What Does OCD Actually Look Like?

By Meron Girmaiy, LMHC

It’s fairly well-known that mental health diagnoses and terminology can and will be largely misused. While this is representative of the fact that people are paying attention to and making room for mental health discussions, it also has the potential to be harmful to our own understanding of self and the expectations we put on others. Creating opportunities for greater understanding of these concepts is a significant part of the therapeutic process.

OCD is undoubtedly one of these more commonly misunderstood diagnoses and this blog post intends to help create a greater awareness of the experience of living with it. 

Why is OCD misunderstood?

Obsessive Compulsive Disorder, or OCD, is a commonly represented mental health diagnosis in modern media. It is also often made to be a character’s defining trait. In many cases, their OCD is what makes them an interesting character. For many people diagnosed with OCD, the diagnosis may be a significant part of their lives but not as a quirky aside and certainly not as a form of comedic relief. Unfortunately, many representations seem to minimize the realities of OCD to be just this, often undermining the severity of which it intrudes on someone's life. 

We all know a character or two whose whole thing is their fear of germs and illness or being excessively particular on how items are organized. And while this is certainly representative of some experiences of living with OCD, it is significantly limiting the perspective of what it means to be an individual with the diagnosis. 

OCD comes in many forms, and when we limit the representation of the various ways it can appear, we unintentionally are limiting the general perspective of what it looks like to experience it- not to mention, an individual’s ability to recognize and validate their own symptoms. When exploring an OCD diagnosis with a client, a hesitation to accept the diagnosis is not uncommon because their symptoms look different than what we’re typically shown.

What is OCD?

OCD is a mental health diagnosis that is characterized by the presence of obsessions and compulsions. To fully understand OCD, it’s important to know what these are and how they interact with one another. Obsessions are the thoughts, beliefs, fears or urges that are repeated and persistent and often overwhelmingly take up mental space. Compulsions are the mental rituals or actions we take in response to these obsessions. Compulsions feel necessary and urgent and often come with significant distress and a perceived consequence if not engaged in. 

In other words, individuals diagnosed with OCD repeatedly experience a cycle of overwhelming thought patterns that trigger fear and anxiety and have learned the best way to reduce this discomfort is by engaging in a compulsive behavior that has previously been determined to “help the problem”. 

While anyone could, and will, fall into anxious thinking patterns based in fears and beliefs, one key differentiator between someone who’s a bit worried about something and someone with OCD is the ability to stop the line of thinking without a compulsive action. For example, if Jasmine is worried about whether or not she turned the lights off in the house before leaving for work, she might think about it for a bit and be a bit frustrated or worried about how it might affect her electric bill before continuing with her job. 

However, if Jasmine experiences OCD and her obsessions/compulsions present around this topic, she may become so preoccupied with it that it leads to persistent thoughts like “what if the lights being on triggers a fire and burns my house down” or “what if me forgetting the lights today causes my bill to go up so much that I am forced to drain my savings account”. She may also feel such distress that she believes the only way to find relief is to engage in the compulsive behavior of driving all the way back home to check on the lights before she can even continue working.

Importantly, this experience repeats over and over again for someone with OCD which can significantly interfere with someone’s ability to function in their day-to-day lives. 

Common Themes in OCD

There are a few different OCD types or themes that can be important to know to help us better understand the diagnosis. Below is a sample of some OCD themes and how they may present through obsessions:

• Contamination OCD: “If I touch that doorknob it will contaminate me with a virus”

• Relationship OCD: “Am I in the wrong relationship? What if there’s someone better out there for me”

• Violent/ Sexual/ Taboo topics: “I can’t believe I just thought about pushing her in front of that car, I must be a violent and dangerous person”

• Not Just Right Experiences: “There might be significant negative consequences for not stacking those books in the right way”

• Responsibility & Harm OCD: “Did my neighbor fall off the ladder because I slept in today?”

With OCD, these thoughts will lead to a compulsive response. Compulsions can vary as well. They can be anything from behaviors or rituals that need to be performed to mental thinking patterns. Common examples of compulsions include checking on things repeatedly, rearranging, seeking reassurance from loved ones, ruminating, or even self harm and negative self talk. 

It’s important to note that some links between obsessions and compulsions are logical and we can understand clearly how they formed. For example, most of us don’t need an explanation on why contamination OCD might lead to excessive cleaning compulsions. However, not all fit neatly into logic. Oftentimes, compulsions may seem to have no connection to an obsessive thought at all. This is because, within the OCD cycle, the purpose of compulsions is to soothe the discomfort that was triggered by the obsessive thought- not because it is regulating to the nervous system but because there is a belief that it is the only lifeline to relief. At some point, that compulsion was associated with temporary solace and it has become reinforced the more it was performed.

