Understanding and Treating Real OCD with Berkeley Runia Paulsen (Part 1)

Foreign.

Welcome to Finding Noble, a podcast where we climb into the world of young people's mental health and where we provide support for the adults who support them. I'm your host, Carly Red. Hello and welcome to another episode of Finding Noble. I'm Carly Red, your host, and I'm with my co Host always, Dr. Kevin Skinner. Hello, Dr. Skinner.

Hey, Carly. How are you?

So great. And we today are discussing the topic of obsessive compulsive disorder, also known as ocd. And our guest today is Berkeley Runia Paulson. She is my sister.

Now, that's fun.

She's my sister and she also works with teens experiencing mental health challenges at Wasatch Behavioral Health. Her background's in psychology and social impact. She's starting her MPA in the fall. And we brought her on our podcast today because with her own personal experience with OCD and with her mental health expertise, we felt like she was the perfect guest to come talk to us about ocd.

And I'm going to say that's fun. I'm glad that your sister's joining us. And Berkeley, I have a question for you.

Yes.

At what age did you start thinking about OCD?

It was after. So our oldest brother died 11 years ago, so I was 11. And then Carly actually was one of the ones. I started washing my hands a ton, so I didn't know anything about ocd. This was like. How long after, do you say? Two or three months.

Yeah.

So two or three months after he died, my hands were like cracking. And I remember one time I came inside and I had washed my hands twice or something and you said, I just. This is a normal.

I just looked at her hands and they were completely raw, bright red, Chafing.

Yeah.

And she was scrubbing them.

Yeah. Luckily you said something to Mom. So then I kind of started learning about OCD then.

So that's when you first were initiated, Started understanding that maybe I. Some obsessive type thoughts.

Yes.

But nothing before that.

Nothing before that. I can't remember anything before that.

Ever since then, you've been on a really long journey and I don't think it was right after. Did you feel like it. You knew it was O, C, D? You just thought it was you dealing with the death of your bro.

Yeah.

And trying to work through that grief. But when did you first start to maybe put a name to ocd?

I. I remember the therapist I saw. So it was Amy add out. Obviously she knew OCD and really could see the signs. She was very helpful with more of the textbook things. That were ocd. And I felt comfortable telling her that. But there were things that I didn't think. I just. For almost the majority of those years since finding out it was ocd, it felt like I had ocd, But I also was just a little bit crazy. There's some of these things in my head that nobody. This for sure isn't. I wouldn't tell a therapist that. They're like, oh, that's normal. You know what I'm saying? It felt like, yeah, I can tell. Amy. I'm washing my hands at the therapist, I'm washing my hands a lot. Or I'm worried about locking the doors. Things that, like, people will joke about around ocd. But some of the darker things that felt really personal and I was embarrassed to tell anybody that. Just felt like I have something weird inside of me, I have OCD and something else going on.

OCD historically fits under what we call an anxiety disorder. A lot of anxious, racing thoughts, mind is going. Sometimes physiologically your body feels a lot of anxiety or maybe a lot of fear. Would those also have been symptoms that you would say you were experiencing?

Yes.

Yeah. So it did feel like, especially because I was 11 when this happened, I could see that other people aren't. At least my friends. It doesn't feel like other people are worrying about these kinds of things. And ever since then, your mind is just going a million miles an hour and you can think of anything bad that could ever happen and think through all situations. Yeah, just some of it was just so much worry. I would just get sick with worry about anything and everything. Whatever I was obsessing about. I.

It was dark. I remember you had, during junior high and high school, you really wanted to be clean. And you talked about later on that perhaps it was a bit of triggering from our brother dying and he had four young kids and you just had this obsessive fear about causing someone else.

Harm to someone else. Yes. That was like the first one.

And so you wanted to be perfectly germ free, clean. You never wanted to contaminate another human being because you felt so much pain watching these kids and so much pain without their dad. I'm not trying to put words in.

Your mouth, but I just remember you.

Saying that it would be like you would shower and then you would get out of the shower and then you would touch like a already hanging towel or something and you'd be like, oh, I gotta start over.

