Living With OCD

Summary

Short Wave Podcast Summary: Living With OCD

Episode Title: Living With OCD
Host: Regina Barber
Guest: Dr. Carolyn Rodriguez, Physician and Director of Stanford's OCD Research Lab
Release Date: June 10, 2025

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Understanding Obsessive-Compulsive Disorder (OCD)

In the June 10, 2025 episode of NPR’s Short Wave, host Regina Barber delves into the complexities of Obsessive-Compulsive Disorder (OCD) with Dr. Carolyn Rodriguez, a physician at Stanford University and the director of Stanford's OCD Research Lab. Approximately 2% of the global population, equating to around 163 million people, grapple with OCD, characterized by cycles of unwanted intrusive thoughts (obsessions) and repetitive behaviors (compulsions) aimed at alleviating the distress caused by these thoughts.

Dr. Rodriguez highlights the disparity between OCD’s portrayal in popular culture and its real-life manifestations:

Dr. Carolyn Rodriguez [00:51]: “Things like very ritualized hand washing or symmetry are often how OCD is shown in movies, but in reality, there's a lot more to it.”

She explains that while common depictions involve behaviors like excessive handwashing or a need for symmetry, OCD encompasses a broader spectrum of symptoms. For instance, she refers to OCD as the “doubting disease” to illustrate how intrusive thoughts can lead to debilitating anxiety and compulsive actions:

Dr. Carolyn Rodriguez [01:21]: “OCD is also called the doubting disease. So for example, an individual may be driving down the road and suddenly have an intrusive thought that they might have run someone over, leading to compulsive behaviors to check and alleviate that anxiety.”

Diverse Manifestations and Hidden Struggles

Dr. Rodriguez shares insights from her clinical experience, emphasizing the varied ways OCD can impact individuals. She recounts cases such as a college student whose obsession with perfection in homework led to academic struggles and life derailment, and individuals who conceal their compulsions, like wearing gloves to hide hands damaged by excessive washing. These examples underscore the profound and often hidden impact of OCD on daily life.

Challenges in Diagnosis and Treatment Initiation

A significant challenge in addressing OCD is the lengthy delay between symptom onset and treatment. Dr. Rodriguez reveals alarming statistics from her training:

Dr. Carolyn Rodriguez [02:59]: “On average, there's a 17-year delay between the onset of OCD symptoms and treatment initiation. And it's heartbreaking.”

This delay is often due to factors like lack of awareness, stigma, and the covert nature of many OCD symptoms, which prevent individuals from seeking help promptly.

Neurological Underpinnings of OCD

Exploring the scientific basis of OCD, Dr. Rodriguez discusses the brain circuits and chemistry involved. While the exact cause of OCD remains elusive, evidence points to dysregulation in specific brain circuits:

Dr. Carolyn Rodriguez [04:54]: “OCD is a circuit gone awry, involving the orbitofrontal cortex, striatum, thalamus, and back to the orbitofrontal cortex. This loop's hyperactivity is associated with OCD behaviors.”

Additionally, she highlights the role of neurotransmitters, particularly serotonin and glutamate, in OCD’s pathology. Current treatments primarily target serotonin reuptake, but her research is pioneering the exploration of glutamate as a novel pathway for intervention.

Expanding Research to Diverse Populations

Addressing the gaps in OCD research, especially concerning diverse populations, Dr. Rodriguez discusses her involvement in the Latino OCD Genomics Study. This NIH-funded initiative aims to include more individuals from Latin American and Hispanic backgrounds to ensure broader representation in genomic studies. She emphasizes the importance of combating stigma in these communities to enhance awareness and treatment accessibility:

Dr. Carolyn Rodriguez [06:32]: “Raising awareness for OCD in Hispanic and Latin American countries is heartwarming and crucial for both science and societal understanding.”