What next?

Exposure Response Prevention (ERP) is a common and structured way to address symptoms. It involves a slow exposure to the fears and, with guidance from a therapist, supports clients in learning how to tolerate the discomfort brought on by obsessions without the need to engage in compulsions.

Cognitive based therapies like Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) can also be beneficial to increase psychological flexibility and change the relationship had with obsessions. 

No matter the approach, OCD is certainly a treatable diagnosis. Visit our OCD specialties page to learn more about treatment options and find a therapist that can support you in diagnosing and treating OCD.

What is Internal Family Systems Therapy (IFS)?

By Lily Hall, LCSW

Have you ever felt like one part of yourself wants one thing and another part of yourself wants something completely different? Maybe at times it’s even felt like these parts of yourself were at war with each other, making it impossible to feel a sense of inner peace. This is a completely normal experience and something that an approach known as internal family systems (IFS) is made to help with! IFS is based on the premise that we all have a complex internal system of “parts” each with their own personality, beliefs, emotions, and sensations. The movie Inside Out is a really simple and beautiful example of parts and how much of an impact it can have when parts of ourselves are in conflict with one another. 

Accompanying the parts of us, IFS also believes that we all have an authentic Self energy. Our Self energy is naturally compassionate, curious, and calm and carries patience, persistence, and perspective. Our Self is able to be a witness to difficult experiences, rather than just reliving them or being flooded by them. Maybe you’ve felt a sense of your Self energy when doing things that help you feel a sense of flow. For some people this could be while hiking, gardening, skiing, meditating, walking, creating art, playing with children; the list goes on!

One element that I love about the model is the foundational belief that all of our parts are trying to help us. Yes, even the ones that seem most extreme (like parts that yell at our loved ones, parts that binge eat, parts that self harm). Parts sometimes get stuck in extreme roles, driven by past pain or vulnerability that was too much for us at the time. This past pain that was too much gets “exiled” within our system and creates protective parts that work hard to keep us from ever feeling that way again. The problem is, many of these protective parts take on their jobs at very young ages, so they often have more limited inner resources to come up with ways to protect us. Imagine a six year old child trying to figure out a way to never feel like mom is upset with them again! Their problem solving for that would look and sound a LOT different than an adult trying to problem solve that; hence why these efforts at problem solving can accidentally end up also causing harm or distress in the longer term.

Prior to doing IFS therapy, our parts generally react outside of our consciousness to situations within ourselves and the outside world. IFS therapy allows us to build a more conscious relationship with these parts, which in turn allows us to make more conscious choices about how we respond. IFS helps us slow down and really listen to these parts so that we can learn how they came to be, why they’re stuck in these roles, and ultimately help heal the exiled, vulnerable parts that are holding onto difficult past experiences. Once these more vulnerable parts feel helped and seen, protective parts of ourselves are generally freed up to play roles within our system that better serve our present day experience. One of my favorite aspects of IFS is that it views humans as having everything we need to heal already within us, so it’s about finding our way back to that inner resource rather than trying to create it from scratch.

IFS might be right for you if: 

• You’ve tried traditional talk therapy before and feel like you’ve gotten what you can out of it, but it’s left you wanting or needing more.

• You’re interested in doing “the deeper work”.

• You’re an intellectualizer who struggles to feel like therapy helps them learn/experience things they don’t already know.

There are MANY more reasons IFS could be right for you too. These are just a few examples! If you’re interested in trying IFS, Ember Psychotherapy Collective has IFS trained therapists who are ready to help.

Written by Lily Hall, LCSW.

Feeling the Pressure to "Do It All" This Spring? You're Not Alone.

As the weather warms up, it can feel like the world shifts into high gear—social calendars fill up, weekends get booked, and there’s this unspoken pressure to “make the most” of every sunny day. For some, it’s exciting. For others, it can feel overwhelming, especially if you’re managing social anxiety, burnout, or simply running low on energy.

If spring and summer leave you feeling behind or overstimulated, know this: you’re not the only one.

The Springtime Social Shift

There’s something about warm weather that seems to shout "Say yes to everything!" With more sunlight, open spaces, and increased energy, invitations often come more frequently—picnics, birthday parties, weddings, after-work hangs, group trips. Social media can amplify the pressure, showing a highlight reel of everyone else’s spring adventures while you might be just trying to make it through the week. We also hold ourselves to high standards- creating plans and expectations of what this time of year should look like.

