By Meron Girmaiy, LMHC

It’s fairly well-known that mental health diagnoses and terminology can and will be largely misused. While this is representative of the fact that people are paying attention to and making room for mental health discussions, it also has the potential to be harmful to our own understanding of self and the expectations we put on others. Creating opportunities for greater understanding of these concepts is a significant part of the therapeutic process.

OCD is undoubtedly one of these more commonly misunderstood diagnoses and this blog post intends to help create a greater awareness of the experience of living with it.

Why is OCD misunderstood?

Obsessive Compulsive Disorder, or OCD, is a commonly represented mental health diagnosis in modern media. It is also often made to be a character’s defining trait. In many cases, their OCD is what makes them an interesting character. For many people diagnosed with OCD, the diagnosis may be a significant part of their lives but not as a quirky aside and certainly not as a form of comedic relief. Unfortunately, many representations seem to minimize the realities of OCD to be just this, often undermining the severity of which it intrudes on someone's life.

We all know a character or two whose whole thing is their fear of germs and illness or being excessively particular on how items are organized. And while this is certainly representative of some experiences of living with OCD, it is significantly limiting the perspective of what it means to be an individual with the diagnosis.

OCD comes in many forms, and when we limit the representation of the various ways it can appear, we unintentionally are limiting the general perspective of what it looks like to experience it- not to mention, an individual’s ability to recognize and validate their own symptoms. When exploring an OCD diagnosis with a client, a hesitation to accept the diagnosis is not uncommon because their symptoms look different than what we’re typically shown.

What is OCD?

OCD is a mental health diagnosis that is characterized by the presence of obsessions and compulsions. To fully understand OCD, it’s important to know what these are and how they interact with one another. Obsessions are the thoughts, beliefs, fears or urges that are repeated and persistent and often overwhelmingly take up mental space. Compulsions are the mental rituals or actions we take in response to these obsessions. Compulsions feel necessary and urgent and often come with significant distress and a perceived consequence if not engaged in.

In other words, individuals diagnosed with OCD repeatedly experience a cycle of overwhelming thought patterns that trigger fear and anxiety and have learned the best way to reduce this discomfort is by engaging in a compulsive behavior that has previously been determined to “help the problem”.

While anyone could, and will, fall into anxious thinking patterns based in fears and beliefs, one key differentiator between someone who’s a bit worried about something and someone with OCD is the ability to stop the line of thinking without a compulsive action. For example, if Jasmine is worried about whether or not she turned the lights off in the house before leaving for work, she might think about it for a bit and be a bit frustrated or worried about how it might affect her electric bill before continuing with her job.

However, if Jasmine experiences OCD and her obsessions/compulsions present around this topic, she may become so preoccupied with it that it leads to persistent thoughts like “what if the lights being on triggers a fire and burns my house down” or “what if me forgetting the lights today causes my bill to go up so much that I am forced to drain my savings account”. She may also feel such distress that she believes the only way to find relief is to engage in the compulsive behavior of driving all the way back home to check on the lights before she can even continue working.

Importantly, this experience repeats over and over again for someone with OCD which can significantly interfere with someone’s ability to function in their day-to-day lives.

Common Themes in OCD

There are a few different OCD types or themes that can be important to know to help us better understand the diagnosis. Below is a sample of some OCD themes and how they may present through obsessions:

Contamination OCD: “If I touch that doorknob it will contaminate me with a virus”
Relationship OCD: “Am I in the wrong relationship? What if there’s someone better out there for me”
Violent/ Sexual/ Taboo topics: “I can’t believe I just thought about pushing her in front of that car, I must be a violent and dangerous person”
Not Just Right Experiences: “There might be significant negative consequences for not stacking those books in the right way”
Responsibility & Harm OCD: “Did my neighbor fall off the ladder because I slept in today?”

With OCD, these thoughts will lead to a compulsive response. Compulsions can vary as well. They can be anything from behaviors or rituals that need to be performed to mental thinking patterns. Common examples of compulsions include checking on things repeatedly, rearranging, seeking reassurance from loved ones, ruminating, or even self harm and negative self talk.

It’s important to note that some links between obsessions and compulsions are logical and we can understand clearly how they formed. For example, most of us don’t need an explanation on why contamination OCD might lead to excessive cleaning compulsions. However, not all fit neatly into logic. Oftentimes, compulsions may seem to have no connection to an obsessive thought at all. This is because, within the OCD cycle, the purpose of compulsions is to soothe the discomfort that was triggered by the obsessive thought- not because it is regulating to the nervous system but because there is a belief that it is the only lifeline to relief. At some point, that compulsion was associated with temporary solace and it has become reinforced the more it was performed.

What next?

Exposure Response Prevention (ERP) is a common and structured way to address symptoms. It involves a slow exposure to the fears and, with guidance from a therapist, supports clients in learning how to tolerate the discomfort brought on by obsessions without the need to engage in compulsions.

Cognitive based therapies like Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) can also be beneficial to increase psychological flexibility and change the relationship had with obsessions.

No matter the approach, OCD is certainly a treatable diagnosis. Visit our OCD specialties page to learn more about treatment options and find a therapist that can support you in diagnosing and treating OCD.