Season 6, Episode 5: OCD (Obsessive Compulsive Disorder) with Penny Moodie
This week we speak with Penny Moodie about Obsessive Compulsive Disorder (OCD).
Penny is a writer, OCD advocate, and mum of three little people. She is the author of The Joy Thief: How OCD steals your happiness – and how to get it back and the co-creator the website soocd.com.au, which is packed with information on OCD and how to get support.
In this episode, Penny very generously shares her personal experience with OCD, and she takes us through the ‘why’ of OCD and the strategies and treatment approaches she has found helpful.
In this episode, we cover:
What is OCD, and crucially, what isn’t OCD?
Some of the key mechanisms of OCD, including thought-action fusion, uncertainty anxiety, the ‘just right’ feeling, and the feedback loop between obsessions and compulsions.
Periods of OCD onset.
Talking to kids about their thoughts.
Penny’s personal experience of OCD throughout her life, including in childhood, her adolescence, and throughout her adulthood, and her path to accurate diagnosis.
OCD in the perinatal period.
Treatment approaches for OCD and strategies that Penny has found useful, including ERP, methods to reframe and manage distressing thoughts, medication, self-compassion practice, and connecting with other people experiencing OCD.
[00:01:14] What is OCD?
Key Takeaways:
Penny explains that Obsessive Compulsive Disorder is often misunderstood, with many people using the term to describe behaviours like liking things tidy, but that’s not what OCD truly is.
True OCD involves obsessions and compulsions:
Obsessions—persistent, unwanted fears or anxieties.
Compulsions—actions or behaviours performed to alleviate the discomfort from those obsessions.
Compulsions aren’t always visible actions like excessive cleaning or handwashing; they can also be behaviours like avoidance. For example, avoiding walking out onto a balcony due to a fear of jumping off, even if there's no desire to do so.
The portrayal of OCD is evolving, but there’s still a common misconception that it only involves compulsive cleaning or tidying up, which simplifies the complex reality of the condition.
Michelle expands on the relationship between obsessive thoughts and compulsions in OCD, emphasising that compulsions specifically aim to neutralise or alleviate discomfort caused by the obsessive thoughts.
Intrusive or strange thoughts are common, but in OCD, these thoughts create intense discomfort that compels the person to act in a specific way to reduce that distress.
Liking things done a certain way or being neat is not OCD, which is a common misconception. These behaviours are more aligned with Obsessive Compulsive Personality Disorder (OCPD).
Penny agrees that OCD and OCPD often get confused, but they are distinct conditions. While some people may experience both, they present very differently.
Monique reflects on how Penny’s book clarified that OCD involves intrusive, unwanted, and distressing thoughts or images that are not consciously sought after but rather invade a person's mind, disrupting daily life and occuring very frequently.
These intrusive thoughts often go against the person’s values, which increases the distress and discomfort they experience.
The repetitive and unwanted nature of these thoughts leads people to believe that having these thoughts must mean something negative about them, like being a bad or shameful person, which can further fuel compulsions.
Understanding this distinction helped her differentiate OCD from other conditions like generalised anxiety disorder (GAD), where the worries tend to revolve more around day-to-day life rather than feelings of being inherently bad or shameful.
Penny agrees that OCD and GAD can be difficult to tease apart, to begin with, and raises the point that OCD and GAD can also coexist, making it difficult to differentiate between them.
One key distinction is that OCD involves thoughts that are ego-dystonic, meaning they go against a person's values, while generalised anxiety typically involves worries that don’t conflict with personal values.
People without OCD may also experience strange or distressing thoughts, but they can usually dismiss them after some discomfort, whereas those with OCD struggle because their brains get “stuck” on these thoughts.
Penny introduces the concept of “thought-action-fusion,” where a person believes that having a thought means it will lead to action.
This can also be called “thought-object-fusion” or “thought-event-fusion,” where certain objects or events are believed to hold undue significance, as seen in hoarding behaviours.
The over-importance placed on thoughts in OCD contributes to the intense distress and difficulty in letting go of them, making the condition particularly challenging.
