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The OCD Stories
Dr Steven Phillipson: Look at you looking at me, and other niche OCD spike themes (#488)
00:48:56
In episode 488 I chat with Dr Steven Phillipson. Steven is a licensed clinical psychologist who specialises in Cognitive-Behavioral Therapy for OCD. Steven is the Clinical Director at the Center for Cognitive Behavioral Psychotherapy in New York. We...
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- [00:00]
A
You're listening to the OCD Stories podcast hosted by me, Stuart Ralph. The OCD Stories is a podcast dedicated to raising awareness and understanding around obsessive compulsive symptoms. I do this through interviewing inspired therapists, psychologists and people who have experienced OCD. Welcome to the OCD stories and welcome to episode 488 of the podcast. And in this one I got back on Dr. Steven Philipson. Stephen is a licensed clinical psychologist who specialises in CBT for ocd. And in this episode we discuss the worries that come up around getting obsessed with others. Responses to us, what Steve calls look at you looking at me, olfactory obsessions, body dysmorphic disorder and other niche OCD spike themes, including worrying if your child is your child, worrying about a loved one having been abducted by aliens and replaced, worries about being in a simulation, worries about being God, worrying your partner is not the sexual orientation they say they are, worrying about catching someone's undesirable aspects of their character and much more. OCD can feel overwhelming, but help is closer than you think. NOCD provides expert led evidence based therapy for children and adults affected by ocd. With convenient online therapy from licensed specialised therapists and real time support between sessions, NOCD makes getting the right treatment easier than ever. Start your journey today@nocd.com or the link will be in the episode description. So thank you to Steve, as always, for his time and expertise. I deeply appreciate it and of course, thank you to you guys for listening. It means a lot. About further ado, here is Steve. Welcome to the podcast, Steve.
- [01:53]
B
Thank you once again, always a pleasure and always look forward to it.
- [01:59]
A
Yeah, it's good to have you back on. So we're going to talk about some niche spike themes today.
- [02:05]
B
Yep. Now with the title, which I would recommend being look at you looking at me, which is a not so common theme that people face challenges with and we can go over some of the foundational themes that create this preoccupation.
- [02:28]
A
Yeah, that'd be good. Let's start. You know, just give us a background in why you wanted to talk about this and how it shows up and.
- [02:36]
B
Yeah, sure, sure. I think, you know, every time we start it deserves reiterating. For anyone who perhaps hasn't heard prior broadcasts or even are just beginning to familiarize themselves with the topic, it's really critical to understand that the foundation of all OCD's themes is the emotional signal that ultimately manipulates and persuades a person to act in a desperate and undoing way to extricate themselves or neutralize or avoid these themes that are in sort of, to use a horrible word, reality. All mirages. But the brain is able to take the amygdala's emotional system and attach it to these extremely varied topics, creating an illusion of authenticity that very intelligent, very rational people are motivated by the emotions to behave in very, very desperate ways and very time consuming ways to undo these emotions. And just to forgive my redundancy, to reiterate that the six classic emotions of OCD are anxiety, guilt, shame, disgust, anger, depression. I think that was all of them.
- [04:12]
A
That was it, yeah.
- [04:13]
B
Okay, great. And, and so just keep in mind that, you know, everyone with OCD has this in common, that their brains imbalance, not their identity, is responsible for infusing this desperate sense of legitimacy to topics that are otherwise, you know, very, very irrational and meaningless. Basically.
- [04:44]
A
Yeah, yeah. Good, good. Important to reiterate that the first topic.
- [04:51]
B
Within the look at you, looking at me theme is one that I've come across occasionally. It's not definitely in the top 50 OCD themes, and I've basically found it with people who have a bit of. With some drug use in which their brain tells them that the residue effects of, let's say, a bad pot experience or a bad shroom experience or even some bad LSD experiences create a sense that a person's appearance has been in some way altered by these drug histories and that their appearance deformity, as it were, is witnessed by those around them. And so these people become very, very tuned in to extremely subtle cues of people around them, giving them evidence that, as they say, they're freaking out their audience. And so, you know, even looking at you now, I'm paying attention to your blinking frequency. And if I had this theme, my brain would say, oh, look, he's so disturbed by my appearance or freaked out by how weird I look that he's blinking rapidly because he can't handle a gaze, you know, to fix on me and looking at me. And so often these people will either engage in a significant amount of reassurance seeking or tragically, they often engage in tremendous amount of social avoidance. Because being around others who may, you know, present these evidences of the legitimacy that I was altered by these drug experiences in any little reaction that might occur substantiates the idea that the, the, the fact of the matter is this history is playing itself out in the way that other people react to me. Have you come across this topic?
