Why Is Managing OCD So Hard?

I was speaking with a worried mom about her daughter. The mom said, "I just don't get it. My daughter talks about her misery in living with unmanaged OCD. She says she wants to be freed from it. She knows what to do. The question is, why isn't she doing it?”

Well, in this blog, I'd like to share with you the three top reasons that it is so difficult to manage OCD. I'll also give you an idea about how you as a parent can create an environment that makes it easier to get to the other side of OCD. 

If you're like most parents, we would do everything in our power to help our kids get to the other side of OCD. This is a difficult medical conditions as you look at your child, you might have questions about why they're doing the things that they're doing. Why can't they just stop? Maybe you face some of the paradoxes of OCD? 

Today I'd like to offer the top three reasons that it's so challenging for your child to get to the other side of OCD. You're not going to be able to walk in your child's shoes or fully understand what it's like to have this kind of brain wiring glitch. 

However your child is on the extreme of a human experience. So the kinds of things that your child is dealing with, I bet that you're dealing with too. And as I look at my own son, learning how to manage OCD, I'm reminded of my own struggle with weight loss.

Let's dig into the first reason that it's so difficult to manage OCD. And that's neurobiology getting OCD is a biologic event. It's caused when there is a brain wiring glitch. We've spoken before about the fact that anatomically and physiologically, the brain has three parts. There's the reptile brain, this is the part of the brain that's active in life and death circumstances. There's the feeling brain, and then there's the thinking brain. 

The nature of the wiring glitch of OCD means that the reptile brain gets activated. So when your child is being held hostage by OCD, it feels like life and death. And in general, when the reptile brain is activated, we act. We don't want to take the risk of dying.

We evolved from cavemen and their main job was to stay alive and pass along their genes to the next generation. In order to be a survivor, they had to do certain things. One is that they had to be on the lookout for danger. 

Imagine a clan and there's a guy by the name of Spike. Spike is revered in the clan because he knows where all of the areas of danger are. 

Let's say there's another clan member and we'll call this person Shrew. Shrew is always reminding other people, “Look, when we find food, eat a lot of it, eat it fast, because we don't know where our next meal is coming from.”

There actually is a mammal called a shrew that spends most of its waking hours eating, it doesn't have any way of storing food as fat. And so if it goes longer than about an hour without food, it could potentially die. So we've also evolved into the kinds of being who can take those excess calories in store it as fat. 

The third thing that helped with survival is this message that look if food is limited, we've got to conserve our energy. So imagine a third clan member and let's call him Sloth. And Sloth says, “What are you doing dancing, come back into the cave relax. You want to save your energy for when it's needed for the next hunt.”

So these three people Spike and Shrew and Sloth contribute it to the survivorship of their clan. So they're our ancestors. These are three things that helped us be alive today. The problem though is that clearly we live in a much different environment, then the cave dwellers dead, and our brains haven't quite caught up with it. 

Imagine your child with OCD imagine carries around a Super-Spike.Spike was once revered for his or her ability to scan the horizon, look for danger and identify it. This quality that once conferred a survival advantage, now is a liability. 

You see what happens to your children with their hyper vigilance. Every time your child's internal OCD voice speaks up, they're activating this reptile brain. 

Well, here's the good news. We don't have to be held captive by our reptile brain. We can override the reptile brain with our thinking brain. This is the best way to manage this Super- Spike. 

As somebody who struggled with my weight for a lifetime, my first diet was an elementary school, I will tell you that I carry with me this Super-Shrew. I am always thinking about food. I'm always seeking food, I made my plans based on access to food. One of the things that I most feared was hunger. And, you know, you think about that what's so scary about hunger? t's just a feeling. Why have I lived so much of my life, trying to organize my relationship to food? But I will tell you that when I think about food deprivation, it feels like I'm facing life and death. 

So my Super-Shrew is really in control of my relationship with food. Just like the kid with OCD needs to basically cage Super-Spike, there are ways for me to cage Super-Shrew. 

