While obsessive-compulsive disorder (OCD) is commonly referenced, some people may not know what the condition looks like. OCD is a common mental illness involving obsessions and compulsions surrounding unique themes. Each person with OCD is different, so reducing stigmas by expanding your knowledge of this condition can be essential.
What Is Obsessive-Compulsive Disorder?
Obsessive-compulsive disorder (OCD) is a mental illness characterized by unwanted, intrusive thoughts and repetitive physical or mental behaviors that may stem from these thoughts. No matter the source of the obsessions, individuals engage in certain behaviors to ward off intrusive and distressing fears.
Not everyone who has intrusive thoughts or actions has OCD. In addition, some people with OCD may only experience obsessions without physical compulsions. Mental compulsions may involve inner rituals that are difficult to notice. To understand OCD, knowing the difference between obsessive and compulsive symptoms can be helpful.
What Are Obsessions In OCD?
Obsessions refer to unwanted and intrusive thoughts, images, or impulses that cause distress to the individual experiencing them. Often, those with OCD are aware that these thoughts are disturbing and unwanted. However, they may struggle to stop them from occurring.
Note that intrusive thoughts often involve highly distressing or extreme subject matter. They are not “random” or “quirky” thoughts and are instead severe and challenging for the individual to cope with. These thoughts often involve illegal subjects or those against the individual’s morals and beliefs, causing them to fear their own minds. They may start to believe they are corrupt or a “bad person” due to these thoughts.
When someone with OCD attempts to rid themselves of thoughts or fears, it may result in a compulsion. Obsessions may fall into one of the following categories.
One of the most common associations with OCD is the preoccupation with germs or bacteria. However, contamination concerns may vary between those with obsessive-compulsive disorder. Concerns may include bodily fluids like urine, diseases, dirt, or chemicals such as household cleaners or chemicals within the environment. Some people may have self-imposed beliefs about what is clean or not. For example, someone with OCD might believe plastic chairs in specific scenarios are dirty or could harm them, even if these fears don’t make sense to another person.
A Lack Or Loss Of Control
Some individuals with OCD may experience anxiety about the idea of losing self-control. For example, someone might worry that they might accidentally commit a crime, hurt others, or partake in dangerous activities. Often, these fears accompany a knowingness that these activities go against the individual’s values and morals. They may know they don’t want to act in these ways but worry that they will do so without knowing or have done so without knowing.
Fear Of Experiencing Or Committing Harm
Those with harm OCD may believe forms of harm will come to them or that they might hurt someone else accidentally. This fear can lead them to take action to prevent harm through compulsions like avoidance.
A Desire For Perfection
Perfection can be a common obsession for those with obsessive-compulsive disorder. For example, people might experience the following:
- A desire for perfection
- Fear of forgetfulness
- Indecisiveness in letting go
- Fear of forgetting information
- Fear of making mistakes
Unwanted Sexual Thoughts And Feelings
Like thoughts of violence, thoughts of certain sexual behaviors that disturb you may indicate OCD. Unwanted sexual thoughts may include obsessions about one’s sexual orientation, aggressive sexual scenarios, or sexual impulses toward others. Some people may have sexual thoughts about disturbing or illegal imagery that they feel they cannot get rid of, which causes extreme distress.
Religious Or Superstitious Obsessions
Religious and superstitious obsessions may feature anxiety or concern surrounding offensiveness to one’s religion, a desire to make moral choices, or a fear of not observing superstitions to avoid bad luck or other consequences.
What Is The Difference Between OCD And Anxiety Disorders?
One difference between those who have OCD and those who don’t is that obsessions often take up most of the day and are followed by compulsive behaviors. People without OCD may process these thoughts without pairing them with behaviors like compulsions. In addition, OCD differs from anxiety disorders because the fears are often based on one’s moral code, values, and beliefs.
What Are OCD Compulsions?
To combat obsessions and fears, individuals with obsessive-compulsive disorder often engage in compulsive behaviors. Compulsive behaviors are repetitive behaviors that individuals with OCD may feel they must complete to manage obsessive thoughts. Some of the most common compulsions of this condition include the following.
If someone with obsessive-compulsive disorder is impacted by contamination OCD, they may engage in repetitive behaviors like washing their hands excessively, grooming multiple times a day, or cleaning their environment regularly to ensure they do not encounter contaminants. This compulsion category may also include arranging objects several times to get the order “right.”
Individuals worried about losing control of their environment may partake in checking behaviors. Checking behaviors can involve repeatedly checking to ensure one hasn’t hurt themselves or others, checking to see if objects are still where they left them, checking information, or ensuring everyone in their life is safe. Checking can also involve looking at messages or social media to see if you made a post or sent a message without your own knowledge.
Repetitive Movements Or Actions
Repetitive compulsions can involve repeating movements like tapping, asking for reassurance, or counting the number of times one completes an activity. For example, someone might count their steps while they walk.
Mental compulsions may include counting while performing an activity, undoing actions or thoughts by replacing them with positive associations repetitively, praying excessively, or regularly reviewing events. It can also involve mental rituals, such as repeating a phrase in your mind before you go to sleep or attempting to block others from “reading your mind” by thinking of specific words or scenarios to block your “real thoughts.”
