OCD - it’s not what you think

Everyone’s a little OCD, right?

It’s not uncommon to hear OCD come up in casual conversation. It has become a personality quirk characterized by the need to have things in order, perfect, or hyperfocus on some small detail. Alternatively, someone might associate OCD with germaphobes or people with contamination fears. The first person I met with a formal diagnosis of OCD needed to wash her hands frequently. I didn’t know OCD had different themes at the time, so I figured that is what OCD, or Obsessive Compulsive Disorder, was - the obsession with germs or contamination and the compulsion to wash hands and stay clear of germs in order to prevent sickness. Little did I know OCD encompasses much, much more.

I first want to share that OCD is not a quirky personality trait or an adjective to describe a person who likes to organize and perfect. And the diagnosis does not only belong to people who have obsessions about contamination and compulsions like cleaning and handwashing (though this is one way OCD shows up and can be debilitating). While handwashing is something a person might do compulsively, it doesn’t encompass what many people with OCD deal with.

When I began having intrusive sexual thoughts (after hearing a classmate in front of me make a crude and disturbing sexual comment), then intrusive thoughts of harm (which were exacerbated whenever I heard news of another shooting or stabbing), and when I did everything in my power to avoid being triggered and everything in my power to get rid of or neutralize the thoughts, I had no idea what I was experiencing was OCD. At my worst, I was worried I’d lose my mind. I felt like I could not trust myself. I knew my thoughts were irrational, that I didn’t really desire to act on the thoughts, but I couldn’t get them to go away and the sensations/urges that I’d sometimes experience felt really powerful. My day was ruined when the intrusive thoughts showed up. I’d try again the next day to not let the thoughts in. What I was dealing with was actually a really common manifestation of OCD. Let me break it down.

The O in OCD

Obsessions are repeated intrusive thoughts, images, or urges (body sensations that seem to indicate an imminent action, though urges ≠ action). These thoughts and feelings are intrusive. They are uninvited and unwanted. For a person suffering with OCD, intrusive thoughts come frequently. They can be relentless. And these thoughts cause a lot of anxiety and discomfort. They are not enjoyable.

This is where the following psychological terms are helpful:  EGO-DYSTONIC and EGO-SYNTONIC

OCD is ego-dystonic, which means that the individual is afraid of the thoughts (obsessions) and they have the impulse to perform a mental or physical ritual or behavior (compulsion) to alleviate anxiety or prevent something bad, like the nature of their obsession, from happening. The thoughts reflect the opposite of their values. On the other hand, a thought, feeling, or behavior that one enjoys or aligns with is ego-syntonic.

For example, a person with Pedophilia OCD (POCD), one theme, experiences unwanted (ego-dystonic) sexual intrusive thoughts, urges/sensations, or images involving children. They worry about being a pedophile. On the contrary, a person with pedophilia has sexual attraction, urges toward (which they may or may not act on), or fantasies about children that they find enjoyable. The pedophile aligns with the thoughts (ego-syntonic).

Keep in mind that people with POCD are the LEAST LIKELY to act on the thoughts they are having. They are no more likely to be a pedophile than someone who does not have OCD. They find the thoughts so uncomfortable that they perform compulsions to prevent the nature of their thoughts from happening. Someone with Harm OCD is no more likely to be a serial killer than someone who does not have OCD.

Some of you might be wondering, what’s the difference between someone without OCD having intrusive thoughts versus a person with OCD having intrusive thoughts of the same nature?

Let me give an example. Two people are at home preparing a meal, chopping vegetables, when they have the thought, “what if I snap and stab my family”. One has OCD (Harm theme) and the other does not. The person who does not have OCD might find thought strange or disturbing and not at all enjoyable, but they quickly brush it off knowing that the thought doesn’t align with their values and desires. They carry on. The person with OCD will also find the thought unenjoyable, but rather than brushing it off, will see the thought as a threat and begin to question if they want to or are capable of acting out the content of the thought. They aren’t certain they can trust themselves even though they really do not want to act on the thought. The discomfort that comes with this uncertainty causes that person to attempt to mitigate the thought or anxiety, and gain some sense of certainty and control, by impulsively performing a mental or physical compulsion.

