As a teenager, Dr. Elizabeth McIngvale learned to live with her obsessive compulsive disorder through treatment. Now she’s helping others find the same freedom, and retake control of their lives.
McIngvale was diagnosed with severe OCD at 12 years old, and within three years it was controlling every aspect of her life. Fear of contamination and infecting someone else had her taking showers that lasted eight hours. She became isolated, unable to leave the house and see her friends.
“It’s a living nightmare,” she said. “It impacts every part of your day, every waking moment.”
McIngvale — the daughter of Houston icon Jim “Mattress Mack” McIngvale and Linda McIngvale — learned to manage her OCD through a residential treatment program in Kansas. She went on to become the national spokesperson for the International OCD Foundation when she was 17 years old and later established the Peace of Mind Foundation.
The residential treatment program moved to Houston a few years after McIngvale underwent treatment. It later closed, but its former clinical team formed what is now the McLean OCD Institute in Houston, one of just a handful of programs in the United States that focus on OCD, anxiety and related disorders. Today McIngvale is its director, helping others to learn to live with OCD the same way she did.
“It’s been a full circle journey for me,” said McIngvale, now 35 years old. “I was a patient of this program, and now I can run it and hopefully help patients get the results they deserve.”
Approximately 2.5 million adults are affected by OCD each year, roughly 1.2 percent of all adults in the United States. The average age of onset is 19, though one-quarter of cases occur by 14, according to the Anxiety and Depression Association of America.
Although OCD is fairly common, it’s often misunderstood, McIngvale said. It’s often associated with a fear of germs and a compulsion to organize, but it can manifest in a variety of ways.
It causes uncontrolled and recurring thoughts, which cause someone to engage in repetitive behaviors or rituals. Those rituals are an attempt to avoid the source of those unwanted thoughts.
“OCD is really the doubting disease,” she said. “They get stuck in these behaviors in the search for certainty that isn’t achievable. And it becomes this never-ending cycle.”
Treatment at McLean OCDI focuses on helping someone learn to live with their doubt – the same way McIngvale has.
“I want you to be able to go into the world, face anything, hear anything, and feel like you have the ability to tolerate it and to face it without feeding your OCD,” she said.
A leap of faith
It’s unclear what causes OCD, but it’s something you’re born with, McIngvale said. It often begins to manifest in adolescence or young adulthood and, if left untreated, it will always worsen.
McIngvale was diagnosed at age 12 after she exhibited a fear of contamination – not of getting sick, but of passing an infection to someone else and causing them harm. She later developed scrupulosity, a guilt or obsession related to religion. She feared the number 6 because of its association with 666 – the number of the beast in the Book of Revelation – and wouldn’t wear black or red because they were the colors of the Devil.
She saw a therapist in Houston, but she wasn’t getting the treatment she needed before the residential program in Kansas.
That’s common for many McLean OCDI residents, said Ryan Judd, one of the program’s behavior therapists. The program also offers outpatient and day services, but if someone’s OCD or anxiety is severe enough, they may require specialized care in a residential setting.
“When it gets to the point where they’re really having trouble functioning normally, that is usually when you kind of say ‘OK, they might need a higher level of care,” Judd said.
The residential program runs from six to 12 weeks, with an average stay of roughly 90 days. There are an average of eight residents at a time, mostly from the United States but also from Canada, South America and Israel.
The team starts by conducting an assessment of each resident, which they use to create a treatment plan that focuses on exposure and response prevention (ERP) therapy. Studies have found ERP therapy to be the gold standard for treatment OCD, achieving clinically-significant results in 50 to 60 percent of patients.
During treatment, a resident confronts the thoughts, objects or images that are causing them anxiety or provoking their OCD. Through repeated exposure, they’re able to overcome that anxiety and resist the urge to engage in compulsive behavior.
“You’re asking people to take a leap of faith and do something that feels very scary to them,” Judd said.
Alie Garza, 28, decided to take that leap of faith in the spring of 2021. The Portland, Oregon resident first developed a fear of contamination when she was 10 years old. It began to control her life in 2020, during the COVID-19 pandemic.
She was suddenly experiencing an onset of symptoms related to health. She stopped eating anything but boiled chicken and vegetables because she worried that she’d developed allergies to other foods. She went the emergency room three times a week because her anxiety was so bad that she felt like she was having a heart attack or stroke.
“I was completely engulfed,” Garza said. “My level of functioning had plummeted.”
Garza’s therapy started small. She’d go to a café and order a decaf coffee, because she worried caffeine would give her heart palpitations. She then watched episodes of Grey’s Anatomy to see dramatized versions of medical emergencies.
Near the end of her stay, she visited a cemetery to confront her fear of becoming sick and dying. It wasn’t easy for her, but she knew it was necessary.
“I had to choose to tolerate the risk,” she said. “Because the life I wanted to live was not possible with OCD running the show.”
Living with doubt
Garza’s feelings toward her OCD are common, McIngvale said. No one enjoys the unwanted thoughts they experience, or the rituals and behaviors they engage in. They do them because they feel like they have to, she said.
Because there is no cure for OCD, the key is to learn to live with the risks that are an unavoidable part of life, Judd said.
“You will still experience triggers,” Judd said. “But you’ve really changed your relationship with those thoughts and feelings to where they don’t bother you as much anymore, and you respond differently to them.”
Garza was apprehensive when she left the program and returned home to Portland, but she reassured herself by thinking of how far she’d come since starting treatment.
Garza, who has a master’s degree in social work, started working with a crisis response team. In that role she brought individuals experiencing a mental health crisis to the same hospital she’d been going to three times a week. She now works at a clinic that specializes in treating OCD and anxiety.
“It’s not easy, but this is what got me through treatment,” she said. “I knew I wanted to do all these things.”
That’s really the focus for McIngvale and the rest of the McLean team – helping to prepare residents for life when they return home. During their stay, residents are encouraged to go out an experience Houston after treatment is finished for the day. They’re encouraged to take in an Astros game, see a movie or have dinner at a restaurant.
“We want individuals going out into the world and living life,” she said. “We don’t want to create this closed environment that feels super safe.”
In the way, treatment has evolved since McIngvale was at the residential program in Kansas. In the past it focused on symptoms and learning how to manage them. Now the aim is to address the fears or triggers that are the underlying cause of those symptoms. That helps residents build confidence to retake control of their lives and return to work or school once they’ve completed the program, McIngvale said.
“I really believe we’ve gotten to a place where we know that it isn’t about addressing certain symptoms, it’s about addressing the core fears that cause you to have those symptoms,” she said. “If we address things at the core, we can actually get you to freedom from your illness. And that is such a different perspective than when I was first in treatment.”
evan.macdonald@chron.com