“Everyone will have weird distressing thoughts. A lot of the time, people without OCD will be able to look at it, maybe feel a bit uncomfortable for a while, and then it might pass. With OCD, the thoughts can very much get stuck. Then, what can often happen is that can be this thing called “thought-action-fusion.” So you have a thought, and then you immediately think that that thought will lead to action.
Or, sometimes it’s called thought-object-fusion or thought-event-fusion. So hoarders, for example, can have thought-object-fusions. They might not want to throw something out because they might feel it has this real importance to something or someone, and if they throw it out, that might do something to that person. So, yeah, there’s this real over importance of thoughts, and when they get stuck, it can be very, very distressing.”
Monique emphasises that another key aspect of OCD is the amount of time consumed by intrusive thoughts and compulsions, which can dominate a person’s daily life. This time factor helps differentiate OCD from general stress or generalised anxiety, where worries might be more temporary or situational.
She notes that Penny’s personal experience and insights in her book highlight how much of a person's day can be spent battling these intrusions, offering a clearer understanding for listeners.
Penny confirms that when she was deeply affected by OCD, her obsessions consumed her thoughts from the moment she woke up until the moment she fell asleep, even appearing in her dreams.
The overwhelming amount of time spent worrying, along with the high level of distress, is a significant part of what sets OCD apart from other types of anxiety.
[00:11:34] Some of the key mechanisms of OCD
Key Takeaways:
Michelle reflects on the underlying reasons behind the “thought stuckness” in OCD, noting that while no one fully knows why it happens, it may be linked to heightened anxiety around uncertainty.
She compares how someone without OCD might handle a fleeting, strange thought—like the possibility of jumping off a balcony—by recognising its improbability and moving on. However, in OCD, even the smallest sliver of possibility causes extreme discomfort.
This discomfort with uncertainty may drive the need to engage in compulsive behaviours, including physical actions like avoidance, as a way to manage the distress caused by intrusive thoughts.
Michelle suggests that the inability to tolerate any level of uncertainty could be a key factor in the persistent intrusiveness of OCD thoughts and the compulsions that follow.
Penny shares her excitement about emerging research on the neurobiology of OCD and hopes it continues to develop, as it offers new insights into the condition.
In her research, Penny spoke with Dr. Jonathan Grayson, who highlighted two significant elements of OCD:
1) the intolerance of uncertainty and
2) the pursuit of the “just right feeling.”
People with OCD often crave certainty, and a big part of the struggle is the inability to ever truly feel certain about anything, which drives much of the obsessive-compulsive cycle.
The “just right feeling” is often sought through compulsions—people repeat actions until it feels right, but achieving this sensation can take hours, further trapping them in the compulsive behaviour.
Michelle highlights the concept of diminishing returns in OCD, where initially, a compulsion may bring relief, but over time, it requires more and more repetition to achieve the same feeling of comfort.
Penny agrees and shares a personal example from her childhood when she had an obsession (fear) about contracting AIDS, dying, and infecting her loved ones. Her compulsion was to seek reassurance from her mum, which initially brought a sense of relief.
Penny explains that reassurance-seeking is a common compulsion, but the more you give in to the compulsion, the more the obsession intensifies.
What started as a momentary relief soon turned into repeatedly asking her mum for reassurance, sometimes multiple times an hour.
“When I was about eight or nine, having the obsession that I had AIDS, worrying that I had contracted AIDS and I would end up dying and I would also end up infecting people that I loved, my compulsion was usually to talk to my mum about it and get her reassurance.
Reassurance-seeking is very much a compulsion. The first time I did it, I was like, “Oh, this wave of relief. Yep, she gets it. She understands, nothing to worry about.” Go back to my day. But it’s not how OCD works. The more you feed into the compulsions, the more they feed the obsessions. ”
Acting out the compulsion feeds the obsession, leading to a cycle where the anxiety grows, rather than diminishes, as the compulsions are repeated.
