What OCD is — and what it isn’t: ‘There are a lot of misperceptions’

Obsessive compulsive disorder, or OCD, is a common, chronic mental health disorder. (Photo: Getty Images)

While obsessive compulsive disorder, or OCD, is an actual mental health condition, the term has been co-opted by the public to describe times when someone is having an anal-retentive moment. But mental health experts say that OCD is so much more than that.

“As we’ve gained awareness and acceptance of mental health conditions, it seems their labels have found their way into popular vocabulary,” psychologist Alicia H. Clark, author of Hack Your Anxiety, tells Yahoo Life. “OCD, like panic and anxiety, has gained traction to reference everything from tidiness to a controlling attitude to wanting to do something a lot.”

Samantha Farris, assistant professor in the department of psychology and director of The Rutgers Emotion, Health and Behavior (REHAB) Laboratory at Rutgers University, agrees. “There are a lot of misperceptions about obsessive compulsive disorder,” Farris tells Yahoo Life. “It’s not the same as just having a preference for things being a certain way.”

Hillary Ammon, assistant professor of clinical psychiatry at Penn Medicine, tells Yahoo Life that this likely stems from how Hollywood has portrayed OCD. “While some movies and TV shows have done a better job than others at accurately reflecting symptoms of OCD, the characters typically only present with OCD symptoms like a need for order or cleanliness,” Ammon says. “As a result, it seems the general public primarily think of these traits as symptoms of OCD.”

Here’s what you need to know about what OCD means — and what it doesn’t.

What does OCD mean?

OCD is a chronic mental health disorder that causes a person to have uncontrollable, repeated obsessions and/or behaviors known as compulsions, according to the National Institute of Mental Health (NIMH). A person with OCD feels the urge to repeat these compulsions over and over.

While cleanliness and order is often associated with OCD, there are actually different forms of the condition that can lead to a range of symptoms. People with OCD, which is typically diagnosed by around age 19, may have symptoms of obsessions — meaning, repeated thoughts, urges, or mental images that cause anxiety — or compulsions, or both, the NIMH explains.

OCD obsessions can include a fear of germs or contamination, aggressive thoughts toward yourself or others, needing things to be in a perfect order, or dealing with taboo intrusive thoughts involving sex, religion or harm, the NIMH says. Compulsions can include needing to do excessive cleaning or hand washing, ordering things a certain way, repeatedly checking on things and compulsive counting.

“With OCD, the thoughts are associated with needing to do something,” Farris says. “It’s really distressing because folks feel like they’re compelled. They have to act in order to address the distress that they’re having.”

OCD also “costs a great deal of time and energy, gets in the way of someone’s life and generally is something dreaded by its sufferer,” Clark says. “No one wakes up wanting to burn their hands washing them, or engage the time-consuming rituals they do to leave their apartment. Instead, they feel trapped by their symptoms, and deeply afraid of doing anything different.”

Obsessive thoughts also tend to be “highly negative and catastrophic,” such as worrying that people will die or horrible things will happen, if compulsions don’t take place, Clark says.

How has the COVID-19 pandemic impacted people with OCD?

Experts say it’s been a mixed bag. “The isolation of the pandemic has allowed more OCD sufferers to avoid social and public situations that can be stressful,” Clark says. “Especially people with hygiene and germ phobias, the pandemic has normalized many of their cleaning and social distancing rituals. Many have commented feeling more normal having many of their rituals normalized.”

But the increase in stress and uncertainty that comes with living through a global pandemic has also increased anxiety in some people and made taking control more challenging, Clark says. “This has been more true for the OCD personalities that rely on planning, control and order to manage anxiety,” she explains. “Uncertainty hasn’t been kind to these more controlling coping strategies, where flexibility and contingency planning has been required.”

Clark adds: “Like for everyone, the pandemic has created stress and a demand to broaden coping skills in general.”

Ammon says she’s seen “varying impacts” on people with OCD. Some feel that treatment has actually helped prepare them for the pandemic. “Many people shared that, for the first time, it felt like collectively a lot of other people in the world could relate to their experience with OCD in that there was so much uncertainty in the world related to the pandemic and people were figuring out ways to manage their anxiety and gain a sense of control and security,” Ammon says.

She continues: “Furthermore, they shared that they felt better equipped to cope with the uncertainty of the pandemic, as compared to their counterparts who did not have OCD…because they learned to tolerate uncertainty through treatment.”

How is OCD treated?

OCD is usually treated with medication, psychotherapy or a combination of both, Farris says. Medications include taking serotonin reuptake inhibitors (SRIs) or selective serotonin reuptake inhibitors (SSRIs) to help reduce symptoms. In some cases, doctors may recommend anti-psychotic medications, NIMH says.

Psychotherapy usually includes cognitive behavioral therapy (CBT), and a specific form of CBT called Exposure and Response Prevention (EX/RP). With Exposure and Response Prevention, patients will spend time in situations that trigger their compulsions but they’re prevented from immediately acting upon them. So, if someone has an hand washing compulsion, they may be asked to touch an object with dirt on it and encouraged to wait to wash their hands.

Ammon stresses that it’s possible to live a normal, healthy life with OCD. “Individuals who complete EX/RP for their OCD not only approach their fears and manage their presenting symptoms of OCD, but also often learn to tolerate uncertainty better,” she says. Clark agrees, noting there are “incredibly effective treatments available, and many practitioners who are trained in them and able to help.”

Clark adds: “OCD does not have to keep ruling your life, and you do not have to suffer alone.”

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