Understanding Obsessive-Compulsive Disorder | #NotAnAdjective

Updated: Feb 15

As a therapist who has specialized training in understanding and treating Obsessive-Compulsive Disorder, it felt important to me to write a blog post about the importance of changing the cultural stigma around OCD and providing some education on what OCD actually is. I hope you find this helpful!


What is Obsessive-Compulsive Disorder?


Obsessive-Compulsive Disorder (OCD) might not be what you think it is. OCD is one of the most stigmatized clinical disorders in the world, and also one of the least understood. In this blog post, I wanted to clear up two myths about OCD before giving some education on OCD and it's various subtypes.


First off, OCD is not just about hand-washing. There are many different subtypes of OCD that cause debilitating suffering and distress and take up multiple hours in someone's day.

Second, OCD is not an adjective. It's a clinical disorder, and it's one of the top 10 most disabling conditions in the world. In fact, the misuse of this term can discourage those who actually have OCD from seeking treatment.

"Oh man, I am just so OCD about everything!"

According to the International OCD Foundation, OCD is defined as a mental health disorder that affects people of all ages and walks of life, and occurs when a person gets caught in a cycle of obsessions and compulsions. Most people have obsessive thoughts and/or compulsive behaviors at some point in their lives, but that does not mean that we all have “some OCD.” In order for a diagnosis of obsessive compulsive disorder to be made, this cycle of obsessions and compulsions becomes so extreme that it consumes significant time nearly every day and gets in the way of important activities that the person values.


In the documentary Uncovering OCD: The Truth About Obsessive Compulsive Disorder (see below for link), one member shares this:

"OCD to me is having a graveyard in your brain of the things you once loved that OCD waged a war upon and just decimated...[OCD is] a monster in your head that is hell-bent, primely influenced [and] motivated to target and kill everything that you love."

As mentioned above, OCD is primarily centered around two symptoms: Obsessions, or ongoing and unwanted intrusive thoughts, feelings, images, and/or urges that cause intense fear, anxiety, disgust, doubt, or shame; and Compulsions, or repetitive or ritualistic behaviors that are aimed at relieving the feelings brought up by the obsessions.


Understanding Subtypes

According to NOCD's website, there are various subtypes of OCD, including:

  • "Just Right" (Perfectionism) OCD: when someone experiences ongoing intrusive thoughts around organization and symmetry, and they perform certain actions until they feel it is "complete," "perfect," or "just right" (e.g., switching a light switch on and off seven times before leaving a room).

  • Contamination OCD: when someone experiences ongoing intrusive thoughts around fears of becoming contaminated, contaminating others, or contracting and spreading a disease, driving various compulsions aimed at alleviating this fear (e.g. showering for hours or until they feel clean).

  • Existential OCD: when someone experiences ongoing intrusive thoughts related to a preoccupation about life and existence, driving various compulsions towards gaining 100% certainty and relief (e.g. spending hours researching the nature of consciousness).

  • False Memory OCD: when someone experiences ongoing intrusive doubting thoughts around a past event that have happened to them and may be convinced that they have done something wrong despite no evidence of these memories being true (e.g. "Did I accidentally steal and don't remember?"), leading to various compulsions aimed at gaining certainty about their memory or even confessing to crimes that you did not commit.

  • Harm OCD: when someone experiences ongoing intrusive thoughts, images, or urges to harm oneself or others. Although thoughts of harm should always be taken seriously, people with Harm OCD are not more likely to harm themselves or others than people with other OCD subtypes. However, they may view their intrusive thoughts and unwanted thoughts as an indication of a desire to act. This drives compulsory behavior aimed at eliminating this fear/possibility (e.g. removing all sharp objects from their kitchen).

  • Hoarding OCD: when someone experiences ongoing intrusive thoughts and compulsive behaviors around acquiring possessions and having difficulty discarding them (e.g. "If I get rid of this shirt I got as a birthday gift, something terrible might happen to the person who gave it to me!"). The key difference between Hoarding OCD and Hoarding Disorder, is in the reason why someone is hoarding. Individuals with hoarding disorder accumulate items because of a belief that they are all valuable, while OCD-related hoarding is generally an unwanted response to an obsessive thought and anxiety/fear.

  • Magical Thinking OCD: when someone experiences ongoing intrusive thoughts and compulsive behaviors around superstition or magical thinking to prevent negative experiences or harm to oneself or others, and believe that they will be responsible for something awful happening if they do not perform specific actions (e.g. If I don't turn my phone on and off three times every day, something bad will happen to my mother).