Monique emphasises that people with OCD are often just seeking relief from their distress, which is a normal and valid desire. However, it’s crucial to understand that compulsions, whether physical or mental, only serve to reinforce the obsessions.
Penny's book effectively illustrates various non-physical compulsions, like reassurance-seeking, which many might not recognise as a compulsion but plays a significant role in feeding OCD.
Compulsions, including avoidance or reassurance-seeking, actually strengthen the OCD over time, creating a behavioural and potentially neurobiological feedback loop that reinforces the obsessions. This feedback loop makes OCD stronger the longer it continues.
Much of the treatment is focused on breaking this feedback loop by disrupting the connection between obsessions and compulsions, gradually weakening the OCD's hold.
“Once you’re enacting these compulsions, even though you might get temporary relief, it’s really giving your brain the feedback that these thoughts are important and that you can’t get on with your day and find that peace without doing the compulsion.”
Penny shares that from a young age, acting on her compulsions likely created a neural pathway in her brain, reinforcing the obsessive-compulsive cycle.
When she began proper treatment in her early 30s, the challenge was to create new neural pathways, a difficult process after years of following the same compulsive patterns.
Again, while compulsions may provide temporary relief, they signal to the brain that the intrusive thoughts are significant, making it harder to find peace without performing the compulsion. This reinforces the compulsive cycle over time.
Monique stresses the importance of discussing OCD openly, as sharing experiences and examples helps break down the stigma surrounding it. There is still significant stigma attached to OCD, making these conversations vital.
Providing accurate information at an earlier age could reduce the delayed diagnosis that many people with OCD face. The longer the delay, the more time OCD has to be reinforced unknowingly.
This delayed diagnosis isn’t the person’s fault; the information about OCD is often highly specialised. Even in psychology, practitioners need additional training beyond the basics to fully understand and treat OCD effectively.
Penny agrees and finds the gap between the onset of symptoms and diagnosis frustrating.
She recalls mentioning in her book that the average delay in diagnosis is around eight years, but some research suggests it could extend to as long as 16 years.
A large portion of people with OCD experience its onset at a young age, as Penny did, although adolescence is also a common time for OCD to emerge due to the significant upheaval of the teenage years.
The perinatal period as another critical time when OCD can first appear. Many women experience an onset of OCD during pregnancy or after childbirth, which can be temporary or persist.
Penny found it alarming how many women develop OCD during the perinatal period without recognising it.
For those unaware of what’s happening, the sudden onset can feel overwhelming and distressing, especially if they don’t have a name or understanding for what they’re experiencing.
Reflecting on her own perinatal experience, Penny notes that while she knew she had OCD, she wasn’t receiving the right treatment yet, but at least she had an idea of what was going on—something many women don’t have in similar situations.
Michelle acknowledges that the postnatal period is a time of significant internal and external changes, which can trigger various mental health conditions like postnatal psychosis and OCD.
While awareness among health practitioners and the public is improving, there’s still a long way to go in ensuring people receive the support they need.
Michelle underscores the importance of raising awareness so people can access proper treatment and, crucially, avoid feeling like they’re “going crazy.” Knowing how to contextualise and conceptualise what’s happening in their mind can make the experience less terrifying, even if it doesn’t make it easy.
Big life transitions, like moving into adulthood, can also trigger OCD in some individuals. These periods of change, whether during adolescence or other major life phases, can be points where OCD first emerges.
Penny reflects that the peaks of her OCD symptoms have aligned with major life upheavals, confirming how transitions can intensify the condition.
[00:24:08] Penny’s personal experience of OCD in childhood
Key Takeaways:
Penny recalls her first obsession around the age of six or seven, centred on the fear that her parents might die in a car crash or never return home, a common childhood worry. This fear, however, became stuck for her, leading to compulsions.
Before bed, if her parents were out, she would perform a specific ritual, believing it would keep them safe.
Penny notes that this is often referred to as “magical thinking OCD,” where there’s no logical connection between the thought and the compulsion, but in her mind, the ritual was a way to protect them.