Criteria for Seeking Diagnosis and Treatment

Dr. Rodriguez outlines the diagnostic criteria for OCD, advising individuals to seek help if they experience obsessions and compulsions lasting more than an hour a day for at least a year, significantly impacting their social, occupational, or other important areas of functioning:

Dr. Carolyn Rodriguez [07:47]: “If obsessions and compulsions last over an hour a day for at least a year and interfere with daily functioning, it may be OCD.”

Effective Treatments: Therapy and Medication

The discussion then shifts to established treatment modalities for OCD. Dr. Rodriguez identifies two first-line, evidence-based strategies:

1. Cognitive Behavioral Therapy with Exposure and Response Prevention (ERP):

   Dr. Rodriguez explains ERP as a method to break the cycle between obsessions and compulsions by gradually exposing individuals to feared stimuli and preventing the ensuing compulsive response:

   Dr. Carolyn Rodriguez [08:24]: “ERP breaks the cycle by organizing a hierarchy from least to most feared stimuli, encouraging individuals to face their fears without performing compulsions.”

2. Serotonin Reuptake Inhibitors (SSRIs):

   Medications like sertraline and fluoxetine are standard treatments, often requiring higher doses and longer durations compared to treatments for depression:

   Dr. Carolyn Rodriguez [10:19]: “SSRIs are effective but need to be administered at higher doses for longer periods in treating OCD.”

Innovative Research: Ketamine as a Potential Treatment

In her quest to find faster-acting treatments, Dr. Rodriguez discusses her research on ketamine, a dissociative anesthetic under investigation for its rapid antidepressant effects. Her NIH-funded study compared a single intravenous infusion of ketamine to midazolam, a benzodiazepine used as a control:

Dr. Carolyn Rodriguez [12:22]: “We found that over half of individuals showed a statistically significant and clinically meaningful decrease in OCD symptoms with ketamine compared to midazolam, lasting up to three weeks post-infusion.”

While acknowledging that ketamine's effects are not permanent and long-term safety remains to be fully understood, Dr. Rodriguez is optimistic about its potential as a bridge to ERP and other therapies:

Dr. Carolyn Rodriguez [10:58]: “If we can quickly reduce OCD symptoms, it helps individuals engage more effectively with therapies like ERP.”

Future Directions and Hopes for the Next Decade

Looking ahead, Dr. Rodriguez envisions several advancements in the field of OCD treatment:

1. Leveraging Technology for Early Identification:

   Utilizing digital tools to detect OCD symptoms early and facilitate prompt treatment initiation.

2. Diversifying Treatment Options:

   Developing a repertoire of treatment strategies to cater to individual preferences and needs, moving beyond the one-size-fits-all approach.

3. Unlocking the Brain’s Role:

   Deepening the understanding of OCD’s neurological basis to create more precise, personalized treatments and predict treatment responses.

Dr. Carolyn Rodriguez [14:00]: “Unlocking the brain basis of OCD will allow us to make more precise treatments and understand who will respond to which treatment, reducing the time between symptom onset and relief.”

Conclusion

Dr. Carolyn Rodriguez’s insights shed light on the multifaceted nature of OCD, the challenges in its diagnosis and treatment, and the promising avenues of research aimed at improving outcomes for those affected. Her dedication to expanding research to diverse populations and exploring innovative treatments like ketamine underscores the evolving landscape of OCD management.

Produced by Rachel Carlson, edited by Rebecca Ramirez, with fact-checking by Tyler Jones.

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Notable Quotes with Timestamps

• Dr. Carolyn Rodriguez [00:51]: “Things like very ritualized hand washing or symmetry are often how OCD is shown in movies, but in reality, there's a lot more to it.”

• Dr. Carolyn Rodriguez [01:21]: “OCD is also called the doubting disease. So for example, an individual may be driving down the road and suddenly have an intrusive thought that they might have run someone over, leading to compulsive behaviors to check and alleviate that anxiety.”

• Dr. Carolyn Rodriguez [02:59]: “On average, there's a 17-year delay between the onset of OCD symptoms and treatment initiation. And it's heartbreaking.”

• Dr. Carolyn Rodriguez [06:32]: “Raising awareness for OCD in Hispanic and Latin American countries is heartwarming and crucial for both science and societal understanding.”

