OCD Family Podcast

S3E145: Water Cooler Chats: When It Looks Like OCD... But Isn't (Exactly)

Host: Nicole Morris, LMFT
Date: August 2, 2025

Episode Overview

In this “Water Cooler” episode, host Nicole Morris dives into conditions that resemble—but aren’t exactly—Obsessive-Compulsive Disorder (OCD). She provides a practical, supportive breakdown to help families, loved ones, and practitioners differentiate between OCD and look-alike disorders. Nicole underscores the importance of a well-educated support network and the critical role of medical evaluation, highlighting how curiosity, teamwork, and advocacy can guide families through confusing or intense symptoms.

Key Topics and Insights

1. When It Looks Like OCD... But Isn't

Nicole opens by addressing the frequent confusion around symptoms that overlap with, mimic, or trigger OCD but stem from different origins. She emphasizes, "This isn't therapy and this will essentially be a drive through understanding so that you can advocate for your loved ones and think is this OCD, something else, or maybe both." (01:00)

2. PANS and PANDAS (Pediatric Acute Onset Neuropsychiatric Syndrome)

[02:00 - 06:30]

• Definitions:
  • PANS: Pediatric Acute Onset Neuropsychiatric Syndrome—acute, sudden-onset symptoms resembling OCD in children.
  • PANDAS: A subset of PANS, triggered specifically by a strep (streptococcal) infection.
• Symptom Profile:
  • Sudden, severe OCD-like compulsions, food restrictions, motor/vocal tics, abrupt personality changes.
  • "They went to bed my child or my sibling or my parent and they woke up a different person. It's worth looking into PANS or PANDAS." (05:05)
• Underlying Cause: Autoimmune, not psychiatric.
• Treatment:
  • Long-term, powerful antibiotics (not just typical short-course antibiotics).
  • Immunological therapies (anti-inflammatories, steroids, IVIG).
  • OCD behavioral therapies can help but are not enough on their own.
• Diagnostic Tip:
  • Even when there’s no apparent illness, testing is required. "Even stress and simple routine dental cleanings can trigger flares." (04:00)
  • Although considered pediatric, adults can also present with PANS/PANDAS.

3. Tick-Borne Infections and OCD-Like Symptoms

[06:45 - 09:15]

• Conditions:
  • Lyme disease and other tick-borne co-infections (e.g., Bartonella).
• Symptoms:
  • Psychiatric: OCD-like thoughts, sudden paranoia, rage, panic.
  • Neurological: Motor function issues; even sudden paralysis.
  • "This isn't just a product of anxiety and it's not all in their head though it is neuroinflammatory in nature." (07:45)
• Treatment:
  • Requires long-term antibiotics or antimicrobials and supportive care.
  • Must involve a "Lyme-literate provider."
  • Nicole expresses frustration at lack of resources and highlights an encouraging local change: "I was delighted to see an endocrinologist that we partner with here in town actually has a Lyme literate provider. But overall our resources are severely lacking." (08:45)
• Resource:
  • Nicole will post links on the episode’s blog for further information and support.

4. Eating Disorders vs. OCD

[09:30 - 12:00]

• Overlap and Key Differences:
  • Malnourished brains become obsessive, anxious, rigid—symptoms can mimic OCD.
  • "In most cases if it's not OCD, then once nutrition is restored and nourishment is achieved, those OC symptoms dissipate or disappear completely. If they stick around, that's a good clue that OCD has also crashed the party." (11:20)
• High Comorbidity:
  • Eating disorders are highly comorbid with anxiety disorders, including OCD.
• Further Learning:
  • Nicole references podcasts with Dr. Jenna DeLassi and Jenna Stone for in-depth exploration (episodes to be linked on the blog).

5. OCD vs. Psychosis

[12:00 - 14:30]

• When Severe OCD Gets Loud:
  • Intense intrusive thoughts (harm, sexual, existential) can look like psychosis.
• Key Distinction—Ego Dystonicity:
  • "OCD is ego dystonic, meaning that the person does not value that, does not want that, it's not in sync with their true intentions or desires. In fact, it's distressing AF and that is why they are so amped up." (13:05)
  • In true psychosis, "reality testing gets blurred and they believe the struggles that they're experiencing."
• Can Both Co-Occur?:
  • Yes—both can happen together, complicating diagnosis and treatment.

6. Action Steps: Advocacy, Teamwork, and Evaluation

[14:45 - 18:00]

• Why a Team Approach Matters:
  • "Similar behaviors and even thought processes can show up in very different conditions. Well, that's where finding your own team can be really helpful. And I emphasize and underscore team..." (15:00)
• Specialized Treatments:
  • OCD requires providers experienced with Exposure and Response Prevention (ERP), inference-based CBT (I-CBT), or Acceptance and Commitment Therapy (ACT).
  • PANS/PANDAS, tick-borne illness, and eating disorders require medical intervention alongside psychiatric support.
• When Severe Symptoms Happen:
  • If “OCD gets really loud… not able to sleep, not able to eat, not able to calm your nervous system down, you often at the very least need medication support. But really that comes from a proper medical evaluation.” (16:25)
• Encouragement for Families:
  • “Be curious, seek a team for evaluation and know that you’re not alone. There’s support.”
  • Nicole applauds PANS/PANDAS parent advocates: "Parents are fierce advocates. It’s so hard to see our loved ones battling intense, intense symptoms. But to the degree that we can slow down and build our team so that we alone don't have to figure it out, these can be really important pieces to the puzzle." (17:30)

Notable Quotes

• "They went to bed my child… and they woke up a different person. It's worth looking into PANS or PANDAS."
  — Nicole Morris [05:05]
• "This isn't just a product of anxiety and it's not all in their head though it is neuroinflammatory in nature."
  — Nicole Morris [07:45]
• "OCD is ego dystonic… it's distressing AF and that is why they are so amped up."
  — Nicole Morris [13:05]
• "Be curious, seek a team for evaluation and know that you’re not alone. There’s support."
  — Nicole Morris [16:45]

Additional Resources

• Further reading and support links for PANS/PANDAS and tick-borne illness will be provided on the blog accompanying this episode at ocdfamilypodcast.com.
• In-depth episodes on eating disorders and OCD with Dr. Jenna DeLassi and Jenna Stone also referenced for deeper learning.

Episode Flow: Quick Reference Timestamps

• [01:00] Main theme introduction: Why some conditions mimic OCD
• [02:00] PANS & PANDAS: Definitions, symptoms, treatment
• [06:45] Tick-borne illness: Lyme, Bartonella, psychiatric & neurological overlap
• [09:30] Eating Disorders: OCD mimics, comorbidity, treatment clues
• [12:00] OCD vs. Psychosis: Intrusive thoughts vs. loss of reality testing
• [14:45] Action steps: Building a support team, when to seek medical evaluation

Tone and Takeaways

Nicole delivers empathy, practical knowledge, and gentle humor, creating a sense of solidarity among listeners—a "you’re not alone" mantra throughout. She balances technical clinical explanations (“ego dystonic,” “reality testing,” “Lyme-literate providers”) with vivid, relatable anecdotes and actionable advice. Her constant encouragement for curiosity, advocacy, and “building your team” leaves listeners empowered and better prepared to distinguish OCD from “look-alike” conditions.