Maureen Diezman, DNP, PMHNP-BC, is a psychiatric mental health nurse practitioner and a Medical Resource Director at Columbia Mental Health’s Aldie, VA clinic. She provides psychiatry services both in-person and via telehealth, working with young clients (ages five to 25) who face a variety of mental health conditions. Maureen tailors treatment to each individual—she listens and helps clients maximize the coping skills they already possess, in addition to managing medications. She approaches every client with a non-judgmental attitude and an optimistic outlook, valuing each session as an opportunity to help someone meet their goals.

In this Q&A, Maureen shares her perspective on obsessive-compulsive disorder (OCD): what it really is, common misconceptions, and how she helps people overcome it.

What OCD really is

If someone doesn’t know much about OCD, how would you explain it?

Maureen: OCD at its core is really an anxiety disorder—it’s rooted in anxiety. We often see OCD come out of people who had a lack of control, especially early in their childhood. OCD stands for obsessive-compulsive disorder. With OCD, we usually see what’s called an obsession and a compulsion (you can have just one or the other, but it’s usually both together). The obsession will be something such as germs, and then the compulsion would be a behavior like hand washing. The obsession is “I’m concerned every time I go out in public, if I touch something I’ll get germs on me and get sick”, and people cannot turn that thought loop off.

And I really mean they can’t turn it off. People with true OCD will usually spend about two hours a day on their obsessions and compulsions.

You can see OCD get exacerbated in certain situations. Take something like COVID—people who have the contamination fear subtype of OCD saw their symptoms go into overdrive. There are lots of different OCD subtypes. There are people who have intense “religiosity” OCD, for example, where they’re obsessed with religious thoughts. Their compulsion might be praying or going to religious services excessively.

The compulsions are pretty specific, because what you’re doing the compulsion for is trying to soothe your anxiety. You see that in a lot of different anxiety disorders, such as skin picking in generalized anxiety disorder. People will do that because it’s something they can control. Whether or not the compulsion is productive (and sometimes it can actually be harmful), it at least temporarily calms the anxiety.

Misconceptions and stigma

What are some things about OCD that people often misunderstand?

I think a big one is that if you have anything other than the classic fear-of-contamination OCD, people don’t always understand that it can still be OCD. For example, with that religiosity obsession I mentioned—someone might say, “Well, I’m just really religious.” And sure, you can be very devout in your faith, but being very religious doesn’t mean you have to pray 20 times a day on the hour every hour, feeling like if you don’t do it something bad is going to happen or your anxiety will be out of control. That is not just being devout—that is more of an OCD thing.

People who have the fear of contamination subtype of OCD are usually less surprised to find out they have OCD because that stereotype is well-known. But I think what would surprise other folks is just how severe those compulsions can get. For example, someone with a hand-washing compulsion—their skin will often be literally broken down. You have natural oils in your skin, and soap strips oil out of the skin. If you’re washing your hands 20 times a day, and not just a quick rinse but like a full 60-second scrub each time, that’s almost an hour of your day spent just washing hands. And that’s just the compulsion, not even the obsessional thinking! You can ruin your skin barrier. People will get chapped, red hands; the skin cracks and it’s really hard for it to heal. They can even get infections. It’s very painful.

What’s wild is that in those cases you’re almost bringing about what you fear—you wash so much that you cause an infection risk—yet that irony usually isn’t even on the person’s radar. They’re not thinking, “Oh no, my cracked skin might get infected.” They’re thinking, “Ugh, now it hurts when I wash”, but they’ll still keep washing. They might be worried about infection, but that concern doesn’t stop the compulsion—OCD is ego-dystonic, so even when people know their fears or behaviors aren’t rational, they still feel driven to act on them.

Some people casually say “I’m so OCD” because they like things neat and organized. Is being a neat freak the same as having OCD?

No—wanting things tidy is a pretty normal human preference. The example I always think of is that Kardashian clip where Khloe has her cookies or fruit organized in a certain way. Someone asks, “What if we mess it up?” and she goes, “I wouldn’t like that.” But she doesn’t totally lose it; she’s just particular. My closet at home is color-coded—I like it that way, but I don’t have OCD. Some people are just neat!

I will say, sometimes a person’s anxiety might manifest in these little controlling behaviors—like needing your fruit arranged “just so” in the bowl. Maybe Khloe has a touch of anxiety and that’s how she’s coping. But that’s very different from true OCD.

With OCD it’s not simply “I prefer this”—it’s “I have to do this.”

