OCD3: Dr. Phillipson Talks Science, Symptoms & Treatment of OCD

Steve shares his journey into psychology, inspired by his father's legacy as a clinical psychologist. Initially considering a career as a dentist, he later pursued psychology, obtaining his major at Lynchburg College and a master's degree at Towson State University. His time at Johns Hopkins Hospital honed his scientific approach to human behavior. Steve's interest in OCD began during his PhD program at Hofstra University, where he encountered Dr. Gordon Ball, a specialist in OCD. This led to the establishment of the first OCD group for behavioral therapy in the NY area, sparking Steve's curiosity about intrusive thoughts and their impact on rational, intelligent individuals.

Steve delves into the complexities of intrusive thoughts, particularly within the context of OCD. He discusses the stark contrast between the intelligent and rational mindset of those suffering from OCD and their irrational behaviors and fears. Drawing from his training and experiences, he began to investigate the reasons behind the intense reactions to thoughts that the individuals themselves recognized as irrational. The narrative touches on the work of Edna Foa and her aggressive exposure treatment for OCD, focusing on observable rituals. Steve's interest in intrusive thoughts, especially those not accompanied by visible rituals, led him to coin the term 'Pure O' to describe this subset of OCD.

Steve explains the concept of 'Pure O', a term he created to describe individuals with OCD whose rituals are primarily mental, such as reassurances and logical reasoning, rather than physical. He contrasts this with the traditional understanding of OCD, which often focuses on observable rituals like handwashing. The term 'Pure O' has resonated with sufferers who felt misunderstood by the medical community and the media, which typically portrays OCD in terms of visible compulsions. The scientific term for this subset is 'non-observable ritualizers', but 'Pure O' has gained popularity for its clarity and distinction.

The conversation highlights the common misperceptions and misdiagnoses associated with OCD, especially 'Pure O'. Steve recounts how patients were often mistaken for having a psychosis due to the imaginative and distressing nature of their intrusive thoughts. He emphasizes the importance of proper training and understanding of OCD's various subsets to avoid such misdiagnoses. The discussion also touches on the personal experience of having intrusive thoughts and how they differ from the distressing and terror-inducing thoughts experienced by individuals with OCD.

Steve provides insight into the nature of intrusive thoughts, likening them to 'creative associations' that everyone experiences. The key difference lies in the reaction to these thoughts; while most people can dismiss them, individuals with OCD have a strong emotional response that triggers distress and the need for rituals to alleviate the perceived danger. He explains the concept of 'rituals' as efforts to neutralize or escape from these thoughts, which paradoxically reinforces the brain's alarm and perpetuates the cycle of anxiety.

Steve discusses the role of the amygdala in the brain's response to intrusive thoughts, suggesting a malfunctioning mechanism that triggers an emergency signal. This signal is paired with thoughts, creating a sense of danger and prompting an instinctual reaction to eliminate the perceived threat. He likens the process to the 'white elephant effect', where the more one tries to avoid a thought, the more it resurfaces. The discussion also addresses the ineffectiveness of seeking reassurance and the importance of understanding that the content of intrusive thoughts does not reflect a person's character.

The conversation turns to the path of effective treatment for OCD, emphasizing the importance of research and understanding the condition. Steve advises sufferers to seek out qualified specialists, particularly those with expertise in Exposure Response Prevention (ERP) therapy. He explains that ERP teaches the brain to recognize the irrelevance of intrusive thoughts through voluntary and repeated exposure, leading to habituation and a reduction in anxiety response. The discussion also highlights the importance of finding the right therapist and the potential of remote therapy through platforms like Skype.

Steve addresses the topic of OCD in children, noting the genetic component and the likelihood of the condition manifesting in a 'Pure O' form due to the shame associated with visible rituals. He suggests that parents should maintain an open dialogue with their children around the age of nine, discussing intrusive thoughts and anxiety. The summary also touches on the common behaviors in young children that may resemble OCD but are actually part of normal developmental processes to establish order and security in their world.

In envisioning the future of OCD discussions, Steve hopes for a clearer understanding of OCD as an anxiety disorder that is distinct from perfectionism. He emphasizes the importance of ERP as the treatment of choice and the desire to eliminate the stigma and mystery surrounding the condition. Steve encourages community involvement, whether through joining OCD support groups or participating in online forums, to foster a sense of camaraderie and shared experience among sufferers.