Summary5 min read

Podcast Summary: Get to Know OCD

Episode: Can You Really Have High-Functioning OCD?
Host: Dr. Patrick McGrath (NOCD Chief Clinical Officer)
Date: July 30, 2026

Overview

This episode explores the concept of "high-functioning" OCD, challenging the usefulness and accuracy of such labels. Dr. Patrick McGrath discusses why categorizing people with OCD as "high" or "low" functioning can be harmful and misleading, and emphasizes the importance of recognizing the internal struggles people with OCD endure, even if their distress isn’t outwardly visible. He also highlights the necessity of treatment, especially exposure and response prevention therapy, and encourages listeners to seek help regardless of how their OCD appears to others.

Key Discussion Points & Insights

1. The Problem with "High Functioning" and "Low Functioning" Labels

[00:00] Dr. McGrath introduces the topic by addressing how people often assess the severity of their OCD based on outward appearance:

“If you're holding it together, you might think that your OCD isn't serious enough for help. But I want to tell you why that could very well be a myth.”
He explains that the terms “high-functioning” and “low-functioning” originated as a way to describe perceived daily coping, but these terms can be dismissive of internal struggles.
He references the autism community’s push against these labels and extends this critique to OCD, advocating for a more nuanced understanding.

2. Internal Distress vs External Appearance

[01:00] Dr. McGrath refocuses the discussion on what matters:

“Let's move away from how you're functioning as high or low and just take a look at what is the interference that's being caused."
He warns against using labels to minimize one's own distress or compare it to others (“I’m doing fine, someone else has it worse”), recognizing the varied and fluctuating nature of OCD symptoms.
Quote:

"Some days we might be able to do just a few compulsions and get through the day. Other days it might take hundreds of compulsions to get through the day."

3. The Hidden Impact of Mental Compulsions

[03:00] Emphasis on the invisibility of mental compulsions:

“While somebody might appear fine on the outside, there could be a lot of things going on internally... someone might look to be not doing any compulsions when the reality is they're doing hours and hours of compulsions.”
Dr. McGrath highlights that mental compulsions don’t always manifest physically, making the level of distress difficult to recognize by others.

4. Consequences of Untreated OCD

[04:00] Dr. McGrath discusses the emotional toll of OCD:

“OCD can create shame and guilt and all sorts of things that affect people's self-confidence and functioning... could lead to even burnout where their level of functioning is just because they can't even focus anymore due to all of the things that are going on internally.”
He warns listeners that OCD does not resolve on its own and that it can worsen over time without intervention.

5. Treatment Works—For Everyone

[05:00] Dr. McGrath reinforces that you do not need visibly apparent compulsions to benefit from treatment:

“You don't have to have visibly apparent compulsions in order for treatment to benefit you. Treatment works for the mental compulsions also.”
He reassures listeners that internal suffering is as valid as external symptoms, stating:

“If you're suffering mentally, even though it doesn't look like it physically, you're still suffering and there is still help available to you.”

6. Self-Reflection: Whose Life Are You Living?

[06:00] Listeners are encouraged to evaluate their lives without using unhelpful labels:

“How is your functioning overall? Not putting a label of high or low on it, right? But am I living the life that I want to live or am I living the life that OCD wants me to live?”
He urges self-inquiry: Is OCD making life smaller, restricting enjoyment, or distancing you from loved ones?

7. Call to Action: Seeking Help

[07:00] Dr. McGrath emphasizes the importance of reaching out for professional help, highlighting exposure and response prevention therapy as the gold standard:

“If you're looking for help to start to take back some control from OCD, we want to help you do that with exposure and response prevention therapy, the gold standard of treatment for OCD.”