• Dr. Carolyn Rodriguez [07:47]: “If obsessions and compulsions last over an hour a day for at least a year and interfere with daily functioning, it may be OCD.”

• Dr. Carolyn Rodriguez [08:24]: “ERP breaks the cycle by organizing a hierarchy from least to most feared stimuli, encouraging individuals to face their fears without performing compulsions.”

• Dr. Carolyn Rodriguez [10:19]: “SSRIs are effective but need to be administered at higher doses for longer periods in treating OCD.”

• Dr. Carolyn Rodriguez [12:22]: “We found that over half of individuals showed a statistically significant and clinically meaningful decrease in OCD symptoms with ketamine compared to midazolam, lasting up to three weeks post-infusion.”

• Dr. Carolyn Rodriguez [14:00]: “Unlocking the brain basis of OCD will allow us to make more precise treatments and understand who will respond to which treatment, reducing the time between symptom onset and relief.”

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This comprehensive overview encapsulates the key discussions, insights, and conclusions from the Short Wave episode on OCD, providing valuable information for listeners and those unfamiliar with the disorder.

Transcript

[Regina Barber]

This message is from NPR sponsor Spectrum Business. From one employee to thousands, Spectrum delivers connectivity solutions at a great value for any size business. And it's all backed by the Spectrum commitment. Learn [e-mail] business. You're listening to Short Wave from NPR. Around 2% of the global population struggles with obsessive compulsive disorder, or OCD. That's roughly 163 million people who go through cycles of obsessions, these unwanted intrusive thoughts, images or urges and compulsions behaviors to decrease the distress caused by these thoughts. And Dr. Carolyn Rodriguez says the way it's often portrayed in pop culture, like the movie as Good As It Gets starring Jack Nicholson, a character might do.

[Dr. Carolyn Rodriguez]

Things like very ritualize hand Washington. Or you might see an individual who needs to have everything symmetrical.

[Regina Barber]

Carolyn is a physician at Stanford University studying ocd. She says these things can all be part of ocd, but they're often the only ways we see it manifested in the media. In reality, there's a lot more to it than symmetry and handwashing.

[Dr. Carolyn Rodriguez]

OCD is also called the doubting disease. So for example, an individual may be driving down the road and all of a sudden have an intrusive thought that, oh, maybe I ran somebody over. And that thought, as you can imagine, really increases anxiety to the point where then the compulsions kick in. They have to drive back to the site where they were and make sure that there isn't a ambulance there, police, or they might go home and check the news to see if there are any reports of somebody who has been run over.

[Regina Barber]

Now she's the director of Stanford's OCD Research lab, and she says there's still a lot of basics we have yet to understand about the condition. In her time practicing medicine, she's seen many permutations of the condition. She's met a student who has just started college.

[Dr. Carolyn Rodriguez]

He was stuck with writing and rewriting his homework, trying to make sure that it was perfect. And that led to him not being able to do well in his classes and really, you know, just derailed his life.

[Regina Barber]

And Carolyn's also seen people who wore gloves to prevent people from seeing their hands raw and red from washing.

[Dr. Carolyn Rodriguez]

And that's when it really hits you that, that this is something that people keep to themselves and are just going on in their day to day lives really profoundly impacted.

[Regina Barber]

Carolyn learned about OCD during her med school rotations and she realized how often people suffering from OCD and even medical health providers may not recognize the symptoms.

[Dr. Carolyn Rodriguez]

When I was in, in my training, one of the most sobering statistics that I saw was that on average there's a 17 year delay between the onset of OCD symptoms and treatment initiation. And it's heartbreaking.

[Regina Barber]

So today on the show, the reality of ocd, how it's managed and how scientists like Carolyn are looking to include more populations in their research and find new ways to treat it. I'm Regina Barber and you're listening to Shortwave, the science podcast from NPR.

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[Regina Barber]

So Carolyn, we're talking about OCD, obsessive compulsive disorder. What's actually happening in the brain of someone who's diagnosed with ocd?