Michelle thanks Penny for sharing her story, as it perfectly illustrates the difference between typical childhood worries—like fearing parents might die—and OCD.
While the fear itself is common, Penny’s experience shows how it became stuck and developed into compulsions, setting it apart from a normal, passing concern.
While children with typical worries might be reassured by explanations like “Here’s the plan. Here’s what will happen,” OCD-related fears persist despite such comfort. In OCD, the worry lingers and remains stuck.
OCD rituals, like Penny’s bedtime ritual to keep her parents safe, are specifically linked to preventing a feared outcome, distinguishing them from ordinary routines that provide comfort without that connection.
Michelle stresses the importance for health professionals to explore the underlying motivations behind a child’s rituals to determine whether they are driven by OCD, rather than assuming they’re just comforting habits.
“So, if there are any medical allied health professionals listening, this really underscores the need to explore the why, particularly with adults, of course, but with kids as well, and not assume that we know why they’re doing something.
Really dig into, “Okay, but what’s the purpose of this? Under what circumstances does it happen?” Because that’s where we really unpick what’s going on for that kid, because someone could have assumed, “Oh yeah, you’re a little bit nervous when your parents aren’t here. So, you like to have a ritual, and that helps you feel safe,” but it’s so much more than that.”
Penny agrees with the importance of recognising that young children, especially those with OCD, might not be able to verbalise their fears.
Many parents may see bedtime rituals as quirky or annoying without realising they could be linked to a much deeper fear.
Monique highlights the common OCD theme of over-responsibility, where children may believe that they are causing harm or that something terrible will happen to a loved one because of them. This sense of responsibility can be a flag for OCD.
Penny adds that speaking with child psychologists helped her understand the importance of asking children direct questions about their fears, even if the topics seem uncomfortable, such as death or hurting others. She reassures parents that asking these questions won’t put ideas in the child's head but may help uncover worries the child is struggling to express.
Michelle agrees that asking direct questions won’t put unwanted thoughts into a child’s head.
→ She suggests a helpful opening question for parents: “Do you ever worry that bad things will happen?” This can be a gentle way to start the conversation.
If a child’s response indicates a connection, parents can follow up with specific examples, like “Do you worry about this or that?”
Sometimes, kids are relieved to hear these questions because they didn’t know they could express those thoughts.
While adults often sanitise topics to avoid scaring children, addressing their worries directly—whether about death, infection, or even sex—can provide clarity and relief. Just saying the words helps children feel like it’s okay to talk about their distressing thoughts.
Penny agrees that while these conversations may feel uncomfortable, they can provide immense relief to a child who otherwise feels alone with their thoughts. The discomfort comes from not sharing those thoughts, not from discussing them openly.
She reflects on a recent experience with her seven-year-old son, explaining that it's important to teach children that there are no “bad” thoughts.
From a young age, kids often believe they can have good or bad thoughts, but she emphasises that any thought, feeling, or image is okay.
Penny stresses the importance of explicitly teaching children that they can’t think the wrong thought, fostering acceptance and openness from an early age.
Monique appreciates Penny's focus on de-shaming and de-stigmatising thoughts, noting that many people with OCD may avoid discussing their intrusive thoughts with health professionals due to fear, shame, or worry about being judged.
Penny shares how her psychologist frames intrusive thoughts as “faulty data,” which helps reduce the over-importance placed on them—a perspective that’s been crucial for her in managing OCD throughout her life.
[00:32:54] Penny’s personal experience of OCD in adolescence and adulthood
Key Takeaways:
Penny recalls that during adolescence, her obsession with AIDS lingered until it was replaced by other obsessions, which she describes as a devastating cycle common in OCD.
Starting high school triggered many identity-related obsessions for Penny.
She remembers the anxiety that surrounded the sexual dynamics at her co-ed school, which led to irrational fears like worrying she’d become pregnant despite not having had sex.
To cope, she frequently took pregnancy tests, realising later how much time was consumed by this irrational fear.
As her high school relationship developed, another obsession emerged—worrying that she might not be into her boyfriend and might be gay.