While this increased activity can be exciting, it can also trigger feelings of anxiety, comparison, and guilt—especially if your emotional bandwidth isn’t aligned with the pace of your social circle.

Why Spring Can Feel So Intense

There’s often a push to be more social this time of year, driven by longer days, more events, and curated social media posts showcasing nonstop fun. This can bring up:

• FOMO (Fear of Missing Out)

• People-pleasing habits

• Social anxiety or burnout

• Guilt for not “doing enough”

Even if you know you need rest, it can be hard to say no when it feels like everyone else is saying yes.

Ways to Navigate the Pressure

At Ember, we encourage tuning into your own pace—not the season’s.

1. Check in with your needs

Before agreeing to plans, ask yourself: Do I really want to do this? Or do I feel like I should?

2. Protect your energy

You don’t have to justify rest. Time alone, unplugged or offline, is just as valid as a packed social schedule.

3. Say “no” and sit with the discomfort that might come with it

This might activate feelings of guilt but if you know you are saying no is for the best, guilt may not have to mean you made the wrong decision.

4. Redefine productivity

Doing less doesn’t mean you’re missing out. Slowing down, setting boundaries, or focusing on your mental health is meaningful.

Let This Season Be Yours

Spring doesn’t have to look like constant activity or perfectly curated plans. Growth can be quiet. Joy can be simple. And your well-being always comes first. If you're feeling overwhelmed, we’re here to help. Reach out for a complimentary consultation on our Contact page.

Why Mental Health Isn’t Just Mental: The Role of the Nervous System in Mental Health Experiences

By Lily Hall, LCSW.

A lot of mental health is talked about through the cognitive lens, however, mental health actually often starts in our body! Have you noticed how so many symptoms of depression and anxiety have to do more with our body than our mind? That is because our nervous system is usually the one sending messages that activate symptoms of mental health conditions or particular thought cycles.

Our nervous system works with our primal brain, which means its focus is very simple: safety and survival. Our nervous system is regulated by the vagus nerve, which you can think of as the brain-body highway. It is constantly communicating from our brain to our body and our body to our brain, but one important thing to note is that 80% of communication is upwards from our body to our brain. This is why no matter how much you try to “think” your way into safety, it often just doesn’t quite work. It’s 20% brain saying we’re safe vs. 80% our body saying it senses something it has deemed a threat.

The nervous system has three states: regulated rest and digest, fight or flight, and freeze. Our system is constantly assessing our internal and external world for threats. When it senses a threat, it typically shifts first into a fight/flight space. In a fight or flight survival response, you may feel increased heart rate, sweating, muscle tension, aggression, a strong urge to leave, dizziness, and/or nausea due to activation of the sympathetic system giving you a burst of survival energy. When our system begins to feel stuck in a stressful situation, it shifts into a freeze state. In a freeze response, it begins to attempt to conserve energy and you may feel things like brain fog, fatigue, hopelessness, and/or numbness.

Let’s think about this through a primal lens for a second. If a rabbit senses a coyote nearby, they’re first going to go into fight/flight and try to escape. If that doesn’t work and they are caught, their freeze response comes online. With their freeze response active, a coyote could think they are dead, put them down, and then the rabbit has the opportunity to bring the stored fight/flight energy back online and run away. Running away discharges the energy and completes the stress response cycle.

Unfortunately, our primal brains in a lot of ways haven’t adapted super well to modern day life. For example, our nervous system could perceive receiving an email as a threat. It can shift into fight/flight, but then we just continue to sit at our desks and never complete the stress response cycle! We’re left with a burst of survival chemicals and energy that has nowhere to go. This can lead to discomfort and an ongoing feeling of anxiety. So, it is really important that we be intentional about creating moments of safety for our nervous system and also creating opportunities to release pent up survival energy from our bodies moving in and out of dysregulated states throughout each day.

One of the great things is that the vagus nerve in some ways is like a muscle. The more you engage it, the stronger it’s ability to bounce back to regulation and move through stress becomes! Increasing your vagal tone helps your body begin to move more flexibly in and out of states of stress, rather than experiencing stress and getting stuck in this survival response. Here are a few of my favorite ways to regulate your nervous system and release stress:

• Practice physiological sighs: Inhale through your nose once. Pause. Take another short inhale in, like an extra sip of oxygen, then exhale through your mouth for 6-8 seconds. Repeat 2-3x. 

• 1 minute somatic release: Unclench your jaw, drop your shoulders, shake your hands out, move your eyes side to side, stick out your tongue and exhale, then take 3 deep belly breaths.