- [07:08]
A
Not yet, no. It reminds me of what we talked about loosely, many years ago in altered states of consciousness.
- [07:17]
B
Yes, so in this regard it is altered states of consciousness, but more by proxy. So rather than the person being extremely introspective about all of the evidence of how they feel internally being evidence that their drug experience altered them, now it's the external data that provides them with a sense of threat and desperation. And so in the therapy with this particular type of form of ocd, you know, we would obviously do a lot of exposure based work in terms of going out socially, exposing yourself to many, many different facets of interpersonal involvement, and then actually looking for the evidence like I, I did about your blinking, which has slowed down significantly, by the way.
- [08:12]
A
I'm still, I'm pretty paranoid about it at the minute.
- [08:16]
B
Sorry about that. I'll be hearing from your lawyer soon, I'm sure. So, you know, so like, even, you know, if you leaned back, you know, there, there are many, many little subtle cues to detect, you know, that convey this confirmatory evidence that, you know, my, my appearance is having this negative impact on you. Other people I've worked with have a sense of their own internal social awkwardness and they feel once again that they freak others out around them by conveying like, as if, as if their anxiety were contagious. And so if I am experiencing panic or disorientation or a sense of being, you know, kind of off by my anxiety experience, once again, these people have almost a sense of the contagiousness that my awkwardness is going to be imposed on you and you will be a victim of my anxiety once again. These are by all means definitely not the top 50, but they're out there. And just to make a point that these types of themes can often be mistaken for social anxiety or public, public speaking anxiety when it's actually ocd. And you differentiate because rather than it being about, oh, you're judging me as kind of a loser, it's more that you're reacting to my offness in a way that shows me that, you know, I, that my concerns are validated.
- [10:03]
A
Okay. Yeah.
- [10:06]
B
So another very common expression of ocd. Well, not very common actually, but one of the more, more common of these very, very obscure themes is an article I wrote about probably 25 years ago. And the name of the article was arose by any other name. And it speaks about people with an olfactory obsession. This is a once again very unique subset of OCD where people believe that some part of their body is emitting some very noxious odor. And you don't really have to use your imagination too much to figure out what areas of their body might be responsible, whether it be their. Their underarms, their breath, or aspects of their groin, front and back, which. Which may be emitting these noxious odors that those around them are clearly reacting to by grimacing, squinting, or backing up. One patient I worked with who was absolutely convinced that she had bad breath and that everyone around her was picking up her bad breath and being very, you know, victimized by the odor of her breath. One time she was in an office and someone just turned on a fan to cool off, we assume, but her brain immediately said, oh, they noticed my breath. They turned on the fan in order to disperse the odor of my. My bad breath. So it gives you the idea. It's kind of like when our brain looks for evidence that that sort of substantiates these concerns, it will often easily find that evidence in very, very subtle and obscure reactions of others. So the next even more common subset of OCD is, and I'm sure you're very familiar with this, and I'm confident of your 8,000 podcasts, you've come across this at least two or three times, is body dysmorphic disorder. This obviously is where people have a sense of their gross deformity. Often maybe it might be to do with the angle of their nose. It might have to do even with the size of the pores on their face. It can be, you know, even amongst some men, it could be like hair loss. And for some people, I've even had people, you know, be very concerned about their thinness in this regard. It's not unusual that you'll see people exercising in the gym in a very excessive way, because according to their visual field, their body is kind of scrawny and skinny, and so they exercise like maniacs to kind of create a sense of bulk. They'll often take products to kind of bulk up. But in this regard, once again, they become convinced that others are noticing their grotesqueness. And this is, excuse me, not a very difficult subset of OCD to recognize, because what the person's brain is concerned about and then what you would actually notice are incredibly, incredibly divergent. So I actually have a crooked smile. If you see my. My lips go up higher on my right side than my left side. No one has ever noticed that. No one has ever said, steve, why do you have a crooked smile? But if I had bdd, my brain would tell me that the defect of my crooked smile was basically like a flagrant beacon of ugliness, and everyone is noticing it and reacting poorly to it. So once again, in this type of body dysmorphic disorder, you really kind of have other people's reactions that substantiate the idea of the person's belief that they are, you know, that ugly.