What Causes Obsessive-Compulsive Disorder?
While OCD isn’t an uncommon disorder, there are no clear causes that researchers can point to as culprits in its development. Often, OCD can be attributed to a combination of factors. The potential causes of obsessive-compulsive disorder may include:
- Other mental illnesses
- A parent with OCD, most commonly passed on by one’s mother
How To Find Professional Treatment
If you are living with obsessive-compulsive disorder and find it challenging to manage your symptoms, support is available. For many, the treatment of OCD consists of a combination of therapy and medication. However, counseling is often considered the most effective form of support.
Despite the popularity of counseling for OCD, some people may not have the resources to get support in a physical location. In these cases, specialized OCD counseling through online platforms like BetterHelp may be beneficial. Whether your OCD is mild or severe, online treatment allows you to speak with a therapist from the comfort of your home. In addition, you can choose between phone, video, or chat sessions and express interest in modalities specific to OCD.
Studies support online therapy’s ability to treat mental health conditions like OCD. One study found that online counseling was more effective and cost-effective than in-person therapy for clients living with OCD.
What does OCD look like in a person?
OCD (obsessive-compulsive disorder) was previously classed as an anxiety disorder, but changed to the class of obsessive-compulsive and related disorders in the Diagnostics and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It’s characterized by the presence of obsessions and/or compulsions:
- Obsessions: Recurring unwanted thoughts or urges that are intrusive and cause anxiety or distress. People experiencing obsessions may attempt to ignore or suppress them through the performance of a compulsion.
- Compulsions: A repetitive behavior (such as washing hands) or mental act (such as repeating words in your head or counting), which are repeated according to rigid rules or in response to an obsession.
If someone with OCD has compulsions, you may notice repetitive compulsive behaviors including:
- Cleaning, such as excessive hand washing
- Checking locks on doors or gas burners repeatedly
- Counting in patterns
- Repeating a prayer, numbers, or phrases silently
- Orderliness, such as organizing books by color, or ensuring the labels of canned goods face the same direction
- Following a strict routine
- Self-doubt, resulting in asking others for reassurances
OCD is not the same thing as being a perfectionist. Instead, OCD is a recognized mental disorder that causes significant distress, intense anxiety, or otherwise interferes with daily life. Compulsions may cause temporary relief, but it’s often a vicious cycle that does not relieve obsessions for long.
How do you tell if someone has OCD?
Unless you are a licensed professional providing a psychological evaluation, you likely will not know whether someone else has symptoms of OCD. However, the following questions may help determine if it’s a good idea to talk with a professional:
- Are you experiencing repetitive or intrusive thoughts or urges that you find distressing or disturbing?
- Do you find yourself constantly worried about germs, dirt, or other substances? Or, are you constantly worried about illnesses or diseases?
- Do you experience a high degree of self doubt and fear of consequences, such as wondering if you forgot to lock the doors and if an intruder will enter the house?
- Do you use repetitive mantras, prayers, or repetitions to quell anxiety?
- Do you worry about harming (emotionally or physically) others even though you do not desire to do so?
- Do you have an ordered, systematized, or rigid way that things need to be done?
- Do obsessive thoughts and compulsions take up a significant portion of your day (over an hour) or otherwise interfere with your daily functioning?
OCD is commonly misunderstood or used colloquially to refer to perfectionism. Sometimes, people use phrases like “I’m so OCD” to refer to the preference for color-coded notes or a sanitary workspace. However, that can trivialize and stigmatize the disorder, and it can conflate “obsessions” with character traits that do not cause significant distress or harm. Obsessive thoughts and compulsions that characterize OCD can be frightening or disturbing, and they result in significant distress or anxiety.
What does OCD look like in daily life?
OCD symptoms can be rated on a scale from 0 (no OCD symptoms) to 40 (extremely severe symptoms). While more severe OCD may cause intense distress and interference with daily life, subclinical OCD may cause only mild obsessive thoughts and/or compulsions. The impact of OCD on daily life varies from case to case. Symptom severity can also fluctuate over time. If you’re experiencing stressful life events, mild or moderate symptoms may become more severe.
In some cases, obsessions and compulsions can be very time-consuming, potentially interfering with relationships, work, and/or school. If you have obsessions about harming family or loved ones (unwanted harm to others or yourself can be common obsessions), you may find yourself hiding potentially dangerous everyday objects or seeking reassurance.
People with OCD may find that they avoid triggers. For example, if hearing a person cough will trigger obsessions about germs, someone may begin avoiding crowded spaces.
How do I know if it's my OCD or real?
If you’ve found yourself questioning whether an intrusive thought is related to OCD or not, consider the following:
- When you have an unwanted thought or see mental images that cause distress, how do you respond to them? Do you dismiss it without much attention? Or, do you find yourself worrying about the thought, ruminating on what the thought means, or considering what physical or mental acts you can do to stop it?
If you have OCD, prolonged engagement with a persistent, distressing thought may indicate that the thought is obsessive. If you’re experiencing an obsession, it may be helpful to try the following strategies, as recommended by the International OCD Foundation:
- Don’t ask for reassurance from others or yourself.
