mind. ACAST powers the world's best podcasts. Here's a show that we recommend.
Dr. Tori Miller
Michael Gargiulo stalked and slaughtered his female neighbors in LA in the 2000s until one survived.
Podcast Advertisers/Narrators
She painted a picture that you could
Dr. Tori Miller
never imagine in a first on Mind of a Monster, we dive into a case that's still active. Did Michael's murderous rampage start in the 1990s when he was just 17? His impulsivity and his rage was starting
Dr. Celine Gelgich
to peak around that age.
Dr. Tori Miller
Listen to Mind of a Monster, the Hollywood Ripper. Wherever you get your podcasts, ACAST helps
Dr. Celine Gelgich
creators launch, grow and monetize their podcasts everywhere. Acast.com. Hi, I'm Dr. Celine Gelgich.
Dr. Tori Miller
And I'm Dr. Tori Miller. Welcome to Breaking the Rules. On Breaking the Rules, we talk about all things OCD.
Dr. Celine Gelgich
Obsessive compulsive disorder. OCD impacts up to 1 to 2% of the population. We are here to provide not just education, but to inspire clinicians, families and people who are impacted by OCD to be able to access the treatment they need in order to get better.
Dr. Tori Miller
Catch us every fortnight wherever you get your podcasts.
Dr. Celine Gelgich
Hi, everyone. Welcome back to the next episode of Breaking the Rules. Hey, Tori.
Dr. Tori Miller
Hello, Celine.
Dr. Celine Gelgich
How you going?
Dr. Tori Miller
Good, good, good.
Dr. Celine Gelgich
Today we're talking about when OCD peaks.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
Like what to watch out for in different periods of life.
Dr. Tori Miller
Yes, yes. Yeah, yeah.
Dr. Celine Gelgich
We're jumping straight into it today.
Dr. Tori Miller
This is something that I find incredibly fascinating about OCD and look, to be honest, about many aspects of mental health difficulties, you know, but it's a. It's a lovely thing, I think, to think about in relation to ocd, because it informs our formulation and the kind of sort of psycho education we can provide and guidance and just sort of, you know, richer understanding. It's so easy to just be symptom focused and that's just. Yeah, yeah, yeah, for sure. It's just not enough to exactly focus.
Dr. Celine Gelgich
No.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
So when do we see it pop up? A lot of research tells us that we will typically see two ages of onset when we're dealing with ocd. One of them, interestingly, is when puberty hits. So between eight and 13 years, I would say you might see a spike where it's enough to. There's enough going on to diagnose OCD. The next cluster is in older adolescence, so around 17 to 25, I'm going to say it's the next kind of age group where you'd see it peak. But then outside of that you've got life transitions.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
Such as getting married, having a baby, starting like your first serious relationship.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
Basically when things become meaningful.
Dr. Tori Miller
Yeah, yeah.
Dr. Celine Gelgich
Is how I would describe it in adolescence when we see those two clusters, I kind of conceptualize it around like for the younger. Older children. Slash. Younger adolescents or the tweens kind of see it as that period where individuation starts to kind of kick in.
Dr. Tori Miller
Yeah, exactly.
Dr. Celine Gelgich
Where you start to think about things for your own self a little bit more. You separate from your family a bit more. You're starting to turn towards your peers. Yeah. It's the start of high school. Yep. There's a transition from primary to high school.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
There's. The topics of conversation are different at school.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
And all that sort of stuff. And then that second cluster is again another transition of leaving high school, but also starting like year 11 and 12 in prep preparation for university. We can see a lot of perfectionism and that sort of. And that sort of stuff. Contamination kicking in.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
Sometimes harm thoughts.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
Etc. So they're also transitions.
Dr. Tori Miller
Absolutely.
Dr. Celine Gelgich
Yeah.
Dr. Tori Miller
And I think you're so right. I mean, I, I think there's a, you know, if you think about those timeframes, I mean, there's an understandable hormonal component there where, you know, feelings are more intense, young people are feeling more dysregulated. So it kind of makes sense that if there's a predisposition, that OCD or often what a lot of parents will say is that there have been OCD like behaviors for a long time, but just not the functional impairment or nothing that really was so strange or intense or distressing that, you know, they couldn't handle it. But that then once the, the hormones start to kick in, that things become a lot more difficult and they tend to, you know, rocket out of control. But there's also, I think around about the age of, you know, eight, you know, or so, you know, kids are starting to develop a sense of their own mortality.