Yeah, I remember what happened that our. One of my brothers was babysitting and we were at an arcade and I went to the bathroom and then I washed my hands, but I only washed my hands for like eight seconds. And I came out and one of our brother's friends was there and he was like, oh, it's nice to meet you. He shook my hand and I felt like I needed to tell. By the way, I only washed my hand for eight seconds, so you should probably go wash your hand. And I didn't say it in the moment, but I think I ended up telling Tanner, maybe our brother, and he was, what are you talking about? But I just, I couldn't stop thinking, oh my gosh, this person could get sick. That's disgusting. I have to tell them. I feel responsible.

And so that started age 11. And did you find that it progressively got a little bit more difficult for you or do you feel like it just from that time on, from the loss of your brother, moving forward, did it. Was that pretty much the same or did you see that it escalated?

I feel like at the beginning, because I was so young, it was really scary because obviously some of those things, like now I have the ability to talk about it or communicate, but at that age, I feel like the first couple years were hard in a different way because I really didn't know what was normal and I didn't know how to express any of those feelings. And it just felt so isolating. But then over the years, it just morphed into different things. So some obsessions are harder than others. Like, obviously contamination is not fun. When I don't like to step on the bathroom floor, that's less concerning than morality based obsession. So it just morphs, it feels like.

Yeah. So, yeah. Into other areas or other ways of living and other thought processes. Yeah, yeah. So interesting point here. Just. And then I'll let you go, Carly. But one of the things that we observe with things like anxiety and OCD is there's often there's a starting point and we don't know the necessarily the trigger. Right. Because you're talking about loss. That may have triggered the obsessive thinking. But that's one of the interesting things about OCD is we can't pinpoint and say this is the starting point or these are the events. It's often a range of things. And so as professionals, we know that it starts. It's just, are there key events that get it started? And in this situation, you're identifying loss. I heard something and this is something I read, and it was just in passing. So I don't even know how much validity there is to this. But they found that children who get fevers at a certain age or ages, that can actually also be a trigger for ocd.

I've read that too. Yeah.

And I'm like, what is that?

Good luck.

But that the point then is we don't know the triggers and we can't predict them, but we do know the signs of it. And I think that's important for all of the listeners, because OCD is not a choice. It is something that happens based upon events, how you respond to it and learning to respond. It is how you make the choices. But you certainly, and this is to all of our listeners, this is not something someone intentionally choose, and they never would intentionally choose it. Right, Berkeley?

Right.

Well, and I think that's an interesting point, because even asking her if she'd be comfortable coming onto the podcast and talking with us today, it is a vulnerable topic. And I do feel I myself would have a hard time talking about it. But she said, this isn't me. This is something that happened to my brain. Something was wrong with my brain, and I had to learn how to deal with what was going on in my brain. And I just thought that was very mature.

Nothing.

I, I, I completely agree. It takes a lot of courage to come in and talk about just the journey. And I look forward to exploring kind of some of the key things or key stepping stones that you took to address it to the point where you're comfortable talking about it.

I love that. Okay, before we go into that, because I do really want to hit heavy on treatment and how it changed your life, but also, what exactly is ocd? So we have these obsessions before we have the repetitive behaviors, which I thought was really interesting in that these obsessions are unwanted, intrusive thoughts, urges, images that cause significant anxiety and distress. And some of these, maybe, Berkeley, you could provide us with some of the more common obsessions that people obsess over. Yeah.

So mine obviously started with contamination obsessions. So derms, like getting people sick, dirt, illness, whatever. So that looks like I, for me, it was washing hands. I still have a hard time walking at my house in the bathroom, like, when the floor is wet, my brain is just disgusted. It's so hard. Things like that, where it just feels, I can't handle that. My brain, it just causes great anxiety.

And when you say it causes anxiety, I'm gonna be clear. Anxiety. Can you feel it physically, like a form of either a disgust or physiologically, your body feels a little bit more like it's anxious. The body feels tense or uptight. Or how would you describe that?

I would say both. I've noticed I have a hard time with showering because things that are wet. If somebody's hands are wet or my feet are wet and I'm on the.

Ground, if I were to cough my hand and then go like this.

Yeah, I love that now our listeners couldn't see what just happen after that and yeah, leave me alone.

