Assistant Professor of Psychology Michael G. Wheaton focuses on the psychopathology and treatment of obsessive-compulsive disorder (OCD) and other related disorders, with an emphasis on cognitive behavioral therapy (CBT). In January, Wheaton was awarded the Katkovsky Research Grant from the American Psychological Foundation for a project titled “CBT alone or CBT plus medication for treating obsessive-compulsive disorder.”

Over the summer, he received two research grants: a $50,000 award from the International Obsessive Compulsive Disorder Foundation to study the active avoidance and fear responses in people with OCD—the first study of its kind—and $70,000 for a NARSAD Young Investigator Grant, which will investigate taking active control over threat cues. He teaches courses on abnormal and clinical psychology and recently published a research paper in the Journal of Obsessive-Compulsive and Related Disorders.

For this “Break This Down” interview—in recognition of Mental Illness Awareness Week (October 7–13) and World Mental Health Day (October 10)—Wheaton discusses the meanings of three ubiquitous letters: OCD. From offering advice to people who may suffer from symptoms to learning if individuals can address OCD symptoms through behavioral changes, Wheaton provides feedback on myths about the disorder. Here he explains the difference between coping and obsessing compulsively.

Your recently published study notes that two percent of the population suffers from OCD, yet it has become a common phrase, suggesting that a far greater percentage of the population has been diagnosed. Why is OCD understood as wider and broader than it actually is?

While it is true that epidemiological estimates suggest that OCD is relatively rare in the population, it is, however, likely many more individuals suffer from "subclinical" or "subthreshold" OCD symptoms. This means that their symptoms consume less of their time (usually occupying less than an hour per day), compared to the people who have full blown symptoms of OCD (an experience that lasts many hours a day, or on a near constant basis).

In your paper, you and your coauthors explore people’s perceptions of two different reasons that OCD exists (biomedical and integrative biopsychosocial models) and how these models affect a person’s belief about their prognosis and treatment. What did you discover?

Our recent paper investigated illness attributions among adults with OCD, or basically, the view someone holds for why they are suffering from the illness. We call these "causal attributions," and they come from various sources, including what patients may have heard from treatment providers. Some of these causal attributions highlight biological factors. For example, some doctors might suggest to their patients that OCD results from dysfunction in the brain, including the functioning of neurotransmitters (chemical imbalances in the brain). Other causal attributions focus on the interplay between biological factors and psychological factors, such as learning history. For example, a therapist might talk about how someone could develop OCD if they are taught to expect the environment to be dangerous and to rely on compulsions to feel safe. 

What we found was that the patients who found the biological explanation to be more plausible experienced more pessimism about their own illness trajectory, including feeling that they would need to have long-term treatment and that their symptoms would likely be chronic. It could be that believing that OCD results from a brain dysfunction makes people feel less optimistic about their ability to change and overcome OCD, which could make them less likely to seek treatment. This is problematic because there are good treatment options available that help many people overcome their OCD.

What are some telltale signs a person is suffering from OCD?

The most obvious signs of OCD are obsessions (repetitive negative thoughts that provoke distress and that the person does not agree with) and compulsions (repetitive behaviors that the person feels compelled to do). The most common of these are obsessions about dirt, germs, and cleanliness (often alongside compulsive washing rituals), as well as obsessions about making a mistake (like leaving the faucet on or the door unlocked), coupled with checking compulsions (constantly making sure the stove is turned off).

If someone believes they have OCD, can behavioral changes improve symptoms?

Yes. The research is clear that behavioral treatments, namely those that involve facing fears while refraining from compulsions, can be highly effective at reducing OCD symptoms. However, people shouldn't feel that they need to make these changes on their own. Rather, they could utilize treatment providers, and family members, to aid them. The International Obsessive-Compulsive Disorder Foundation (IOCDF), of which I am affiliated, has many good resources to help recognize OCD symptoms and learn about treatment options. 

What are some of the biggest misconceptions about OCD?

In our paper, we tried to address the myth, believed by many patients, that because OCD may relate to changes in underlying brain structures, behavioral changes and psychotherapy are unlikely to help. This isn't true because substantial research suggests that behavioral treatments can help many individuals with OCD. 

Another common myth is that OCD is always about being a "germaphobe" or "neatfreak." In fact, there is a huge amount of variety in terms of what OCD symptoms look like. While some people with OCD experience obsessions about cleanliness, there are many other OCD symptoms, such as fears relating to religious practices (the fear of saying or doing something blasphemous or sacrilegious) and the fear of harming someone else even though you don't want to (the fear of hitting someone while driving). 

There are also some forms of OCD that relate to romantic relationships, often called relationship OCD, such as the obsession that one doesn't love one's partner enough or that they might be in the wrong relationship. Despite all of these different forms of OCD, the number one treatment recommended for all OCD presentations is still behavioral therapy. 

To learn more about OCD, read Wheaton's recent interview on hoarding in Zencare.