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Chances are, you know someone with Obsessive Compulsive Disorder. According to the National Institute of Mental Health, 1 in 40 people will develop OCD at some point in their life. But what is it, and why does it show up so differently in each person? Ricki speaks with Dr. Patrick McGrath from NOCD, the world’s leading provider of OCD treatment, about ways to support people with OCD, how mindfulness can help with treatment, and why we should stop using the term flippantly. This episode was sponsored by NOCD. You can learn about them at treatmyocd.com.

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Transcript

SPEAKERS

Ricki Lake, Patrick McGrath

Ricki Lake  00:02

This is The High Life with me, Ricki Lake, where we get to find out how my guests crack the code to living a full and vibrant life. So you can too understanding how our minds work is one of the big juicy topics that I personally find so fascinating. I am still learning very much about my brain and my way of thinking, and it has changed so much over the course of my life. I’ll admit, I’ve had a history of depression. When I lost my husband, I definitely went through some deep, dark times, and therapy has been so helpful for me. I actually started therapy when I was 24 years old, when I was starting my talk show, my executive producer had recommended it for me so that I was more in touch with my own feelings and ways of just communicating so that I would be a better host. And I have to say, I’m grateful that he suggested it all those years back then. Well, part of my understanding about mental health is understanding a whole range of conditions and illnesses. Take obsessive compulsive disorder, more commonly known as OCD, even though it doesn’t affect me personally, it certainly affects many people that I know. In fact, one in 40 people have OCD, and it’s also something that I’m super curious about. I’m so happy to have my guest here today to explore this. Dr Patrick McGrath is a licensed clinical psychologist with over 20 years of OCD treatment experience. Patrick serves as the Chief Clinical Officer of nocd, the world’s leading provider of virtual therapy for OCD. NOCD offers evidence based treatment for adults and children around the world struggling with OCD and related conditions, and they have sponsored today’s episode. Today we’re going to learn more about what OCD really is, how widely misunderstood and misdiagnosed it is, the difference in symptoms across age groups and how to treat it. Dr McGrath, welcome so good to have you.

 

Patrick McGrath  01:44

Well, thank you, Ricki, so great to be here and excited to chat about my favorite topic in the world. So let’s dig in.

 

Ricki Lake  01:51

All right, well, let’s get started with my opening question I ask all of my guests this, where are you getting your highs from right now? Like, what is bringing you joy lately?

 

Patrick McGrath  02:02

Wow, that’s an interesting question, especially today, on the eve of the anniversary of my wife’s death. Tomorrow, she passed away two years ago tomorrow, from cancer.

 

Ricki Lake  02:14

I’m so sorry.

 

Patrick McGrath  02:16

So I’ve been thinking a lot about that, actually. And tomorrow it will be going out for a meal that we used to enjoy together, and that is how I continue to celebrate her. Is to keep some of those traditions alive, of the things that that we used to do. So that will bring me joy. Even though it will be a day of remembering her, it will there will be joy tomorrow as I, as I go to a restaurant we used to go and get the meal we used to get.

 

Ricki Lake  02:42

I’m so sorry. Well, what is her name and what’s the meal, I have to ask.

 

Patrick McGrath  02:46

Susan Loic was her name and she loved sushi, so there will be some sushi tomorrow night on the menu.

 

Ricki Lake  02:55

Well, I’m glad to hear that will bring you some joy. All right, let’s talk about OCD. So set the record straight. What exactly is obsessive compulsive disorder?

 

Patrick McGrath  03:04

Sure, it is two things. It’s first an obsession. An obsession is a thought or image or urge that we experience that we might find to be intrusive or inappropriate. We may want it gone. We may think it’s bad, and so we try to neutralize it in some way. We try to make it go away through another thought or an action. And that thought or action is a compulsion, and when we do the compulsion, there’s a instantaneous kind of relief from the discomfort brought on by the obsession. That discomfort could be shame, guilt, anxiety, distress and anything like that. But then the clock starts ticking again, and now that thought or image urge pops back in your head and you have to do the whole thing all over, and you get that moment of relief, and be like, oh, good. And then OCD is kind of the jerk of a disorder that it is, says, All right, you got relief. Now remember, don’t think about that anymore. And boom, here we go again, and we do it. And people get stuck sometimes for hours and hours of a day in this loop.

 

Ricki Lake  04:05

Like give us an example, so we can all picture what what would be, because I know we all get obsessive. I obsess about certain things, but I don’t think I would be described as having OCD.

