“I'm so OCD.” It’s a phrase most of us have heard before or even used ourselves — perhaps without understanding that OCD is a real condition. With many false notions spread by entertainment media, as well as this kind of casual usage, it’s no wonder there’s a widely held misconception that “OCD” is interchangeable with perfectionism or a focus on organization and tidiness.
However, for people with OCD, the reality is far different. According to licensed professional counselor Angelique Works, the owner of Works Counseling Center, “It’s a disorder that causes fear, chaos, and intense distress for people who have it.” In this post, we’re taking a deep dive into what OCD really is and how you can support someone who has OCD.
OCD (obsessive compulsive disorder) is a psychological disorder that causes a person to have intrusive thoughts (obsessions) and then feel they must neutralize those thoughts by completing a an action or a ritual (a compulsion). OCD used to be classified as an anxiety disorder in the DSM (Diagnostic and Statistical Manual of Mental Disorders); however, it is now included in its own category of obsessive-compulsive and related disorders.
Similar to many anxiety disorders, OCD often produces symptoms that leave a person feeling overly anxious, upset, and overwhelmed.
On average, a human being has more than 6,000 thoughts a day, many of which are seemingly insignificant or happen without us even realizing it. However, for a person with OCD, certain thoughts can get “stuck” in the mind, causing extreme distress.
The thoughts that become stuck often go against a person’s belief or value system, causing them to worry that the thoughts mean something about their character or might predict future actions.
According to Works, “The biggest misconception about OCD is that the thoughts mean something about the person having them, when in reality, they are just thoughts. This is why it’s especially important to work with an OCD specialist, because if OCD is not properly diagnosed, certain treatment methods can actually be harmful to a person with OCD.”
These thoughts may seem irrational to others but can become so distressing for a person with OCD that they try to find ways to neutralize the feeling of the thought by compulsing. The problem is that the act of compulsing only makes the thought feel more valid, causing the person to become stuck in a vicious cycle.
Hand washing is one of the most commonly depicted compulsions for OCD, but compulsions depend entirely on the person and the content of their fears. Common compulsions include counting, tapping, repeating or avoiding certain words, and cleaning or washing. However, some people can have compulsions that are not physical — a symptom of a subset of OCD commonly referred to as Pure-O.
Pure-O, which is short for “purely obsessional,” is the name given to a type of OCD in which a person’s compulsions are not outward and happen in the mind.
Many people who initially are diagnosed with Pure-O often think that they do not participate in a compulsion because the action is not visible; however, the compulsion happens through reviewing feelings, thoughts, past experiences, and emotional reactions.
There are many different subsets of Pure-O, including:
Harm OCD — A person with harm OCD fears causing harm (mostly physical) to another person.
Relationship OCD — A person with relationship OCD fears being in the wrong relationship and often checks their feelings towards their partner (more than a person with reasonable doubts would).
Religious OCD — A person with religious OCD fears being blasphemous or participating in any actions that would go against their religious beliefs.
Sexual orientation OCD — A person with sexual orientation OCD fears they may be a sexual orientation that differs from the one they identify with. (This can occur in someone with any sexual identity.)
Sexually intrusive OCD — A person with sexually intrusive OCD fears having any sort of inappropriate sexual desires, including incest fears or pedophilia fears.
According to Works, “These types of thoughts are the reason it is imperative a person work with an OCD specialist, because that person should be able to properly diagnose and treat the patient. Without that knowledge, some doctors and therapists may do something they think is helpful — such as suggesting patient admittance into a hospital or calling social services — where there is actually no threat to the person or their loved ones.”
One of the biggest obstacles for people with OCD is that the intrusive thoughts are often around taboo topics. This makes it difficult for the person to seek help, especially if they are unaware they have OCD, as they are worried the thoughts might make them a “bad person.” However, the reality is exactly the opposite. The fact that the thoughts are so distressing to the person means that the thoughts go against their values.
So the answer to the question “What do my obsessive thoughts mean about me?” is, according to Works, simple: “Nothing.” The only thing the obsessive thoughts mean about a person is that they have OCD.
Works says, “Too often, people get attached to the content of their thoughts and what they might mean. When the truth is, the thoughts are likely something we’ve all had before, but people without OCD typically dismiss them as silly and unimportant. An OCD sufferer worries that the thoughts mean something about their character or their value system, which is what begins the obsessive cycle.”
Technically, OCD does not have a cure. However, it can be successfully managed, which means that many people who have worked with an OCD specialist are able to live without experiencing obsessions or compulsions.
According to Works, “OCD isn’t curable; it’s manageable. Some people are able to completely manage their symptoms, while others will have OCD that is chronic. And just as with any other chronic condition, it takes continual work and care to manage symptoms.”
One of the most difficult parts about treating OCD is that it does not respond to logic. Many people get caught in a trap of trying to think themselves out of their OCD by reviewing past experiences or using logic against it, but that only perpetuates the cycle of compulsions and, in the end, winds up making OCD worse.
Although it is incredibly difficult, one of the most effective treatments for OCD has been shown to be ERP (exposure and response prevention therapy). During ERP, the person is tasked with directly exposing themselves to their fear and then sitting in that fear until they are no longer bothered by the exposure. When done repetitively, this sends a signal to the brain that the thought is no longer significant or important. Over time, this can help the person no longer react to that thought, helping them break free of the vicious OCD cycle.
It is important to note that the content of an obsessive thought often changes once a person has overcome their reaction to that particular thought. It is not uncommon for a person to experience a new obsession once they have overcome their old fear. Which is why it is important to continue ERP regardless of the content, until the person finds themselves living a relatively symptom-free life. There is also a stage in the recovery process commonly known as the “backdoor spike”. During this stage, when ERP is beginning to work, the person will no longer experience extreme distress when exposed to the triggering event. However, that lack of distress in itself can be distressing, as the person may believe that not being bothered by the thought now means something new about their character — perpetuating the vicious OCD cycle.
For many people, OCD can be a lifelong condition, as the brain has been wired for so long to react in a particular way. It is not uncommon for a person with OCD to have recurring bouts of it throughout their lifetime, which is why it’s crucial to learn the proper coping tools. Learning how to identify your obsessive thoughts — as well as the tools to combat them — increases the likelihood that the person can reduce their symptoms in a shorter period of time, and with less distress, in the future.
If someone you love may be experiencing OCD, the first and most important step is to encourage them to seek professional help. If your loved one is already seeking help from a therapist, it may also be beneficial to join one of their therapy sessions — with their permission, of course — to ask their therapist about how you can support them in their healing plan.
According to Works, “Unfortunately, many people unintentionally participate in their loved one’s compulsions without realizing it. Learning to pick up on when the person is compulsing allows you to provide the right type of support to help them get through this difficult time.”
OCD is a highly complex disorder that takes a great amount of will and strength to overcome. It is so much more than neatly piled books, washing hands, or tidying up your home. If you are concerned that you or a loved one may be dealing with obsessive compulsive disorder, it’s important to speak to a professional and remember that your thoughts do not say anything about your character — they are just thoughts.
At Carbon Health, we understand that OCD can come with many uncomfortable and overwhelming emotions. We offer virtual mental health appointments to California residents; make an appointment via carbonhealth.com or through the Carbon Health app. (If you or a loved one is experiencing thoughts of self-harm, seek emergency medical care or call the National Suicide Prevention Lifeline at any time, day or night, for free and confidential support, at 1-800-273-8255.)