In Part 2 of our conversation with eating disorder specialist with Dr Alissa Knight, we dive deeper into one of the most complex areas of mental health treatment: the overlap between OCD, eating disorders, autism, trauma, and ARFID.

How do clinicians untangle symptoms when OCD and eating disorders are working together? What happens when OCD disguises itself as an eating disorder, or when an eating disorder hides behind OCD? And how do you know where to begin treatment when both conditions are causing significant distress?

Dr Alissa shares her unique, person-centred approach to formulation, treatment planning, and building trust with clients who have often been misunderstood, misdiagnosed, or passed between services. She also provides practical insights into working with ARFID, including how Exposure and Response Prevention (ERP) can be adapted to help people gradually overcome intense fears around food.

This episode is packed with clinical wisdom for psychologists, therapists, students, families, and anyone interested in understanding the deeper relationship between OCD and eating disorders.

In this episode, you'll learn:

• Why OCD and eating disorders so commonly occur together

• How OCD can unintentionally protect and reinforce eating disorder behaviours

• The difference between OCD-driven food restriction and eating disorder pathology

• How to determine which condition to treat first

• Why collaboration and client buy-in are essential for successful treatment

• The role of trauma, autism and nervous system dysregulation in eating disorders

• Practical ways to adapt ERP for ARFID treatment

• Why rapport is often more important than any therapy model

• The biggest mistakes clinicians make when working with eating disorders

• How to help clients feel safe, understood and empowered in treatment

Dr Alissa also shares a powerful reminder for clinicians: your greatest therapeutic tool isn't a treatment manual, it's your ability to connect with another human being.

Whether you're treating OCD, ARFID, anorexia nervosa, or working with complex presentations, this episode offers a refreshing perspective on what effective and compassionate care can look like.

To learn more about Dr Alissa Knight follow this link

www.melbournewellbeinggroup.com.au

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For the Season Premiere of Breaking the Rules, Dr Celine Gelgec and Dr Tori Miller are joined by eating disorder specialist Dr Alissa Knight from Calming Suite Psychology Clinic in Adelaide for a powerful and thought-provoking conversation about eating disorders, trauma, OCD, and why traditional treatment approaches may be failing many young people.

After seeing Dr Alissa present at the Child and Adolescent Mental Health Conference, Celine and Tori knew they had to bring her onto the podcast. What follows is an honest discussion about the realities of eating disorder treatment, the fear-based messages many clinicians receive, and why genuine connection, trust, and understanding a person's full story may be far more important than rigid treatment manuals.

Together, they explore the complex relationship between eating disorders and OCD, the role of trauma and attachment, why relapse rates remain so high, and how a more collaborative and compassionate approach can help people move towards true wellness rather than simply chasing "recovery."

In this episode, you'll learn:

• Why eating disorders are far more than food and weight

• The hidden links between OCD, trauma, anxiety and eating disorders

• How traditional treatment approaches can unintentionally damage trust

• Why rapport and connection are often the most important therapeutic tools

• The dangers of fear-based treatment and clinician burnout

• How trauma-informed care can change outcomes for young people

• Why wellness may be a more helpful goal than "recovery"

• The challenges clinicians face when balancing medical risk and compassion

This conversation challenges long-held assumptions about eating disorder treatment and offers a hopeful, human-centred perspective for clinicians, families, and anyone supporting a loved one through recovery.

If you're a clinician, parent, educator, or someone living with OCD or an eating disorder, this is an episode you won't want to miss.

To learn more about Dr Alissa Knight follow this link

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In this episode of Breaking the Rules, we record from an unusual location — the bathroom floor of a public restroom — as we explore an increasingly popular social media trend: “clean girl culture.”

Across platforms like TikTok and Instagram, the clean girl aesthetic promotes a polished, minimalist lifestyle — natural makeup, tidy wardrobes, “clean” eating, and curated routines that appear effortless and healthy.

But when does a healthy routine become rigidity, anxiety, or compulsive behavior?