And often the person feels like if they don’t do it, something bad could happen. It’s driven by anxiety and fear, not preference. The other key difference is that OCD is ego-dystonic—people with OCD usually know their thoughts and behaviors don’t make sense, and they often feel embarrassed or ashamed. They might even try to hide what they’re doing or act in a subtle way so others don’t notice. But they still can’t stop doing it. It’s not a quirk or a fun trait; it’s something causing them distress.

Is OCD the same as obsessive-compulsive personality disorder (OCPD)?

No—they’re actually very different. OCD is what we call “ego-dystonic.” Ego referring to the mind or self, and dystonic meaning not in harmony. With OCD, you have thoughts that don’t line up with your values or what you want—intrusive thoughts that you don’t like and can’t control. By contrast, OCPD (obsessive-compulsive personality disorder) is ego-syntonic—syn meaning together. If something is ego-syntonic, it means the person’s thoughts and behaviors do align with their own ideas of what’s right.

In plainer terms, people with OCD don’t want to be doing what they’re doing. They don’t like it; they often know it’s not logical or normal or helpful—but they just can’t stop. Whereas someone with OCPD is typically very rigid or perfectionistic in their lifestyle, but they don’t see anything wrong with the way they operate. And it’s usually not as extreme as OCD compulsions.

What do you think about people who casually say “I’m so OCD” as a joke or figure of speech?

Honestly, the stigma around that is so frustrating to me. I can’t imagine being someone who literally cannot bring themselves to, say, touch a floor or leave the house because of OCD, and then hearing someone toss out ‘Haha, I’m so OCD!’ because they like their desk organized. That would make me so mad on their behalf.

I do think as time goes on, our culture is becoming more aware of this kind of thing in general. But when it comes to mental health, we still have to be careful not to use diagnoses like punchlines or adjectives. This happens with the term “bipolar” as well—you don’t want to throw these words around casually, because you never know who’s listening and what they’re going through. It can really diminish everything a person with that condition has experienced.

Approach to treatment

How do you approach treating OCD?

The first thing to know is that people with OCD are usually seeking help—by the time they come to me, they genuinely want to get better. It’s not typically hard to get them to open up about their obsessions or compulsions. They’re not happy about what they’re doing, and they want to change it. In fact, one unique aspect of OCD treatment is that progress can often be measured in a very concrete way.

For example, if someone was washing their hands 20 times a day, and after treatment they’re down to 10 times a day—hey, that’s a 50% reduction. It’s easy to track that kind of improvement. With something like depression, progress is a lot harder to quantify (someone might say “I’m feeling a bit better” but it’s subjective). With OCD, if the compulsions take up a certain number of hours or occur X times a day, we can literally watch those numbers go down.

In terms of treatment itself, first-line treatment is to start with medication in the SSRI category. We can also augment with other medications. I’ve seen success adding a low-dose antipsychotic like aripiprazole (Abilify) to an SSRI for some patients. And then there are some older antidepressants we know work really well for OCD—for instance, Elavil (amitriptyline). That’s a tricyclic antidepressant.

One newer option—and I’m just speaking for our region here (the D.C./Maryland/Virginia area)—is transcranial magnetic stimulation (TMS). There are specific OCD protocols for TMS. We’re just getting those integrated into our offerings right now. I think we have one provider trained on it so far. We’re not consistently taking OCD patients for TMS quite yet, but it’s something we’re hoping to offer because it can be a great option. We’re excited about it because it’s another tool in the toolbox for OCD.

And of course, therapy is absolutely essential if you are treating OCD.

I always tell people: the only way out is through with OCD.

People don’t love to hear that, but it’s true. You usually have to go through exposure therapy, which is not fun for anybody, but it’s how you get to the other side. Basically, over time you’re desensitizing yourself to the thing you’re afraid of.

Imagine someone with the fear of contamination subtype of OCD being told to walk out of a public restroom without washing their hands. The first time, their anxiety is probably a 10 out of 10—sheer panic, “Get me out of here, I can’t do this!” But then, when nothing terrible happens afterward, there’s this desensitization moment. So maybe the next time they do it, their anxiety is a 9.5 out of 10 instead of a 10. Each time it might get a tiny bit lower, until they reach a point where they’re desensitized enough that it’s like, “Okay, I’m not as worried about this as I used to be.” That’s how exposure therapy breaks the cycle. It retrains that part of the mind. It’s a long, hard road—and definitely not pleasant in the moment—but it works.

OCD doesn’t have to define your life