 

Patrick McGrath  04:15

So imagine driving and you hit a pothole and you go through the intersection and you think, Hmm, that sounded different than some other potholes. Maybe it wasn’t a pothole. Maybe I ran someone over. I’m going to go back around the block just to see if there’s a dead body there. And so you you go around the block and you don’t see a dead body, but you hit that pothole again, it’s like, oh, but, but maybe that time was the time that I ran someone over. So I’m gonna go back around the block again and see if there’s a dead body now. And you might do that 150 times before you’re convinced that you haven’t killed somebody.

 

Ricki Lake  04:55

And so what gets you out of that loop?

 

Patrick McGrath  04:58

The notion of feeling just. Just right, and that can change daily. Today, I might do something to the point of it being just right five times, and tomorrow might be 200 times. It’s it’s a moving target, unfortunately. And so people with OCD feel very stuck and and they’re they’re afraid of two things. They’re afraid of a day something bad doesn’t happen because it means tomorrow it’s going to happen. And they’re afraid of the day something bad does happen. Bad does happen, because it means, well, look, that thing finally happened, and I knew it was going to happen. So you’re kind of damned if you do, damned.

 

Ricki Lake  05:28

If you don’t. So what is the age that most people are diagnosed with this? Would you say it’s it starts with kids, or are there people later in life that find that they are suffering?

 

Patrick McGrath  05:37

Yeah, it’s a bimodal distribution. So we have the teenage years, like the beginning of teen and then toward the end of teenage years, or very often, the transition from grade to middle school or middle high school, and then the transition from high school to either college or apprenticeship or job. Those are, those are stressor times for people in the beginning. It’s also hormonal change times as well, too, and so that’s where we will see it. But yes, you can have a stressor anytime in your life and develop OCD. OCD does not discriminate by age.

 

Ricki Lake  06:06

Right, and where does it come from? Is it like one day these thoughts come through? Is it like an immediate change or and can you turn it off as quickly as it came?

 

Patrick McGrath  06:16

Well, we don’t know how to turn it off as quickly as it came, so we’re not there yet, hopefully one day through some genetic studies or things, I think we’re a good 100 years away from there, but I they are already working on trying to map it in the genes and everything. But it’s, it’s a very slow go kind of process. Where does it come from? Well, we know that, in general, one in 40 people will have OCD. And that means, you know, they may have a relative who has OCD. If they do, they had a 20% better chance of having OCD than than if it was just the general population. You may have an identical twin who has OCD. If you do have a 70% chance of having OCD, if they have it as well too. What does that tell us? Though, it’s not all genes, there’s environmental stressors and things that come along too. So all of us are a mix of the genetic makeup we have and the environment in which we live. And sometimes things just kind of hit at the wrong time for some things, and something might just develop and and be there.

 

Ricki Lake  07:20

And I would imagine, during the pandemic, did you see more cases of people suffering with OCD?

 

Patrick McGrath  07:25

We saw contamination cases, for sure. That was a trigger, but it was interesting. On the flip side, for anyone who had OCD, that wasn’t contamination, covid didn’t really bother them. I had very few people who said that that was an issue. They they would I would ask them. I’d say, how about covid? Any concerns, they’d say, No, I’m still worried. I ran someone over last week, and I keep going back to the to that intersection to see if there’s a dead body. So OCD can be so singularly focused on something that you might not get too distracted by other things.

 

Ricki Lake  07:55

So it’s very specific. So that person that thinks the pothole is actually a person that that’s the loop they’re in. It wouldn’t be anything else. Like, oh, a germaphobe, like someone, I mean, I think of Howie Mandel is like, sort of the is he, oh, is he a friend of yours? How does he describe what it’s like living, you know, where he doesn’t want to shake people’s hands, right? He’s, he’s a germaphobe. Is that? Is it safe to say that?

 

Patrick McGrath  08:18

Well, we don’t say the word germaphobe.

 

Ricki Lake  08:21

Sorry.

 

Patrick McGrath  08:21

No, that’s okay. I mean, we just say that’s his obsession, right? Is, is, what if something were to be on his hands? And his compulsion is, is to not shake hands. And he spoke very frankly about that when we were talking about it, and he describes it as it’s held to live with OCD. It’s absolutely awful. It’s not something he would wish on his worst enemy whatsoever, because you live life through kind of a screen, constantly seeing things that are dangerous or bad or awful out there, and it’s hard to filter that out. So instead, what do you do just in case that thing might happen? It’d probably be good to do a compulsion just to neutralize it.

 

Ricki Lake  08:57

Right, so how I mean, he’s so successful, you know, he’s had this incredible career. Everyone loves him. How does he manage it?

