Essentials: The Science & Treatment of Obsessive Compulsive Disorder (OCD)

**Andrew Huberman** (0:00)
Welcome to Huberman Lab Essentials, where we revisit past episodes for the most potent and actionable science-based tools for mental health, physical health and performance.
I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. Today, we are talking about Obsessive Compulsive Disorder, or OCD. First of all, as the name suggests, OCD includes thoughts or obsessions, and compulsions, which are actions. The obsessions and the compulsions are often linked. In fact, most of the time, the obsessions and the compulsions are linked, such that the compulsion, the behavior, is designed to relieve the obsession.
However, one of the hallmark themes of Obsessive Compulsive Disorder is that the obsessions are intrusive. People don't want to have them. They don't enjoy having them. They just seem to pop into people's minds, and they seem to pop into their mind recurrently.
And the compulsions, unlike other sorts of behaviors, provide brief relief to the obsession, but then very quickly reinforce or strengthen the obsession. OCD is extremely common.
In fact, current estimates are that anywhere from 2.5% to as high as three or even 4% of people suffer from true OCD. That is an astonishingly high number. Another thing to point out is that OCD is currently listed as number seven in terms of the most debilitating illnesses, not just mental illnesses or disorders, but all types of illnesses, including things like asthma and cancer, et cetera. So you can imagine with that standing at number seven, that it is both extremely common and extremely debilitating. And as a consequence, it's now realized that many hours, days, weeks, months, or even years of work performance or showing up at work of relational interactions really suffer as a consequence of people having OCD. With recurrent intrusive thoughts happening at very high frequency or even at moderate frequency, people are spending a lot of time thinking about this stuff and they're thinking about the behaviors they need to engage in and then engaging in the behaviors, which as I mentioned before, just serve to strengthen the compulsions. And so they're not actually doing the other things that make us functional human beings, like commuting to work or doing homework or doing work or listening when people are talking or interacting or sports or working out, all the things that make for a rich quality life are taken over by OCD in many cases. Another thing you'll soon learn is that sadly, a lot of the obsessions and compulsions in OCD often relate to taboo topics. And that's because the general categories of OCD fall into three different bins, checking obsessions and compulsions, repetition obsessions and compulsions, and order obsessions and compulsions. The checking ones are somewhat obvious, checking the stove or checking the locks. Repetition obsessions and compulsions obviously can dovetail with the checking ones, but those tend to be things like counting off of a certain number of numbers, like one, two, three, four, five, six, seven, seven, six, five, four, three, two, one. People perform that repeatedly, repeatedly, repeatedly, or feel that they have to.
So we have checking, we have repetition, and then there's order.
Order oftentimes is thought of as putting cleanliness or making sure everything is aligned and perfect and orderly. And oftentimes that is the case, but there are other forms of order that people with OCD can focus on in a obsessive and compulsive way. Things like incompleteness, the idea that one can't walk away from something or stop doing something because something's not right or complete in that picture. It could be the way the table is set. It could be the way that something's written on a page. It could be an email. It can also be in terms of symmetry, that everything be aligned and symmetric in some way. This could be seen perhaps in young kids. This is one example that I read in the literature of children that need to arrange their stuffed animals in exact same order every day. And in a particular order to the point where if you were to move the little stuffed frog over next to the stuffed rabbit, the child will have an anxiety reaction to that and feel literally compelled, driven to fix that, maybe even multiple times over and over again. And then the other aspect of order, which is a little bit less than intuitive is this notion of disgust. This idea that something is contaminated. So we often think about OCD and hand washing behavior in response to people feeling that something is contaminated, a space, a towel, et cetera, or even simply somebody else's hand. So they're unwilling to shake somebody's hand. You can imagine how these different bins of obsessions and compulsions, checking, repetition and order, be extremely debilitating depending on how severe they are and how many different domains of life they show up in. And I know I've said it multiple times now, but I'm going to say it many times throughout this episode in a somewhat obsessive, but I believe justified way that every time that one engages in the compulsion related to the obsession, the obsession simply becomes stronger. So you can imagine what a powerful and debilitating loop that really is. I'd like to take a quick break and acknowledge our sponsor, AG1.