Penny highlights that her anxiety was rooted in uncertainty about herself, not in any opposition to being gay, but in the fear of confronting something she didn’t fully understand and needing to articulate it to those around her.
Michelle reflects on Penny’s experience, linking it back to the idea of uncertainty anxiety. She suggests that as life becomes more complex with age, the less certainty one has, particularly about deep, profound questions related to identity.
These are questions no one can ever fully answer with certainty, and wonders if Penny’s discomfort wasn’t about being gay, but rather the fear of not being certain about her identity and wanting to feel secure in who she was.
Again, the ego-dystonic element in Penny’s experience wasn’t about being gay, but more about the discomfort of not being certain about her identity and the desire for that certainty.
The need to know who she was and to feel certain about it was tied to a sense of safety and security for Penny.
Penny shares that her obsessions around sexuality hit in early adulthood, but by her mid to late twenties, they morphed again.
At one point, she became fixated on the fear of hitting someone while driving, retracing her route to make sure no one was lying injured.
Michelle comments on how time-consuming this must have been, and Penny agrees, noting that this fear can lead some people to stop driving altogether, though it didn’t reach that point for her.
Penny recalls a brief period of relief where her OCD seemed to disappear for a couple of years, though her general anxiety levels remained high. She reflects on how unusual and relieving it was not to feel hostage to her obsessions during that time.
Eventually, she began experiencing relationship OCD, where persistent doubts arose about whether her partner was the right person for her or whether she felt the “right” feelings.
This is a common manifestation of OCD, where people also worry whether their partner is into them enough.
Michelle reflects that it seems like Penny’s need for certainty manifests in different areas of her life, including relationships. It’s as though she seeks to have no doubts about her identity, her life, or how others perceive her.
Penny agrees, noting that this need for certainty extends to relationships, which are inherently uncertain and ever-changing. One day, you may feel one way, and the next day those feelings can shift.
Penny explains that her experience with relationship OCD has taught her a lot, particularly about the unreliability of feelings and the importance of actions. While thoughts and feelings can fluctuate, actions carry more weight in relationships.
Penny shares that many of her compulsions in relationship OCD were mental ruminations, where she would constantly go over thoughts like, “Was this feeling the right feeling?”
She also found herself comparing her emotions to those depicted in movies, particularly rom-coms, asking herself, “Am I feeling the same thing that that character’s feeling?”
Monique asks if Penny found herself seeking reassurance from herself, which Penny agrees with, noting that much of her life has involved self-reassurance.
As an adult, Penny explains that instead of asking her mum for reassurance, she would often turn to her partner, which is common in relationship OCD. However, this can be an awkward and unsettling conversation for a partner, leading to their own insecurity and potentially worsening the anxiety cycle.
One of the most helpful things for Penny and her husband, Hugh, was seeing her psychologist together.
The psychologist was able to explain relationship OCD to Hugh, which alleviated some of the pressure and emotion on Penny and allowed them to discuss the issue without causing him undue stress.
Monique reflects on how difficult it can be for both people in a relationship if one partner has undiagnosed relationship OCD.
Without knowing the cause of their thoughts and feelings, the person with OCD may be constantly questioning and checking the relationship, leaving their partner confused and distressed.
She emphasises how important it is for both partners to understand what’s going on, recognising that the OCD-driven thoughts aren’t personal.
It’s not about the relationship itself, but rather the brain getting stuck in a loop, with the relationship being the current theme that the OCD is fixating on.
Penny explains that OCD often targets what you value most. In the case of relationship OCD, the obsessive thoughts usually stem from the fact that you deeply care about your partner and value the relationship.
The fear of losing someone important can drive the obsessions, which can actually offer some comfort when you realise that these thoughts are a reflection of how much you value the person rather than a sign that something is wrong with the relationship.
Penny describes how her OCD evolved during the perinatal stage, particularly after having her first child at 29. Despite feeling great during pregnancy, everything worsened after the birth due to exhaustion and hormonal changes.