 

Patrick McGrath  09:05

Well, he described it in our interview, the fact that he is in therapy and he works on that with someone. So he he works on it every day, and that’s what we try to do with anybody that we’re treating who have OCD that we try to work on it every day. We want people doing homework all the time. If, if you go to a piano lesson and you only play the piano during the lesson, you only get a half hour better every week, right? We want you to practice every day after the lesson as well, too. And that’s what we want for therapy as well. So like I said, our therapy is more of a doing therapy than a talking therapy. If you’re afraid of something. I want you to do it so, you know, that person I talked about, who’s driving, I want you to drive and hit some potholes and not go back and check, you know, I want you to feel the discomfort of that and not give in to what the OCD wants you to do and learn that you can handle that.

 

Ricki Lake  09:55

And so when they do that, does this compulsion go away?

 

Patrick McGrath  09:58

It decreases. Significantly, yes. There. There may always be a thought or image or urge. We don’t know how to get rid of those yet. No one has figured out how to get you to stop thinking something. But we can teach you that just because you think something doesn’t mean you have to do anything about it.

 

Ricki Lake  10:14

I mean, I know I’m guilty. I’ll say something at times like, Oh, I’m obsessing about this. I’m so OCD about this. That’s offensive to say that, right?

 

Patrick McGrath  10:23

I’m glad you brought that up. It’s always a tough subject, because, you know, and once I tell people what I do for a living, they all say, Oh, I have a little OCD, you know. And, and it is a tough thing, because that really for people who have OCD, makes them think, well, if everybody has this. I don’t know why I have a problem with it, because everybody has it. Because everybody tells me they have it. You know, the other thing that happens in OCD, it’s one of the only, it’s the only condition I know of, actually, where people say, I wish I had a little bit of it. How many people during covid said, I wish I had a little OCD as a way to deal with the germs? Yeah. And I say this with all respect to everybody listening, but if I walked into a group of people who had weight issues and I said, Have you all considered anorexia, just a little bit of it, I would lose my license tomorrow. So it’s really tough when people with OCD hear, Oh, I wish I had some OCD, or I have a little OCD, because it really does say to them, it’s not really a problem, and in fact, it could be really helpful. You should be happy to have.

 

Ricki Lake  11:27

Wow, yeah, we got to really stop and really think about what our words mean and how they are interpreted by someone who’s suffering. There is more with Dr Patrick McGrath, after this quick break.

 

Ricki Lake  11:50

What got you interested in working with OCD patients?

 

Patrick McGrath  11:55

Well, I was very fortunate when I finished my doctorate to get a postdoctoral fellowship at the St Louis Behavioral Medicine Institute in their anxiety disorder program, and I was there for about a week and realized this is probably what I’m going to do for the rest of my life. And here we are, 25 years later now, and I am still in this field, doing work with people who have anxiety and obsessive compulsive disorder. I just felt that it was great because people could get better, and there’s a really amazing treatment, and the treatment fit my personality as well too. Instead of spending time with people talking about things, I spend time with people doing things, doing the things they’re afraid of, and learning how to handle the things they’re afraid of.

 

Ricki Lake  12:44

What makes OCD different than other mental health conditions?

 

Patrick McGrath  12:49

The neutralization with the compulsion is what what is really fascinating about OCD, the the fact that you can get this momentary kind of feeling of okay, relief, and then that, that it comes back, and that over time, it seems to just kind of grow for people as well, too. And it can get to a point where it can consume your entire day, where from the moment you wake up, you are stuck in loops of these obsessions and doing these compulsions.

 

Ricki Lake  13:18

So are OCD and like, phobias connected.

 

Patrick McGrath  13:22

Yeah, there’s, they can be anxiety based kinds of experiences, right? The thing with phobias is they don’t have compulsions. You may have other safety behaviors with compulsions, like, or with phobias, you may, you may avoid flying on a plane, or if you do fly on a plane, you have to bring a paper bag, a bottle of water, the rosary, you know, all these things with you. And because if you don’t, the plane is obviously going to crash. If you don’t have any of those things, and you’ll have the worst panic attack in the world and die. So you think that all these things are what gets you through the flight. And even when I’m working with people with phobias, I want them to do the things they’re afraid of without all of that stuff. Don’t bring anything with you. Just get on the plane and fly and learn you can handle that, and that’s what we want.

 

Ricki Lake  14:05

Can you be specific and tell us like a patient of yours, like give us an example of someone who’s been consumed throughout the day.

