One of the most common misconceptions about obsessive-compulsive disorder (OCD) is that it’s all about keeping things in order and being super tidy. Many of us have heard someone say “I’m so OCD” because they color-code their closet or make sure everyone who comes into their home takes off their shoes. But simply being neat, having quirky habits, or exhibiting a Type-A personality does not add up to an OCD diagnosis.
Nonetheless, it’s understandable that many don’t know what OCD really is. It’s a highly misunderstood disorder—so much so that it takes sufferers up to 17 years on average to receive proper treatment.
It’s also worth noting that it’s quite common for people who do meet the diagnostic criteria for OCD to continually ask, “What if my OCD isn’t really OCD?” After all, OCD is dubbed the “doubting disorder.” It pushes your brain to doubt everything you know to be true, and one of its most creative loopholes is to make people doubt if they even have OCD in the first place.
Keep reading for the essential facts about OCD, a breakdown of symptoms, and how to get help, with advice from Dr. Nicholas Farrell, a clinical psychologist and Regional Clinical Officer at NOCD, and other experts.
What are the symptoms of OCD?
OCD is a rather common and very serious—sometimes even debilitating—mental illness. It’s characterized by two main groups of symptoms: obsessions and compulsions.
Obsessions
Obsessions consist of repetitive intrusive thoughts, images, urges, sensations that lead to feelings of distress.
If you’re experiencing OCD, your obsessions will be:
- Recurring
- feel out of your control
- seem out of character with your true self.
They may subside for a limited amount of time because of the temporary relief brought by compulsions, but they will always return. Without proper treatment, obsessions only intensify as time goes on.
It’s important to note that everyone has intrusive thoughts from time to time, but people with OCD find them impossible to dismiss. As a result, obsessions are time-consuming and get in the way of the OCD sufferer’s daily life.
Here’s an example: Someone without OCD may think “What if I stabbed someone with this knife I’m using to cut vegetables?” and acknowledge that was a strange thought and not in alignment with who they really are—and move on with their day. Someone with OCD, on the other hand, may ruminate over this thought for hours, feel fear or panic about the intrusive thought, and attempt to draw conclusions about what it means about themselves.
Compulsions
A compulsion is any behavior or mental action that is done with the intention of relieving the distress brought on by obsessions or preventing a perceived bad outcome from occurring. They’re often driven by a search for certainty or reassurance. Compulsions can be highly repetitive or ritualistic in nature, and can take up a great deal of time.
Any relief that compulsions bring is temporary, and the obsessions inevitably return (perpetuating what’s called the OCD cycle).
Common physical compulsions include:
- Checking (i.e. repeatedly making sure the stove is off, or that the door is locked)
- Tapping/touching (i.e. tapping your knee a certain number of times in order to feel “okay” or “just right”)
- Reassurance-seeking (i.e. asking a loved one, “Did you see me push anyone when we were walking down that busy street?” or “Do you really love me?)
- Avoidance (i.e. refusing to go to places, be in situations, or take in stimuli that may trigger your intrusive thoughts)
- Excessive washing/cleaning (i.e. hand washing, showering, or disinfecting surfaces multiple times a day)
Common mental compulsions include:
- Rumination (i.e. turning something over and over in your mind, even for hours a day.)
- Mental reassurance (i.e. giving yourself reassurance, such as “I would never do anything awful like that because I’m not a bad person”)
- Thought-replacing (i.e. replacing a “bad” thought with a “good” one in your mind)
Diagnosing OCD
The DSM-5, the gold-standard manual for classifying mental health conditions, requires the following criteria for an official diagnosis:
- Presence of obsessions and/or compulsions that
- are time-consuming, meaning they either take up at least one hour per day or considerably interfere with a person’s normal routine
- Cause significant distress
- Impair one’s ability to function at work or in social situations
Experts note that you might also experience physical symptoms of stress and anxiety, which can include a tight chest, gastrointestinal issues, jaw-clenching, dizziness, and headaches. Dr. Farrell says this physical experience of OCD is “one of the most underappreciated aspects of OCD.”
It’s a very anxiety-and-fear-based condition, and those emotions, especially when we experience them at more intense levels, take a physical toll on us.
Dr. Nicholas Farrell
Are there different types of OCD?