Dr. Celine Gelgich
Yeah.
Dr. Tori Miller
They're starting to understand the bad things happen to people that they love. They're starting to have more independence. They're start. Know there's a component of individuation. There are all sorts of things that are happening that are reinforcing this idea that they are not necessarily like, protected in this little cocoon of life by their parents. And, and, and conceptually that sort of kicks off existential thinking.
Dr. Celine Gelgich
Yes.
Dr. Tori Miller
And as well as existential anxiety.
Dr. Celine Gelgich
Yeah.
Dr. Tori Miller
And so underneath we're seeing sort of, you know, the understandable kind of awareness of things that start to generate anxiety, discomfort, uncertainty, fear at a time when they're going out in the world doing more things independently and feeling less protected.
Dr. Celine Gelgich
Yeah.
Dr. Tori Miller
And.
Dr. Celine Gelgich
And not necessarily having the language to actually articulate what's going on. The skills manage. Yes. So it manifests as ocd.
Dr. Tori Miller
Yeah, absolutely. So I think that the age of onset, those two sort of periods, I think, makes. Makes a lot of sense whether. Whether we're talking about sort of the tween period or the older adolescent, young adult period. And you know, what you're saying about the idea of life having meaning makes perfect sense for people when we think about what OCD is all about. It's about our sense of ourselves, our sense of capability, our sense of identity. And so these time periods are. I mean, that's what these time periods are all about. It's all about, who am I? What do I stand for? What do I value? What do I want? What do other people think of me?
Dr. Celine Gelgich
Yes.
Dr. Tori Miller
Was. Was that a choice? Do I back my choice here or do I have regret? It's a very, very complicated time. And so for vulnerable people with that, you know, with that predisposition for ocd, this is when OCD will come in to help them handle all of those intense thoughts and feelings.
Dr. Celine Gelgich
So we can almost see it as like a maladaptive coping strategy or a maladaptive way to regulate that uncertainty and stress that comes in.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
When things become really meaningful.
Dr. Tori Miller
Yeah, Ye. Yeah, for sure. Yeah.
Dr. Celine Gelgich
So being mindful of these life transitions is important because when we're doing our assessment or formulating with our clients, it will be really helpful to be able to ask some of these questions to be like, you know, where is this person developmentally different to their chronological age?
Dr. Tori Miller
Yes, that's exactly right.
Dr. Celine Gelgich
Because I think you can have someone in their early twenties really struggling with individuation, which we can, you know, typically needs to occur a little bit earlier.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
And so on and so forth. Or there are different things that have, like it might be their first experience of grief, for example, if they've lost a loved one or somebody. Yeah. Brokenhearted. Yeah, absolutely. Experiencing struggles from an attachment perspective as well.
Dr. Tori Miller
Yeah, absolutely.
Dr. Celine Gelgich
Relationally. And all that sort of stuff. So all of those are really important to just hold in mind and ask when we're doing our assessments. Yeah. And our formulations with our clients and just kind of being curious and open around these sorts of moments in life. Yeah. So that we can then help our client put the pieces of the puzzle together.
Dr. Tori Miller
Yeah, that's right. Answering the question of why now?
Dr. Celine Gelgich
Yeah, yeah, yeah. Why we're coming to therapy.
Dr. Tori Miller
And I think people can be very alarmed by, you know, what can feel like an incredibly sudden onset sometimes, especially parents. Yes, absolutely. And I think to put it in the developmental frame actually really can ease people's mind, can help make it understandable, but also understand why there are ebbs and flows in the intensity of OCD symptoms, but also can make it feel a little more predictable or understandable, which I think is really, you know, treating OCD or supporting a loved one with OCD or having OCD is a long journey. And so having a sense of kind of, I don't know, being able to predict it or anticipate it, you know, through the recovery journey can be really helpful.
Dr. Celine Gelgich
Yeah, for sure.
Dr. Tori Miller
Yeah, for sure. Yeah. And then also thinking about what the developmental tasks are for an individual, what it is they're grappling with, gives us as clinicians some clues as to what might be sitting underneath the compulsion. So, again, moving away from just what symptoms are and thinking about what is it that this person might be really afraid of, what is it that they're trying to avoid or grapple with? And I think about new parents.
Dr. Celine Gelgich
Right.