 

Patrick McGrath  14:12

There was a woman we treated who, when pregnant, had her baby shower and returned all of the gifts from the baby shower to the stores they came from in exchange for the same gifts, because if the gifts had gone to someone’s home and they had a cat, she was afraid about the contamination that you could get while you’re pregnant from kitty litter, and so just in case these people had cats, she didn’t want those gifts around her so she couldn’t accidentally get this parasite that could cause harm to her baby. After the baby was born, she did not hold or touch her child for the first six months of her child’s life, wow. And this was all out of fear of what if she were to harm her child in some way.

 

Ricki Lake  14:54

Wow, and then six months it just went away?

 

Patrick McGrath  14:58

No, she came to treatment. I. So the first thing I did was I ordered anatomically correct dolls, and I had her start holding the dolls, and I had her change the diapers on the dolls and practice those things. And then I had she had her mother move in with her, along with her husband. They were the ones taking care of the child. She was always six feet away from the baby, minimum, telling them, you know, do this now, do that, but she would not get any closer to the baby. So then what we did is we had every day, this was in an intensive program. I was working at Alexian brothers hospital in the Chicago area at the time, and so they came in for six hours a day for treatment in our partial hospital program. And her husband was outpatient. This was outpatient, but it was six hours a day of outpatient. Yeah. So we started with her being five feet away, and then four feet away and just progressively getting closer, and then holding her child’s hand. So she finally held her son’s hand for the first time. And then we had her start practicing changing her son. And then we had diaper changes, and we had mom on one side and her on the other, and they were doing it together. And she had a practice wiping. She did not want to go near her child’s genitals, thinking that was molesting her child. You know, that’s these are all the things OCD was telling her that she was doing. We knew that wasn’t the case, but OCD was saying, Ah, maybe, maybe you like this too much, or maybe, maybe you rubbed a little too hard, or something like that, and maybe, maybe your child liked it. And what does that say about you two? And and then finally, we got to a point after doing that where we had her son in in the at that point, we had, like, even a little crib at the at the office, because she was there for a while, so we had this little crib, so we had her son in the crib, and we said, Okay, we’re gonna be in the hall. We’re gonna have you in the room. We’re gonna leave the door open. And then every five minutes, we closed the door a little bit more and a little bit more. And then we finally closed the door all the way. Now, this was the first time she was ever alone with her child in a room by herself, without another person being there. And about a minute later, the door opened and she walked out carrying her child. And it was there was not a dry eye, let me tell you, in the hall, it was the first time she’d ever picked up her son and held her son, and it was about seven and a half months after he was born.

 

Ricki Lake  17:09

Wow, and did was she emotional during that time?

 

Patrick McGrath  17:11

Oh, everybody was, we were we lost. Everybody lost it. I mean, it was, it was crazy.

 

Ricki Lake  17:16

So was she cured then?

 

Patrick McGrath  17:19

Well beyond that, then she had to do other things. She had to be at home alone with her child, and she had to drive with her child and and she had to then do diapers by herself with the child. And then she had to have her mom not stay overnight. So her mom came during the day, but not over, you know. And then we decreased mom coming, and then it was just her and her husband. So there were still things that we did. And we stepped her down from the six hour program to the three hour program, and then into an outpatient program and then our support group. But, you know, it was so cool. Even a year later, she she’d come to the the once a week support group, and she’d have her kid in the stroller, and she’d be like, here […]

 

Ricki Lake  17:53

And where is this woman. Now, how is she doing?

 

Patrick McGrath  17:56

Last I saw she was doing fantastic. She was back at work. Her kid was, you know, almost a teenager. Yeah, doing great.

 

Ricki Lake  18:04

What a story. What a success story.

 

Patrick McGrath  18:07

That’s the kind of stuff I get to do, and it’s so awesome. I love my job. I love the stuff that I get to do, and I get to help people get their life back, which is amazing.

 

Ricki Lake  18:15

Wow now you call this treatment exposure and response prevention, right? ERP, can you explain exactly what that means?

 

Patrick McGrath  18:24

Sure. So we’re purposely exposing people to the obsessions, whatever those thoughts or those images or those urges are, and we’re having them not do compulsions. That’s response prevention. So if a compulsion is a typical response to the obsession, we want to stop that response. We want to do something else instead. So it could be the opposite of the compulsion. It could be just allowing for that thought or image or urge to be there, whatever it would be. But we want to teach people that they can handle the things that pop into their head, and they don’t have to live their life based on the fear we all have weird thoughts. I mean, I’ve treated so many people who are afraid of, what if I were to, like, push people down the stairs, right because.

