One look at Ally Duncan’s miniature sweet treats on Instagram or TikTok—a glass of lemonade smaller than her thumb, a perfectly decorated bite-sized pink cake, bundts that need to be handled with tweezers—and you’d never know that behind her cheerful creations and bubbly persona she’s struggling with her mental health.
The content creator, pastry chef, and chocolatier started posting baking videos only a few years ago in 2020. Since then, she has amassed more than 300K followers on Instagram (@sugarpusher) and 473K followers on TikTok (@sugarpusher) and boasts collabs with Country Crock, Amazon’s Alexa, Heilala Vanilla, Sees Candies, Amoretti, and others—with more opportunities coming her way.
But for all the gratitude she has for her career success and a happy home life (including her husband and two cats), Ally has to fight every day for her mental well-being.
“OCD felt like the crutch I needed to get through my anxiety.”
For as long as Ally, 37, can remember, she’s had anxiety. Specifically health anxiety, which peaked any time she had to go to the doctor or thought something was physically wrong with her. Her first diagnosis came at 15 years old, for depression. “At that time my dad was told he had a year or less to live,” she says.
Her doctors put her on medication, even switching it around several times, which only made matters worse. “I developed pretty severe anxiety and agoraphobia. And that’s when I also realized I had obsessive-compulsive disorder (OCD).”
Ally’s OCD diagnosis came at around 16 years old. Early on, she recalls that her compulsions were focused on making sure things were placed perfectly (this is often called Just Right or Perfectionism OCD). Other compulsions included repeating or doing things a certain number of times, counting, and avoiding throwing things away. She also formed obsessions centered around food, fearing that anything she ate would make her sick. As a result, she developed bulimia (eating disorders and OCD can be connected). At the time, Ally didn’t realize that her bulimia was a compulsion connected to OCD.
These compulsions (behaviors, including mental and physical actions, done to cope with the distress of an obsession) in OCD existed with the belief that they would prevent something bad from happening to her, says Ally. “As a kid, I had a couple of seizures. It was a traumatic experience that my OCD latched onto, telling me that if I didn’t do a compulsion, I would have a seizure.”
OCD also served as a lifeline during a chaotic time when she was younger. “OCD can feel like the crutch you need to get through your anxiety. Of course, it’s a trap, which is something I’m finding out now at almost 40 years old.”
A perfect storm
Over the years, Ally’s OCD had quieted down a bit. Though it never fully resolved, she was able to function. But a culmination of events brought her OCD roaring back with vigor she never experienced before.
Her father, who lived much longer than expected, passed away 8 years ago. After that, we were plunged into a global pandemic. “Once we started coming out of the pandemic, my mental health took a complete nosedive. Last year, I had a complete nervous breakdown, and it’s been bad ever since,” she says.
Her contamination OCD flared up. Ally didn’t leave her house for a year until she received her first vaccine—though compulsions surrounding washing her groceries or avoiding going out didn’t feel unreasonable, she says. In fact, they felt like the right thing to do when the world was told to keep safe at all costs. “When you try to come out of that mindset as a person with OCD, it does not go well,” Ally says.
So, when restrictions started to lift and people were expected to go out and have a good time and travel, Ally discovered that the renewed freedom wasn’t so easy to deal with. In May 2022, she took her first flight during the pandemic, to Toronto. She got sick afterward, and since then feared flying. “In June 2023, I got on an airplane and had a four-hour panic attack. I was begging my husband to ask them to land the plane.”
Then, two other things happened: When on a recent trip to the UK, her husband got COVID. Ally is also the age her dad was when he first got sick. All of these factors threw her intrusive thoughts (unwanted thoughts, images, or urges that are unpleasant or distressing and happen against your will) into overdrive.
Currently, her compulsions are centered around researching health information, seeing multiple doctors, and seeking reassurance from her husband that any pain or twinge doesn’t mean she’s dying.
It’s gotten so bad that she’s unable to work at her normal clip, get things done like go to the grocery store, and even eat normally, which adds an extra layer of difficulty as someone who works in the food space. Ally says that this is not necessarily a manifestation of her eating disorder, but conditions like irritable bowel syndrome (IBS), a recent diagnosis of Hashimoto’s disease (which affects the thyroid), and migraines have extremely limited her food choices and made her fear food, which triggers her OCD so much that she’s rarely even hungry anymore.
OCD threatens the very things we love the most, and for Ally, that’s her relationship with her husband and career. Currently, her OCD is keeping her at home—when she needs to be able to get on a plane. “I potentially have a great work opportunity that would require me to fly. But my OCD says I can’t do it. It’s convinced me that I get altitude sickness, something that doctors can’t prove or disprove.”
And because Ally spends a lot of money on doctor’s bills (after being convinced something is physically wrong with her and having to undergo expensive testing and appointments), it’s putting a financial strain on her marriage.
