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Join us for an episode with guest Brandi Lawless, an associate professor of communications, as we delve into the misconceptions and realities of obsessive-compulsive disorder (OCD). Through her personal journey and expertise, Brandi challenges the popular notion of “being OCD” as a positive attribute and highlights the real anxieties experienced by individuals living with OCD on a daily basis. We explore the impact of OCD on mental well-being and the toll it takes on one’s daily life. With a focus on changing the conversation around OCD, Brandi shares insights on the importance of using language responsibly and understanding the difference between OCD and perfectionism. In the context of the COVID-19 pandemic, we discuss the rise in OCD cases and the need for increased awareness and support. Don’t miss this enlightening discussion that aims to break down stigma, foster empathy, and create a more compassionate society for individuals living with OCD.

Brandi Lawless is an associate professor of communications.

She discusses the KevinMD article, “Stop saying you ‘are OCD’ if you don’t have OCD.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Get CME for this episode by clicking on the CME link in the show notes. Today we welcome Brandi, a professor of communications, and the KevinMD article we’re going to talk about today is “Stop saying you ‘are OCD’ if you don’t have OCD.” Brandi, welcome to the show.

Brandi Lawless: Thank you.

Kevin Pho: So we’ll get into the article in a little bit. First off, briefly share your story and journey to where you are today.

Brandi Lawless: Sure. So, as you mentioned, I’m a professor of communication studies, and I’ve been at the University of San Francisco since 2011. Right before I started, my mom passed away from a drug overdose, and it caused a lot of anxiety, stress, and depression. I mentioned to some of my colleagues in my first year at USF that I had some things going on that I thought weren’t just depression or typical forms of anxiety, and I thought it might be OCD. But I didn’t know, because the typical perception of OCD is that you’re touching a doorknob 42 times or have to check that the stove is off, and I didn’t do those. Instead, I was doing things like checking my finances several times a day and transferring money from my checking to my savings account to make sure it was an even number.

But one of my colleagues said, “Well, is it enough that it is disrupting your daily life?” And when I answered, he said, “Well, then you need to go get it checked out by a doctor.” So I went. I was diagnosed with obsessive-compulsive disorder, OCD, and learned that it was an anxiety disorder, and it definitely came from my mom. Anxiety runs in our family, but when she passed away, it spiked for me in this particular way. And so I just started thinking about it more recently in terms of talking about it, accepting that it is a wider mental health concern, and sharing that story.

Kevin Pho: So you said that your symptoms were disrupting your daily life. How so?

Brandi Lawless: It meant that, like how many people feel an addiction to their cell phones and have to check them several times and wonder, “Would my life be better if I took a social media break?” it was kind of like that. But I had to stop and check my Mint account and see if two cents of interest had been added and if it would throw off the evenness of my account. Or one thing that also happened was that I started weighing myself several times a day just to see if my weight would fluctuate by 0.2 or something like that. I even mentioned to a therapist, “I don’t think that I have an eating disorder, but I think I easily could.”

So these sorts of things stopped me in my tracks several times a day. And then there was also thinking about the lack of logic behind them, thinking, “I’m smart enough to know that this is a problem, but I can’t stop it. Why is that?” And then I would ruminate on that as well.

Kevin Pho: So we see representations of OCD in mainstream media, as you said. But give us a definition. What is OCD?

Brandi Lawless: Well, it deals with obsession and compulsion. The obsessions are the thoughts behind something, and the compulsion is the act. So I might think several times a day about my finances, and then logging in to check them and make sure they’re OK and even is the compulsion.

One thing that I’ve been doing lately, in the last five years, after I was the target of a right-wing trolling attack, is that I Google myself several times a day. So my obsession is thinking about whether there is something new about me on the internet, and the compulsion is needing to check and scroll through the different articles about me to make sure there aren’t any new attacks. And so the disorder of it is that it kind of takes over the day and fuels anxiety.