 

Ricki Lake  19:05

Oh, so that’s normal to think like that.

 

Patrick McGrath  19:07

Oh yeah.

 

Ricki Lake  19:07

I sometimes think, what if I just drove off this cliff? Like, like, I’m oh no, yeah. You have, that’s a normal thought.

 

Patrick McGrath  19:13

Yeah, you’re a human. That’s what you are. You’re just a human, right there. I have so many intrusive thoughts every day because I’ve treated so many people who have so many intrusive thoughts that I kind of absorb them.

 

Ricki Lake  19:22

They give you the idea, yeah.

 

Patrick McGrath  19:25

There’s not a thing I do in life anymore without, oh, I could die there, or I could kill people there that, you know, disaster, this could blow up, or something like that. And I’m just like, Yeah, okay. And here we go, and I live my life, yeah, and that’s what I want everyone else to do.

 

Ricki Lake  19:38

What’s the card you carry in your wallet you have something about your parents?

 

Patrick McGrath  19:42

Oh, yeah, I was working with somebody once who who was very afraid of if they had a negative thought about their parents, that they had to say a prayer, because if they didn’t say a prayer, their parents would die by the end of the day. And. So I said when, when you are ready to have a thought about your parents and not say the prayer, you know that? Well, we’re going to work up to that. By the way, we do work up to it. It’s a hierarchy. We don’t, we don’t throw you in the deep end of the pool and tell you to swim. We we stick a toe in the water and we see how it feels. So first we had thoughts about his parents being harmed, and waiting a minute to say the prayer, and then two minutes to, you know? So we, we put some time, and when we got to the point where he was ready to not do it, I said, I’m going to join you. And I, I pulled a card out of my wallet, and I wrote down on the card, I hope my parents died tonight, Please, God and I put a 666, on the card. And I’ve had that card in my wallet for 18 years now. It’s still in my wallet to this day.

 

Ricki Lake  20:38

Wow, what as a reminder, or as a just a touchstone for the work you do.

 

Patrick McGrath  20:43

That a little bit. And I also said to him, If you ever see me again, ever on the street or at a conference.

 

Ricki Lake  20:49

I’ll have that card in my wallet, no way.

 

Patrick McGrath  20:51

And I wanted him to know how much I believed in the therapy that I was doing, that I made the promise to him that that card will always be in my wallet with me, and if he ever sees me, I’m still going to live without doing a compulsion.

 

Ricki Lake  21:04

Wow. And what would you say the success rate is with this type of treatment?

 

Patrick McGrath  21:08

It’s amazing. You know, over 85% of people see some relief from the OCD in doing the ERP. But you know, it requires doing the practice of it as well, too. You’ve got to face your fears. It it comes down to a very simple question, how do you overcome the fear of an elevator without getting on an elevator? And if you can answer that, Ricki, we’ll write a book together and make a billion dollars, because that’s what everybody would love. But right now, we know you’re going to have to get on the elevator at some point.

 

Ricki Lake  21:37

Wow, and as far as medication, like, are there? Like, I think of Xanax like an anti anxiety medication. Do you use that with your treatment?

 

Patrick McGrath  21:46

We’d rather go with the antidepressants, the SSRIs, especially for the anxiety disorders and OCD. The problem with the benzodiazepines like Xanax and Klonopin and things of that is they work too well. So if you, Ricki, come to see me and you take one and you say, All right, I’m ready to go do anything, we’re afraid of, you’re going to attribute the fact that you did it because you took the drug and not because you learned anything from my therapy with you.

 

Ricki Lake  22:12

So it could be like a placebo effect, even, right? Like in your mind, you think you’re okay, because of the crutch of this medication.

 

Patrick McGrath  22:20

Yeah, we, we call it state dependent learning. I learned that I can handle doing what I’m afraid of in a drug state, and now if I want to keep doing it, I have to stay in a drug state.

 

Ricki Lake  22:30

What about like beta blockers and stuff like that? Does that work?

 

Patrick McGrath  22:35

They’re better than the benzodiazepines. But I want people to feel the feelings, right? I really do. You know I mean it. If you think about OCD, going back to some of the things I described, like with harm, one person with OCD may have an intrusive thought that they think is the worst thing in the world. They have to do a compulsion. And someone else might write a horror film about that thought and make a million dollars and think that was the greatest thought I’ve ever had in my life. Look at the movie we made out of them again, the thoughts and the images and urges are not the problem. It’s it’s the way we react to them. And so I want people to learn how to react in a different way.