Dr. Tori Miller
I mean, this is another life transition where we see a lot of ocd, either, you know, a flare up in ocd, you know, or perhaps emergence. But we're talking about people who have an enormous sense of responsibility and fear of doing the wrong thing and having this sense of responsibility for this new life, which can just feel overwhelming, really freak, really scary, and can make someone feel very dangerous, you know? Yeah.
Dr. Celine Gelgich
And just as important for dads as it is for moms.
Dr. Tori Miller
Absolutely.
Dr. Celine Gelgich
I agree. Shouldn't discount that in terms of when we're working with dads or new dads as well, just being mindful and asking those questions for them as well as for mums as well.
Dr. Tori Miller
Yeah, absolutely. Yeah. And I think that being able to sort of say, answer the question of, like, why now? Why has this popped up? I think being able to sort of to normalize, you know, the journey that someone's got, that somebody's on going through this major life transition, that it actually makes a lot of sense that I actually think AIDS treatment. Because if someone can understand that that enormous sense of responsibility and the fear is actually a perfectly normal response, then it can help with the process of acceptance that these feelings of Fear are not something to be fought or survived or. Or avoided or shut down. Actually, it speaks to who I am as a person and what my wishes and dreams are for this baby.
Dr. Celine Gelgich
Yes.
Dr. Tori Miller
And for our life as a family. And so give you permission to sort of embrace that and sort of accept that it's sort of absolutely representative of the person that you are. And I think it can really help.
Dr. Celine Gelgich
It really does. Like, I often tell my clients these. These thoughts and feelings, aside from the fact that they're frustrating, annoying, and all the rest of it. Yeah. When I have them, they're telling you something really important.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
For the teen, it's like they tell you that they. That you care and that you want to do well at school.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
And you want to succeed.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
They tell you like, if you're a new parent, they tell you that you love and care about your.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
If you're someone who's lost a loved one, it tells you that you value that relationship, you know, so it's one of these things where we can use that, as you beautifully described, as a way to help normalize, but also get our clients or encourage our clients to reconnect with the value. Because one of the things that OCD does when it. When life transitions are the driver of the theme around what. What type of OCD someone's presenting with is use our clients values against them.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
And so they start to disconnect from the value and they start to lose touch with it and feel frustrated and all that sort of stuff and almost lose sight of that. So I think to be able to reconnect with it in that way and flip it on its head can be a really nice way of creating that separation between them. And ocd.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
So that you can kind of get your wedge in there and then use that to help guide exposures as well. Yeah. As well. As a motivator.
Dr. Tori Miller
Yes. Agreed. Agreed.
Dr. Celine Gelgich
An important one too, I think.
Dr. Tori Miller
Yeah, yeah, yeah, I agree. And I think for us as clinicians as well, I. I think. Well, I certainly found that thinking about these aspects of a person, their development, where they're at, how they're ocd, like sort of formulating the OCD has helped OCD seem less alarming to me as a clinician.
Dr. Celine Gelgich
Yeah.
Dr. Tori Miller
Which has enabled me to sit in the room and help of my clients sort of unpack it too.
Dr. Celine Gelgich
Yeah.
Dr. Tori Miller
I think it just makes it all.
Dr. Celine Gelgich
It's helpful for everyone.
Dr. Tori Miller
Understandable.
Dr. Celine Gelgich
Yeah, totally.
Dr. Tori Miller
Yeah. So it's as good for. For us in our roles as it is for our clients.
Dr. Celine Gelgich
Absolutely.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
And it helps explain the shape shifting.
Dr. Tori Miller
Yeah. As well.
Dr. Celine Gelgich
Because a lot of clients, the theme will shape shift. Yeah. Based on what transition they're going through and what moment they're going through in life.
Dr. Tori Miller
Yeah, yeah, yeah, yeah.
Dr. Celine Gelgich
Definitely.
Dr. Tori Miller
Yeah, yeah.
Dr. Celine Gelgich
So with that in mind, I think life transitions and moments in time where OCD can kind of flare up, as we've mentioned, is really important to hold in mind for assessment and formulation as well as treatment. It can help us, as we've described, connect with our clients on a level where we're not freaking out about it, but also encouraging our clients to reconnect with that value.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
That it's trying to, I guess, latch itself onto in an unhelpful way. And from a treatment perspective, I think it can be really valuable to make sure that we're addressing that. Similar to what we've described in previous episodes, where we've got the symptoms we're treating, but we also want to be treating what the function like.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
What the function is underneath.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
And making sure that we're incorporating that.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
As well.