No, yeah, it's, I would say it's physical work. I also will, I'll walk on the edges of my feet a lot of the time when I have to remind myself not to. But then also just that internal feeling, it's painful. A shower for somebody else is not a big deal, but for me it's like, all right, here we go. Exhausting. It is, it's exhausting.

Yeah.

And you just get used to it. You don't think about it cuz it happens so often, but it's tiring.

Okay, tell us some more of the other obsessions.

Okay, so, so harm is in my situation, harm obsessions could be here it says fear of causing harm to oneself or others. So in my case in that situation of telling the story about getting somebody else sick, like I'm really, I'm really, I feel like I'm responsible or I don't want to hurt other people. I think about all the different ways my actions could hurt other people. So get my job. I work with teens at this behavioral place. I think about what if I did this, what if this car crash and what if it was my fault and how can I do everything to prevent that? So responsibility based obsessions, I've experienced those, I've heard those are pretty common. Symmetry and order. That's, I think this is more typical of what when people think about ocd, this is the need for things to be arranged in a specific way and.

They'Ll say I have ocd. Like jokingly, yeah, I'm so ocd. And you're.

No, no you don't. But yeah, I mean that's, I feel that like even I just got married and setting up our house was a battle because I was like, oh, I'm sorry, you can't put that there.

That doesn't fit there. That doesn't belong there.

Yeah.

Fit in this order.

Yes. And I think sometimes it is just a preference but sometimes it is really, no, we're not, that's, I'm not going to rest until that's how I'm in my head. It should be. So that's, that's really fun.

I, I, I Often see that with clients who if a picture and like on the wall is a little bit crooked, they almost have to point it out and say, hey, can I fix that for you?

Oh, yeah.

Talk about the symmetry. I. It's not uncommon.

The religious one. People have religious obsessions or scrupulosity, people probably will go hand in hand. I'm not sure if I'm using those terms correctly, but could you maybe go.

Into what more of that means?

Yes, I. When I kind of went into further treatment and more specific OCD treatment, I mean, they obviously knew about cerebral velocity, especially because we live in a very religious place and have very outlined religious standards. So scrupulosity is when somebody feels this extreme need to do things correctly, mostly in terms of salvation.

I guess it's just an intense moral or religious anxiety. I've got to do this exactly right. So then the religiosity comes in and it gets fear of doing something wrong. Let me just give a couple of examples about that. If I have a bad thought, the scrupulosity, like, I can't that. That thought. I'm. I'm obviously a sinner. And then somehow I've got to wash my hands. I've got to do something to clean up the thought. Just as one example, another one that I was identifying is worshiping correctly. And so I have to worship exactly the right way, otherwise God will somehow punish me or punish my family or punish somebody. So scrupulosity can come across as this religiosity of. This fear of I have to worship the right way. I have to do everything right. And I can't have these kind of thoughts. And so what it does is it makes me even more anxious. And because it's just everything has to be exactly perfect. I have to do it exactly right. And so I might even have excessive prayer. I have to be pray, pray, pray, pray, pray. And it's become so overwhelming that I don't do much else.

Yeah, that was also a really tough one. I think this is where OCD got really hard for me when it was so internal. Some of these obsessions and compulsions are really physical, but when the compulsions are invisible, like, that was so isolating. And especially when it comes to religious stuff, you pick up. Like, I remember at church on Sunday, somebody talking about how they felt bad about not praying before they read scriptures and how they needed to be doing that. And I. I remember exactly where I was sitting and how I felt when they said that. And I felt like I had to do that every single time. You just pick up on things that you hear. And like our dad is very. If you're not sure about seeing the bishop, go see the bishop. So in high school, I don't think I had any reason to see the bishop, but every time I had to talk to the bishop, I just felt like I was gonna throw up. And even going to see that, like our yearly interview with the bishop just to check in at 13, I would, for a week I would think about it and I would be so worried I'm gonna think about something that I did wrong and then I'm gonna have to tell him. And it's so embarrassing. It just was. You're just so hard on yourself. And that kind of ties to perfectionism. I think there's can be some perfectionist obsessions that would correlate. And then this last one written here is sexual obsessions. This was when also it got really hard. It was probably within the same year my OCD started or when it was coined OCD in my life. But I was really worried about. I don't really think I even had sexual thoughts because I also. I was 12, so I didn't really obviously don't know enough, but I had a sphere of thinking sexual things and I knew that wasn't normal because nobody in life, house or friends are talking about that or saying that. And that felt like that's not ocd because I didn't know enough about OCD to feel comfortable telling anybody that. So that felt like I didn't even want to go to therapy because I didn't want to lie because that's like a scrupulosity thing. I was. I can't lie, but I can't tell her what I'm thinking. Like that's a.

