When many people think of obsessive-compulsive disorder or OCD, they think of someone who is uncomfortable when they encounter a mess. When a disorder like OCD is used as the butt of jokes, e.g. “I’m being so OCD right now!” or “He’s a neat freak, totally OCD about it”, it can make it harder for people to grasp what OCD really looks like. While there are forms of OCD that include compulsions around neatness, the disorder is so much more than pop culture would have you believe.
Misconceptions about OCD
There are enough misconceptions around OCD that many people don’t realize that they or someone they know actually experience OCD. People may dismiss their symptoms as being just anxious or uptight, or they may spend years misdiagnosed with other mental health conditions. OCD is very treatable, so understanding what it looks like in the real world can be a critical step toward getting help.
A guide to understanding what obsessive-compulsive disorder looks like
We have created a guide for you to counter some of the misconceptions about OCD and help you learn what OCD actually looks like. If you are wondering whether you have OCD, we welcome you to get in touch with Patterns Psychiatry for a virtual psychiatric evaluation, especially if you are in Texas, Minnesota, or Iowa. A psychiatric evaluation can be the perfect starting point toward relieving the symptoms of OCD and living a life of choices instead of compulsions.
What does obsessive-compulsive disorder really look like?
The OCD cycle, a “disease of doubt”
OCD is a cycle of compulsions performed in response to obsessions. Obsessions are based on a person’s fears and are intrusive, disturbing mental images or thoughts. In OCD, your mind will try to soothe the anxiety that comes from these intrusive thoughts by performing actions called compulsions.
It’s common to perform compulsions to try to find certainty; obsessions often center around frightening events that might happen, and so compulsions are often an OCD sufferer’s attempt to find certainty. The mind then links the compulsion to the feeling that the obsession will not happen, so compulsions begin to feel protective.
Compulsions can include any action or thought someone repeatedly does when intrusive thoughts recur. As someone with OCD continues to have repetitive intrusive thoughts, they repeat the compulsions, creating a cycle. When compulsions no longer soothe the anxiety that comes from the obsessions, the need to perform compulsions can escalate in intensity and frequency. This can be incredibly disruptive, even disabling, without treatment.
Compulsions can include:
- Counting and recounting
- Excessive cleaning or organizing
- Arranging things
- Symptom checking (taking temperature multiple times, becoming hyperaware of different body parts)
- Hypervigilance around triggers
- Rumination or constant circular thinking
- Avoidance
- Praying or repeating mantras
- Checking and rechecking, seeking reassurance
OCD subtypes
The most well-known OCD subtypes tend to be contamination and organization, but there are many subtypes of OCD, including:
- Scrupulosity/Religious OCD: fears around you or someone else being a bad person or violating religious rules
- Harm: Worry about harming yourself or others
- False memory: Fears of forgetting having done something terrible
- Responsibility: Taking responsibility for things you aren't in control of
- Symmetry: Fearing bad things will happen if objects aren’t orderly or symmetrical
- Contamination: Fearing people, places, or things are contaminated and will cause harm
- Hoarding: Fear that getting rid of something will cause problems
- Relationship: Fears involving your personal relationships
- POCD: Fears that you are secretly going to abuse children
- Sensorimotor: Fears involving hyperawareness of physical sensations
Mental vs. physical compulsions
Recognizing that compulsions can be entirely mental or a blend of mental and physical can help you recognize OCD more easily. Physical compulsions can be obvious, like excessive handwashing, repeatedly returning to check on something, rearranging things, moving in specific ways, obsessively researching, etc. It is a common misconception about OCD that compulsions are only physical, as many compulsions only happen in the mind.
Mental compulsions can include rumination (the inability to stop thinking about a topic), counting, praying, seeking reassurance, persistent doubt or questioning oneself, avoiding people, places, or things, and more.
A note on intrusive thoughts
Intrusive thoughts, also sometimes called obsessions in OCD, can be disturbing and upsetting. People who experience intrusive thoughts may worry that these thoughts show who they really are.
Intrusive thoughts are your greatest fears, the things you want to happen least in the world. People with OCD often have intrusive thoughts about the people they care about, including friends, family, and themselves. Intrusive thoughts show up in your mind as an attempt to keep you vigilant and safe, but with OCD they can lead to the obsession/compulsion cycle if a person’s OCD goes untreated.
If you find yourself feeling guilt or shame because of your intrusive thoughts, we at Patterns Psychiatry want you to know these thoughts reflect only what you don’t want to have happen in the world and don’t represent hidden desires. You are not your intrusive thoughts.
How is OCD treated?
The most common OCD treatment is called Exposure and Response Prevention therapy, or ERP. ERP is a highly effective treatment adapted from cognitive behavior therapy (CBT). ERP helps people with OCD to break the obsession/compulsion cycle.
ERP asks people to stop themselves from performing compulsions and use healthy coping mechanisms like mindfulness, self-compassion, humor, acceptance, and deflection to cope with the ensuing anxiety. This may seem counterintuitive, to make no attempt to manage anxiety, but when a person with OCD simply lets intrusive thoughts exist without trying to argue or soothe them, they lose their power to cause as much anxiety.
Breaking the obsession/compulsion cycle can lead to less life disruption from OCD in the short and long term. OCD can go into full remission and can flare back up, so having tools to use that don’t reinforce anxiety around obsessions can help people manage their OCD throughout their lives. Remember, OCD is not a failure, it is a disorder that is treatable with care from qualified providers, with your first step being a psychiatric evaluation and diagnosis from the team at Patterns Psychiatry.
