"Mark's obsessive-compulsive disorder (OCD) symptoms always flared up at the holidays. Family visits made him feel like unless he had every inch of his house organized, something terrible would happen. He couldn't say what-it was just a feeling. His OCD specialist instructed him to follow the gold-standard protocol of exposure and response prevention (ERP): "Don't engage any of the deeper questions, that's just a waste of energy and a trap. Learn to embrace the uncertainty of not-knowing, and then you will live your values.""
"Mark had grown up with a highly critical mother who only showed love when her home was immaculate and pristine. Not surprisingly, she couldn't carry her own "messy feelings," and when they metaphorically dropped all over the place, Mark was expected to catch them, name them, and console her, like a doting puppy dog. As if the feelings never existed in the first place, he must lap them up."
OCD is underdiagnosed and often improperly treated in the United States. Reports recommend exposure and response prevention (ERP) as a first-line treatment, yet many clients do not gravitate toward or benefit from ERP. Some OCD symptoms emerge as protective or communicative responses tied to early family dynamics and attachment needs, making standard ERP feel invalidating or ineffective. Clinicians frequently avoid exploring underlying relational or emotional functions of compulsions. Greater attention is needed to understand why clients resist ERP and to develop or offer alternative, trauma- and attachment-informed treatments that safely address OCD's signaling role.
Read at Psychology Today
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