 

Ricki Lake  23:11

And not have it get in the way of your everyday life.

 

Patrick McGrath  23:14

100% you got it.

 

Ricki Lake  23:15

Now is it true that MDMA can help with with treatment?

 

Patrick McGrath  23:21

Could be lots of research being done on that, ketamine, psilocybin, there’s, there’s tons of psychedelic work being done right now to test that out. We don’t, we don’t have any, if you know, fully double blind research studies out yet, but they are definitely in the beginning stages of seeing what are some of the next wave of medications that might be influential in obsessive compulsive disorder.

 

Ricki Lake  23:44

And you said ketamine therapy has been useful.

 

Patrick McGrath  23:47

They’re studying it now. Yeah, there are people who have gotten some good results from it. But again, I’m waiting to see what some of the double blind studies will be. But anecdotally, I’ve seen people who have who have benefited.

 

Ricki Lake  23:59

Wow, I wonder, for your patience, is meditation, like part of it, and mindfulness and that kind of activity?

 

Patrick McGrath  24:07

Absolutely, yeah. You know, there’s a huge mindfulness kind of compo component to this, where we want people to do what you do in mindfulness, which is allow for something to be there and not have to try to make it go away. You know, it’s, it’s the leaves on a stream kind of thing. There’s the leaf, and there it goes. And that’s fine. I’m not doing anything to force that experience. Make it once we start doing that, that’s when things start to get all stuck, right? Because we’re, we’re trying to force a thought away or something, and again, you know, all I have to tell you is, don’t think of a pink elephant. And I bet you’re gonna think of, yeah.

 

Ricki Lake  24:43

I’m thinking of one right now.

 

Patrick McGrath  24:45

There you go. And that’s what happens with an obsession.

 

Ricki Lake  24:49

Okay, we’re gonna take a quick break. We’ll be right back with more. With Patrick McGrath.

 

Ricki Lake  25:03

How does OCD show up differently in women compared to men? Like, how do hormones play a role?

 

Patrick McGrath  25:09

Well, a couple of things. It could get worse around your period, so hormonal changes can lead to ups and downs in the presentation of OCD. So that’s one thing. If you’re a perimenopausal or menopausal, there’s hormonal changes too. So you may see rises and falls. It’s it’s an interesting disorder that seems to start in boys earlier than girls, but by the time that that we hit puberty, it evens out right. So those hormonal changes there were where we see that happening too. The other thing is that there’s perinatal OCD, which is, you know, very much, fears around what if I were to harm my child or even ingest something that could harm my child. That was like the case that I talked about. But interestingly, the spouse can get that as well, because having a baby is a stressor, and OCD loves a stressor. So I’ve worked with dads who have this OCD about harm coming to their child. They don’t have the hormonal change, but it’s the stressor having the baby, and that’s enough for them.

 

Ricki Lake  26:11

And what about postpartum? Like when you said the hormones like that can really I mean, I remember when I was a new mom having that tiny baby, and I, you know, I felt like, Oh, I’m gonna touch him too hard.

 

Patrick McGrath  26:22

Yeah, I’m gonna press my finger in the back of his head, just a little too heavy.

 

Ricki Lake  26:25

Yeah, that but that’s normal. That’s normal. Have those thoughts.

 

Patrick McGrath  26:29

Totally, yes, but OCD bastardizes normal and says Normal is bad in this situation. You You shouldn’t have that thought, Ricky, what a bad person you are for having it. You better do everything you can now to make sure you don’t have it ever again, because now that you’ve had it, we have this thing in OCD called thought action fusion, this idea that a thought or an image or urge is as bad as an action. So therefore, guess what, Ricki, thinking it is just as bad as doing it.

 

Ricki Lake  26:59

Wow, and what about relationships and intimacy. How are they impacted by with someone who has OCD?

 

Patrick McGrath  27:05

Well, since OCD attacks the most important thing in your life, if your relationship is the most important thing in your life, OCD, being the doubting disorder that is its nickname, will instill doubt and insecurity into your relationship. Do you know that you love each other enough? Huh? The neighbors seem to hold hands more than us. Does that mean they like each other more than us? I’ve even seen people who are of a religious bent, where they believe that even after they die, they are still married. And I had one person one time ask me, what if in 10,000 years from now, I’m not attracted to my wife the way I am today?

 

Ricki Lake  27:41

So obsessing about the future and going to that place and not being able to get out of that loop. How did you help that person?