Honestly like getting tired, like exhausted. Even just hearing your whole mind process, it is so consuming.

It is consuming and it makes me.

I think OCD is a full time job for those who have it.

Yeah. Yes.

And then combining that with the religious scrupulosity, I bet it was hell yeah.

I just, it just feels mis. Like you just feel so bad and it feels like something's wrong with you. Especially like a child feeling so guilty for thoughts that come in your head and being like, what is wrong with me? You don't know that people just have thoughts and that could be normal. And because when also a parent's not gonna be like, that's normal to have. I was like, if I told my dad that if I'm worried I'm gonna have sexual thoughts about somebody, somebody who doesn't know OCD is gonna be like, what, you're 12?

But I think this is really important to bring up because even there in our communication, as a. From a parent's perspective, boy, that is so much courage for any child to just talk about that. Right. And then the fear of how they're gonna respond. But as a parent, what a gift your child is giving you in that moment. And I use it in that word and very intentionally. It is a gift if your child can do that. And how you respond can be very validating. Example, imagine a parent saying, as you get older, as you go through puberty, you're going to have those thoughts.

Yeah.

And you're not a sinner.

Yeah.

What would have that done for Berkeley?

Yeah.

Helpful.

Yeah.

And I also think like, also I studied psychology in college just for my bachelor's degree, but it was helpful to find things out about the brain. Things just pop in your head. It's not. No, it's not anybody's fault. Obviously if you're dwelling in those things and you could make it weird and uncomfortable and inappropriate, but if that comes in your head, that everybody has that.

Right. And attaching a thought to some form of your worth, which is never going to work.

Yeah, yeah, yeah.

One of my friends, Ken Patey, he said that one of the best ways I've heard it said, you can't stop a bird from landing on your head, but you can stop it from building a nest.

Yeah.

Oh, that's good. I like the visual of that.

Anyway, so yes, we're going to have thoughts because we're humans, how we respond to those thoughts and understanding them, the intrusiveness, especially with ocd. And somebody once said it's like with ocd, if you've ever driven a clutch, a standard car, you put it in, in neutral and you push on the gas and you hope you're gonna go somewhere. Right. And that's typical of OCD is we get repetitive thoughts. That's why it becomes obsessive. And so it's learning how to shift it into first gear and then down to second gear and make movement. Otherwise these thoughts become repetitive and it creates the neuro patterns where in the brain. It. It's just literally it's like a super highway.

Yeah.

And that's how it's often described.

Hey, hey. A plus on these visuals today. I'm liking them.

Hey, well, I'll keep them on.

Yeah, I like them.

Okay.

I think this is important to talk about the compulsions then. Cuz I thought this Was really interesting that compulsions are the repetitive behaviors, not just the thoughts, but the behaviors or mental acts that individuals feel compelled to perform to reduce anxiety associated with the obsessions. So the compulsions are in an attempt, correct me if I'm wrong, to control the obsession so they don't overtake your life. Yeah.

Yes.

You looked at me like, duh.

Huh?

We know.

And I'm curious what that was like for you.

Oh, yeah. So I guess with the contamination stuff, the compulsion would be like washing my hands. Like, I feel. I don't want to be responsible for getting anybody else sick. Or I feel my. Like my hands are gross or it's been long enough, whatever. Time to wash my hands, that feels like it's going to alleviate the anxiety. The sexual thoughts, prayer, or I guess counteracting it. This is also what's weird. And I think unless you understand the process of ocd, it just seems crazy. I think in my head it was like, if I think a sexual thought, then I'll have to. How do I counteract that? So I'd think something else and be like, well, no, I'm. I'd reassure myself in some way, or with the religious stuff, it's okay. Then maybe I'll just go see the bishop. All the time. I w. One time I went to see the bishop, literally, because I was like, I think I'm having impure thoughts. And he was, what the heck? What's going on?