- [14:23]
A
Yeah.
- [14:24]
B
So I'm sorry, go ahead.
- [14:26]
A
Well, I'd say in the, the smile example, your brain would obviously extremely blow out proportion. You would see something that I wouldn't see. In your mind, would. I had this as a kid, my brain saw something that wasn't there, and for a couple years it was hell. But I could only describe it now as like a delusion. It wasn't a delusion, but I was seeing something that wasn't there. It was, you know, there's no other word I have for it. I wish I had a better word than that, but that's the way I could describe it.
- [14:58]
B
Well, it's interesting that you're using the term delusion because tragically, 40 years ago, amongst many, many mental health providers, many of these themes seem delusional. And many people were misdiagnosed as having a delusion and therefore as being psychotic or schizophrenic and were very much medicated with extremely inappropriate medications. One thing that's interesting is for people with olfactory obsession or body dysmorphic disorder, and even people with the idea that their drug history has kind of altered their appearance in a way that others notice and react to is these subset themes of OCD tend to be associated with what's called overvalued ideation, or another name is ego syntonic ocd. And in this regard, and this is the case where a person's depth of belief in the legitimacy of these topics go even farther beyond what most people with OCD carry some sense of the irrationality of the way that their brain is malfunctioning. But people with overvalued ideation, that line of delineation between it being kind of broken brain material versus a valid concern is very, very blurred. And that can make treatment success a lot more precarious.
- [16:40]
A
Yeah, interesting. I was going to ask you earlier, like, before you mentioned bdd, because the first niche topic you gave felt very much similar to bdd. How does it differ, do you think? The first one you gave me at the very beginning of the podcast versus bdd, because the first one, I'm still reading your blinking and thinking he's blinking too much, because.
- [17:06]
B
You often have these very specific pinpointed defects like the crooked smile or crooked nose or a blemish or, you know, even the idea of like a receding hairline might look extremely gross. But with the first topic with. You mean like the. The drug. The altered drug effect. See, in that regard, it's more of a facial expression than a pinpointed defect. So a person's, like, awkwardness would show up on their face more than some specific aspect of their appearance. It's kind of like, you know, a person's awkwardness is very, very discernible. And therefore, you know, it's very subject to. Being judged in a negative way is like being, like, a loser or weird. Whereas with body dysmorphic disorder, it's very clearly about the grotesqueness of appearance versus the awkwardness and the, you know, the. The defectiveness of one's demeanor. Okay, yeah, but that is a very, very important distinction. And another subset where the other person's reaction tends to be the foundational driving force of the spike theme. And we went over this is where people have intrusive thoughts that they're noticing another person's sort of inappropriate body parts. Even women noticing another woman's breasts or a man noticing a woman's breasts or someone looking at someone's crotch and being like, oh, my God. Boy, it just looked in the wrong place. And so, once again, like, you know, you'll. People like women will be adjusting their top constantly. And so people with this bike theme, you know, or even, like, they'll be lowering their skirt, people with a spike theme will be like, oh, my God. That's because they noticed me noticing them and are reacting to my, you know, creepy noticing or creepy attention to their inappropriate body part and are reacting to that. And so once again, the substantiation of these spikes comes in through the data of other people's reactions to them, you know, on a. On a very regular and chronic basis.
- [19:39]
A
Yeah. So all of these themes you're kind of giving are yet about the other person and the data they're giving me through their behavior. And I'm overthinking and reading into what they do. Obviously, with bdd, it's also, you know, the mirror checking and the Googling and all of that stuff, but.