In this conversation we unpack how trends like clean girl culture can blur the line between wellbeing and preoccupation, and how certain aspects of the aesthetic can overlap with OCD patterns, particularly around contamination, checking, perfectionism, and the need for control.

We also explore the broader question clinicians and individuals often face: how do we know when something has gone too far?

In this episode we discuss:

• What “clean girl culture” is and why it’s trending on social media
• The appeal of curated lifestyles and polished aesthetics
• When healthy habits start becoming rigid or anxiety-driven
• Parallels with orthorexia and other wellness trends
• How social media trends can reinforce perfectionism and control
• When checking, reassurance seeking, and contamination fears creep in
• How compulsive behaviours can sometimes hide behind socially rewarded habits
• The importance of flexibility, connection, and values when evaluating lifestyle choices
• Questions clinicians can ask when assessing whether a habit has become unhealthy
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Ultimately, this episode isn’t about criticising trends — it’s about helping people reflect on the “why” behind their behaviours and recognizing when something that started as self-care begins to shrink a person’s life instead of expanding it.

🔖 Chapters

00:00 Recording From a Public Bathroom

01:30 Using Location as an Exposure Exercise

03:00 Introducing Clean Girl Culture

05:00 The Appeal of Polished Aesthetics

07:00 When Wellness Trends Go Too Far

09:00 Orthorexia and the Pursuit of Health

11:00 Perfectionism, Checking & Social Media

13:00 How OCD Can Hide Behind Trends

14:30 When Habits Start Shrinking Your Life

16:00 Values, Flexibility & Mental Health

17:30 Questions to Ask Yourself or Clients

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In this episode of Breaking the Rules, we unpack one of the most confusing and frustrating parts of OCD treatment: extinction bursts.

If you’ve ever started exposure therapy and felt like your intrusive thoughts suddenly became louder, more intense, or more frequent, you’re not alone. Many people interpret this spike in discomfort as proof that therapy isn’t working — when in reality, it can be evidence that change is actually happening.

We explore what extinction bursts are, why they occur when people begin changing compulsive behaviors, and why the brain often reacts with a kind of “hissy fit” when long-standing patterns are challenged.

This episode focuses on helping both clinicians and individuals understand that the initial surge in anxiety, intrusive thoughts, or urges isn’t failure — it’s often the brain’s attempt to pull you back into familiar safety behaviors.

We also discuss practical ways clinicians can prepare clients for extinction bursts, coach them through these moments, and help them recognize these experiences as part of the change process rather than a sign that treatment is going wrong.

In this episode we discuss:

• What extinction bursts are and why they happen
• Why OCD often gets louder when compulsions start changing
• How long-standing habits create powerful neural patterns
• Why many people misinterpret extinction bursts as therapy failure
• The role of psychoeducation in preparing clients for this phase of treatment
• Coaching clients to observe and ride out the “burst”
• Using curiosity instead of self-judgment during difficult moments
• Why discomfort during treatment can actually be evidence of progress
• Helping clients track patterns without becoming trapped in distress monitoring
• Reframing extinction bursts as a sign of meaningful change

🔖 Chapters

00:00 Introduction

01:20 What Is an Extinction Burst?

03:00 Why the Brain Reacts When Habits Change

05:10 Why ERP Can Feel Worse Before It Feels Better

07:00 How Clients Misinterpret Extinction Bursts

09:00 Why Psychoeducation Is So Important

11:00 Coaching Clients Through the “Hissy Fit” Phase

13:30 Curiosity vs Resistance During ERP

15:00 Using Data Carefully in OCD Treatment

17:00 Measuring Coping Rather Than Distress

18:30 Reframing Extinction Bursts as Evidence of Change

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In this episode of Breaking the Rules, we do something a little different — we guide you through a live experiential exercise used in therapy to demonstrate how Exposure and Response Prevention (ERP) actually feels in the moment.

Using a simple jelly bean (or Mentos), we walk through an exercise that highlights one of the most important lessons in OCD treatment: the urge to escape discomfort can be powerful, but it can also be tolerated.