 

Patrick McGrath  27:48

Well, we had to accept doubt and insecurity and be okay with I don’t know, right? And think about how many things we don’t know that we live with every day that we don’t care about. I mean, when, when I’m done with this interview, I’m going to walk upstairs. I could fall down the stairs, break my neck and die after this interview. It’s a possibility. But you know what? I’m still going to walk up the stairs anyway, and I’m not going to do any extra safety. I’m not going to crawl up the stairs or slither up I’m going to walk like I always do, and I might fall. I accept the fact that life is not 100% guarantee, and that no matter what I do, there’s some potential dangerous thing that could happen. OCD says that’s not acceptable. You need the guarantee of safety and security and certainty, and you must find it or else poop will hit the fan. So it’s control, really, there’s a ton of control, a ton of control. Yeah, you got it.

 

Ricki Lake  28:44

See, I relate to that honestly, like I, I do better when I feel like I’m in control of whatever it may be. You know, of late, it’s been about my my body and my my my losing weight, changing my physicality, doing, you know, because I, I felt like the world was so out of control with, you know, the State of Israel, and I there’s these, these, these factors I can’t control. And so my focus went into what can I control? And so I went on this kick to lose 40 pounds, and I did it, but like that maybe, I mean, I don’t know. I don’t know if that’s an OCD thing, but I’m just thinking about my behavior and my anxiety and how I was able to balance the anxiety with taking control of my my little world.

 

Patrick McGrath  29:27

Yeah, you know, I don’t want any kind of control to seem like it’s a bad thing, right? You set yourself a goal, you work toward it. You got it. Sometimes we overuse the word obsessive, and we think that it’s bad or in every situation, right? When I’m talking about obsessive I really am just meaning these intrusive thoughts, images and urges that people are having. So the thing for you, though, Ricki in that situation would have been if you felt like you somehow had to do things because you could be in control of the world. So if you Ricky, don’t knock on wood whenever you have a neutral. Thought that means a bomb goes off in Israel or in Palestine or something like that. It’s all your fault. You’re somehow in control of those things. That’s a magical type of thinking that we see in obsessive compulsive disorder, that it tells you that you singularly are somehow the conduit to all sorts of other bad things happening in the world. And as long as you do these compulsions, those things won’t happen.

 

Ricki Lake  30:26

Okay, let me bring up superstitions too.

 

Patrick McGrath  30:28

Oh yeah.

 

Ricki Lake  30:29

Yeah, how does that work in the in the world of OCD.

 

Patrick McGrath  30:31

Well, I have a I’m probably not supposed to hawk products. I apologize, Rick, but I have a new product coming out next week called block of wood, and you can just carry it around in your pocket. And when you need it, you take it out and you knock on it three times, and nothing bad will ever happen in your life because you’ve knocked on wood, and there you go. Or does knocking on wood actually do anything whatsoever? Or do we just think, well, it can’t hurt, so why not do it anyway? Right? And that’s kind of where superstitions come in. It can’t hurt. So let’s just in case. Well, OCD is just in case on steroids, right? You better do this compulsion, because if you don’t, then that thing could happen. So just in case, you should probably do this compulsion.

 

Ricki Lake  31:15

Wow, it’s so interesting. What brings a patient to you? Is it usually themselves, or is it their family or friends that are worried?

 

Patrick McGrath  31:23

We see all of it, right? They may read an article that we put out, or see some of our podcasts, or I do a webinar I’ll do tonight, actually, where people from all over the world just randomly throw questions at me, and for an hour, I have no idea what the questions are, until I get on and I just start answering them. People see that we try to put out a ton of content so people with OCD don’t feel alone and hidden. I mean, there, there are so many taboo thoughts with OCD, like I said about what if I were to molest my child? You know, what a what a taboo thought that is, and why? You know, you don’t see people just randomly going around. Oh, yeah, you know, I have this fear that I’m going to bless my child. No, they, they hide that. They hold that in so if we can bring this information out to people and get them to realize this is where OCD goes, this is what it does, then they feel more comfortable coming to us and saying, Yeah, I have that thought too. And then the nocd app is the largest community of people with OCD. We’ve got over 50,000 active users on there at all at any time, and they’re all telling their story, supporting each other and things of that nature as well, too. We want to break the stigma.

 

Ricki Lake  32:27

What would you tell someone whose loved one is resistant to getting help, but they clearly see that they need it?