Kevin Pho: And how were you diagnosed?

Brandi Lawless: So after my colleague said, “It sounds like you need to talk to a doctor,” I spoke with my primary care physician, who referred me to a psychiatrist. The psychiatrist said, “These are common ruminations. Let me be clear that this is an anxiety disorder, and it’s called obsessive-compulsive disorder,” and then asked if I would be interested in a prescription to help control that anxiety.

Kevin Pho: Good. How are you doing today?

Brandi Lawless: I feel good. I am on medication, and I doubled that during the pandemic, actually, because I had a spike in my symptoms. My doctor said that almost everybody who has OCD or other anxiety disorders doubled their medication during the pandemic. Right now I feel pretty good about it. I feel like with the increase in medication, things have leveled off. I also regularly see a therapist who helps me think through ways to catch those thoughts, recognize them, and then let them go.

Kevin Pho: Your KevinMD article is “Stop saying you ‘are OCD’ if you don’t have OCD.” Now tell us, how did your article come together?

Brandi Lawless: Well, I was talking with another friend who was also on the KevinMD podcast, who studies disability, and she tried to get me to think about this as a disability. As a white, middle-class woman, it was hard for me to say, “I have this disadvantage. This is a disability.” But she said, “We need to think more about mental health as disability.” And so we were talking more and more about our disabilities (hers is Crohn’s disease; mine is obsessive-compulsive disorder) and how people communicate to us. We’re both scholars of communication, right?

So when I think about how people communicate to us and how we communicate to each other, this is one common theme: One, people often say that they are OCD, and then, two, people think OCD is a superpower. The research on obsessive-compulsive disorder and some other disorders shows that there’s a hierarchy of mental illness, where people think, “Oh, well, that’s not that bad, because maybe it’ll just help you keep your house clean,” rather than thinking about the story that I told you with my colleague, where we talked about how this was interrupting my daily life and how it quickly became debilitating. So when people say, “I’m OCD,” because they like to keep a planner or they like to make sure that the picture frames on their wall are hung just so, it discounts the experience of people who are diagnosed with obsessive-compulsive disorder. So I’ve been thinking through that communication.

Kevin Pho: In mainstream media, what are some examples where OCD is misrepresented?

Brandi Lawless: Well, the one that first came to mind, which I mentioned in my article, is the old talk show scenario, like Maury. People would come on, and Maury would have these guests who say, “I can’t leave the house unless I check this 162 times,” and then they’d tail them with a camera going through their house, watching them touch the doorknobs or the stoves and things like that. And I thought that’s what obsessive-compulsive disorder was. And it is; that’s an example. I had to actually learn more about OCD on my own, because even when I was diagnosed, the different types of examples weren’t given to me, and I was like, “This doesn’t really make sense, but I’ll look into it,” right? So those representations of these extreme behaviors take away from the fact that there might be some things that seem pretty normalized or easily hidden for somebody who has ruminating thoughts, for example.

Kevin Pho: The distinction between OCD and perfectionism: Why is it important to distinguish between those two?

Brandi Lawless: People who are perfectionists call themselves OCD. They don’t have OCD. They don’t have a debilitating anxiety disorder, and they also don’t have to seek medical professional help. Distinguishing between the two helps the people who do need that to seek that professional help. I’m not a perfectionist. I have OCD, but I’m more about efficiency rather than perfectionism. And so I think that demarcating that from an anxiety disorder helps people who have any sort of anxiety disorder recognize it, seek help, and get treatment.

Kevin Pho: As you know, I’m a primary care physician. In the exam room, what are some things that I should look out for that may suggest the patient may have OCD?

Brandi Lawless: Instead of just thinking about these overt examples that I talk about as media representations or stereotypes, you might think about just breaking it down to: Are there obsessions, and are there compulsions? And they might be smaller, right? But that doesn’t mean that they’re not debilitating.

