OCD is a term that’s incorrectly thrown around a lot to describe when people are being particular or obsessive about something. But obsessive compulsive disorder (OCD) is a clinical mental health diagnosis, and this flippant use of the term isn’t just inaccurate and stigmatizing—it can also prevent people from truly understanding what the condition is and the various ways it can actually present in people.
OCD is a chronic mental health condition characterized by uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions), according to the National Institute of Mental Health. The condition affects approximately 2.2 million people in the U.S., which is about one percent of the population, according to the Anxiety and Depression Association of America (ADAA). Obsessions are defined as intrusive and unwanted thoughts, images, or urges that cause a person to be stressed or anxious, while compulsions are behaviors that someone feels compelled to do in order to ease their stress or anxiety, or to help suppress their thoughts.
Common obsessions include thoughts about harming someone, a fear of germs or contamination, or unwanted thoughts about topics like sex, aggression, or religion. Compulsions are repetitive acts that the person feels they must perform in order to relieve the anxiety of the obsessions or, sometimes, to prevent something from happening, according to the National Alliance on Mental Illness (NAMI). Common compulsions can include checking behaviors (like repeatedly checking to make sure the stove is off or the door is locked), excessive cleaning or hand washing, or compulsive counting.
There’s a difference between occasionally feeling the urge to double check or deep clean something and having OCD.
Everyone repeats or double-checks things sometimes, and you may also like to do things a certain way, Mark Reinecke, Ph.D., chief of psychology at Northwestern Memorial Hospital, tells SELF. The key things to keep in mind are the frequency of these behaviors, the level of distress someone feels over them, and the amount that it interferes with a person’s life.
“Simply liking things a certain way is a matter of preference and you get a sense of reward for it,” Dr. Reinecke says. So, for example, you probably feel good (or at least glad it’s over) when you clean your kitchen or fold your laundry. But OCD is an anxiety disorder, and people take action based on things that they see as a threat, he explains. That could be germs, worry about a fire, or a personal safety concern (though compulsions aren’t always logically linked to an obsession). When people with OCD engage in their compulsions, they may feel temporary relief from their anxiety, but it doesn’t last, Dr. Reinecke adds.
People with OCD are also often distressed by their thoughts and behaviors, even when they recognize that they’re excessive, licensed clinical psychologist John Mayer, Ph.D., author of Family Fit: Find Your Balance in Life, tells SELF. “OCD causes conflict within the individual, whereas order or organization is a pleasant and peaceful thought,” he says. OCD is also repetitive and exists over a long period of time. This is very different from occasionally having the urge to stay home and clean your place or occasionally running home to make sure you locked your door.
People with OCD also spend at least an hour a day on their obsessions or compulsions, and have significant problems in their life due to their obsessions or compulsions, Jason S. Moser, Ph.D., an associate professor of psychology at Michigan State University, tells SELF. OCD can interfere with a person’s ability to get to work on time, or their ability to begin or maintain relationships, he says.
There’s also a difference between having occasional intrusive, obsessive thoughts and having OCD.
Again, the difference boils down to three major things, Dr. Moser says: how often you’re having these thoughts, how intense they are, and how much they interfere with your life.
“It’s pretty common for people to have ‘obsessions,’ that is, stressful thoughts that pop into our heads and feel uncontrollable,” Dr. Moser says. A lot of the things that people with OCD and those who don’t have the disorder obsess over can be similar, he says, like concerns about dirt and germs, personal safety, and fears that a spouse is unfaithful.
If you’re obsessing over a problem at work but stop once it’s resolved, it’s unlikely that you have OCD. But if you spend at least an hour every day having obsessive thoughts about an issue and have associated rituals that make you feel better, you may actually have OCD.
There is treatment for OCD. And with the right regimen, OCD can be very manageable.
The disorder is usually treated with medication, psychotherapy, or a combination of both, Dr. Reinecke says, adding that the combination seems to be the most effective.
Antidepressants like selective serotonin reuptake inhibitors (SSRIs) can be used to help reduce OCD symptoms, the NIMH says. Certain types of psychotherapy, including cognitive behavioral therapy (CBT) and a specific form of CBT called exposure and response prevention (ERP) can be incredibly helpful for some people, according to NAMI.
ERP involves purposefully facing the things that make the person with OCD uncomfortable or fearful (like dirty handles) while not performing compulsions (washing their hands). “The therapist and client work together to build a list of situations or things that make the patient uncomfortable and gradually work up the ladder of distress,” Dr. Moser says. “When the person gets the experiences of exposing him/herself to something distressing but sits with that distress until it goes away, they get the learning experience that it is not as bad as they think and they can manage the distress without using their compulsion.”
However, therapy isn’t a one and done thing, Lawrence Needleman, Ph.D., a psychiatrist at The Ohio State University Wexner Medical Center, tells SELF. Many patients will start out going to therapy more regularly, like once a week, and then gradually reduce the amount they go to every three, and then six weeks, until they’re able to face their fears without compulsions, he explains.
If you suspect that you have OCD, reach out to a mental health professional for help. It can make a huge difference in your quality of life.
For many people, some combination of medication and therapy can greatly improve their symptoms so that they can live a fulfilling, productive life. “A person can recover and thrive,” Dr. Mayer says. “The cycle of OCD can be broken.”