How Erica Lugo Beat OCD

This story discusses thoughts about self-harm. If you are in crisis, please call, text or chat with the Suicide and Crisis Lifeline at 988, or contact the Crisis Text Line by texting TALK to 741741.

As Erica Lugo hit her mid-30s, life looked perfect. Ten years earlier, she’d shed 160 of her 322 pounds and become a fitness evangelist. Then, hard work and charisma shot her into the stratosphere of success. By 2019, she was a health-and-fitness celebrity—starring on the USA Network hit “The Biggest Loser,” charming hundreds of thousands of Instagram followers with her bubbly, can-do vibe, and appearing on magazine covers and TV shows. She owned a thriving business, had three amazing kids, and she and her husband, Danny McGeady, had bought a piece of land near Dayton, Ohio, where they planned to build their dream home. 

But in the fall of 2022, things suddenly changed. “I just didn’t feel like myself,” Lugo told the OCD Stories podcast. She was anxious and shaky all the time. And even though she was used to spending two or three hours a day on her fitness routine, she couldn’t get herself to go to the gym. Adding to the stress was the emotional labor of staying on brand. “With my job being my platform, and being an influencer in fitness, it was really tough for me,” she says.  

The wrong mental health treatment can make things worse

Lugo wondered if her feelings could be the result of hormonal changes from being in her late 30s. But her doctor said no. She was too young to be experiencing menopause. He sent her to a psychiatrist, who prescribed the antidepressant Zoloft.

The pills didn’t help. And she began having intrusive thoughts—which are unwanted, distressing thoughts, feelings, images, sensations, or urges that go against your true values and beliefs. (That’s part of what makes them so disturbing.) Everyone has intrusive thoughts from time to time, and most people can usually cast them aside as random and weird. Lugo could not. She was terrified that she might use a knife to kill herself. “That black-box warning about how Zoloft can trigger suicidal thoughts?” she says. “That’s what happened to me.”

She didn’t want to kill herself. And there was no plan to act on her intrusive thoughts. But the worry that she might had a hold of her mind and would not let go. “These thoughts, and looping and ruminations would occur every hour,” she says. “I just wouldn’t get a break. It’d be on my mind all the time.”

The psychiatrist switched her to another antidepressant. That didn’t work, either. He recommended that she stick with the medication because eventually it would help. But the thoughts didn’t stop. “Everything just felt hopeless, and very dark,” Lugo says of her fear of self harm. “The first thing I would wake up to would be that thought and that feeling.” 

Lugo felt her normal life was slipping away. Her husband drove her to the spot where they were going to build their new home. “I was crying,” she says. “He pointed to the land and said, ‘This is our future.’ And I said, ‘I don’t think I’m going to make it to see it.'”  

As it became clear how much pain she was in, her husband and kids naturally wanted to talk—to learn about her symptoms and what they could do to help.

Her loved ones had to learn that talking often doesn’t help with OCD. “They wanted me to let them know every time that sensation came up, so they could help me out. But that’s not how OCD works.” Telling them about every intrusive thought would have fed into the OCD, rather than helping to weaken it.

Life just got harder. Even running errands became difficult. “I would be driving the car, and I’d have, like, that vision or sensation. And it would distract me to the point where I’m like, ‘Oh my gosh, I wasn’t focused on driving and I have my kids in my car!’”

Soon, she says, “I thought I was just doomed with this—this is just something that happened to me at the age of 36. And I’m just stuck with it, this is my life now.” 

As Lugo struggled with her intrusive thoughts, she sought help from a therapist. But spending hours focused on her terrifying thoughts of harming herself—recounting them in detail—didn’t change anything. “Talk therapy just wasn’t doing it for me,” she says. Yet as her therapist listened to Lugo explain her incessant thoughts, she had a different idea.

Maybe, her therapist said, you have obsessive-compulsive disorder (OCD).

OCD explained

Lugo was surprised. She had always been an intense person—the kind who would spend sleepless days and nights online exhaustively researching an upcoming trip, or gadget purchase. But how could she have OCD? She’d never been worried about germs or keeping things neat and even, and isn’t that what OCD is all about? “I thought OCD meant I’d like things that are in a very particular order, or I like cleanliness, or I need to check the doorknob,” Lugo says. 

Her therapist explained that OCD isn’t just being eccentric or fussy. It’s a major mental disorder, with many subtypes—one of which is worry about self-harm. 

OCD hijacks your mind with disturbing thoughts that can’t be ignored. (This is the obsession part of the condition.) You feel compelled to calm yourself with mental or physical actions (called compulsions) that bring a little temporary relief—like throwing away all of the large knives in the house, or constantly asking for reassurance that you won’t stab yourself. 

But the thoughts always come back, and, in fact, the actions you perform to try to quiet your intrusive thoughts just encourage the cycle to continue. If you have OCD, you might spend hours each day coping with your intrusive thoughts, and performing your special behaviors. 

This hadn’t been Lugo’s life for three-plus decades. But her hormonal balance was changing as her 30s went on—and these changes can trigger a mood disorder. It’s something that research shows happens to many women between 35 and 60. Often, doctors don’t take these feelings seriously—like the first physician Lugo consulted, who told her she was too young to worry about hormonal impacts. He was wrong. In fact, there’s good evidence that hormonal changes often coincide with OCD symptoms.  

While OCD is a serious mental illness, Lugo was relieved to finally get a diagnosis. “It took away a lot of the fear,” she says. “It gave me some hope. Like, there’s a different way I could tackle this versus talk therapy, because that talk therapy just wasn’t working.”