Through this exercise, we explore how quickly the mind and body react to discomfort, how intrusive thoughts and urges show up, and how reconnecting with meaning and values can shift our relationship with those experiences.

Experiential exercises like this are commonly used in ACT, DBT, and ERP therapy because they allow people to learn through doing, rather than just talking about the skills intellectually.

In this episode we discuss:

• What experiential exercises are and why they are powerful in therapy
• Why learning skills during calm moments is different from using them during triggers
• The Mentos (or jelly bean) exercise used to simulate urge surfing and response prevention
• What happens in the mind and body when discomfort rises
• Intrusive thoughts, urges, and the instinct to escape discomfort
• The role of meaning and values in increasing distress tolerance
• Why acceptance changes our relationship to discomfort, not the discomfort itself
• How clinicians can use this exercise with clients, families, and teen group.

🔖 Chapters

00:00 Introduction – Doing Something Different Today

02:00 What Is an Experiential Exercise?

04:00 Why Experiential Learning Matters in ERP

06:00 The Mentos (Jelly Bean) Exercise Begins

08:00 Surfing the Urge to Swallow

10:00 Intrusive Thoughts and Rising Discomfort

11:30 Debrief: What Happened During the Exercise

14:00 Acceptance and Changing Your Relationship to Discomfort

16:00 Intrusive Thoughts, Images, and Urges

18:00 Using This Exercise With Clients and Families

20:00 Teaching ERP Through Experience

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In this episode of Breaking the Rules, we explore one of the most frustrating and often misunderstood impacts of OCD - how it interferes with studying, productivity, and performance at work.

For many people, OCD hides behind traits that are often praised: diligence, responsibility, perfectionism, and attention to detail. But beneath the surface, what may look like hard work or conscientiousness can actually be hours of painful compulsions, paralysis, and mental exhaustion.

We unpack how OCD shows up in school, university, and the workplace — from endlessly rewriting emails and rereading textbooks, to missed deadlines, avoidance, and overwhelming fatigue. We also discuss how these patterns can sometimes be mistaken for ADHD, learning difficulties, or lack of motivation, making accurate assessment and treatment even more important.

Most importantly, we share practical strategies clinicians and individuals can use to support functioning while treating the underlying OCD.

In this episode we discuss:

• Why OCD often becomes most visible in study and work environments
• How compulsions like checking, rereading, researching, and reassurance seeking sabotage productivity
• The difference between perfectionism and OCD paralysis
• Why OCD is often misinterpreted as ADHD or executive dysfunction
• The emotional toll of feeling “ineffective” despite working incredibly hard
• Strategies for managing compulsions while studying or working
• Setting limits around checking, researching, and rewriting
• Learning the practice of “good enough”
• Rebuilding trust in your own judgement after OCD
• Using values to guide action when motivation disappears

🔖 Chapters

00:00 Welcome Back – Recording Post Baby

03:08 How OCD Shows Up in Study and Work

05:30 The Hidden Nature of OCD Productivity Struggles

08:20 Email Checking, Reassurance & Workplace Compulsions

10:00 OCD Paralysis vs Normal Perfectionism

12:00 How OCD Impacts Teens and Students

13:45 When OCD Is Mistaken for ADHD

17:00 Assessing Functional Impact in OCD

18:30 Strategies for Studying With OCD

21:00 Attention Redirecting & Mindfulness

22:30 Practicing “Good Enough”

24:00 Limiting Checks, Research & Reassurance

25:30 Rebuilding Trust in Yourself

27:00 Using Values to Guide Action

29:20 Final Thoughts

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In this episode of Breaking the Rules, we’re joined by researcher and clinician Dr. Clarissa Ong to unpack the complex relationship between perfectionism, anxiety, and OCD — and to explore how process-based therapy, particularly ACT, offers a powerful lens for understanding and treating these patterns.