Notable Quotes & Memorable Moments

On Hidden Suffering:

"Someone might look to be not doing any compulsions when the reality is they're doing hours and hours of compulsions." — Dr. Patrick McGrath (03:15)
On Labels:

"Do we say that I'm high functioning today and low functioning tomorrow or something like that? I mean, that just sounds kind of strange if we would do that." — Dr. Patrick McGrath (02:00)
On Self-Determination:

“Am I living the life that I want to live or am I living the life that OCD wants me to live?” — Dr. Patrick McGrath (06:30)
On Seeking Help:

“Reach out to us here at NOCD.com. Our therapists understand the way that OCD affects you both internally and how it can appear externally... Start living that life that you want to live and not the life that OCD wants you to.” — Dr. Patrick McGrath (07:45)

Important Timestamps

| Timestamp | Segment | |-----------|----------------------------------------------| | 00:00 | Introduction to the myth of “high-functioning” OCD | | 01:00 | Critique of labels; focus on interference | | 03:00 | Invisible mental compulsions and internal distress | | 04:00 | Emotional toll, shame, guilt, and burnout | | 05:00 | Treatment benefits everyone, even without visible symptoms | | 06:00 | Questions for self-reflection | | 07:00 | Call to action: exposure and response prevention therapy |

Tone and Style

Dr. McGrath speaks with empathy, clarity, and encouragement throughout the episode. His tone is supportive, aiming to de-stigmatize invisible suffering and motivate listeners to seek help without shame.

Summary

The episode dispels the notion of “high-functioning OCD,” emphasizing that external appearances can mask serious internal struggles. Dr. McGrath encourages listeners to focus on the ways OCD interferes with their lives rather than how "well" they appear to function, and reassures listeners that help is available. He stresses the effectiveness of exposure and response prevention therapy for all types of OCD symptoms, visible or not, and urges anyone struggling to reach out and reclaim their life from OCD.

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Transcript1 lines

[00:00]
A
If you're holding it together, you might think that your OCD isn't serious enough for help. But I want to tell you why that could very well be a myth. We hear terms like high functioning and low functioning, and this grew out of our attempts to describe how people might be navigating their daily lives. But in recent years, people with conditions like autism have really begun to call out how these terms really unfortunately overlook people's internal struggles. And I think that we should do the same with ocd. Let's move away from how you're functioning as high or low and just take a look at what is the interference that's being caused. Right. When you're using terms to minimize or maximize symptoms like I'm doing fine, someone else has it worse. Maybe what we're saying is that functioning and freedom of from distress have some relationships to each other. Right? Well, OCD brings distress. Let's just talk about it from that level. Right? Some days the distress might be worse than others. Some days we might be able to do just a few compulsions and get through the day. Other days it might take hundreds of compulsions to get through the day. Do we say that I'm high functioning today and low functioning tomorrow or something like that? I mean, that just sounds kind of strange if we would do that. Also keep in mind that we don't always see the full impact of ocd. Why? Because while somebody might appear fine on the outside, there could be a lot of things going on internally. There are mental compulsions that have. And those mental compulsions don't always show just how extreme the OCD is going. Because someone might look to be not doing any compulsions when the reality is they're doing hours and hours of compulsions. Right. OCD can create shame and guilt and all sorts of things that affect people's self confidence and functioning could well could lead to even burnout where their level of functioning is just because they can't even focus anymore due to all of the things that are going on internally. We know this OCD is not going to resolve on its own and unfortunately often gets worse over time. Treatment can really help prevent that worsening and reduce the long term impairment that people with OCD have. You don't have to have visibly apparent compulsions in order for treatment to benefit you. Treatment works for the mental compulsions also, Right. If you're suffering mentally, even though it doesn't look like it physically, you're still suffering and there is still help available to you, you might think you're doing fine. Because you're not checking locks or people aren't noticing what's going on. And yet it could be difficult to go to work, go to school, function with friends, socially with family, any of that. So I want you to think about this. How is your functioning overall? Right? Not putting a label of high or low on it, right? But am I living the life that I want to live or am I living the life that OCD wants me to live? Is OCD influencing the choices that I'm making in day to day life? Is it costing me the ability to be at peace with who I am as a person or to be around people that I love or do things that I enjoy? Is my life smaller because of ocd? And if you find that that's the, that OCD is leading the charge and seems to be in the driver's seat, it doesn't have to be. And we're available to help you with that. If you're looking for help to start to take back some control from ocd, we want to help you do that with exposure and response prevention therapy, the gold standard of treatment for OCD. So reach out to us here@nocd.com our therapists understand the way that OCD affects you both internally and how it can appear externally. Book a call with our care team who's standing by to talk to you. We'll get all of your information. We take insurance and we'd be ready to help you get set up with a therapist who's expertly trained in doing work for ocd. Start living that life that you want to live and not the life that OCD wants you to. Reach out to us now. Thanks.