And I was.

I just. Sometimes my brain isn't perfectly clean and people talk about that church. And he was, okay, you're okay. But in my head, I was like, that felt better. I wasn't sure, but I needed to go do that just so it could feel better. I'm trying to think, what were some of my other.

Did you ever count?

I. That's one thing I never did. I've heard about that, but I've never had counting or numbers, anything like that.

Except for when you were washing your hands for eight seconds.

Okay. Yeah.

And did you count the seconds or how did you measure how much, how long you.

I did count the seconds, and that was for like two years. And then finally I was all right. My therapist knew enough to try not to do that. And so that I could, I weaned myself up of the full 20 seconds every time.

Got it.

Maybe people think I'm disgusting. I do wash my hands, but I.

Don'T think you're disgusting. In fact, if anybody washed their hands for 20 seconds in today's world, as fast paced as we are, I'd be very surprised.

That's what hand sanitizer is for. Yeah, sanitizer.

Okay.

Any other compulsions that you feel like are common, even if they weren't something that you dealt with yourself?

I think morality based ones. So for example, this week I slept until 10 minutes before church. And in my head I'm. That would be really bad if I miss church. And that says something about me. So I feel every time this. Something like this happens or I feel like I'm sick or I don't know if I should go to church or do something, I feel like I had to ask people and I'll ask, is this bad or even financial? Like spending money was. I bought a rug this week and I bugged everybody about the stupid rug because I was like, is this too much?

Is like really did it's taken a few months.

No, everybody has been okay, just buy it.

It doesn't matter.

But I'm. Is it so embarrassing that I'm spending so much money on the rug? Or how much would you spend and just make me a bad person? What do you. What would you think of me? So things like that, the morality based ones, it feels like those can go up, infiltrate every part of your life. And that's. It's a lot of seeking assurance with me is. Would be the complete. Is asking, is this okay? Am I okay? Also, there were existential obsessions. So that's. That could. For me, it was kind of religion related. But what's gonna happen with us? What is the future like for us? And it becomes such a burden that you feel you need to read everything. And I don't know, that one's kind of a weird one. Maybe I'll go into that. Maybe less common.

No, I feel like that's a good one though too. I am catching a sort of pattern here that there's such a desire and a need to control outcomes and thoughts and to feel like you need to be in control of whatever's happening in your life. Yes, that's true. Is that correct? Yes.

And pretty common because again, one of the core elements of obsessing and compulsive behaviors is it's a desire to put in control or to control an outcome. And that's what you would expect with it. Because I need to be in control. Because if I'm not in control, then something bad will happen. So that statement, don't step on a crack because you'll break your mother's back.

Right.

And really not good for people with ocd. They might take it literally. That fear, like you were saying, Berkeley, what's going to happen to us? That fear. And. And again, it begins the mind into this place of I. I worry extensively and I worry so much. And when you can let that worry go, what's it like being able to let it go? Berkeley.

And after the treatment I've done, it really feels. My life feels different. And also it's funny now talking about some of these things I can. It's. I'm seeing it from somebody who doesn't have ocd, where I'm like, why does that. Why was that going through my head? That's weird. And that doesn't make sense. But now it feels. I just feel like a different person. I used to think in my head, what do people think about when they're. When they're just sitting there? Cuz for me it's humming. Personal health. This is. I could think of all day about. Yes.

That you could just spiral down for hours and hours and.

Yeah. And now. Oh, I think about fun things and I think about hobbies and it feels like I'm. And just in a healthy place where there's just so much more happiness and freedom.

Yeah. I remember we were on a girls trip and with. Me and Berkeley were the only girls in our family. We have five brothers and we were with our mom and we were in Santa Barbara, Montecito area. And we were walking down the beach. And typical me, I was just chatting everybody's ear off and I was like leaping and dancing and kicking san at everybody and being obnoxious. And Berkeley was really quiet. And I said something to the effect of man. I just wish that I was known as the Zen mature sister. Even though I'm almost 17 years older than Berkeley. And I said something like, you're so much more mature. You're so much more calm. I'm spazzy. I have this high energy. I'm always moving and jumping and leaping and screaming and yelling just loud and she was it in the moment that you said it. I think it was in the moment that you said it. You turned and looked at me and you said, if you understood what was going on in my brain and how intense and active and horrible it is. Just the amount of action happening in my brain, it is so exhausting that all I can do is walk on this beach. I can't leap, I can't jump. I can't do anything other than just barely be here because so much is happening on the inside. I'm too exhausted to be loud on the outside. And I then Felt like crying and he probably did. I felt so sad that I didn't know. And I think it is a good and just a good realization that it is a very lonely.