Kevin Pho: So what are some examples on, say, the smaller end of the spectrum that you would typically see?

Brandi Lawless: Like those related to eating disorders. I think eating disorders are often linked to obsessive-compulsive disorder because it’s about anxiety and these ruminations, so weighing oneself, tracking calories, tracking food, those sorts of things. I’m not an expert on other types of obsessive-compulsive disorder, but I have heard examples in an online support group where anxiety emerges around parenthood and the concern that something’s going to happen to somebody’s children. So they’re constantly worried about them, calling their school, checking in on them, not letting them do things. So these obsessions that seem maybe like just extreme parenting might actually be a mental health disorder.

Kevin Pho: Now, what about from the patient side? Because you mentioned things like tracking and periodically weighing themselves, and this is something that a lot of people do. What would be an example where this can cross into something that requires further professional help?

Brandi Lawless: I think for myself, and I can only speak for myself with these examples, it’s when it wasn’t just a one-time-a-day thing, when it happened multiple times a day, and then that becomes abnormal, right? When you ask around and talk to your friends, they’re doing their bullet journals and doing their habit tracking, and it’s at the end of the day, one time, whereas I’m thinking about it all day long. The other thing is, if I forget to do it one day, I’m crushed, and it brings on a different wave of anxiety. So it shouldn’t be that disheartening when you miss one of your ruminations.

Kevin Pho: So you mentioned that during the pandemic, you had to adjust your medication. Talk more about that, about how the pandemic affected your OCD.

Brandi Lawless: For me, particularly, I had a spike in anxiety because I had a 16-month-old kid at home, which was really difficult. I had come out of postpartum depression, and the pandemic reminded me a lot of that time because it felt so isolating. When I had just had my son and I was trying to breastfeed, I found myself so isolated on the couch. Nobody could do for him what I needed to do. And so when I was once again isolated at home with just my son, it was like I came back to that all at once, and so my anxiety spiked.

And I’ve talked about how two things that I ruminate over are finances and weight, and of course, those were two things that a lot of people ruminated over during the pandemic: “Am I gaining my COVID-19 pounds?” and “Can I sustain a lack of security around my job?” So those two things hit hard. Once again, it just happened to be that the two things that I obsess over are the two things that everyone’s obsessing over. And so all of those combined to create this perfect storm of anxiety, and for me, that resulted in more obsessions.

Kevin Pho: We’re talking to Brandi Lawless, a professor of communications, and we’re talking about the KevinMD article “Stop saying you ‘are OCD’ if you don’t have OCD.” Brandi, what kind of messages do you have for people as it relates to how they should address OCD or how to involve it in conversation? What kind of messages do you have for us?

Brandi Lawless: Sure. So one easy thing is to follow the title of my article. Don’t say you are OCD. Instead, you can say, “I’m a perfectionist,” or, “I like things a particular way.” But you can also take the message that you can communicate differently to people who have OCD and not communicate to them as if they are superheroes. A lot of people say, “Wow, how can I get some of the medication you’re on?” or, “Wow, maybe I should get some OCD for myself.” Rethinking the idea that this is something that benefits me or benefits other people who have OCD is really important.

We can change our communication to be more supportive, and that might look like saying, “Oh, OK, wow. Can you tell me more about that?” Or somebody could say, “Is there something that I can do to help?” or, “I am sorry that you have this disability, that you’re experiencing this. I’m here to talk if you need.”

Kevin Pho: And my final question, Brandi: Tell us some take-home messages that you want to leave with the KevinMD audience.

Brandi Lawless: Sure. If you’re having these experiences multiple times a day, it might be time to talk to a medical professional. In addition, for those who don’t experience multiple ruminations, obsessions, and compulsions a day, please stop saying that you are OCD. Instead, you can say that you’re a perfectionist. You can think about other ways to communicate the stress that you feel.

Kevin Pho: Brandi, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

Brandi Lawless: Thanks so much for having me.