Anxiety & Stress

What OCD Is, and What It Isn’t

A woman who looks distressed holding her head in her hands.

Have you heard OCD used as a label for someone who is organized or superstitious? These casual references can make it difficult to understand what exactly OCD really is and what it is not.

What is OCD?

First, let’s go over what it is. OCD stands for Obsessive-Compulsive Disorder, and it is characterized by the presence of obsessions, compulsions, or both. Both obsessions and compulsions have specific definitions.

Obsessions are thoughts, urges, or images that the person cannot “get out of their heads,” and they are experienced as unwanted and intrusive. Obsessions most often cause the person experiencing them significant distress or anxiety. To be true obsessions, the person must attempt to ignore, suppress or “neutralize” the obsessions with some other action or thought (i.e., a compulsion). Common obsessions include those about contamination, losing control, physical harm, perfectionism or symmetry, and unwanted sexual thoughts.

Compulsions are repetitive mental acts or behaviors that the person feels driven to perform either according to rigid rules or in an attempt to neutralize an obsession. They are meant to prevent or reduce distress or anxiety, or prevent a dreaded event or situation. In reality, compulsions are not connected to whatever they are meant to neutralize or prevent in a realistic way. Common compulsions include washing and cleaning, checking, repeating, counting, and other mental acts like reciting a particular word or phrase.

Obsessions and compulsions in OCD are time-consuming or cause significant distress or impairment in important areas of functioning.

Take the following vignettes as examples:

  • Sasha experiences recurrent and persistent images (obsessions) of her family members being injured. These images cause her marked anxiety. Whenever she experiences one of these images, she feels driven to count to 3 repetitively until it “feels right” (compulsion).
  • Tom experiences obsessions about getting sick. He washes his hands as much as 60 times a day and he avoids certain places like public restrooms and doctors’ offices. (Note: although washing his hands is logically connected to preventing illness, Tom’s washing is excessive beyond reason).
  • Mary has symmetry obsessions. She spends almost two hours every day compulsively rearranging her perfume bottles, picture frames, books, etc. until her anxiety decreases. She can’t explain why certain things are meant to go where they do other than it just “feels right.”

What OCD Isn’t

Now that we’ve laid out what OCD is, let’s go back to talking about what OCD is not. In the example of an organized person being labeled as “OCD”, unless that person’s organizing behaviors were compulsions meant to reduce anxiety caused by an obsession in a way that was not logically connected, the person would just be organized and not have OCD.

In terms of the difference between superstition and OCD, superstitions are not recurrent in nature, as are obsessions and compulsions. For example, someone may believe that breaking a mirror will cause them bad luck. In effect, they might be careful to never break mirrors. However, someone with OCD might “obsess” about breaking mirrors, which could manifest as recurrent, intrusive, and unwanted thoughts about breaking mirrors even when there are no mirrors in sight. These obsessions would cause the person distress and they would attempt to ignore, suppress, or “neutralize” the stressful thoughts by performing some type of compulsion. Note how this contrasts from the superstitious person who might worry about breaking mirrors from time to time but does not experience true obsessions or compulsions in relation to that fear.

Here is some more information about OCD:

  • OCD affects about 1 in every 100 people in the United States.
  • The average age of symptom onset is 19.5 years.
  • 25% of cases start by age 14.
  • It is rare for someone over 35 to experience OCD symptoms for the first time, but it can occur.
  • Aside from the distress caused by obsessions and compulsions themselves, people with OCD may experience any number of other detrimental functional consequences as well. For example:
    • Obsessions about perfectionism can make it very difficult for the person to complete school or work projects in that it never feels “just right”, which can lead to poor performance at school or job loss.
    • Obsessions about contamination can lead to health issues if the person avoids doctors’ offices or hospitals out of fear of exposure to germs, and skin problems like lesions or abrasions can arise because of washing compulsions.
  • OCD can be extremely difficult to live with; in fact, according to the DSM-5 (APA, 2013), as many as 50% of individuals with OCD may have suicidal thoughts, and about 25% may attempt suicide. Suicide risk may increase in those with OCD who are also depressed.

Did you know there are effective evidence-based treatments for OCD? Without treatment, the course of OCD is often chronic, meaning symptoms will likely come and go over the course of a person’s lifetime. The OCD therapists in the Great Lakes Psychology Group network can help. If you are struggling, make an appointment with a therapist today.

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

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