Yeah.

Condition. And that I had no idea as your sister, who I know you don't like saying this, but helped raise you. I gave you your first bath. I potty trained you. And it obviously like someone who knows you so intimately and was there for so much to miss a lot of that and to not see that and just assume that you were in a Zen state all the time, like perfect mindfulness, when really that's not what was happening on the inside. I think as parents, as teachers, as guardians, whatever, it might be helpful to know there may be more under the surface than we recognize.

And I think that bringing that up to the forefront, it may be one of the core solutions. I think if I. From an observer Berkeley, I'm going to guess giving it a voice might have been one of the most effective or healthy things you did to get help to acknowledge this. This is what it's really like being me. I think many times people keep it inside and they carry that burden and feel crazy and they do it in silence for so long. And so the courage that you had to reach out for help and say, this is what's going on. Major kudos to you.

Thank you. I do feel. I also feel lucky. I mean, for so long I didn't know enough about ocd. And there were so many times where it just felt like, this is. This will be my life. I've had these obstacles in my mind and I see myself a certain way and I feel a certain way. This is how I'm gonna live my life. And that's hard, but these are the cards. I was down like a pretty negative thing because it felt like for so long I couldn't solve this problem myself. But then I feel really lucky because there is research based treatment that has worked and once you know about ocd, it's a whole different thing. So I want you to talk about.

How did you finally decide? Cause it was pretty quick that all of a sudden I'm actually gonna go get this treatment done. And it was a pretty intense treatment. And I'm making it sound like it was done to you. You participated in her brain severed severance. No, talk about your friend that you. My roommate that you had at college and her family's experience with ocd.

Okay. Yes. So I moved in with my friend Kate. We played soccer together growing up, but we were never super close. And the first week we moved together, I said something about ocd. Jokingly, on the surface, it was real, but obviously not just bringing that on everybody. Like, by the way, I have ocd. But I said it. And then she was, oh, do you actually have ocd? Are you just saying that? And I was like, oh, I actually do. And she said, well, my sister. But that runs deep in my family. We talked about it and how two of her sisters have experienced that. And one of them went to this treatment place that changed her life. And she said several times that she feels like a different person. She is a different person. She seems so much happier. And so she talked. It's called the OCD and Anxiety Treatment Center. I know they have a few locations. Utah, Arizona, Texas, I think. And now I think it's just ocd anxiety center.

OCD anxiety center.

Okay. Yes.

Yeah.

So it was an intense program. There's not a set time that you go, I was there for 11 weeks, and it was five days a week for three hours. I wasn't in school at that time. Their theory or their way of treating OCD is erp. So exposure, response, prevention. And what that looked like in my case was you. How do I say expose yourself without sounding.

You're exposing the thoughts, right? You're exposing your thoughts. Fears. You're leaning into your fears.

Yes.

So then they literally have an exposure to your anxiety, and then it's response, prevention. So what they're trying to do would be, okay, we're put you in a situation where you do feel triggered by something. It brings up that OCD feeling, but instead of doing that compulsion, you're going to use DBT skills or something, whatever you need to do.

What does DBT mean?

What's dialectical?

Dialectical behavioral therapy.

So what does that mean? Like, fewer talking than me?

So DBT has four different modalities, and I haven't been trained in dbt, but everything from mindfulness to cognitive behavioral thinking processes how you're thinking and how your thoughts are with emotions. And so it really helps you have a deeper understanding of self and what the thought patterns are and how you're feeling and how you're thinking in this situation, leaning into those fears. With ocd, if I don't complete something, I feel even more anxious. And that's typical for washing hands or turning off a stove or closing a door, locking a door. If I don't do that, I physically feel more anxious. And so it's learning how to expose yourself into the fear.

Yeah.

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