The C in OCD

Compulsions are mental (covert or not noticeable by others) or physical (overt or can be noticed by others) behaviors that an individual with OCD feels the need to engage in, in order to relieve anxiety produced by an obsession or somehow neutralize the unwanted thought, image, or urge. This person might recognize their compulsions are irrational but, nonetheless, feel they are necessary to carry out. This can be mentally or physically exhausting. Unfortunately, engaging in compulsions only worsens the OCD cycle of obsessions and compulsions as the obsession will quickly return following a compulsion. So, the relief felt by the person engaging in compulsions is only temporary.

I’ll have you put yourself in the shoes of someone with Harm OCD. You have recurring unwanted thoughts or feelings that you will harm someone. These might be your compulsions:

• Avoiding people or situations that could trigger your obsession. For example, you might

• Avoid knives or lock them away so they’re inaccessible

• Avoid rooms or places where potential weapons are

• Avoid being alone with someone

• Avoid watching the news, crime documentaries, or horror movies

• Avoid situations where you could become angry or upset

• Asking for reassurance from others that you are a good person and have not and will not harm anyone

• Checking places you were recently to ensure you did not harm anyone

• Mentally reviewing your memories to ensure you did not harm anyone

• Replacing your “bad” thoughts with “good” thoughts

• Saying certain phrases or words in your head to neutralize or replace the uncomfortable mental dialogue, thoughts, or images

• Researching what personality traits are common in someone who harms others to ensure that isn’t you

• Performing some kind of physical behavior to alleviate your anxiety. For example, when you have an intrusive thought while putting away laundry, you might have the impulse to rearrange your clothing or re-hang your clothes on specific hangers until it feels “just right” and the intrusive thoughts dissipate. You might get in and out the shower or turn on and off the water faucet repeatedly until your intrusive thoughts dissipate.

Tired yet? The list could really go on. But these are some common examples. 

The D in OCD

OCD is a mental disorder. There is a biological and genetic element to OCD, though the environment may also contribute to the development of the disorder. There are many OCD themes and people might experience more than one at a time. It is all treated the same way - with medications, psychotherapy, including the gold standard treatment of Exposure and Response Prevention (ERP), or a combination of treatments. Treating OCD can help people manage symptoms and lead full, active lives. My advice for anyone who thinks they have OCD is to get help right away. Finding a therapist who specializes in OCD treatment is important. Don’t stay silent. Remember you are not your thoughts. With treatment and work, thoughts that feel really noisy and overbearing can lose their power and show up less and less. I understand how hard it can be to get out of the OCD cycle, so give yourself grace as you navigate treatment. Connect with others who have it and have had success in treating it.

For all my readers who have made it this far, I have one ask.

Next time you hear someone use OCD incorrectly, I encourage you to invite them into a conversation about what it really is. OCD is not something most people are educated on and most likely they don’t know they are spreading misinformation and stereotypes. But because of this, it can be very challenging for someone suffering to recognize that their symptoms are part of a disorder that is frequently misunderstood and misdiagnosed. I’ve chosen to talk about more taboo OCD themes because they are what I wish I knew about sooner. If 18 year old me wouldn’t have Googled something like “turning off and on faucet to get rid of violent thoughts”, it might have taken me a lot longer to learn about OCD. Unfortunately, not all our medical professionals understand the full scope of this disorder. I carried a lot of shame because of my thoughts and feared what could happen if I told someone. It took me until my mid-twenties to talk with a therapist about these things even though I knew I had OCD (or at least thought I did). OCD is a doubting disorder, so it’s possible to still question something I was sure of a few minutes ago. Accepting uncertainty is part of treatment.

Thanks for being here. If you enjoyed this post and want to learn more about OCD, please return to the home page and send me a message with suggestions for post topics or general feedback. Comments are welcome, too.

Resource: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.)