“After so much struggle in most of my adult life, I now have my dream career. I have a stable marriage. But can my marriage withstand me not being the partner that I know I can be? It feels as if I’m going to lose everything if I don’t get my stuff together,” she says.
“I’m struggling to get the help I need.”
Every day, Ally has to fight for her mental health—and it wears her down. She’s been on this journey for more than two decades but hasn’t been able to access the treatment she needs.
Ally has never been one to shy away from seeking out mental health therapy. She’s seen the same therapist for 13 years. In addition to regular therapy, Ally has also been to intensive outpatient treatment for anxiety and tried EMDR therapy, the latter of which she says backfired by triggering an intense anxiety episode.
While she recognizes it’s important to treat her anxiety, she has recently come to the conclusion that the root of her mental health challenges and health anxiety is OCD, and that needs to take precedence if she has hope of healing.
But she can’t address her obsessions and compulsions with her therapist, as they treat her anxiety. “As great as my regular therapist is, she’s not an OCD specialist. She doesn’t know much about the condition, and we don’t talk much about it,” Ally says. Besides, she adds, the shame attached to OCD has made it difficult to talk about.
So, she set out to find OCD treatment. Specifically, Ally would like to use exposure and response prevention therapy, or ERP, a form of behavioral therapy that’s regarded as the most successful treatment for OCD. ERP involves working with an OCD specialist to reduce the distress caused by your unwanted thoughts.
In short, you’ll face a specific fear, but instead of responding with a compulsion, you’ll learn to tolerate the discomfort. When you make this choice, your brain builds the connections that nothing bad happened as a result—and you don’t need your compulsions after all.
ERP is clinically proven to be highly effective in the majority of people—but it only works if you can access it. Unfortunately, there are often multiple roadblocks in the way, as Ally discovered.
The problem is pervasive. In a 2021 meta-analysis in Psychiatric Services on 27 studies, researchers concluded that there are several large gaps in OCD care, including misdiagnosis and undertreatment due to a lack of knowledge of OCD and a misunderstanding of how to treat it effectively, which limits the use of ERP therapy.
For anyone seeking care, the first step is finding an OCD specialist. Having someone who’s an expert in this area is key for successful treatment because often talk therapy—as well-intentioned as it is—can make OCD symptoms worse.
An interesting thing happened when Ally tried to find an OCD specialist: She couldn’t. At first, it was a challenge to even find someone to call. Living in Huntsville, Alabama, she recognizes that the options for mental health care are lacking. “When I was looking for a therapist, I couldn’t find anyone who specializes in treating OCD.” Several healthcare practitioners recommended names to her—but when she reached out, all she got were voicemails.
No one called her back. She understood they had long wait lists, but not one offered to connect her with another resource or recommend a different professional.
She was on her own again. With a lack of providers, long waitlists, and high out-of-pocket costs of treatment, Ally couldn’t find an expert trained in ERP that she could meet with where she lives. “I’m really struggling. And I’m struggling to get the help I need,” she says.
This struggle is not unique to Ally. In fact, NOCD’s Co-founder and CEO, Stephen Smith, faced similar barriers, which led to the company’s founding in order to create virtual OCD care with trained ERP therapists that was more accessible and affordable.
This, it turns out, is lifesaving. A large cohort study in BMJ published in 2024 on nearly 5,000 people with OCD found that those who have OCD have an 82% higher risk of dying from any cause compared to those who do not have the disorder. People are more likely to die from hormonal and metabolic diseases, mental disorders, and many other conditions when they have OCD.
And so, given the mental and physical consequences of OCD, it’s shocking that some insurance plans do not cover ERP therapy. Although NOCD accepts insurance that covers 2 out of 3 Americans, insurers can do better in offering access to this treatment to everyone.
Recently, Ally has recently been able to start ERP therapy with NOCD. “I want to get out of this loop of intrusive thoughts. I want to go back to my life,” she says. Looking toward the future, Ally has so many goals. There’s the cookbook she wants to write. She wants to be able to travel. She’d like to go to the UK, where her husband is from. Her hope is that OCD treatment will help her achieve them. “I need to be able to go out for a meal without thinking that it will poison me or cause a severe allergic reaction. I need to be able to convince myself that my chest pain is not a heart attack when testing says my heart is fine,” Ally says.
Ally is grateful for her career success, and she acknowledges that she speaks from a place of privilege. Still, she’s understandably angry for people who don’t have health insurance or whose health insurance doesn’t cover the care they need. “If you don’t have money, sometimes you can’t access the mental health resources you need. It should be more accessible. There should be an easier way to get it. We don’t need one more thing to make getting help difficult,” she says.
Still, Ally sees the beauty in her life and the possibilities that are ahead of her. “I’ve been in a place before where I thought that things would never get better, but as cliché as it sounds, things do get better.” Her biggest piece of advice for someone who is similarly grappling with OCD? “Don’t let the shame that comes from OCD stop you from getting treatment. I wish someone had told me that. You don’t have to judge yourself. You only need to be kind to yourself.”