Drawing on her research and her book The Anxious Perfectionist, Clarissa helps us move beyond surface-level symptoms and into the underlying processes that drive rigidity, rule-following, self-criticism, and all-or-nothing thinking.

We explore perfectionism not as a simple personality trait, but as a pattern of inflexible rule-governed behaviour — one that can show up across OCD, generalized anxiety, depression, eating disorders, and beyond. The conversation dives into how values can become fused with perfectionistic rules, how therapy itself can become “a thing to perfect,” and why flexibility — not flawless performance — is the real treatment target.

💬 Key themes:

• Perfectionism as rigidity around internal rules and standards

• The overlap between perfectionism, OCD, and generalized anxiety

• Why perfectionism is often more process than diagnosis

• ACT vs CBT in the treatment of perfectionism

• Experiential work vs intellectualizing in therapy

• How values can become hijacked by perfectionism

• The “all-or-nothing” trap and treatment drop-off

• The role of context in determining helpful vs unhelpful striving

• Therapist perfectionism and projected expectations

• Letting go of the need to be liked

This conversation is especially valuable for clinicians wanting to deepen their formulations beyond symptom reduction and into process-based change.

https://www.melbournewellbeinggroup.com.au

#perfectionism

#ocd

#anxiety

#acttherapy

#processbasedtherapy

#theanxiousperfectionist

#clinicalpsychology

#mentalhealthprofessionals

#psychologicalflexibility

#therapistlife

#cbt

#acceptanceandcommitmenttherapy

#ocdrecovery

#valuesbasedliving

#mentalhealthpodcast

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In this episode of Breaking the Rules, we explore when and why OCD tends to peak across the lifespan — and why symptoms often intensify during moments of growth, change, and meaning rather than out of nowhere.

Drawing on clinical experience and developmental theory, this conversation looks at the predictable windows of vulnerability where OCD commonly emerges or flares: childhood and puberty, late adolescence and young adulthood, and major life transitions such as starting high school, exams, relationships, parenthood, grief, and identity shifts.

Rather than focusing solely on symptoms, the discussion centres on formulation, psychoeducation, and normalisation — helping both clinicians and clients answer the critical question: why now?

💬 Key themes:

• The two most common ages of onset for OCD
• Puberty, hormones, and emotional intensity
• Individuation, identity formation, and existential anxiety
• Why OCD spikes when life becomes meaningful
• New parenthood, responsibility, and fear of harm
• How values drive OCD themes during transitions
• Understanding symptom “shape-shifting” across life stages
• Using developmental context to reduce fear and shame
• Anticipating flare-ups and planning support proactively

💡 “OCD often shows up when life matters most.”

🧠 “These thoughts tell us what we care about.”

💬 “Be alert, not alarmed.”

🔖 Chapters

00:00 Introduction: When does OCD peak?

01:30 Early onset and puberty

03:30 Adolescence, identity, and individuation

06:00 Hormones, emotions, and existential fear

08:00 Life transitions and meaning

10:00 New parenthood and responsibility

12:00 Why themes change over time

14:00 Using formulation to answer ‘why now?’

16:00 Anticipating flare-ups and building support

#OCD #MentalHealthPodcast #BreakingTheRulesPodcast #OCDRecovery #ClinicianSupport #LifeTransitions #PerinatalMentalHealth #AdolescentMentalHealth #TherapyTalk #MentalHealthAwareness

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In this long-awaited episode of Breaking the Rules, we finally do a deep dive into contamination-themed OCD — one of the most common, misunderstood, and physically debilitating OCD presentations.

This conversation goes far beyond clichés about handwashing and cleanliness. We unpack what contamination OCD actually looks like day-to-day: the pain, the exhaustion, the food avoidance, the disrupted routines, the impact on relationships, parenting, work, and health — and the quiet suffering that often goes unseen.

We explore both physical contamination fears (germs, illness, food safety, asbestos, chemicals) and moral contamination, where people fear being “tainted” by proximity to someone or something that conflicts with their values. The episode also tackles one of the trickiest clinical questions: how to work with ego-syntonic rules without turning therapy into another rigid rule system.