Dr. Tori Miller
Agreed. And I think we can also think about for our clients who perhaps, you know, we've been treating with ocd, let's say they're moving into a major life transition, we can also use it in an anticipatory way by providing additional psychoeducation about to sort of normalize what kinds of changes that they might expect or might experience and then also to help facilitate, you know, the implementation of additional support measures in anticipation of that. So, you know, that idea about, you know, be alert, not alarmed, and, and let's just get prepared and if those changes occur, don't be frightened. It makes perfect sense.
Dr. Celine Gelgich
It does, yeah. And the most obvious one that comes to mind for me is working with clients who fall pregnant and them coming to session going, I've got some exciting news. But also, holy shit, how's my OCD gonna show up? And so we do. We spend a lot of time, thankfully, we have time to spend that time talking about how might it show up, anticipating what skills and strategies can you use to kind of help with that to then be able to build their community around them and build that village that they need. And you know what, in all honesty, a lot of the time, clients who have been in treatment do so well after Bubs is born.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
And yes, there might be little flare ups of OCD here and there, but their knowledge, their skill set, their. The village they've got around them, the support seeking, staying in therapy, all that Sort of stuff just helps buffer all of it beautifully. And we avoid things like postnatal depression and stuff like that. I think where clients can struggle is if they've not had access to treatment and then something like that happens. You've not only got the hormone. The craziness of hormones happening, but also the lack of knowledge of what. What's going on as well as a lack of support with maternal and child health nurses and whatnot in terms of not necessarily being able to pick up on ocd. Yeah. It's getting better now, but it's always tricky.
Dr. Tori Miller
Yeah. Really tricky.
Dr. Celine Gelgich
Yeah. So that. That's a tricky. That's a hard one. But I also find it harder for dads to. Because they're more likely to present after.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
Than they are before.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
Whereas with women, I think we can get them in a little bit earlier. But that's an obvious example.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
But if you've been. Another one might be if you've been working with someone who's transitioning to high school, for example, or heading into vc.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
Meaning, you know, end of high school exams for those people that don't know what VC is, it might be another discussion to have.
Dr. Tori Miller
Agreed. Agreed.
Dr. Celine Gelgich
Starting a new job. Yep. All those sorts of things.
Dr. Tori Miller
Yep, agreed.
Dr. Celine Gelgich
Yeah.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
It's an interesting topic, I think, to kind of hold in an interesting theme. Not theme, but like an interesting, like aspect of therapy. Aspect of therapy. Thank you. To hold in mind. Yeah. But one that's very valuable.
Dr. Tori Miller
Yeah. Agreed.
Dr. Celine Gelgich
Yeah, agreed.
Dr. Tori Miller
Glad we talked about this today.
Dr. Celine Gelgich
Me too. Short and sweet today, I think.
Dr. Tori Miller
Sweet.
Dr. Celine Gelgich
Yes.
Dr. Tori Miller
Yeah.
Dr. Celine Gelgich
Hopefully you guys found that really helpful. Thank you so much for watching and listening. Please don't forget to subscribe. Please don't forget to subscribe and we'll catch you next time.
Dr. Tori Miller
Bye. Lifelock. How can I help? The IRS said I filed my return, but I haven't.
Podcast Advertisers/Narrators
One in four tax paying Americans has paid the price of identity fraud.
Dr. Tori Miller
What do I do? My refund though.
Podcast Advertisers/Narrators
I'm freaking out.
Dr. Tori Miller
Don't worry, I can fix this.
Podcast Advertisers/Narrators
Lifelock fixes identity theft guaranteed and gets your money back with up to $3 million in coverage.
Dr. Tori Miller
I'm so relieved. No problem. I'll be with you every step of the way.
Podcast Advertisers/Narrators
One in four was a fraud paying American. Not anymore. Save up to 40% your first year. Visit lifelock.com specialoffer terms apply
Dr. Celine Gelgich
acast Powers the world's best podcasts. Here's a show that we recommend.