A recurring theme for her OCD during this time was the fear that something might be wrong with her child, such as a lifelong illness, and the worry that she might have caused it by doing something wrong during pregnancy.
Michelle connects Penny's experience to the recurring theme of self-blame, where the OCD leads to thoughts like, “Hello. I'm the problem.”
Penny agrees, noting again how OCD fixates on what you value most.
In the OCD peer support groups Penny’s started, many women in the perinatal phase face overwhelming responsibility—whether it’s about diet during pregnancy, drinking alcohol before knowing they were pregnant, or fears like toxoplasmosis from cat poo.
Penny recalls a stressful moment with her third child’s inconclusive hearing test, where uncertainty fuelled her obsessive thoughts, even after the situation was resolved.
She also mentions her experience with Googling potential risks from taking SSRIs (a type of antidepressant) during pregnancy, which only amplified her anxiety, but she was able to manage it better by then, having started treatment.
Penny reflects on how, without understanding OCD, new mums can feel like they’re going crazy. Even when their child is asleep, and they should be getting some respite, they can’t.
Michelle highlights the importance of seeking intervention and treatment for OCD before having children, if possible. The uncertainties and fears that come with parenthood can be a breeding ground for OCD, so going into that phase with a toolbox of support can help make the process easier.
In her experience with her third child, Penny shares that having already started OCD treatment helped significantly. She was proactive, booking online sessions with her psychologist right after giving birth, which allowed her to manage her symptoms early on.
She acknowledges the financial difficulty of ongoing therapy but recommends it for those who can afford it, as it helped her nip her OCD symptoms in the bud.
Penny also had to stop seeking reassurance from her husband, which was difficult, and she followed her psychologist’s advice by texting several people for neutral responses like “We don’t know” instead of reassurance.
Ultimately, Penny reflects that having sessions already booked in, even though she felt fine during pregnancy, was the most helpful part, as she knew how quickly things could change postpartum.
[00:47:23] Penny’s own path and barriers to diagnosis
Key Takeaways:
Penny reflects on her long journey to diagnosis, finally receiving it at 31. However, like many others she has spoken to, she had self-diagnosed before getting an official diagnosis, which felt unfair, as it shouldn’t be up to individuals to diagnose themselves.
She shares that she had been seeing a psychologist since the age of 19, but she wasn’t fully honest in her sessions. She avoided discussing her intrusive thoughts, which led to being misdiagnosed with generalised anxiety disorder.
Penny acknowledges that the misdiagnosis was understandable, as she wasn’t fully opening up about what she was experiencing.
Michelle reflects on how many psychologists and health professionals, including herself, can feel hesitant to ask certain questions if they don’t fully understand the topic or don’t consider themselves experts in that area.
She stresses the importance of asking the question, even if it feels uncomfortable. It’s never a bad idea to screen for conditions like OCD, even if the you don’t specialise in treating it.
Refer clients to specialists if you notice red flags for OCD. If it’s not your area of expertise, you should still ask the question and then connect the person with someone who can provide appropriate support.
Penny reflects on her early experiences with therapists, noting how important it is for professionals to offer warmth and create a sense of safety.
In her case, the lack of warmth made her reluctant to open up about her true struggles.
It wasn’t until her late twenties, when she found a psychologist who made her feel comfortable, that she was able to fully express what was happening.
This psychologist identified OCD and referred her to resources, but the referral was too generic, making it difficult to find a specialist in OCD treatment.
This challenge led Penny and her friend Rosie to start their website, So OCD, to provide better access to OCD resources in one place.
Penny had made it her mission for six to twelve months to find someone with expertise in treating OCD and became aware of ERP (Exposure and Response Prevention) as the most successful treatment method before beginning her journey with it.
What Penny found helpful in treating and managing her OCD
ERP (Exposure and Response Prevention) was a game changer for Penny after spending most of her life trying to avoid uncertainty and discomfort. ERP pushed her in the opposite direction, forcing her to confront her fears, which was initially terrifying.
