Kimberley Quinlan, LMFT, is an Los Angeles-based OCD specialist helping clients navigate the tragedy caused by the recent fires. She shares thoughts on how people with OCD in LA can navigate the uncertainty and grief of this moment, as well as broader advice for understanding and coping with climate anxiety.
In January, unprecedented fires ravaged the city of Los Angeles and surrounding areas, leaving acres of devastation in their wake. Twenty-nine people were killed, and more than 16,000 structures were destroyed. As the city grapples with how to rebuild, we also face a potential mental health crisis. Climate disasters cause feelings of loss, grief, and anxiety—and have been shown to impact mental health. Navigating the uncertainty of these events can be difficult for anyone, but may be especially challenging for people living with obsessive-compulsive disorder (OCD).
Local therapists are working to make sure that people with OCD have the tools to navigate the aftermath of this event. Kimberley Quinlan, LMFT, is one such clinician. She specializes in OCD, anxiety disorders, and OCD-related disorders, and has been helping clients in the LA area learn to navigate intrusive thoughts, resist compulsions, and accept the uncertainty California is facing right now.
I sat down with Quinlan to discuss survivor’s guilt, hypervigilance, and strategies for navigating climate anxiety.
Fi Lowenstein: How long have you been working as an OCD specialist, and what brought you to this work?
Kimberley Quinlan: I’ve been an OCD specialist for 14 years. I got an internship at an OCD center. As soon as I interviewed there, and they talked about ERP [exposure and response prevention therapy]—which I had never heard of—I knew this was what I wanted to do. I took the role, got fully trained, and just loved it. It’s the specialty I wanted to be in.
FL: Do you see climate anxiety come up a lot for people with OCD?
KQ: So many people have questions about how to navigate it. Climate anxiety isn’t irrational. It’s not ego-dystonic, like obsessions often are. However, OCD often circles around themes of uncertainty, so it can take these genuine fears to a very catastrophic place. People worry about the worst-case scenario. Often, it’s not just intrusive thoughts. They have intrusive images about fires or rising sea levels, and that imagery is very, very anxiety provoking.
FL: For many people, the fires actually were the worst-case scenario. We both live in LA, and had to evacuate. How do you think the stress of the recent climate catastrophe in LA may be impacting people with OCD?
KQ: There’s multiple layers to this. The general stress and grief that the city is feeling can trigger increases in OCD symptoms. Just having that gray cloud over the city—whether it be metaphorical or the actual smoke—can be very impactful for mood.
In addition to that, during the time when the fires broke out, everyone was very vigilant to the danger, packing bags, and making an escape plan. When we’re having to do that for rational reasons, it can trigger off the part of the brain where OCD exists. OCD takes that and runs with it, bringing on lots of catastrophic intrusive thoughts or catastrophic intrusive imagery that can create a chain reaction.
Even though the fires are now [contained], people are still experiencing a sense of hypervigilance. A lot of my patients have reported that they still haven’t unpacked their bags, even though we’re two or three weeks out. They aren’t comfortable. They don’t like the uncertainty. I think that their general distress is absolutely warranted, but OCD is taking advantage of that stress.
FL: How are you helping people navigate what might be genuine public health concerns related to, say, drinking water or hazardous materials, and what might be a more overly cautious behavior—like keeping your bags packed once you’re no longer in an evacuation zone?
KQ: There’s usually a series of questions that we may explore. What would they do if they didn’t have OCD? What is a trusted friend or loved one doing? How can we model their behavior? This is the same thing that happened with COVID. When COVID happened, a lot of people with OCD were trying to navigate questions like, is wearing a mask appropriate or compulsive? It’s often about being okay with the fact that we don’t always know the answer, taking reasonable precautions, and knowing that OCD can come in and pretend that it’s a rational thought.
FL: In LA right now, public health officials are telling us there’s a lot we just don’t know yet. Can you speak to how people with OCD are navigating the unknown?
KQ: I have found that some of my clients have got a leg up, compared to the people who haven’t had to practice sitting with uncertainty before. The fact that they’re already in treatment can actually be very positive for dealing with these real life stresses. What we would do is use this as an opportunity to recover more from our OCD.
A lot of the research and the work that I have done with my community about climate anxiety is around how we can’t take the uncertainty away. We can’t even take our anxiety about it away, but what we can do is continue to practice our skills and show up in a way where you’re advocating for change, or you’re contributing to the good of the world. We want to practice controlling what we can, and letting go and being uncertain with what we can’t.
A lot of the research and the work that I have done with my community about climate anxiety is around how we can’t take the uncertainty away.
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FL: I love the idea that engaging with more collective efforts can be a way to get outside of your individual experience of anxiety. Can you say more on that?
KQ: The news presents things the same way OCD does: doom and gloom. That can really terrorize you. Or, you can be looking for how the community is coming together. Where are you putting your attention? Are you only putting your attention toward how bad it is? It’s fair to give that some air time, but you should also be asking, how can I support people? When you shift your attention to that, you see some amazing stuff. You start to have faith in the human race again.
You should also be asking, how can I support people? When you shift your attention to that, you see some amazing stuff.
FL: I’m curious about survivor’s guilt. Is that something that you’re seeing come up?
KQ: One of the main obsessions that I have seen for folks with OCD is intrusive guilt. Of course we feel sad for people who have lost their house, were evacuated, or had their businesses impacted. But, a lot of people with OCD are having this intrusive guilt that will not stop. It’s relentless. Then, as a compulsion, they’re beating themselves up, ruminating, comparing. Some people even were compulsively donating. I think in that case, the guilt is extreme, and causes the person with OCD to feel guilty for something that wasn’t their responsibility.
FL: I can imagine that being very debilitating. What might ERP look like for these sorts of symptoms?
KQ: We’re going to prioritize response prevention more than exposure, because the exposure has happened. It was the fire. Now, we have to move into the reduction of any safety behaviors or compulsions we’re doing to reduce or remove the discomfort we have. There are some who are needing exposure, and that’s usually people who have checking compulsions due to fear of fire. A lot of those clients are having an increased severity and frequency of checking behaviors. Did I leave the stove on? Did I leave the hair straightener plugged in? So, we may need to do some exposures, like leaving the house without checking.
For someone who’s struggling to unpack their bag, response prevention might look like unpacking one item at a time. Response prevention also will often involve reducing mental compulsions. A lot of people are still mentally going over an escape route. So, it would be reducing those behaviors, as well as any safety compulsions we’re doing in the day-to-day. Often, what we’ll do is write down all the compulsions that we’re engaging in around this situation.
FL: What about for people who have lost their home?
KQ: If you’re someone who has lost your house, we may want to assess whether there is any kind of PTSD involved. We would need to consider that before engaging in ERP. I even have several clients who didn’t lose their house, but they’re the one house on the block that didn’t go up. For them, there’s still a degree of trauma that they’re seeing physically. They still can’t move back into their house, even though it’s still standing.
FL: If you could leave people with one final message to get through this right now, what would it be?
KQ: This is a time when we have so much grief. We need to be as gentle and kind to ourselves as we can. Self-compassion always has to be our first line of response when we’re navigating these topics, because they’re very painful. We deserve to be kind to ourselves as we navigate these really difficult times.
If you or anyone you know has OCD and have been affected by this tragedy, we are here to help. Book a free call to get set up with an OCD therapist. We also encourage you to share Kimberley Quinlan’s tips on navigating the aftermath of the LA fires.