Now, if you've set a fitness plan, and you haven't quite gotten there, you might be carrying around Super-Sloth. So when your alarm goes off in the morning, you're supposed to get up and go to the gym,  Super-Sloth might say to you. “Look, just rest, you can exercise later.” And that  Super-Sloth can get in the way of you achieving your fitness goals. So if that's been a problem for you, there are ways of managing your  Super-Sloth.

Just like our kids can learn how to manage their Super-Spike, or people like me with weight issues can learn how to manage their Super- Shrew.

 All right, reason number two, that it is so difficult to manage OCD is quite honestly the limitations of medical science and I say this as a physician. 

So let me just tell you this story about George Washington's death. He was very fit 67 year old, he was out on horseback riding through his acres came back and told Martha that he had a sore throat. She put him to bed. She called the doctors who gave the former president state of the art medical care. They bled about a half a pint of blood from him. 

He kept on getting worse. He talked about problems breathing, so they bled him some more. They gave him emetics that made him vomit, they gave him enemas. According to a medical historian, there was somebody there who's witnessing the breathing problems, and suggested this idea that maybe they could make a really teeny hole in the trachea like he had seen at Johns Hopkins. That was dismissed as experimental treatment. 

George Washington died within 21 hours of getting these symptoms. Medical historians think that George Washington died of strep pharyngitis. He had a bacterial infection with strep that caused a pseudo membrane to form in his breathing pipes. And basically he suffocated.

This experimental treatment that was rejected of doing a tracheostomy that probably would have been life saving. So George Washington got state of the art medical care. The problem is that it was the wrong care.

 I remember the first day of medical school, we were greeted. And we were told by the dean, I've got some good news and some bad news, at least half of what you're learning is right. The problem is, we can't tell you which half. 

So I look at my own issues with weight gain. So I've successfully lost weight on pretty much every diet. The problem, though, is when the weight loss is over the pounds re accumulated take a look at pictures of Oprah over time. 

What is the problem here? The problem is that we're dealing with the wrong model. The thought leaders in obesity medicine, who are helping real patients get real sustained results, say that weight loss is not about a calorie imbalance; it's about a hormone imbalance. And probably the most important hormone at play is insulin. So insulin keeps your blood glucose level. But it's also a hormone that tells your body to store excess calories as fat. Now, because we're eating so often, and we're eating so much sugar, we are all subjected to very high levels of insulin. 

If you want to lose weight, do the things that lower insulin. In so doing, your body will then turn to your fat stores for its nutritional needs. Your body will be dining in more, I am getting much, much different results. So thank goodness that I had access to this kind of information. 

What does this have to do with OCD? Well, as far as I'm concerned, OCD is pretty much a big black box. And our health care professionals really want to help all of us, but they're dealing with limited information. I missed my son's diagnosis of OCD by yours, because he had a flavor of obsessions that didn't have anything to do with cleanliness or orderliness. So I missed the diagnosis.

Your child might have gotten many different kinds of treatments that were about as effective as the treatments that George Washington got for a strep pharyngitis, they probably made things worse and not better. 

Think about how many medical conditions are treated without a lab test without imaging studies, yet, we diagnose a brain issue without brain imaging, it just doesn't make sense. Well, here's the good news for you, we actually do know what works. And that's ERP, I will leave a link below. If you don't know what ERP is, it's time to get educated.

I believe that it's going to get easier as more people like you educate yourself, get your child into the hands of people who are actually going to make things better. And then maybe you're educating your doctor who will be able to help the next patient in a better and different way. 

Again, I am not bashing doctors, I assure you that doctors go to work every morning, really wanting to do the best for their patients. And we're now in a time in medicine, where we're actually looking for the evidence that we're getting the kinds of results that we want. 

