Obsessive-compulsive disorder is not simply being neat

How many times have you heard someone say, “I am obsessive-compulsive about keeping my house neat”? Yet, people with Obsessive-Compulsive Disorder (OCD) resent hearing this type of comment. OCD is not simply about being neat or clean. OCD is a serious mental illness characterized by anxiety and can be severely disabling. This week is OCD Awareness Week and I’d like to show you how OCD is much more than just a quirky character trait.

OCD can take many different forms. OCD can present itself in the woman who is terrified that she will harm her child even though she has no intention of doing so. It manifests in the child who repeatedly asks his mom if he has done things against the law even though he follows rules strictly. The man who avoids touching doorknobs because he believes he will get cancer if he does — he also probably has OCD.

The vast majority of individuals with OCD have both obsessions and compulsions. The DSM-5 defines obsessions as “recurrent and persistent thoughts, urges, or images that are experienced…as intrusive and unwanted.” Any thought can become an obsession if it is associated with anxiety or distress. Classic obsessions are often related to contamination, making mistakes, and having unwanted impulses. However, the content of obsessions vary greatly across individuals with OCD. Other obsessions include distress about loss of identity, fear of accidentally performing a socially inappropriate behavior, or distress because something doesn’t feel “just right.”

Compulsions, as defined by DSM-5, are “behaviors or mental acts…that the individual feels driven to perform in response to an obsession.” Any behavior could be a compulsion if it is being performed in an effort to reduce or avoid distress associated with an obsession. Typical compulsions are excessive washing, cleaning, counting, and reassurance seeking, but compulsions can vary. For example, a person with OCD may tap his fingers together to prevent poor grades on an exam. Another may silently repeat, “all will be OK” in response to an obsession.