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

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.

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.”

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.