- [19:59]
B
Exactly, exactly. Most like. Most with bdd, there's actually a really okay book about BDD called the Broken Mirror. Basically, you know, kind of outlining the idea that people with BDD literally can't see sort of. I hate using this phrase, but, like, objective reality, it's kind of very close to, like, anorexia nervosa. Whereas a person, predominantly women, see their body design as being excessively fat and engage in tremendous starvation to get control of that perception. But are the last people on the planet that can ever look in the mirror and have a kind of objective discerning of what's really going on with their body design. And the same thing with people with bdd, that they are not in any way the appropriate or acceptable judge of, you know, what their appearance actually is. And so, you know, you have to sort of, sort of suspend reality when you have these forms of ocd rather than trying to gain sort of a. An awareness or an answer that says, oh, these things are, you know, my illusion, they're not real. You know, I can see that even though I have a crooked smile, it doesn't make me gross or other people won't react to it like I'm some weirdo. A person just has to be like, okay, I'm going to give my brain total license to indicate to me that other people are being victimized by my broken appearance, other people are being victimized by my awkwardness or my anxieties, contagiousness. And I'm just going to kind of make room for the ideas that others, you know, are having these very, very negative impact based on these variables within myself.
- [22:12]
A
Good points. And I think it might be worth spending a couple of minutes on olfactory obsessions because it's not something that's ever really come up on the podcast and you mentioned it there as, you know, a part of my body might be emitting an odor. And there's something I experienced only for like a week, but it was, it was. And I wonder if this falls into olfactory obsessions. And I just want to talk about it in case it resonates with anyone else, which was in a flat I used to live in. I felt the bathroom was emitting a smell, almost like a chemically smell, but it was. I felt like something in the. Behind all the cabinets, the piping was dirty and I become. I became hyper fixed on this, thinking it was some sort of something that was dangerous, that could hurt me. Blah, blah, blah. For about a week, I couldn't think about anything else. As soon as I come home from work or in the morning, I was using all new cleaning products. I'd pretty much ripped all the cabinets out. I was. No matter what I did. And obviously this was in a bathroom without a window. So it was getting worse. The more chemicals I used, the worse the smell got to the point where my wife was like, I can't smell anything. But in my head it was the most pungent thing in the world. And eventually I had to just make peace with, well, you know, and it eventually passed, but I guess I'm just sharing that.
- [23:31]
B
So me. Yeah. And that's very interesting, Stu. Trying to think.
- [23:35]
A
I was very anxious as well.
- [23:37]
B
Yeah, I've heard. I've had patients who are constantly smelling like gas. And I don't mean our own bodies, methane. I mean, you know, like a gas leak. You know, I'm not sure if England uses gas for stoves or heating, but, you know, here we do. As a matter of fact, the front of my house, about. I'd say 15 meters away from my house, there was a gas leak right on the curb. And, you know, it was not near anything dangerous, but you could definitely pick up the fumes from the gas. And after reporting it for, like 10 times, it took, I think, 10 years for the gas company to come by. They would come by like, oh, yeah, there's a gas leak. But they had no concern about it because, you know, you could light a match and nothing was going to blow up. But so many of my patients will have just. What you're describing is this kind of olfactory obsession, but not about their own body emitting an odor, but just as you're describing, you know, that something in their environment, their. Their home. And I've worked with people, even with responsibility, oc, where if someone walked past my house and had OCD and was like, hey, I smell gas. They would have to knock on the door and be like, you know, hey, I. I smell gas coming from the front of your house. I need to warn you about that. So, you know, what you're describing is definitely. Especially since your wife confirmed that there was nothing that she detected. And it's funny because, you know, as is the beautiful part of the entire foundation of treatment for ocd, we. When you stopped fighting it, right when you acquiesced, okay, it's going to smell. I'm not going to do anything more to uncover the source of the odor, and you're just going to make room for it. The brain was just like, you don't need to be given the signal anymore. And so, you know, the brain lets go of its information. You know, the funny thing is, is that, like, body dysmorphic disorder, whether there is a profoundly faint smell or whether the brain is just sort of conjuring up its own, you know, kind of fabricated concern and their fabricated experience, you know, that is very much, you know, within that. That guideline. It's also interesting in terms of. You used the word delusion before, but, you know, tragically, the most severe form of schizophrenia is where people hallucinate odors. And so, you know, I'm glad that you didn't go to a psychiatrist and tell them that, you know, your wife doesn't smell anything. But you're sure there are these chemical smells from your bathroom and you're ripping out your cabinets because you probably would have been put on an antipsychotic because it does look very closely like that very tragic form of schizophrenia.