 

Patrick McGrath  32:34

Well, it’s always an interesting discussion, because very often the loved ones, without knowing it, are involved in some kind of safety behavior with the person who has OCD. You know, I get calls all the time from families who say, our our kid has such contamination fears that we are forced to take all our clothes off in the garage and have to put robes on when we come inside, we can only use one bathroom. They use the other bathroom. We’re not allowed to have friends or family over. We have to wash our hands and take a shower when we come in the house and and I say to these families, so your your your daughter, your son, is in charge of the home then, and they sometimes they get offended, like, No, it’s my house. And I say, okay, well then go use the other bathroom. And they pause for a moment. They’re like, damn it, I don’t even own my own home anymore. OCD owns my home. It is in charge of everything, and so even if that kid is not interested in getting treatment, you have to have that family start to work toward not accommodating the OCD anymore, and that might be the thing that finally gets the kid into treatment. But if all you do is accommodate everything that OCD wants, why would it change? Why would it go away? It’s very comfortable there.

 

Ricki Lake  33:50

And OCD is your organization, and you believe that if you, if you go through this program, you can eliminate any OCD behaviors. You can there is a cure. Would you say?

 

Patrick McGrath  34:00

What I say is this, you can learn to live with whatever in your head, because some people will think of a cure as I’ll never have that thought or image or urge again and again. I don’t know how to do that. I There are memories of things that I have in my life that I wish I would never have again, but I haven’t even figured out to get rid of those myself, much less teach any of my patients how to do it so, so instead, what we talk about is OCD doesn’t have to be in the driver’s seat. You can be back in the driver’s seat, and you can learn to put OCD in the trunk. And it may try to knock once in a while and flare up, but you can, you can close the trunk again, and you can drive your life the way you want to drive.

 

 

Ricki Lake  34:38

What’s the one thing that I could do today to support someone with OCD?

 

Patrick McGrath  34:44

Be very open and honest with them about I accept whatever it is that pops into your head and recognize that those are things that you find ego dystonic. We say those are things that you don’t I don’t believe are your character, and I know you logic. Don’t believe your character, and I want to help you deal with the fear of, what if that is your character. OCD is a what if disorder. If you can, what if it? OCD is going to grab it and and, you know, no one’s ever done this. No one’s walked in my my zoom or office, and said, Patrick, what if? What if everyone loves me and thinks I’m great. You know, I’ve, I’ve treated nobody for that ever in 25 years, it’s always the worst case scenario.

 

Ricki Lake  35:25

Patrick, how has this work, this really rewarding work, impacted the rest of your life and the way you live?

 

Patrick McGrath  35:32

Once I learned about exposure and Response Prevention therapy, the idea that the best way to help people is to have them learn how to handle things instead of trying to provide things like diaphragmatic breathing and muscle relaxation and and benzodiazepines that make all of this go away, which which just seems to prolong it afterwards. And let me say, I have no issue with people doing diaphragmatic breathing and muscle relaxation. That’s fine, but not while we’re doing the therapy, not while we’re facing our fears. I want people fully engaged in the experience and and in doing that, that’s what’s been helpful the most, like I said earlier, you know, with with my wife passing away, the thing that I found the most helpful was following my own advice that I was giving to all of the therapy members that I was working with and and instead of trying to run away from the experience or hide or something like that. I was trying to be with her as much as possible. I didn’t turn to drinking or any drugs while I was with her. I wasn’t trying to numb myself or my feelings. I was working on accepting the feelings that I had and the pain and suffering that she was going through and and I think it led me to be there for her more than I would have been if I was trying to hide from the experience and run away.

 

Ricki Lake  36:45

Wow, I have to say. Dr Patrick McGrath, this has been an enlightening conversation. Thank you so much for your time and for the work you do for so many.

 

Patrick McGrath  36:54

It’s been awesome, I appreciate it. Thank you so much.

 

Ricki Lake  36:58

I really enjoyed and learned so much from my conversation with Dr Patrick McGrath. I honestly I never I used to use the phrase OCD a lot, and I know now that it is offensive to people suffering with that condition, and I will no longer say those words flippantly. Any of you listening, if you want more information, you can learn about NoCD at treatmyocd.com thanks to NoCD for sponsoring this episode, and thank you all so much for listening. There is much more of The High Life with Lemonada Premium subscribers get exclusive access to bonus content like rapid fire questions with Karamo, subscribe now in Apple podcasts. The High Life is a production of Lemonada Media. Isabella Kulkarni and Kathryn Barnes, produced our show. Our mixes by James Sparber. Executive Producers are Stephanie Wittels Wachs and Jessica Cordova Kramer. Additional Lemonada support from Rachel Neel and Steve Nelson. You can find me  @Rickilake on Instagram. Follow The High Life with Ricki Lake, wherever you get your podcasts, or listen ad free on Amazon music with your Prime membership.