A little more than a year later, Lugo found the right treatment and is on a healthier path. Now she wants others with OCD to know they can get help, too. 

Lugo says that the disorder is so misunderstood and scary that too many people try to hide their symptoms rather than look for help—like she originally did. “I can understand where people would feel very fearful about talking about it,” she says. 

A lot of OCD subtypes are hard to admit to. “There’s sexual orientation subtypes. There’s pedophilia subtypes. There’s other very taboo subtypes. And for someone to openly admit that they have those thoughts, and then not really understand what it is? That’s why people just don’t discuss it. That’s why I’m going to talk about it.”

What to know about ERP

The question then became, what to do next? There is a shortage of psychologists and therapists who specialize in OCD. That’s part of the reason why 30 to 40% of people with OCD don’t seek treatment for the disorder. 

Some clinicians try to treat OCD despite not being trained in how to handle it. But Lugo’s therapist flat-out told her that she wasn’t qualified to provide the help she needed. But she did diagnose her with self harm OCD, and Lugo then met with a therapist at NOCD, the leading provider of telehealth therapy for OCD and its related conditions. “My therapist knew everything I was going through. All she did was OCD,” she says. “She knew what to do.”

Lugo’s treatment involved a form of therapy that’s supported by decades of research: Exposure and Response Prevention (ERP). It’s considered the front-line treatment for OCD.

While each patient’s plan is tailored to their individual needs, the general principle of ERP is simple. Clients are gradually exposed to the things that trigger their obsessive thoughts, and learn how to tolerate the distress that follows without resorting to compulsions. 

“At first I was not a good student,” Lugo admits. “I was scared.” Because the trigger for her self-harm OCD was knives, “I avoided them in the house, I was terrified of them. So with exposure therapy, I would be holding a knife, just breathing and allowing those thoughts to come and go, and allowing the thought to just be a thought. Allowing the sensation to come and go, to just be a sensation. And it was really hard. I’m not going to lie, it really tested me and my boundaries.”

Of course, ERP therapy doesn’t throw you into the deep end. It begins with the least troubling triggers, and gradually moves up the ladder of fears. Lugo’s therapist, for example, started with asking her to hold a plastic knife to keep the work manageable.

Yet she also knew how to keep challenging Lugo—when she was ready—to face bigger and bigger fears. Getting to a real knife was hard. So was another exercise designed to help Lugo deal with her fear of hurting herself: Wrapping a scarf tightly around her throat. 

 “A traditional talk therapist wouldn’t understand it,” she says. (Traditional therapy often aims to make the patient comfortable and get them talking, which doesn’t do much to counter OCD.) Lugo’s NOCD therapist “really pushed my boundaries. She’d make me uncomfortable. And we don’t always like people who make us uncomfortable.” 

But under her stress, Lugo sensed that her therapist was pushing her in a good direction. In fact, studies have found that seven out of ten people who do ERP experience relief from their OCD symptoms.

OCD under control

OCD was a tough opponent, but as her self-harm OCD symptoms got under control, Lugo began to have intrusive thoughts about other things. “My therapist called it ‘Whack-a-Mole,'” she says. Her fears shifted to car accidents, which had her avoiding certain highways, constantly checking traffic and asking others if the road was safe. Then her OCD latched on to her three kids, and she had obsessive thoughts about something bad happening to them. 

She was seeing her therapist three times a week, but she also had homework. Knives to hold at home. Sometimes a photo her therapist would send for her to sit with for a few minutes. Lugo worked on her ERP treatment every day. “OCD doesn’t take breaks,” she says. “I needed to do the homework every day, not just three times a week.”

What kept her going? Progress. Lugo’s OCD scores dropped significantly as her ERP therapy went on. “When you can see that the work that you’re putting in is doing something for your life, it’s a big weight taken off,” she says.

The tools she learned with ERP empower her to live with an intrusive thought—when and if it occurs. “I’ll sit with it and allow it to come and go,” says Lugo. That was months and months ago. “I felt the emotion in my body, and I didn’t try to push it away, and I didn’t ask ‘what does it mean?’  I just sat with it and it left. I don’t give those thoughts power any more. I know there are people out there thinking ‘no way!’ But you’ll get there.”

Now, she sees her NOCD therapist once a month for “maintenance,” but her evaluations have consistently shown her OCD to be under control. And she says, “It’s very empowering to fill out that chart and feel, ‘Wow, I have my life back.” 

What Erica Lugo wants you to know about OCD

Reflecting on her search for treatment, Lugo offers these tips:

• Trust your gut. Doctors may be quick to dismiss the effects of hormonal changes. If they are affecting your life, don’t hesitate to get a second, or even a third, opinion.
• Find qualified help. Few therapists have much knowledge of OCD, or training in how to treat it. Take the time to find a clinician with real expertise in ERP treatment.
• Medications that target anxiety or depression may not work for OCD. Antidepressants alone may not be enough to tackle your symptoms. They can sometimes help in conjunction with ERP therapy, but there isn’t good evidence that they work on their own for OCD. Behavior changes are what is key. And that’s something pharmaceuticals can’t stand in for. Also worth considering: If you do want to explore SSRIs, know that the dose may be different than what is typically prescribed for anxiety and depression, and that you shouldn’t hesitate to speak up and explore other options if you give it a chance and don’t feel like it’s working. You might be right!
• Don’t give up. It’s true that many therapists aren’t trained to treat OCD. But there are professionals out there who can help you get the care you need.