Therapy for Black Girls: Session 425

Understanding OCD

Host: Dr. Joy Harden Bradford
Guest: Dr. Jameika Moore, Licensed Clinical Psychologist
Date: August 20, 2025

Episode Overview

This episode explores obsessive-compulsive disorder (OCD)—moving beyond stereotypes like “hand washing” or “neatness”—with a focus on how it affects Black women. Dr. Joy Harden Bradford welcomes back Dr. Jameika Moore, an expert in OCD, anxiety, and trauma. Together, they unpack the realities of OCD’s symptoms, its cultural nuances, the challenges of diagnosis, treatment options (especially Exposure and Response Prevention/ERP), family involvement, and resources for both clinicians and those seeking help.

Key Discussion Points & Insights

1. What OCD Really Is

• Intrusive thoughts & compulsions: OCD involves unwanted, intrusive thoughts/images/impulses that trigger significant distress, leading people to perform rituals or compulsions for relief.
• Not ‘just’ cleanliness: Dr. Moore emphasizes that OCD can attach itself to any area of life, especially the things we value most—family, relationships, or morality.
• Cycle of relief and distress: Compulsions temporarily reduce anxiety, reinforcing their use, but ultimately make the individual’s world smaller.

Memorable Quote:
“OCD is a liar, for sure. And it'll have you doing things in the best interest of the OCD and not in the best interest of your own life.”
— Dr. Moore [06:41]

2. OCD's Value System & Cultural Context

• OCD targets what matters most. E.g., a new mother may obsess about her baby's safety because of how much she cares, leading to avoidance and distress.
• Cultural lens: For Black communities, historical and contemporary stereotypes about “cleanliness” can shape the specific manifestation and focus areas of OCD (e.g., contamination fears).

Memorable Quote:
“When I say it attaches on a values level...if it's something I genuinely care about, then it's like, whoa, wait a minute.”
— Dr. Moore [07:52]

3. How OCD Develops

• Predisposition: There is a biological component (brain structures, serotonin) and possible genetic predisposition, but not everyone with the genes will develop OCD.
• Family modeling: Children may learn behaviors from family, but a predisposition is not destiny.

4. Presentations of OCD Beyond Stereotypes

• Subtypes: Relationship OCD, sexual orientation OCD, religious/moral scrupulosity, existential OCD (questions about meaning/purpose/reality), “just right” obsessions, and more.
• Relationship OCD Example: Constant doubts about a partner’s suitability, excessive reassurance-seeking, fear of moral failure.
• Religious OCD: Excessive, ritualized engagement with faith practices, often confusing true devotion with OCD-driven compulsions.

Notable Quote:
“Uncertainty is the core distortion of OCD. Essentially, people are struggling with intolerance of uncertainty.”
— Dr. Moore [15:17]

5. Challenges for Clinicians, Recognition, & Assessment

• Under-recognition: OCD is often missed if it doesn’t fit the typical “media” portrayal. Subtler forms (harm OCD, relationship OCD) go undiagnosed.
• Assessment tools: Clinicians should use structured assessments like the Y-BOCS (Yale-Brown Obsessive Compulsive Scale) and explore the full range of obsessions and compulsions.
• Self-assessment cautioned: Online checklists can be informative, but a diagnosis requires professional context.

Notable Quote:
“OCD is painful. It's not like, 'I wish I had a little bit of OCD.' People are struggling. It can be a pretty disabling condition...”
— Dr. Moore [30:02]

6. Trauma, Co-Compulsing, and Family Involvement

• Trauma’s impact: Trauma may interact with OCD, intensifying avoidance and compulsions; sometimes needs to be addressed before or alongside OCD treatment.
• Co-compulsing: Family/friends may inadvertently participate in rituals (reassurance, checking, etc.), reinforcing OCD.
• Supporting loved ones: Be aware of “co-compulsing” and focus on supporting the person without reinforcing the OCD. Set boundaries and resist the urge to “rescue” by providing constant reassurance.

Memorable Quote:
“If every time I ask you for reassurance, you give it...I'm just learning that this behavior makes my anxiety go down...so I'm going to continue to do this behavior.”
— Dr. Moore [33:32]

7. Treatment: Exposure and Response Prevention (ERP)

• Gold standard: ERP is the front-line therapy, not traditional talk therapy or standard CBT. It involves exposing the person to fears and preventing the compulsion.
• Not about talking: Talking alone can provide temporary reassurance but does not break the OCD cycle.
• Types of exposure: In vivo (real-life), imaginal (scripted scenarios), and interoceptive (body sensations).
• Treatment duration: Check-in and reassess around 12-20 sessions; aim is management rather than total elimination of anxiety/thoughts.