The third major barrier is this belief, the transformation should be fast and easy, and relatively free of discomfort. If somebody said. “Here, take this pill and you'll lose weight.” Hey, I'd be pretty excited about that. 

But here's the reality. True transformation requires hard work. And it's not just work that you do once it's work that you do every single da

Our kids are being asked to do some very, very difficult work to manage their OCD. They're asked to witness their thoughts and distinguish a thought that comes from their healthy brain from a thought generated by Super-Spike you know that OCD, hyper vigilant watcher. They are asked to resist the urges to do what Super-Spike tells them to do. 

The easiest way for them to deal with the anxiety that they experience sense, or the disgust or whatever unpleasant feeling associated with a thought or image that Super-Spike offers, the fastest way to get rid of that is just to give in to the urge. 

We're asking them to resist it, and then knowingly lean into those unpleasant feelings, so that they know that they don't have anything to fear, kind of like I learned that I'm okay, when I'm hungry, it's just a feeling it's going to pass. 

If you want to evolve into the best version of yourself, it's going to take hard work, it's going to require new skills, it's going to require new practices. And it's not just one and done. This is something that needs to be attended to every day that these skills that our children are learning in order to get to the other side of OCD are meta skills that are going to serve them in all parts of life. 

So if our kids want to be freed from the tyranny of OCD, they're going to learn that they can use their thinking brain, their prefrontal cortex, in order to override the reptile brain. They're going to have to trust enough to move forward, even if they've tried things in the past that haven't worked. And third, I think we all need to tell the truth, that this is really hard work, your kids don't have to do this. They have the choice of living their lives, just like they've been living now that there are consequences to those choices, there really is a path for them to get to the other side of OCD, and being in charge of this Super-Spike.

So what can you as a parent do in order to create an environment that helps your child do

the hard work? I'm going to suggest that you be the change that you want to see in your child.

Is there something hard that you want to do? Do you want to lose weight? Do you want to achieve a fitness goal, maybe run in a half marathon? Do you want to live in a cleaner house? 

I recommend that you set a goal, say these are the things that I'm going to be doing to achieve this goal. And then maybe you invite every member of your family to choose something hard to do, and you hold each other accountable, then you can be transparent. 

When you fall off the wagon when you face difficulties when you gave into an urge, and talk about what that was like for you. You know, our children, watch what we do. And if they see you managing these hard things, it's going to make it easier for them to do it. So I invite you to take on this challenge. 

Now, if you're excited about this, I want to offer you another option. May you know the power of community. We’re launching our own private community of people committed to a transformation. So by joining our community, you will be able to publicly let others know what your goal is, and be accountable to the community. We will be transparent about what's going on. We'll celebrate successes, we'll identify places that were getting stuck, and offer ideas about how to move forward. 

We've got this general community, and you can bring whatever goal that you want, we will also have to break out communities.  I will moderate the community of people committed to weight loss, and Meir will moderate the community dedicated to a fitness goal.

On a regular basis, we will have coaching sessions. So you're welcome to hop on a group call, get in the hot seat and get some advice for a specific challenge that you are facing that's getting in the way. 

Now just to be clear, we're not going to tell you what to eat. We're not going to tell you how much to run. We're looking at the process. How do you pick a hard thing and actually get it done? 

There is a membership fee to be a part of this community. And the main reason that we're doing this is to find people who are truly interested in making a commitment. We understand that there are many people who are facing financial challenges right now. And we don't want finances to be a barrier to participation in our community, we've created alternative ways for you to contribute to the community other than with your dollars. 

We've got a special promotional rate for our founding members. And this is a family membership. We believe that when you create a culture of doing hard things in your family, you make it easier for your child with OCD to take on the hard work of freeing themselves from OCD. 

I want to thank you so much for investing your time reading this blog. I hope that you found value in the content. Please feel welcome to share this blog with your family members, with your child who's learning how to manage OCD, and their champions who are helping them get to the other side of OCD, their friends, teachers, and other members of your family to whom your children turned.