“I’m so OCD.”
We’ve all heard this phrase thrown about when someone defends their preference for organization or cleanliness. For instance, maybe someone has described themselves as being OCD about how the dishwasher should be loaded, the towels folded, or the direction of the toilet paper on the holder. In reality, this is NOT OCD. Therefore, this kind of language spreads misinformation and perpetuates harmful stigmas around diagnoses like these.
What is OCD?
OCD stands for Obsessive Compulsive Disorder and is a clinically diagnosable condition. It is an often debilitating condition characterized by intrusive thoughts, images, and impulses (obsessions) that are unwanted. A person diagnosed with OCD finds themselves unable to shake these things.
Then, in an effort to lessen the distress of the obsessions, they engage in a repetitive compulsive behavior. Everyone can experience distressing and unwanted thoughts at times and even an urge to engage in a behavior, but the key component for OCD is that there is a functional relationship between the obsession and compulsion.
What does OCD look like?
The most common image people have of this disorder is a fear of germs which causes excessive hand washing. This would fall under one of the subtypes of OCD. However, OCD can present itself in many different ways and have many overlapping obsessions and compulsions.
For example, here is a list of OCD subtypes:
A fear of harming oneself or others, physically or emotionally. Or, being responsible for something terrible happening
A fear of contamination of self or others. This includes emotional contamination.
A fear of being a different sexual orientation than the one previously believed. Similarly, a fear of not knowing one’s orientation ever or of how other’s perceive their orientation.
A fear of having sexual thoughts or arousal about children. Further, a fear of molesting children.
A fear of things not feeling “just right”. Fear that if if something is not done correctly then something bad will occur.
Fears about the quality or legitimacy of one’s relationship. Additionally, fear about their partner being a good enough match or fear of being a good enough partner themselves.
This is the over awareness of bodily sensations and processes. For instance, blinking, vomiting, breathing, swallowing, and heartbeat. Further, there is fear that these process will never be automatic again.
Intrusive thoughts that focus on existential themes like the meaning of life, reality, and one’s own existence.
The fear of violating a religious or moral norm or of being an immoral or bad person.
Categories of compulsive behaviors
Similarly to subtypes, compulsions can also show up differently for people.
- ritualized eating behaviors
- skin picking/hair pulling
- seeking reassurance
- superstitious behaviors
This is not an exhaustive list. However, it is a structured list used to help screen for the functional relationship between obsessions and compulsions.
How Do I Know If I Have OCD?
If you’re reading this, you are already on the right path to getting more information. Start with the resources available to you. For instance, talk to your doctor. Get a referral for a mental health professional. They can administer screening tools to determine a possible OCD diagnosis.
The most common screening tools are the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) for adults, and the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) for children. Another common one is the Diagnostic Interview for Anxiety, Mood, and OCD and Related Neuropsychiatric Disorders (DIAMOND).
I Have An OCD Diagnosis
Once it is determined you meet the criteria for an OCD diagnosis, your provider will discuss treatment options with you. Common treatment includes medications and therapy. However, Exposure and Response Prevention, or ERP, is the gold standard of treatment for OCD.
The first few sessions of ERP focus on gaining information about your specific obsessions and compulsions. Further, a hierarchy of these will be developed to determine specific targets throughout treatment. Finally, you and your provider will engage in a series of exposures, which are intentional engagements with triggers to heighten the distress response. This will be controlled with the support of a trained clinician. The focus of this is to resist the urge to engage in compulsive behaviors.
That Sounds Terrible. Why Would I Want To Do That?!
Studies have shown that repeated controlled exposures to fears while resisting urges to behave compulsively helps to rewire the brain. This allows your brain to interact with anxiety and OCD differently. You learn to experience your emotions as feelings and sensations – not as facts. Similarly, you experience your thoughts as thoughts and not as threats or calls to act.
Overtime your distress response becomes less and less. Therefore, you learn alternative ways to soothe your fight/flight/freeze/fawn response. You will not have to do these exposures by yourself. They will also be done in a safe place, like your home or a therapist’s office. You may be asked to complete exposures on your own as homework eventually, but not until you are ready.
If you or someone you love may be experiencing symptoms related to OCD, don’t hesitate to reach out to a professional. In conclusion, it’s important to know that you are not alone, you don’t have to do this alone, and there is help.