[Dr. Carolyn Rodriguez]

Although we don't know the exact cause of ocd, there's converging lines of evidence suggesting that it is a circuit gone awry. And so you'll hear people talk about in the field of the orbitofrontal cortex, which is a front part of the brain that's important for gener thoughts, to the striatum, which is a deeper structure within the brain that's important for generating behaviors, and then to the thalamus, which is a relay station and then back to the orbitofrontal cortex. So this loop or corticostriatal hyperactivity can result and is associated with these kind of OCD behaviors. Then the other piece is the brain chemistry. So the main chemical messengers in the brain brain, are they making things go awry as well? And we know that a lot of the treatments that we currently have are based on serotonin reuptake inhibitors. And one of the emerging lines of evidence has been, you know, could it be glutamate the main excitatory chemical messenger in the brain. And so my research is really focused on glutamate.

[Regina Barber]

So there's still a lot we like, don't know when it comes to ocd. Right now there are gaps in populations on who we are looking at who have ocd. So, like, studies tend to be largely white, they're largely male, largely young, sometimes because we're taking college students. But you're looking at people within the Latin American community and having Hispanic ancestry. What are you finding?

[Dr. Carolyn Rodriguez]

Yeah, so I'm a site in an NIH funded study called the Latino OCD Genomics Study, and sites across the US and Latin America are looking to see if we can collect more samples of individuals with OCD from these backgrounds so that we maybe have a greater representation within genomic studies. That study is ongoing. I'm really excited about it. I think one of the things that is difficult in mental health more broadly, but also in Latin America and Hispanic countries is stigma. And it's just so heartwarming to see a group of scientists and researchers coming together raising awareness for OCD in Hispanic and Latin American countries. And I'm really hopeful that this will do a lot of good, not only for the genomics and the science, but also in terms of raising awareness of the importance of these issues in their home countries.

[Regina Barber]

Yeah, that's very important work. So, Carolyn, when should someone seek diagnosis and treatment if they think they might have ocd?

[Dr. Carolyn Rodriguez]

So individuals with obsessions and compulsions and part of the OCD diagnosis, if they have these obsessions and compulsions for greater than an hour a day for at least a year, then we consider that they may have obsessive compulsive disorder. Also as part of the diagnosis, it needs to impact and interfere with social or work or other important aspects of functioning.

[Regina Barber]

Okay, so when somebody is diagnosed, then you'd mentioned therapy and medication. Can you kind of walk me through these treatments?

[Dr. Carolyn Rodriguez]

So when somebody is first diagnosed with ocd, there are two first line evidence based strategies for treatment. One of these is cognitive behavioral therapy with exposure and response prevention. Or for shorthand, I'll use erp. So with erp, what you're trying to do is try and unlink the connection that individuals have with an obsession that causes anxiety and the need to do a repetitive behavior to decrease the anxiety. Because you can imagine if you have an obsessive thought, then you do a compulsion, then you feel better, then that tells the brain like, yes, you should have done that. That was a scary thing.

[Regina Barber]

Right.

[Dr. Carolyn Rodriguez]

So ERP breaks that cycle and so typically that's done by organizing a hierarchy from the least feared stimulus to the most feared stimulus. So I'll give you an example. So somebody with contamination, let's say they believe that the door handles have germs. You might take a tissue and just rub it. As a therapist, rub it across the door, and then gently rub it over the. The individual's pinky. And then encourage them not to do their compulsive behavior. That may be a little bit lower on the hierarchy. The very top of the hierarchy may be them putting their hand in the toilet at Grand Central Station. Right. So your reaction. Your reaction speaks volumes. Right. Which is this is a scary and hard thing to do for anyone, let alone somebody with ocd. But it's very, very difficult.

[Regina Barber]

They would have won at that point. Wow.

[Dr. Carolyn Rodriguez]

Well, it's effective. But from your reaction, I can see the challenge that we have as a field is how do you get somebody to do this really wonderful treatment when it involves doing the thing that you fear the most?