- [26:52]
A
Yeah, yeah, yeah. Thank you for talking about that. I just wanted to share that because it's not something that's come up and I know that many people probably have experienced that, so. But yeah, today what we're talking about.
- [27:04]
B
Volfactory, who had her bad breath and the fans being turned on because she was thinking of the room. And so this was like I said 25 years ago. And silly me, I leaned in and took a big whiff, you know, of her breathing out into my nose. And guess what, Stu, she had bad breath. No, not ocd, it's not real. Her breath is perfect.
- [27:37]
A
But equally, you might have smelt something, but it might have just been like, like, we all have bad breath from time to time. Like. But nothing. Like, in her mind, it was like she was pumping out fart.
- [27:47]
B
Right. You know, but the funny thing is here I'm telling her, you know, just once, you know, hey, I smell absolutely nothing. And she's totally convinced that I'm just being nice.
- [27:58]
A
Yeah.
- [27:59]
B
And me of all people, boy, she got that wrong. I'd be the first one to be like, well, you can brush your teeth and floss and maybe like scrape your tongue. I hear these things can be effective. But her dentist also regularly would do a check and not once did he say, you have bad breath. And yet, obviously we know that reassurance, no matter who it's from, doesn't quell the imbalanced brain.
- [28:27]
A
Yeah, yeah, exactly. Good point. So there, yeah, she was going to get dental checkups regularly, right?
- [28:34]
B
Pretty regularly. Just sometimes just stopping in and asking her dentist whether you could. I'm totally sure. I know that it's happening now. I know. Happening now. And he would take a whiff and be like, nothing so much.
- [28:48]
A
He charged for that?
- [28:49]
B
No, I.
- [28:51]
A
10 pound a sniff?
- [28:52]
B
No, no. She was a very, very lovely woman. And. And I'm sure he just took a two second sniff and was like, get out of here once again. Anyway, so, you know, that kind of wraps up on the, you know, look at you looking at me theme. If you have any other questions, I'd be happy to kind of delve into them. Otherwise I was going to bring up some of the even more obscure subsets of OCD that I've run into. What's interesting is, with pure O, as you're probably well aware, it's really limitless. The brain, as I say, ocd, is an energy that looks for a face. And so the amygdala is malfunctioning. And, you know, patients who are in recovery from one theme they will cite, they're aware that their brain is actually looking for a topic. They can actually feel the brain search for, I'm feeling off. What must be the justification for me feeling off. And so the brain will look for some topic and then attach the energy to. And that then becomes the new spike. And that really also reminds us clinicians that the topic is never the relevant part of this condition or treatment. It's all about having people manage the energy and demonstrate to the brain that that energy is inconsequential.
- [30:28]
A
Yeah, exactly. Forgetting my point now. But, yeah, if you go on to the other spike themes, that'd be great.
- [30:36]
B
Sure. So the, the first one I wanted to mention is, and I find, you know, it's funny because I, I say, you know, I think all OCD themes are sort of created equal because it's just this topic with this terrible energy. But the, the theme that I have the most empathy and, and concern or upset about is there are mothers who will have a spike that their baby was switched in the hospital and that they brought home the wrong baby. And think about, you know, breastfeeding or changing a diaper and looking at this child and the brain being like, nope, that's not your child, and not being able to kind of put out that fire, no matter how much you call the hospital or do a DNA test, whatever, that. That signal persists. So everyone will say, you know, it's the pedophile spikes that are the worst. And I think this is sort of even more insidious in terms of creating a kind of unescapable, you know, kind of uncertainty as to, you know, is this my child that I'm raising? Another similar topic is I have a patient who, when he is not making eye contact with his son, his brain tells him that aliens abducted his son and replaced him with this, you know, kind of droid. And so even though he looks the same and talks the same, his brain says, no, that's not my son. That's the alien replacement. So once again, it just kind of shows how endlessly creative the brain can be. And by the way, this is not in Any way, a crazy person, even though it sounds incredibly crazy, it's just, you know, the endlessness of the creative brain.