Memorable Quotes:
“ERP is about learning how to live with anxiety versus pure symptom reduction.”
— Dr. Moore [57:13]

“Be anxious and do it anyway. Be disgusted and do it anyway.”
— Dr. Moore [53:18]

8. OCD in Specific Populations & Situations

• Hoarding: Hoarding can be part of the OCD spectrum when focused on compulsions about keeping items “just right.”
• PANDAS/PANS: Pediatric autoimmune-related OCD linked to infections like strep. Important for clinicians to assess possible biological contributors.

9. Cultural Considerations: Superstition vs. OCD

• Many Black families engage in superstitions (splitting a pole, purses on the floor, etc.).
• Key difference: With superstition, not following the “rule” may induce mild annoyance but not lasting distress; with OCD, there’s high anxiety and perceived inability to continue without completing the compulsion.

Memorable Quote:
“OCD has a high level of distress around it...if the compulsion has to be completed or they're going to be very dysregulated.”
— Dr. Moore [52:22]

10. Resources & Next Steps

• For help:

  • International OCD Foundation (IOCDF)
  • ERP Kaleidoscope (especially for Black community and clinicians)
  • Consider specialist referral for trauma or pediatric autoimmune cases.

• Finding treatment: Look for ERP-trained clinicians.

• Clinician training: IOCDF and Knowledge Tree offer advanced ERP training.

• Affirmation for those struggling:

  • “You must be willing to risk. If you want your life back, you have to go get your life back. That means you have to take actions and steps.”

Notable Quotes & Memorable Moments

• “OCD is a liar, for sure. And it'll have you doing things in the best interest of the OCD and not in the best interest of your own life.”
  — Dr. Jameika Moore [06:41]

• “Uncertainty is the core distortion of OCD. Essentially, people are struggling with intolerance of uncertainty.”
  — Dr. Jameika Moore [15:17]

• “ERP is about learning how to live with anxiety versus pure symptom reduction.”
  — Dr. Jameika Moore [57:13]

• “Be anxious and do it anyway. Be disgusted and do it anyway.”
  — Dr. Jameika Moore [53:18]

Timestamps to Important Segments

• 03:48 — Introduction to episode theme & guest
• 05:38 — What OCD really is & Dr. Moore’s path to specialization
• 07:43 — OCD as a ‘value-driven’ disorder with illustrative example
• 11:04 — Cultural context: OCD and cleanliness in Black communities
• 14:00 — Various forms of OCD beyond stereotypes
• 15:17 — Deep dive into relationship OCD and “uncertainty”
• 18:08 — Religious/moral OCD and the challenge of support
• 24:04 — Importance of assessments and tools like Y-BOCS
• 33:11 — Impact of trauma & what “co-compulsing” looks like
• 35:10 — What ERP treatment looks like, with practical examples
• 42:45 — OCD's impact on relationships & family system
• 44:54 — OCD, hoarding, and distinguishing features
• 48:23 — PANDAS/PANS and medical causes of OCD
• 50:19 — Resources for patients and clinicians
• 53:18 — ERP affirmation and the necessity of risk-taking
• 57:13 — Duration, goals, and outcomes of ERP treatment
• 58:29 — Where to connect with Dr. Jameika Moore

Resources Recommended

• International OCD Foundation (iocdf.org)
• ERP Kaleidoscope (for Black therapists & clients)
• Training for clinicians: IOCDF, Knowledge Tree
• Dr. Jameika Moore:
  • Website: drjamore.com
  • Instagram: @jamsessionz

Takeaway Messages

• OCD is a misunderstood, often misdiagnosed condition that goes far beyond popular stereotypes.
• It attaches itself to a person’s deepest values and can take many forms—including around relationships, religion, or morality.
• Treatment with ERP is highly effective but requires a willingness to lean into discomfort and uncertainty.
• Family and social support are important, but must avoid reinforcing compulsions (“co-compulsing”).
• If you suspect OCD in yourself or a loved one, seek a culturally responsive, ERP-trained therapist.