She acknowledges that ERP can be extremely confronting, and some people may take years to feel ready to start. This is why it’s crucial to work with a therapist experienced in ERP.
Penny reflects that facing her fears head-on helped her realise that the anxiety, while uncomfortable, wasn’t going to harm her. Over time, she learned to manage it, and the anxiety gradually lessened.
Penny provides an example of ERP (Exposure and Response Prevention) from her postnatal phase with her third child, where she was worried something terrible might happen to him.
She would record a voice note saying, “Maybe he will develop some kind of disorder or disease, and that will then change the trajectory of our lives, but maybe he won't, and maybe he will be totally fine, and he'll hit all the developmental milestones, and that won't even be an issue.”
By embracing the uncertainty with the phrase “maybe,” Penny allowed the anxiety to flood in, which is part of the process. She would then listen to the voice note repeatedly, each time feeling the anxiety lessen.
Penny also practiced resisting reassurance from her husband by not asking him for confirmation on things like “Oh, is he smiling? Is he smiling yet? Do you think he should be smiling? Is he?”
Instead, she encouraged him to respond with uncertainty, saying, “We don’t know for sure. We don’t know what’s going on yet, but he’s doing all the things he’s meant to do.” This helped her manage the anxiety without seeking constant reassurance.
Michelle highlights how Penny's example perfectly illustrates the key aspects of ERP—exposing oneself to the anxiety and uncertainty while preventing the compulsion, in this case, seeking reassurance from her husband.
She notes that by responding with uncertainty, Penny's husband was also participating in the exposure, reinforcing the fear rather than alleviating it with certainty.
Penny agrees, emphasising that the crucial part of ERP is preventing the compulsion. The process involves sitting with the discomfort without doing anything to relieve it.
Penny adds that while ERP is challenging, it’s also straightforward: “It’s hard, but it’s simple. You sit with the discomfort, and you don’t do anything.”
Monique likens ERP to starving the OCD by sitting with the discomfort and not engaging in the compulsion, causing the obsession to shrink over time rather than grow.
Penny agrees, sharing a metaphor from her psychologist that she included in her book: Feeding the compulsion is like feeding a lion, making it stronger and louder. By withholding the compulsion, the “lion” becomes smaller and weaker, eventually turning from a roar into a quiet peep.
“A metaphor that my psychologist used and I put in the book is about starving the lion. The more you do the compulsion, the more you’re feeding the lion. It’s getting stronger. The roar’s getting louder. The more you can hold off from feeding, it’ll get smaller, weaker. It’ll be more of like a little peep, it won’t be a roar in the long run.”
Penny mentions seeing an OCD therapist on Instagram who suggested helpful reframing. He suggested to shift the common “What if?” mindset in OCD to “Even if.”
For example, “Even if this thing happens to my child, I will face that challenge when it comes and get the support I need.”
Penny shares that she started taking an SSRI antidepressant at 21 and has remained on the same medication ever since.
While it didn’t stop her obsessions, it quietened them and reduced her panic attacks, allowing her to engage more effectively in therapy.
For Penny, the combination of therapy and medication has been crucial.
Michelle highlights that medication is a tool, and it’s important to recognise that it’s morally neutral. There is still stigma around taking medication, but it can provide the capacity to engage in behavioural or therapeutic strategies, like talk therapy, allowing people to live a life aligned with your values.
Penny loves the term “morally neutral” and reflects on how she used to feel shame about taking medication, but now it’s something she no longer gives a second thought.
She also shares her experience with an OCD support group started by her psychologist, who noticed she was having the same conversations with five or six clients and thought a group setting might help them extend compassion to each other, and ultimately to themselves.
Penny was initially nervous but found the group life-changing, as she met others with OCD for the first time. Seeing her struggles reflected in others helped her extend more compassion toward herself.
Michelle notes that OCD can be isolating, making it feel like you're the only one experiencing these struggles.
Showing compassion to others in similar situations can be an easier step toward extending that same compassion to yourself.
Penny shares that she’s learned a lot about self-compassion in recent years.
