People With Obsessive-Compulsive Disorder
I first started treating people with obsessive compulsive disorder early in my career. Most therapists cut their teeth by seeing quite a few different types of clients and I was no different. I was curious in the field and wanted to explore an array of modalities, diagnoses, and populations. They tell you when you are in grad school to pay attention to how you are feeling before your clients are coming in. Have you got somebody on your schedule that you're not that excited to see because you are feeling under equipped to actually help them or conversely, do you have clients on your schedule that you just can't wait to see because you know you're going to have a kick-ass productive therapy session? That's right, therapists get stoked to do some good therapy. It's like our version of a good concert.
And the latter is exactly how I felt when it came to my clients with anxiety disorders and especially those experiencing OCD symptoms. And if any former clients are reading this who are not having the OCD experience, I probably really enjoyed our therapeutic journey as well. But there was a different way that treating the symptoms of OCD is approached and I felt like it just really made sense to me.
I felt like I could sort of crawl inside their brain and understand the way that the obsessive thoughts were spiraling around. But in addition to feeling that I could help them with their compulsive behaviors, I just truly loved these people, and largely because I think they are so easy to love.
What I've Noticed
When you work with a specific population over time you start to see some of the patterns that exist within that population. For instance, most people with OCD had experienced the cycle of obsessions at some other point in their childhood, and it might have gone unnoticed or misdiagnosed. Or that some superstitious beliefs often came alongside their OCD.
But then you notice things as well that are sort of outside of the diagnosis, such as people with OCD tend to be quite intelligent. I am not sure if we've got any research showing that this is the case, but it sort of makes sense if you think about it. They spend so much time living in their heads that their brain has gotten a few more reps than the average person when it comes to thinking and analysis.
They are almost always very kind and sweet people. Again, think about it. So many topics within OCD come down to "I am afraid I am going to hurt somebody in some way." I've even had clients where their contamination/health was less about them contracting a deadly virus and more about them contracting it and accidentally giving it to somebody else.
In other words, "I can handle it if I get HIV, but the thought of unknowingly giving it to somebody else is too much to handle."
And while I could go on, the last thing I would point out is that they often tend to be more sensitive to some of the sensory experiences of life. We already know that there is a decent correlation with autism spectrum disorder and OCD. And like autistic individuals, people with OCD often have a higher reactivity to sound, touch, or visual stimulation.
Taking all of this into account we can already start to see the underpinnings of a neurodivergent brain and thus moving this diagnosis into the neurodivergent umbrella is far from a stretch.
OCD Neurodivergent Conditions
So to answer our initial question, if having OCD is a form of neurodivergence, we do not have a clear answer of "yes or no." We do not necessarily have an exact definition of how to define neurodivergent individuals. For the most part, people tend to think of this as having a brain that is "wired different."
The neurodiversity paradigm takes into account that variation exists across the human brain in regards to how information is processed. This can add some complication to our diagnosis, as when does one move out of having a neurotypical brain to having one become labeled as a neurodivergent person. I would argue that a better way to look at this is does thiss person exhibit neurodivergent traits? If we ask the question this way we can look at how one's OCD brain processes information.
Almost all of OCD stems in uncertainty. In fact, Dr. Patrick McGrath who is the clinical director of NOCD, says that anxiety can be boiled down to the words "what if."
And what ifs exist everywhere! There's no escaping them as they come up in daily life over and over again. And thus the brain has developed to be able to handle certain "what if" scenarios. But when you have OCD, it's not so easy. It's not as simple as just sitting with the uncertainty of what may or may not happen.
It's like taking one of those intrusive thoughts and tossing it in a dryer and watching it spin and spin around. In other words, the brain is processing the information differently than somebody who does not have OCD. And if we look at it this way, it points us to answering the question of whether or not OCD is one of the forms of neurodivergence with a "yes."
It's also important to note that having a neurotypical brain does not mean that it is better. Like I mentioned before, I love people with OCD. They're smart, sweet, creative, and interesting thinkers. And while I think most of them find some level of pain from the way that their brain works, there is often a certain brilliance that comes with it. They can see things from more angles than the average person and bring a number of different strengths to the table.
Diagnosis
One of the things that I hear from people from time to time is how receiving a diagnosis is actually something that is very helpful for them. I remember watching a video of an autistic person describing the day that they were actually diagnosed with autism as being one of the best days of their life! She described going through life noticing herself feeling different in social situations and noticing her peers having an easier time in social interactions than she did. For the longest time she just "there is something wrong with me." Receiving the diagnosis was helpful in letting her know that there is nothing "wrong" with her but there is something that exists that is different than the societal norms. Again, not better or worse, but rather different.
And understanding that difference can give us space to deciding if it is something that we want to work on and if gaining a certain amount of skills that may not be as innate will lead to a more fulfilling life.
Thus, to me, knowing if OCD is neurodivergence or not doesn't really change the scope of treatment. We are still going to use ERP (exposure response prevention) as the frontline treatment for helping people engage in less compulsive and repetitive behaviors and create space from obsessions. But for some people having this classification and embracing the neurological diversity might be a really profound step in their life. If there are thoughts we can align to that help us understand and love ourselves better, as long as they are not harmful to others, I am all for it.
I can of course understand if you are experiencing a certain condition and everybody just starts saying that they have it too, it could feel dismissive and invalidating. If coming to understand my mind as being a neurodivergent one has been helpful for me, I would probably not like hearing every random person saying that they are also neurodivergent because they like also feel uncomfortable in social situations sometimes. It's the same thing that happens whenever somebody finds out I'm an OCD therapist and wants to talk about the ways in which they are "so OCD." It's a guaranteed way to get me fired up.
But given the overlap in "different wiring" and cooccurrence that exists within OCD and other disorders such as autism, tourette syndrome, and attention deficit hyperactivity disorder, I feel comfortable fitting OCD into the umbrella term of neurodivergence.
Resources
If you are local to Phoenix and wanting additional support for your OCD treatment, look no further than our OCD Group! A weekly ERP group that is made to create community, and work on your OCD. If you are needing more than weekly support, our OCD IOP may be the right fit for you.
In our online membership we feature more psychoeducation like this, but in much more detail, all you have to do is start! We are here to support you, each step of the way.