- [32:39]
A
Yeah.
- [32:41]
B
So, yeah, go ahead.
- [32:43]
A
Was going to say it's not that. I mean, if there's a kind of a. I guess it's a comedy called Resident Alien. I don't know if you've seen it. It's an American one. It's come out a few years ago. And season three, there's, there's. It's quite. Gets quite sad actually, in season three where it involves aliens, basically the bad aliens and there's good aliens in the TV show and the bad aliens, I won't go into it, but they abduct a kid or kids, and it's, it's quite sad. But I guess hearing his worry, it's, it's. You could, you could see something like that, that TV show and see how you could then fixate on that idea and. Yeah. Become focused on it.
- [33:25]
B
Yeah. Another sort of interesting theme are people who think that they're living a simulation and that sort of. They are the only people on this planet and everyone around them are fabrications of alien design. So I'm not sure if you've ever seen the movie the Matrix.
- [33:49]
A
Yeah.
- [33:50]
B
Where, you know, it turns out everyone's living this happy, happy life. And this select group of people figured out that all humans are actually plugged into some massive energy drain from their brain and that the actual Earth is like a catastrophic landfill of waste. And they sort of figured out that they're living within a computer code and that all everyone's living this illusion. And so that has also been a Spike theme. So one person can be living within the Matrix illusion. And I always tell those patients, don't go to sleep, because when you go to sleep, I stop existing since you've completely created me. And then I've also had people spike that they are a God and that they've created everything and everything around them is a fabrication of their, you know, omnipotent godliness. And once again, that nothing actually exists, you know, outside of their own perception. So these are also obscure. What's funny is that my Tuesday group, currently there are two people who apparently have created the universe. One is a God and the other one is just someone who is just kind of living this kind of mind dream reality and that there is no reality outside of his brain's creation. And so I'm always like, okay, which of you was really the one creating the universe? Come on, stand up. So it's, it's interesting that even that obscure theme exists twice within a 12 person group.
- [35:33]
A
Yeah. If that is true, at least they can end wars pretty quickly if it's all their creation. Win the lottery while you're at it.
- [35:43]
B
That's where I'm coming from. Yeah.
- [35:45]
A
No, it's a horrible theme, obviously. And I guess all of that kind of feels like it falls into like existential theme if we kind of boil it into like a main category. Exactly. Yeah. Existential stuff can get really far out there confusing. And especially if you listen to some of the philosophers that give you these varying views of existence and, and in films like the Matrix, like you're saying. Yeah, it can get really confusing.
- [36:13]
B
Yeah, definitely. Whether it be within philosophy or just the idea of like, you know, what is reality? Is there a God? What's like, what's the meaning of life? You know, it's interesting that these questions, which are, to my mind, very, very stimulating philosophical discussions for people with ocd. You know, you have to treat it like any other spike and just kind of leave room for the mass void of the unknown as to why are we here? Is there God? Is there certainty? Is anything real? And I mean, those are topics I would love to delve into. Unfortunately, when my OCD patients bring them up, it's a no fly zone.
- [36:57]
A
Yeah.
- [36:58]
B
So anytime you want to talk about that, Stu, definitely we could spend hours, you know, bending elbow on that one. Another unusual spike theme is the idea like, you know, the hocd, am I gay? And I've worked with people who spike that their partner is gay. So in that regard, you know, every little piece of evidence that looks somewhat not traditional from that other sexual, you know, becomes a spike. And, you know, obviously there can be a lot of ruminating and ritualizing trying to gather evidence. Is the person gay? Is the person not gay? So I call that HOCD by proxy. You know, the idea that the question lies within the other person's world and, and not within the OCD sufferer's uncertainty.
