It’s not uncommon for people to feel like their mental health isn’t “bad enough” to warrant help. Your OCD isn’t totally debilitating you, so do you really need therapy?
You accomplish the things you need to accomplish—more or less—at work, school, or home. Your relationships are doing just fine. Isn’t therapy reserved for those who are not able to do those things? Those who are at their breaking point and unable to leave their beds or their homes?
These are common misconceptions, but no—therapy is for anyone. With the help of April Kilduff, LCPC, LPCC, LMHC, it’s time to dispel the myths about “high-functioning” OCD and when it’s time to seek help.
What is “high-functioning” OCD?
This is not really a term used in clinical settings. “What we look at more with OCD is how much impairment there is,” Kilduff says. While the severity of OCD varies from person to person, OCD is OCD. The pattern of the disorder is for it to get worse the longer it goes untreated, so how well someone is currently functioning doesn’t negate the need for intervention.
Impairment can take form in many different ways. Perhaps you go to work and perform well, but feel unable to use the restrooms there. Or you then return home completely consumed with doubt about a conversation with your boss.
Maybe you maintain the relationships in your life, but have a hard time fully participating in them because OCD is always running in the background. You’re a good partner, but it comes at a cost: you’re constantly putting yourself second, and the burden of OCD gradually accumulates around both yourself and your partner.
All this is to say that in the case of OCD (and many mental health conditions, for that matter), someone being externally “high-functioning” doesn’t often represent what’s really happening. Someone may be able to uphold their obligations and responsibilities, but they can still feel debilitating anxiety and distress while doing so. It can prevent them from doing things, take hours of their time, and ultimately keep them from living their best life.
Consider the following example:
Stacey has had OCD for almost as long as she can remember. She experiences what’s known as harm OCD, a subtype of the disorder in which one becomes very afraid that they are going to harm someone, either by accident or on purpose.
She owns her own home, exercises every day, and eats nutritious meals. She goes to work every day, excelling in her role. However, when she gets home, she spends at least two hours doing research online. She looks up news stories of people who suddenly “snapped” and acted out violently, looks for research about one’s likelihood to become violent, and watches TikTok videos of people sharing their stories with violent people.
She spends the remainder of her night comparing herself to the people she heard about and reviewing the events of her day, urgently searching for signs of violence or a desire to commit violence. Did she get angry? Was she always under perfect control? She is constantly anxious and has started to avoid going out with friends, as she is afraid she will either hurt them or tell them about her disturbing thoughts.
Stacey’s case could be considered a “high-functioning” one: she’s able to take care of her physical body, her material needs, and fulfill the duties of her job. Yet, her life is still being significantly impacted—she’s anxious all the time and is starting to self-isolate. Her life is starting to become smaller and smaller. The fact that she’s able to “function” becomes less and less relevant when she is not able to actually enjoy her life and live it on her own terms.
“I think there are a lot of people who can just ‘rally’ and put on a good front, and make it out the door, and look like they’re doing well, but you have no idea what they’re dealing with internally,” says Kilduff.
Moreover, she stresses, “There’s still so much stigma around mental health. It’s hard for people to be open about it, so there’s this pressure to look and act like you’re performing even if you’ve got things going on underneath that.” Thus, when referring to yourself as “high-functioning,” consider whether external pressures are contributing to how you see your own mental health.
So, should you get help even if you’re “functioning”?
Absolutely. There’s a popular misconception about therapy that you have to be in crisis in order to go—that you have to be unable to get out of bed, constantly in tears, or otherwise incapacitated. In reality, though, therapy can prevent you from ever having a crisis. The sooner you receive treatment, the less likely you are to reach rock bottom.
Kilduff says, “I wish more people realized that therapy can be preventative and that at the very first sign of a mental health concern, you can go get help rather than wait until it becomes horrible.”
That’s how most of us treat our physical health, she notes. If you have flu-like symptoms for days on end that show no sign of letting up, for example, you’re probably not going to wait until it develops into, say, pneumonia. You’re going to go to the doctor. Therapy can be thought of the same way: the sooner you address your concerns, the more you can stop them from escalating.
You don’t have to settle for “good enough” in your life. You deserve not just to survive, but to thrive. From personal experience, I know it can be hard to make the final push to seek therapy services, especially with the lingering stigmas that exist around mental health and therapy. I was initially resistant to therapy—I thought of myself as rather “high-functioning”—but without it, I would’ve continued on a trajectory toward crisis.
At seventeen, when my primary care doctor told me I should consider therapy, I practically scoffed in her face. I’m not that bad, I thought. Therapy is for people who are ‘crazy’ or can’t live their lives.
Eventually, I gave in because of two factors that Kilduff names as universal signals that it’s time to seek help: impairment and distress. My fear and anxiety were reaching levels that felt unmanageable, and I was not able to participate in my life fully because of it. I might have gotten used to the level of impairment that OCD was causing me, but that didn’t mean it wasn’t significant.
If I hadn’t relented and sought help, I probably wouldn’t be living the current life I have and love.
How is OCD treated?
The gold-standard treatment for OCD is exposure and response prevention (ERP) therapy. You may have previously heard this referred to as simply “exposure therapy,” but the response prevention part of ERP is absolutely crucial.
To begin the process, you and your ERP-trained therapist will work together to better understand the details of your OCD—what your obsessions sound like, what triggers them, and what compulsions you engage in for a sense of relief. From there, you’ll create a treatment plan, collaborating to create therapy exercises and confront your obsessions gradually and carefully, learning to loosen the grip that OCD has on your life.
What happens over time is that you realize you can tolerate the discomfort of anxiety, and you can tolerate the uncertainty that your intrusive thoughts bring. This retrains your brain to not take intrusive thoughts so seriously, ultimately breaking the vicious cycle of OCD.
It may not be an easy process. It can be hard work, but it is highly rewarding and empowering. Regardless of your outward “functioning,” this form of therapy can transform how you feel on the inside, and will only strengthen the freedom you feel to live your life. Just because you’ve gotten used to your disorder doesn’t mean you have to continue the same way. You may feel like you’re okay, but imagine just how much better you could be without OCD.