[Regina Barber]

Yeah. What kind of medications are there then?

[Dr. Carolyn Rodriguez]

Yeah, they're serotonin reuptake inhibitors. So these include things like sertraline or fluoxet. And sometimes one of the things that clinicians don't realize in treating with ocd, you need to have it at much higher doses for longer periods of time than you do in treating depression.

[Regina Barber]

And some of your work has been looking at potential future treatments like ketamine. It's a dissociative anesthetic, but more recent research has looked at its potential to treat things like depression and ptsd. What made you want to test it for ocd?

[Dr. Carolyn Rodriguez]

Yeah, so as a clinical researcher, I felt really frustrated. The treatment of OCD with serotonin reuptake inhibitors can take a long time, like two to three months for symptom relief. And even then, roughly half of patients will experience only minor symptom reduction. And similarly, with erp, it can take two to three months. It's very helpful, but sometimes it takes a long time and individuals are worried and concerned about doing the treatment. And so I really wanted to try and find a way to quickly reduce symptoms and to help have it be a bridge to these really wonderful therapies. If you can knock down OCD a little bit and get people to do erp, it would be wonderful. But you don't have to be in pain. Right. And so I identified glutamate as a potential pathway and novel medication strategy based on increasing evidence that glutamate plays a significant role in ocd and Also at the time there was really wonderful reports of ketamine having rapid antidepress depressive effects.

[Regina Barber]

Right. And the research has like mixed results. Right. It's not definitive treatment. In some studies with people with ocd, it hasn't shown any benefit. But you've seen some results in your work. Right.

[Dr. Carolyn Rodriguez]

With NIH funding, we completed a five year study looking at a single infusion of IV ketamine compared to midazolam. Midazolam is a drug class called a benzodiazepine. And it's given to people sometimes before, you know, surgery. Sometimes these are medications that make people feel more relaxed, they can feel woozy. And so given that ketamine has this side effect of feeling a little bit out of it, feeling a little bit dissociated, it serves, yeah, it serves as a better comparison then so that people can't tell as much that it is ketamine. It's not perfect. Got it. But it does blind things a little bit more. And what we found was that in a little over half of individuals, the OCD symptom reduction was statistically significant and different between ketamine and midazolam, where ketamine had this decrease clinically meaningful decrease in OCD symptoms. And further, what we found is when we continued assessing their symptoms using the Yale Brown Obsessive Compulsive Scale for up to four weeks after that initial infusion, there was a statistically significant separation between ketamine and midazolam out to three weeks and not four weeks.

[Regina Barber]

Yeah. It's gonna be really interesting to see if these effects can be widely replicated. Right. And safely continue for long term use. So what would you want to see from the field in the next 10 years?

[Dr. Carolyn Rodriguez]

One thing I'd like to see from the field in the next 10 years is using technology to support clinicians in trying to identify OCD symptoms as soon as possible and being able to offer first line treatments. Because half of people will be helped by just trying one of these first line treatments of medications or therapy. And then for people who are not helped by these first line treatments, I'd love to be able to, to understand how we can relieve OCD symptoms quickly, how we can diversify our current tools. There's not one size fits all. Not everybody is going to want to do ERP because they are afraid. How do we build bridges so that people can get the most out of these treatments? And finally unlocking the brain basis of OCD so we can make even more precise treatments and even be able to understand who will respond to which treatment so that we can really greatly reduce the amount of time somebody has between symptoms and symptom relief.

[Regina Barber]

Thank you, Carolyn. Dr. Rodriguez, thank you so much.

[Dr. Carolyn Rodriguez]

Thank you. It was such a pleasure to be here.

[Regina Barber]

This episode was produced by Rachel Carlson and edited by our showrunner, Rebecca Ramirez. Tyler Jones checked the facts, Maggie Luthar was the audio engineer, Beth Donovan is our senior director, and Colin Campbell is our senior vice president of podcasting strategy. I'm Regina Barber. Thanks for listening to Short Wave from npr.

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[Regina Barber]

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