- [37:45]
A
Yeah. And I guess that can happen the other way. Right. Where, you know, two women worrying what the other one's worrying, well, is my partner heterosexual and interested in men? And yeah, yeah, I guess it goes across all the varying sexual preferences. Not preferences, you know, I mean, sexuality.
- [38:06]
B
Another one is, is my partner cheating on me? I had a. A patient who literally, while getting out of the car on the driver's side and her husband would get out of the car on the passenger side. Like, if she didn't see him for three seconds, her brain would be like, he just cheated on you, and you need to find out. So she obviously would engage in a lot of reassurance. She ended up getting a divorce, I think, because he sort of couldn't handle her endless scrutinizing and questioning. And her next boyfriend, the Brain, came out with, oh, is he cheating on me? And she used to, you know, hang out in his. He was a professional. She's a hangout in his waiting room, just kind of making sure that no attractive women were going in there. And. And so she would sometimes even just burst into a meeting, kind of look around, make sure nothing was going on. So, you know, once again, when a person gives into these desperate rituals, you know, it can be very, very disruptive.
- [39:08]
A
Absolutely. Yeah, 100%.
- [39:13]
B
I just wanted to just circle back on that concept of paranoia and just make a very clear differentiation that with ocd, the sort of seemingly paranoid theme, you know, is, is my husband cheating on me, or are these people looking at me like I'm weird? With ocd, obviously, there's a very clear energy of desperation to get an answer. And with paranoia, there is no question it is the answer. So the person who's paranoid has what's called a fixed delusion. And a fixed delusion means that this is their absolute certainty. There's no wavering about the possibility of these things being anything other than the truth. And they will, unfortunately, act often in a way that substantiates their reality that others are sort of out to get them or others are plotting against them. And so that's really a very important distinction from the OCD sufferer who's endlessly looking for the answer, versus a person with paranoid schizophrenia or even paranoid personality who sort of has the answer, and it's not really debated.
- [40:37]
A
Yeah, no, that's a good distinction. Thank you for clarifying. So any other. These spike themes you want to bring up?
- [40:45]
B
Let me do a quick check. I think I've covered the majority.
- [40:52]
A
But like you said, it's endless. Right? It's really based on each individual. As many as there are many individuals on the planet, there are probably that many worries, if not more.
- [41:02]
B
You know, probably not that many. But one. One more I just want to mention, sort of interesting is the idea of a contamination of a person's sort of identity or character. So I've worked with people where if I saw someone else as being, let's say, beneath me, even though I don't use terms like that, but, you know, if I'm. I'm. I'm thinking, let's say my next Door neighbor is a, what we call sanitation engineer or a garbage man. I'm not sure what you guys call it in England. The guy who picks up. What's that?
- [41:42]
A
Bin man.
- [41:43]
B
Bin man. Bin man. I've never heard that one. So let's say my next door neighbor is a bin man and obviously bin men are below me in stature. And so a person would actually have a spike that the person's kind of character has a contamination that can be transferred. And so the person's anxiety is that if they touch anything of these, you know, kind of beneath them humans, that they can actually catch that character, those characteristics and, and be, be sort of become that person once again. These are kind of more out there on the continuum. But I've worked with more than one person where someone else that they deem to be caricologically flawed, they then are afraid of being contaminated by their flawed nature.
- [42:38]
A
Yeah, yeah. No, it's interesting. I mean, I see that quite a lot with my teen clients. This sort of theme, it's not always so much social status. It might be that some someone is. They deem someone as a bit of an unruly kid who's a troublemaker and then they worry they're going to pick up those traits of that kid and become a troublemaker or whatever it is.
- [43:02]
B
Exactly. And it's funny you said that because the majority of cases that I've worked with with that exact spike theme have been mostly teenagers. So very interesting in that regard. It's more of a age related spike than it is a just common spike across the ages.