Having OCD often leads to believing the worst about yourself and depriving yourself of joy, which is why she titled her book The Joy Thief—because, at her lowest point, she wouldn’t let herself experience happiness, feeling like a “monster,” which is how many people with OCD feel.
So, learning to treat yourself with the same compassion you’d extend to a best friend can be life-changing.
Michelle reflects on how self-compassion can feel revolutionary, even for people without OCD. When you add the experience of repetitive, intrusive, and judgmental thoughts, incorporating self-compassion into the treatment and recovery plan becomes essential.
Penny agrees and shares that she’s been practising self-compassion when she feels herself getting caught in an OCD loop.
She tells herself, “Oh, you’re having a feeling that xyz, that’s a really hard feeling to hold, and that’s a really distressing thought to have.” This compassionate approach has been very helpful for her in managing her anxiety.
Penny introduces the concept of cognitive diffusion, which has been important for her.
Instead of thinking, “I am going to do this” or “I am bad,” she reframes it as “I’m having the thought that I might hurt someone,” creating some distance from the thought.
Monique notes that cognitive diffusion helps create a step back from the thoughts. Rather than identifying with them, it allows the realisation that “It’s just a thought passing through my mind,” which is a skill that can be developed but isn’t often taught.
Michelle highlights the importance of combining cognitive diffusion with self-compassion, noting how useful it is to have scripts like, “That’s a really hard feeling and thought to hold.”
Coming up with these scripts on your own can be difficult, especially when you feel like you don’t deserve to talk to yourself that way.
Penny shares how she struggled with extremely dark thoughts and mentions that, for her, the worst thought she could imagine was being a pedophile.
When learning about ERP, she found it impossible to use the “What if”/“Even if” reframing for those kinds of thoughts.
Instead, Penny explains that cognitive diffusion was crucial for handling such difficult thoughts.
Using a thought like “I am having the thought that I am a pedophile” as an example, she shows how acknowledging the thought without engaging in mental compulsions—by recognising it as a thought and sitting with the discomfort—was an important part of her ERP practice.
Monique highlights how the process of cognitive diffusion can involve recognising that OCD often has a genetic or neurobiological component.
→ Try acknowledging, “This is not something that I’ve chosen. It’s not my fault that I have OCD. This is an experience in a neurotype that makes life harder, and there is suffering involved in this, and that really sucks, and that’s really hard.”
Holding this understanding can help people extend more compassion to themselves when experiencing intrusive thoughts and distressing images.
Monique acknowledges the importance of discussing OCD, especially from lived experience, on The Neurodivergent Woman Podcast, particularly for their audience, many of whom are Autistic, ADHD, or AuDHD.
While OCD can occur in anyone, it is overrepresented in both Autistic and ADHD populations.
If you're working with Autistic or ADHD individuals, it's crucial to understand and screen for OCD, as it is more common in these neurotypes. Monique also notes that some people may be Autistic, ADHD, and have OCD, making it essential to be aware of this overlap.
[01:06:57] Penny’s key advice for other people who may have resonated with your story or who are supporting someone with OCD
Key takeaways:
Start by speaking with a trusted GP and work towards getting a mental health care plan. While it can be hard to get an appointment, finding someone you trust to begin this conversation is a crucial first step.
Waiting times to see specialists can be long, so Penny encourages you to use that time to learn more about OCD through books and even on Instagram, if they feel up to it.
Penny found The Man Who Couldn't Stop particularly impactful in her own journey to self-diagnosis.
She advises against starting ERP without professional guidance but stresses the importance of self-education to help separate yourself from the disorder and recognise, “This isn’t my fault. I’m not a bad person. There’s something going on in my brain, which can absolutely be managed.”
Connect with Penny Moodie:
Penny’s website So OCD
Penny’s Instagram @penny_moodie
Penny’s book The Joy Thief: How OCD steals your happiness – and how to get it back
Things We Mentioned:
How to grow your self-compassion: Compassionate Practice
The Man Who Couldn't Stop: OCD and the true story of a life lost in thought by David Adam
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