• Proprioceptive Input: Proprioception is your body’s ability to know where it is at any given time. You can create proprioceptive input by- getting or giving hugs, stomping your feet, weighted blankets, rolling up tightly in a blanket like a burrito, star jumps or pushups, massages, or sitting on the ground and pressing your back firmly into the wall.

• Progressive Muscle Relaxation: Find a comfortable position laying down or seated. Take a few deep, grounding belly breaths and begin to focus on your breathing. Starting with your feet, begin to tense your feet muscles as tightly as you can without strain, hold for 5 seconds, then release. Continue to repeat this, moving through muscle groups in your body (calves, thighs/hips, stomach/chest, arms/hands, face, then the entire body together). Focus on noticing the sensation of tension, then the opposite sensations of relaxation. 

For a more in-depth list of options, you can click here.

This blog was written by Lily Hall, LCSW

Differentiating Social Anxiety and Generalized Anxiety Disorder

The various anxiety disorders can be a complicated few topics to decipher. One of the most common concerns we hear from clients is whether they’re experiencing social anxiety or anxiety in general or Generalized Anxiety Disorder. Though both are common presentations of anxiety, they manifest in different ways and may require different approaches for effective treatment. Understanding the distinctions between the two can help you find the right path to growth and healing.

Social Anxiety Disorder (SAD)

Overview:
Social Anxiety Disorder (SAD) is characterized by a fear of being judged in social situations. This anxiety can lead to significant discomfort in various social settings and avoiding social events altogether. SAD can be so debilitating that it affects relationships, sense of self, and socio-occupational functioning.

Some Symptoms:

• Intense or overwhelming worry about upcoming social events

• A disproportionate level of fear of being negatively evaluated or embarrassed Physical symptoms such as sweating, shaking, or a racing heart

• Avoidance of social situations, such as parties, get togethers, or public speaking.

Key Takeaway:
SAD is a situational anxious response typically triggered by social situations and interactions or public speaking. The anxiety revolves around the fear of being observed or judged by others.

Generalized Anxiety Disorder (GAD)

Overview:
Generalized Anxiety Disorder (GAD) is characterized by persistent and excessive worry about a wide range of everyday situations. At times, the triggering event may be difficult to identify. Unlike social anxiety, GAD isn’t limited to social contexts.

Some Symptoms:

• Continuous  and excessive worry about various aspects of life (work, health, relationships, etc.) 

• Trouble relaxing or concentrating

• Physical symptoms such as shortness of breath, muscle tension, nausea, and sleep disturbances

• Tendency to catastrophize and imagine worst-case scenarios

• Disrupted day-to-day functioning

Key Difference:
GAD manifests in many areas of life and is often present on a day-to-day basis. The anxiety is often generalized, with no specific trigger like in social anxiety.

Key Differences Between Social Anxiety and Generalized Anxiety

• Focus of Anxiety: SAD focuses on social interactions, while GAD covers a wide range of everyday concerns.

• Triggers: Social anxiety is triggered by social events, while GAD can be triggered by nearly any part of life.

• Duration: SAD tends to rise and fall around social events, while GAD is a more constant, low-level worry.

How Therapy Can Help

Both social anxiety and generalized anxiety can be effectively treated with individual outpatient therapy sessions. Everyone’s experience with treatment is unique so a therapist can work with you to help you identify the best path forward. 

Cognitive Behavioral Therapy (CBT)- explore how to shift your thought patterns and modify your behaviors to learn healthy ways to challenge your anxious patterns.

Dialectical behavior therapy (DBT)- learn healthy and efficient coping strategies such as acceptance, distress tolerance, and emotion regulation skills to better navigate anxiety.

Exposure Response Prevention (ERP)- gradually expose yourself to your anxieties and fears to help your mind and body better tolerate them and gain confidence in your ability to manage your anxieties.

Internal Family Systems (IFS)- a therapeutic approach that views the mind as containing multiple sub-personalities or "parts," including wounded "exiles" and protective "managers" and "firefighters." The goal of IFS therapy is to help people access their compassionate "Self" to heal and harmonize such as anxiety disorders.

Somatic Therapies and Mindfulness - through meditative and somatic practices, explore how the mind body connection plays a role in responding to anxiety triggers.

If you're unsure which type of anxiety you’re experiencing, or if you need support in managing your anxiety, we’re here to help. Reach out today to start your journey toward relief and recovery. 

Our therapists specialize in anxiety work. Have a look at their profiles and see who may fit.