This is an essential listen for clinicians, clients, and loved ones wanting a clearer, more compassionate understanding of contamination OCD — and how ERP can be done flexibly, ethically, and effectively.

💬 Key themes:

• What contamination OCD really looks like behind closed doors
• Why it’s not about being “clean” or “house-proud”
• The physical toll: pain, skin damage, exhaustion, hunger
• Food avoidance, illness fears, and misdiagnosis with eating disorders
• Moral contamination and value-based fear
• Ego-syntonic vs ego-dystonic rules
• How to assess contamination OCD properly
• Flexibility vs rigidity in treatment
• ERP without reinforcing “right vs wrong” rules
• Helping clients choose values over compulsions

💡 “Contamination OCD holds people hostage.”

🧠 “This isn’t quirky — it’s devastating.”

💬 “There is no ‘right’ amount. Flexibility is the goal.”

🔖 Chapters

00:00 Why we avoided this topic (and why we’re doing it now)

01:00 What contamination OCD actually means

02:30 Moral contamination explained

05:00 The physical and emotional toll

08:00 Illness fears, COVID, and community safety

10:00 When contamination affects parenting and relationships

12:00 Ego-syntonic rules and client-led goals

14:00 Flexibility vs rigid hygiene rules

16:00 ERP and realistic exposure work

19:00 Messing up rituals and tolerating uncertainty

22:00 Assessment questions clinicians should be asking

25:00 Creative exposure ideas

27:30 Final reflections and encouragement

#OCD #ContaminationOCD #ERP #TherapyPodcast #MentalHealthProfessionals #OCDRecovery #ExposureTherapy #BreakingTheRulesPodcast #ClinicianSupport #MentalHealthAwareness

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In this reflective and practical episode of Breaking the Rules, the hosts unpack a phrase that shows up constantly in therapy rooms: “I don’t feel ready.” What does it actually mean? Is readiness a feeling—or is it a decision we make in the presence of fear, uncertainty, and discomfort?

Using OCD as the primary lens, this conversation explores how clients often wait for certainty, calm, or clarity before taking action—and how that waiting quietly reinforces avoidance. The discussion moves beyond symptom management and into the deeper work of distinguishing thoughts vs feelings, building emotional literacy, and helping clients move forward despite anxiety rather than waiting for it to disappear.

This episode is especially valuable for clinicians working with ambivalence, treatment resistance, or clients who feel “stuck” before starting ERP or making meaningful behavioural change.

💬 Key themes:

• Why “ready” is not an emotion—but a choice
• The difference between thoughts, feelings, and bodily sensations
• How emotional reasoning keeps OCD in control
• The trap of waiting for certainty before acting
• Using ACT, motivational interviewing, and values-based action
• Helping clients name fear, dread, shame, and excitement accurately
• Why language matters in therapy—and how it can open or close change
• Moving clients out of intellectual insight and into embodied experience
• Supporting behaviour change without reassurance or avoidance

💡 “Ready is not a feeling—it’s a decision.”

🧠 “Certainty is the fantasy OCD keeps chasing.”

💬 “Of course you’re scared—and you can still act.”

🔖 Chapters

00:00 Introduction and the origin of the idea

03:00 What clients mean when they say “I don’t feel ready”

05:00 Readiness, certainty, and the OCD trap

07:00 Thoughts vs feelings: why we confuse them

09:30 Emotional reasoning and avoidance

11:00 Values-based action and willingness

13:00 Naming emotions vs shutting change down

15:00 Anxiety, excitement, and bodily sensations

17:00 Moving from insight to action

19:00 Why waiting for readiness keeps clients stuck

21:00 Final reflections for clinicians

#OCD #TherapyPodcast #MentalHealthProfessionals #ERP #ACT #BehaviourChange #ValuesBasedLiving #BreakingTheRulesPodcast #ClinicianSupport #AnxietyRecovery

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