- Practice skills learned in therapy.
- Don’t try to ignore or prevent obsessive thoughts.
- Interrupt all-or-nothing thinking. You are not a failure if you mess up.
- Don’t avoid the anxiety or try to run away from your thoughts.
- Pause when an intrusive thought comes up, rather than immediately responding to it.
- After pausing, consider what may have triggered the obsessive thought.
- Separate your thoughts from your identity. A distressing thought doesn’t make you a “bad” person.
- Try not to use compulsive behaviors, rituals, or substances to numb your thoughts. Self-medication may lead to substance abuse.
- Remember that everyone experiences unwanted thoughts from time to time.
Many people who have obsessive-compulsive disorder experience self-doubt. According to psychiatrist Gerald Nestadt, doubt can act as a behavioral trait that demonstrates a “lack of confidence in one’s own memory, attention and perception necessary to reach a decision.” For example, someone may repeatedly check that a door is locked or gas burners are turned off. These types of OCD compulsions are strongly connected to self-doubt, which correlates with higher levels of dysfunction. Despite this finding, Nestadt found that cognitive behavioral therapy (CBT) effectively reduced obsessive fears and self-doubt for 60-70% of his patients.
Is overthinking OCD or anxiety?
OCD and anxiety disorders can have similar features. For example, fear and persistent worry may occur in both OCD and anxiety disorders. However, while anxiety disorders are characterized by worry that is disproportionate with the situation, OCD involves obsessive thoughts (which can cause fear, anxiety, or distress) and/or compulsive behaviors that are used to temporarily relieve obsessions.
OCD and anxiety disorders commonly co-occur, leading some people to wonder if their overthinking is connected to OCD or anxiety. Overthinking can include:
- Excessive consideration before taking action
- Focusing on the worst-case scenario
- Lack of decisiveness or second-guessing
- Difficulty concentrating
- Seeking reassurance from others
Unlike problem-solving, overthinking can lead to decision paralysis and rumination. Many people find themselves overthinking things from time-to-time, but it may be symptomatic of low self-esteem or a psychiatric disorder, such as generalized anxiety disorder, major depressive disorder, or OCD.
How does OCD usually start?
According to Stanford Medicine, 66% of people with OCD first develop major symptoms before age 25. In many cases, a period of high stress or a major life change (such as the death of a loved one, starting college, or the birth of a child) is thought to trigger the onset of the disorder.
What triggers OCD?
OCD triggers are things that may initiate OCD symptoms or make them more severe. Triggers can vary widely, but common ones include:
- Major life changes: Such as moving, financial problems, conflict, job loss/change, school challenges, marriage, the birth of a child, serious illness, or the loss of a loved one (including through divorce or breakup)
- Lack of sleep: Poor sleep quality can negatively impact mental health
- Things that initiate obsessive thoughts: For example, if you have obsessive thoughts about germs and illnesses, a doorknob in a public restroom may be a trigger
- Trauma: Childhood abuse and trauma can trigger OCD
Many people try to avoid triggers to limit their symptoms. However, avoidance is a maladaptive coping mechanism that often leads to limitations, reduced ability to function in daily life, and increasing symptom severity. If you are concerned about your symptoms, it’s a good idea to talk with a professional, such as a licensed psychologist or psychiatrist.
Can someone with OCD fall in love?
OCD is a mental disorder characterized by obsessions and/or compulsions. It does not mean that someone with OCD cannot fall in love. However, partners can benefit from discussing the disorder and symptoms that may arise. For some people, OCD obsessions about things like contamination may interfere with physical intimacy. Having honest conversations with loved ones can help them understand symptoms and how they may show up in the relationship.
If your partner has OCD, you can support them by building trust, being honest, practicing empathy and patience, educating yourself, and establishing healthy boundaries.
Are OCD thoughts just thoughts?
If you have OCD, you may have heard the phrase, “You are not your thoughts.” However, when a thought is sticky (meaning it doesn’t seem to go away), many people begin believing that these thoughts must mean something about them. For example, if you experience frightening thoughts about harming your loved ones, you may begin believing that you will act upon them. Remembering what advocate Jordaine Chattaway says may be helpful in these circumstances: "OCD takes your core values, flips them, and serves them back to you in the nastiest way possible."
Obsessive, intrusive thoughts are indeed just thoughts, even if you find them distressing or frightening. They are not a reflection of your character, and thoughts do not make you a “bad” person.
Can we self-diagnose OCD?
Many people use online quizzes in an effort to self-diagnose OCD. However, there is no test you can take that will accurately tell you whether you have OCD. Instead, you’ll need to meet with a licensed mental health professional or healthcare provider. They’ll use the following criteria, established in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), to make an OCD diagnosis:
- Presence of obsessions, compulsions, or both
- Obsessions and/or compulsions take up more than an hour per day
- Obsessions/compulsions cause significant distress or disruption to daily life
- The symptoms cannot be attributed to a physical disorder or substance use
- The symptoms are not better explained by another mental disorder, such as an eating disorder, anxiety disorder, or depressive disorder
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