- [43:19]
A
Yeah, yeah. And yeah, I, I feel like caveating. I really like bin men because I think if they didn't do their job, bin people, it's always men down my street, but bin people, if they didn't do their job, we'd be in utter chaos and filth within a week. So it's like, yeah, really important job.
- [43:40]
B
Yeah, no, I certainly was not trying to be.
- [43:42]
A
No, I know you were.
- [43:43]
B
Yeah, yeah.
- [43:45]
A
There is that stigma in society though. Right. But it's actually when you think about it, such a critical job.
- [43:52]
B
Yeah.
- [43:52]
A
I'm grateful whenever people want to do it.
- [43:57]
B
So those are, for now, the unique themes on the OCD continuum. I think it's important that, you know, people recognize that, you know, OCD is not hand washing. As I occasionally still hear someone like, oh, you don't have ocd, you don't wash your hands or you don't straighten your shoes out or make your bed. So it's still a little Bit discouraging that OCD and perfectionism are still so confused within the general population.
- [44:30]
A
Well, and among many therapists as well. Non ICD therapists, but therapists. Which is a shame. Okay. But no, it's good. I'm glad we talked about a lot of these varying spike themes. I'm sure it will relate to many people. So, yeah, I'll try and word it in the show notes as many people can Google it and find it as possible. So let me think of an end question. I can't think of one. So we just go, if you got another billboard, what do you want written on it?
- [45:10]
B
Another billboard? Oh, boy. Yeah. I would say that going to a psychologist, going to a mental health professional and an expert is not a sign of weakness, it's a sign of intelligence. So many people still, I think, particularly, sorry to say, in Europe, not that England is part of Europe, but what's that?
- [45:40]
A
Geographic. Geographically, we are. But not.
- [45:43]
B
Yeah, let's spit you guys off. Particularly the French. But, you know, many people, even in the rural parts of this country, you know, still think of mental health and mental health assistance as a sign of weakness. And, you know, like the Italians would say, only crazy people go to psychologists. So certainly I think that would be the billboard that it's not that crazy people go to psychologists, it's that intelligent people go to psychologists. So that's what my. That's what my latest billboard would say still.
- [46:18]
A
Yeah, yeah, I like that. There's still a lot of stigma around therapy. Right. And going to therapy. It's definitely way better in the young population I treat now, they're much more, at least in my area of this country, way more understanding, way more accepting of therapy. Still, sometimes there's a bit of shame and stigma, but a lot of the time they're okay with people knowing they go to therapy or, you know, it's. It's. So I think it is changing.
- [46:45]
B
Yeah. I would say in the New York area, many people sort of almost brag about going to their therapist and they. Many a dinner conversation is like, well, my therapist said X, so. But that's still sort of a small little enclave of the New York City area rather than, let's say Des Moines.
- [47:04]
A
Iowa, or shout out to Des Moines. Anyone listening?
- [47:11]
B
Yeah.
- [47:14]
A
Okay. So, yeah, thank you so much for coming on. Talking about these. These small. What would we call them? Rare or unusual or.
- [47:23]
B
I like your word.
- [47:24]
A
Niche.
- [47:24]
B
I really need that topic. So, you know, niche or less. Less common themes of ocd.
- [47:36]
A
Cool. Perfect. Niche. I like it. All right, thank you so much as always.
- [47:42]
B
I had a great time. As always. You're a very inspiring person to speak to. Every time I start a podcast with you I have this little mini panic attack. What if I run out of things to say and then we always pull it together and always go past the 45 minute mark.
- [48:02]
A
Thanks a lot Steve.
- [48:03]
B
Okay, terrific.
- [48:04]
A
Thank you for listening to this week's podcast and thank you to our Patreons who helped make this episode possible. And if you would like to find out more about Patreon and the rewards and benefits, then there will be a link in the episode description. If you enjoy the OCD Stories podcast and would like to support us, please subscribe and rate the show wherever you listen to the podcast. And thank you to NOCD for supporting our work. If you want to find out more about nocd, you can click the link in the episode description and quick disclaimer. Guys, this podcast is not therapy. It is not a replacement for therapy. Please seek treatment from a trained professional and until we speak, take care that.