Intrusive thoughts, images, urges, sensations or feelings vary widely. Remember, they are unwanted and not enjoyed by the sufferer. They can latch onto anything that you value, but there are some common themes. Here’s what they are and how they can manifest:
- Perfectionism OCD: Revolves around organization, perfection, and making things feel “just right”
- Repeating actions until they are done “perfectly” (i.e. turning on and off lights)
- Thinking something bad will happen if your hair isn’t done in a certain way
- Sexual orientation OCD: Constant fears and doubts about your own sexuality
- “What if I’m actually straight, and I’ve been lying to my partner this whole time?”
- A groinal response to someone of a gender you’ve never been attracted to before
- Recurring denial or confusion about what your “true” sexuality is
- Contamination OCD: Intense fear about becoming contaminated or becoming ill
- “What if I contract germs at the concert and bring them home to my family?”
- Seeing mental images of yourself on life support in the hospital
- Scrupulosity/religious OCD: Consistent worrying about violating religious, moral, or ethical beliefs
- “What if I am not living by my morals?”
- “What if I go to hell for my intrusive thoughts?
- An urge to do something that’s against your moral/ethical/religious code
- Sensorimotor/somatic OCD: Fixations on bodily sensations or involuntary bodily functions
- “What if I’m not breathing normally?”
- Constantly counting your steps, blinks, heartbeats, or breaths
- Harm OCD: Unwanted thoughts about hurting oneself or others
- “What if I pushed someone in front of train?”
- An urge to stab someone with a knife
- An image of yourself doing something violent
- Relationship OCD: Questioning everything about your relationships, most often the intimate ones
- “What if I’m not attracted to my partner?”
- An urge to break up with your partner
- Unfounded fears that your partner might cheat
- Existential OCD: Ongoing philosophical questioning about the meaning, purpose, or reality of life, or even your own existence.
- “Is there a God?”
- “Is anything real?”
- False Memory OCD: Recurring doubts about things that happened in the past
- “Did I accidentally say something inappropriate that offended my friend?
- “Did I crash into someone while driving and forget about it?”
When does OCD start and what causes it?
OCD symptoms can manifest at any age, but experts have noted two peak periods of onset. The first timeframe happens between late childhood and early adolescence, specifically ages 10 to 12. The second peak occurs during early adulthood, around ages 18 to 24.
OCD is not caused by one single factor. Instead, there are a variety of genetic, behavioral, and environmental elements that are more common in individuals diagnosed with OCD. These include:
- A family history of OCD or related disorders
- Chronic stress or trauma
- Genetic and structural differences in the brain
Are there severity levels of OCD?
Yes. OCD is a complex condition and severity varies from person to person. The distress caused by obsessions and compulsions can also vary from day to day. You may have days, weeks, or months where you’re able to effectively manage your symptoms. Even if at some point it feels like you’re cured, it’s important to note that OCD is a chronic disorder. That’s why it’s critical to be equipped with the tools to address OCD symptoms when they surface.
One of the factors that can also make OCD feel more intense for some people: Those with OCD are more likely than the general population to have a co-occuring mental health condition. Most often that will be general anxiety disorder or depression. A specialist who is properly trained in treating OCD will be mindful about how your treatment plan needs to address other mental health issues.
What if you’re not sure you have OCD?
You are not responsible for your own diagnosis—that’s where a trained therapist comes in.
Whether or not you have OCD, there’s no harm in seeking out an opinion from a professional. “If you’re asking the question, there’s a good chance that it’s worth your time to go talk to someone,” says Mia Nuñez, PhD, Regional Clinical Director for NOCD.
Often, people wonder if an online OCD quiz can be sufficient for diagnosis. While free online quizzes that provide clues about OCD symptoms can be helpful, they aren’t a replacement for a proper diagnosis from a professional.
Treatment for OCD
Exposure and Response Prevention (ERP) therapy is considered the gold-standard treatment for OCD. ERP is an evidence-based therapy, which in simple terms means that extensive research has been done to prove that it’s successful. This specialized treatment is unlike traditional talk therapy or general cognitive behavioral therapy (CBT). And without practicing ERP specifically, it’s very likely that your symptoms will get worse, not better.
ERP works by gradually exposing you to what triggers your obsessions, and teaching you response prevention strategies to use when distressed—things that don’t involve engaging in safety behaviors or compulsions. You will never be forced into anything before you’re ready, but you will be encouraged to take steps that move you toward recovery.
Through the ERP process, you learn to realize that your fears are often unfounded, or that you can handle your worst-case-scenarios better than you thought you could.
If you feel hesitant to reach out for help, Dr. Farrell encourages people to ask themselves: “What kinds of things is this problem starting to take away from me?” And to use that as motivation to seek treatment.