Podcast Advertisers/Narrators
Do you like being educated on things that entertain but don't matter? Well, then you need to be listening to the Podcast with Knox and Jamie Every Wednesday, we put together an episode dedicated to delightful idiocy to give your brain a break from all the serious and important stuff. Whether we're deep diving a classic movie,
Dr. Celine Gelgich
dissecting the true meanings behind the newest slang, or dunking on our own listeners
Podcast Advertisers/Narrators
for their bad takes or cringy stories,
Dr. Celine Gelgich
we always approach our topics with humor and just a little bit of side eye. And we end every episode with recommendations on all the best new movies, books,
Podcast Advertisers/Narrators
TV shows, or music. To find out more, just search up the Podcast with Knox and Jamie. Wherever you listen to podcasts and prepare to make Wednesday your new favorite day of the week.
Dr. Celine Gelgich
ACAST helps creators launch, grow, and monetize their podcasts everywhere. Acast.com.
Episode: Developmental Patterns in OCD Onset and Flare-Ups
Hosts: Dr. Celine Gelgec and Dr. Victoria (Tori) Miller
Date: March 9, 2026
This episode delves into when and why Obsessive Compulsive Disorder (OCD) commonly emerges or intensifies across the lifespan. Dr. Celine Gelgec and Dr. Tori Miller, drawing from clinical experience and research, discuss the developmental and situational peaks in OCD onset and symptom flare-ups. They focus on the importance of understanding these patterns for better assessment, formulation, and treatment planning, including the necessity of contextualizing symptoms within life transitions and a client’s developmental trajectory.
“One of them, interestingly, is when puberty hits ... you might see a spike ... The next cluster is in older adolescence, so around 17 to 25... But then outside of that you've got life transitions.” — Dr. Celine Gelgec (02:29)
“They're starting to develop a sense of their own mortality ... there's a component of individuation ... that sort of kicks off existential thinking ... and existential anxiety.” — Dr. Tori Miller (05:08)
“So we can almost see it as like a maladaptive coping strategy or a maladaptive way to regulate that uncertainty and stress that comes in.” — Dr. Celine Gelgec (07:06)
“Being mindful of these life transitions is important because ... it will be really helpful to ... ask some of these questions ... where is this person developmentally different to their chronological age?” — Dr. Celine Gelgec (07:19)
“To put it in the developmental frame actually really can ease people's mind, can help make it understandable, but also understand why there are ebbs and flows in the intensity of OCD symptoms.” — Dr. Tori Miller (08:30)
“We can use that ... as a way to help normalize, but also get our clients or encourage our clients to reconnect with the value. Because ... OCD does ... use our client's values against them.” — Dr. Celine Gelgec (12:08)
“The theme will shape shift ... based on what transition they're going through and what moment they're going through in life.” — Dr. Celine Gelgec (13:23)
“We can also use it in an anticipatory way ... by providing additional psychoeducation ... to sort of normalize what kinds of changes that they might expect or might experience.” — Dr. Tori Miller (14:33)
“And just as important for dads as it is for moms ... just being mindful and asking those questions for them as well as for mums as well.” — Dr. Celine Gelgec (10:06)
“Clients who have been in treatment do so well after Bubs is born ... their knowledge, their skill set, ... the support seeking, staying in therapy, all that sort of stuff just helps buffer all of it beautifully.” — Dr. Celine Gelgec (16:01)
“Answering the question of why now?” — Dr. Tori Miller (08:25)
“We also want to be treating what the function is underneath ... and making sure that we're incorporating that.” — Dr. Celine Gelgec (14:26)
“Thinking about these aspects ... has helped OCD seem less alarming to me as a clinician ... which has enabled me to sit in the room and help my clients sort of unpack it too.” — Dr. Tori Miller (13:01)
| Life Stage / Event | Common OCD Manifestations | Clinical Considerations | |------------------------------------|------------------------------------------------|----------------------------------| | Puberty (8–13) | Existential worries, contamination, early rituals | Check for individuation struggles | | Late Adolescence (17–25) | Perfectionism, harm obsessions, ordering | Identity and independence themes | | Starting university / new work | Social themes, compulsive checking | Self-efficacy, fear of failure | | New parenthood (Mothers/Fathers) | Harm, responsibility OCD | Normalize anxiety, involve both parents | | Grief / Major loss | Rumination, reassurance seeking | Address attachment, loss, identity issues | | Any major life shift | Theme shifts (shape-shifting) | Proactive planning, psychoeducation|
Ending Note:
This episode is a valuable resource for clinicians seeking a nuanced, developmentally informed approach to assessing and treating OCD, emphasizing the importance of timing, context, and the client’s lived experience through transitions.