  • Pedophilia OCD (P-OCD): when someone experiences ongoing unwanted intrusive thoughts, images, and impulses around sexual thoughts about children. A person with P-OCD may be obsessively concerned with proving to themselves they are not a pedophile. Since the idea of potentially harming a child is terrifying, this fear causes them to engage in compulsive behaviors aimed at alleviating this fear/possibility (e.g. excessive online research about what makes someone a pedophile).

  • Pure OCD: when someone experiences ongoing intrusive thoughts, images, or urges about a number of different themes like harm, relationships, religion, sex, etc., without any physical compulsions/actions. Instead these compulsions take place in a person's head like: mental reviewing, mental checking, and reassurance seeking. This particular subtype can often be confusing for many people, so I've attached this video here to give more detail:


  • Real Events OCD: when someone experiences ongoing intrusive thoughts and compulsive behaviors around someone's past actions and whether they've done something potentially immoral or wrong. A person without OCD may think, “I probably shouldn’t have made fun of that boy in middle school,” reflect on their feelings, and move on. But, for someone with Real Events OCD, guilt over this reflection can feel overwhelming, equivalent to committing a murder. Their OCD will take hold of past events and warp them until they are a villain who can never be excused.

  • Relationships OCD: when someone experiences ongoing intrusive thoughts and compulsive behavior around uncertainty of a relationship. They might experience frequent doubting thoughts (e.g. "Am I truly in love with my partner?", which are often viewed as an indication that the relationship may be disingenuous or flawed in some way. These thoughts then drive compulsory behavior aimed at gaining certainty about their relationship status (e.g. asking for continual reassurance from a friend).

  • Religious/Scrupulosity OCD: when someone experiences ongoing intrusive thoughts, images, or urges around violating a religious, moral, or ethical belief; and can experience frequent worry and guilt about what it means about them as a person (e.g. "Did I allow myself to have an 'impure' thought in church? Does it mean that I'm a sinner and must repent?"). People then in engage in various compulsions aimed at relieving their feeling of guilt and anxiety (e.g. confessing to a religious figure).

  • Sexual Orientation OCD: when someone experiences ongoing intrusive thoughts around denial of or confusion about their true sexual orientation. They may experience fears around being perceived as having a certain sexual orientation, or has having one that's different than what they thought. Or, they may fear that their sexual orientation could abruptly change (e.g. "turn" gay or straight) and what this change will mean for their life. These feelings drive various compulsive behaviors aimed at gaining certainty and relieving fear like: avoiding certain people/locations, excessive checking of their sexual arousal response for "proof," compulsive dating, mental reviewing, reassurance seeking, repeating statements like "I am not gay" 17 times, and praying.

  • Somatic OCD: when someone experiences ongoing intrusive thoughts and compulsive behaviors around one's somatic experience-- the physical sensations they can't control. For example, someone with Somatic OCD may be fixated on the pace and/or size of their breaths, how often they are blinking, or their heart rate. To stop these intrusive thoughts, compulsions are aimed at making them "go away" (e.g. carefully monitoring their blinking to "check" it if is frequent enough).

  • Suicidal OCD: when someone experiences ongoing unwanted thoughts, images, or impulses related to killing oneself. Like Harm OCD, thoughts of suicide should be taken seriously, which can make this type of OCD particularly frightening and alarming. However, people with Suicidal OCD are not more likely to commit suicide than people with other OCD subtypes. In fact, suicidal OCD is driven by the need to protect oneself from potential self-harm, which is why compulsions are often aimed at protecting themselves from the risk of harm.

Treatment

While OCD can be incredibly difficult and debilitating, it can also be managed. As a therapist, I have received specialized training in understanding and treating OCD through an intervention called Exposure and Response Prevention (ERP). ERP is considered to be the "gold-standard" in the treatment of OCD and is also recommended by the American Psychological Association.


If anything above sounds like something you've been experiencing, or if you just want to learn more about Exposure and Response Prevention, I want to invite you to book a free consultation with me to see if we could be a good fit together in helping you get unstuck from OCD, and move forward to a better future.


I've included here a link to this free documentary made by the International OCD Foundation. Check out their website for even more information about OCD and treatment.



Do you have any feedback/questions on this article? Feel free to leave a comment and let me know. I'd love to continue learning with you :)

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