We’ve all heard someone say it: “I’m sooo OCD about that.” It’s a flippant sort of statement people make when they try to explain that they like their desk arranged in a certain way, or that they don’t like touching the poles on public transit. But aside from popular images like one of a person ferociously scrubbing their hands with soap until they are red and raw, not many people have an understanding of what obsessive-compulsive disorder really looks like or what it does to a person.
OCD, as its name describes, is a chronic disorder that is characterized by obsessions and compulsions. Those obsessions, the National Institute of Mental Health says, are uncontrollable, upsetting and recurring thoughts, while the compulsions are irresistible behavioral urges, often resulting from the obsessions. For example, if a person’s OCD is linked to cleanliness, an obsessive fear of germs and contamination could lead a person to compulsively wash themselves. But the compulsions do not necessarily make that much rational sense — a person may alleviate an obsession focused on the fear they will harm their parents with a compulsion centered on counting. And the symptoms can be debilitating, the NIMH says: “These symptoms can interfere with all aspects of life, such as work, school, and personal relationships.”
In addition to the fear of contamination, common obsessions include aggressive thoughts about harming other people, unwanted sexual images that are unpleasant or otherwise taboo, fears about doing something inappropriate in public, or needing things to be symmetrical, the Mayo Clinic lists. The most important piece is that they are persistent and unwanted, and cause anxiety or some level of distress.
The compulsions people with OCD perform are in response to the disturbing obsessions as a way to relieve the anxiety coming from them “or prevent something bad from happening,” the Mayo Clinic says. “However, engaging in the compulsions brings no pleasure and may offer only a temporary relief from anxiety.” Common compulsions involve washing and cleaning — the most well-known of the group — but can also be repeatedly double-checking things, such as a doorknob to make sure it is locked or a stove to make sure it is off.
Other compulsions are counting, repeating words or phrases either silently or out loud, or arranging things in a certain way. While everyone will occasionally double-check things or have their own rituals or habits, people with OCD cannot control their behaviors, even if they identify that they are excessive and do not want to do them.
Sometimes OCD can come with a tic disorder. The NIMH says there are motor tics and vocal tics — motor tics are “sudden, brief, repetitive movements, such as eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking,” while the vocal tics could be repeated throat-clearing, sniffing or grunting.
If the obsessions or compulsions themselves are not apparent, sometimes a person will show physical or social signs of the mental illness. The Mayo Clinic lists health issues like skin conditions caused by excessive hand-washing, an inability to go to school, work or social events, troubled relationships and suicidal behavior as some of them. There is also the risk of substance abuse. The National Institute of Mental Health notes that, like with other mental illnesses, people with OCD might use alcohol or drugs to cope with their symptoms.
OCD vs. OCD tendencies
One of the biggest differences between a personal quirk and a mental illness is the amount it disrupts your life. “There’s a difference between being a perfectionist — someone who requires flawless results or performance, for example — and having OCD,” the Mayo Clinic says. “OCD thoughts aren’t simply excessive worries about real problems in your life or liking to have things clean or arranged in a specific way.”
The National Alliance on Mental Illness explains that while most people occasionally have some obsessive thoughts and behaviors, people with OCD typically experience them for more than an hour every day. And while they often know their thoughts are irrational, they “are afraid that somehow they might be true.” The same goes for the behaviors — they might know they don’t make sense but are powerless to stop them. That being said, there are people who do not realize their thoughts or behaviors are unusual.
OCD is not that rare: NAMI notes that almost one in 40 people will be diagnosed with OCD at some point in their lives, and symptoms typically start by young adulthood. However, it might at times be hard to spot because symptoms may increase or decrease in intensity over time, often on the same path as stress levels, and can affect some people more intensely than others. Some people even experience only obsessions or compulsions, not both.
At the end of the day, if you are questioning, it’s better to be safe than sorry — if intrusive thoughts and compulsions are affecting your life, speak to your doctor.