Picture this: Just as you’re getting ready to head out for a crucial appointment, you can’t seem to rid yourself of the nagging worry that you forgot to turn off the iron. You check once, twice, three times – each time knowing it’s off, but unable to trust your own eyes. Your hands are clammy, your pulse is rapid, and you’re running behind schedule, but you can’t resist the urge to keep checking.
One of the most misunderstood mental health conditions is Obsessive-compulsive disorder (OCD). Often misrepresented as a quirky trait or or a desire for neatness and organisation, the truth about OCD is far more complex and challenging. In Australia, OCD affects about 3% or nearly 800,000 individuals, who will experience OCD at some point in their life. For many people, OCD is not just a temporary phase or a quirky habit, but a condition that significantly affects their daily life.
Despite its prevalence, it is frequently underestimated or misunderstood. A lot of individuals continue to think that OCD is solely about having a preference for neatness and order, when in reality it also includes distressing thoughts, intense anxiety, and uncontrollable compulsions. Living with OCD can be tiring, lonely, and overwhelming.
What OCD is Exactly?
OCD is a long-lasting mental health disorder marked by obsessions (repeated, unwanted, intrusive thoughts or images), accompanied by distressing emotions (such as anxiety or disgust), along with compulsions (repetitive behaviours or mental acts compelled to be performed to alleviate distress of the obsessions). These fixations and rituals are not simply occasional concerns or behaviours; they are continuous, troubling, and take up a lot of time. In the context of OCD, obsessions are time-consuming and get in the way of things that really matter to the person. This is a key point as it, in part, determines whether someone has OCD — a psychological disorder — rather than an obsessive personality trait. Someone diagnosed with OCD could be aware that their thoughts and actions are illogical, yet struggle to control them.
For instance, an individual could be consumed by the worry of getting contaminated by germs. They might dedicate hours each day to clean, wash their hands multiple times, and steer clear of places they consider unclean. Despite being aware that the cleaning is unnecessary, individuals still have a strong compulsion to carry out these rituals in order to avoid the anxiety triggered by their obsessive thoughts.
OCD can interfere with daily activities and greatly affect work, relationships, and overall quality of life. People suffering from OCD may spend a considerable amount of time involved in compulsive actions, resulting in limited time for other activities. This pattern of fixations and urges can lead to notable fatigue, both mentally and physically.
Obsessions: More Than Just Worrying
In contrast to usual worries or concerns, obsessions are repetitive and frequently centre on specific themes, which can differ significantly among people.
Sub-types of OCD:
- Fear of contamination: Fear of touching things or substances that are perceived as contaminated such as a strong dread of germs, dirt, body fluids (eg. urine, faeces), environmental contaminants (eg. asbestos), household chemicals (eg. solvents) or disease. This fixation may result in actions like staying away from crowded areas, avoiding touching specific items, or constantly washing hands.
- Responsibility: An apprehension of unintentionally harming oneself or others, either through negligence or accident. For instance, an individual may fear they forgot to turn off the stove, leading to a potential fire hazard.
- Perfectionism: The desire for things to be symmetrical, precise, or in the correct order is known as perfectionism. A person may feel the need to arrange things over and over until they seem satisfactory. They may fear losing or forgetting important information when throwing something out. Or alternatively, fear making mistakes.
- Violent Obsessions: Overwhelming concern with extremely disturbing or violent thoughts. Fear of impulsively harming others. Fear of impulsively harming oneself.
- Unwanted religious / moral obsessions: Fear offending God. Certain individuals undergo distressing thoughts concerning inappropriate or immoral behaviours, often linked to religious beliefs.
- Sexual obsessions: Unwanted sexual thoughts or mental images, including – Fear of sexually harming children, relatives, or others; Fear of acting on sexual impulses; Fears of performing aggressive sexual behaviours towards others.
- Identity obsessions: Some individuals with OCD experience excessive worry about their sexual orientation or gender identity. This can lead to constant questioning and doubt, even if there’s no real uncertainty about who they are. These obsessions can be distressing and can interfere with a person’s sense of self.
Other Types of Obsessions
OCD can also lead to a variety of other obsessions that affect different aspects of life:
- Relationship-Related Obsessions: These might involve constant worry about whether your partner is “the one” or fixating on their flaws and qualities. These obsessions can extend beyond romantic relationships, affecting friends, relatives, or any significant connection.
- Obsessions about Death and Existence: Some people become consumed with existential or philosophical thoughts, like excessive preoccupation with death, the universe, or questioning their role in the “grand scheme” of things.
- Real Event and False Memory Obsessions: These involve intense worry about past events, often questioning their significance or what impact they might have had, whether the events are remembered accurately or distorted by the mind.
- Emotional Contamination Obsessions: This type involves the fear of “catching” negative personality traits or personal characteristics from others, leading to feelings of emotional contamination.
It is important to understand that these obsessions are not wants or convictions; rather, they are intrusive thoughts that result in severe levels of anxiety and distress. For instance, an individual with OCD experiencing intrusive thoughts about causing harm to another person is not aggressive but rather extremely troubled by the idea of doing so.
Compulsions: The Urge to “Fix” the Obsession
Compulsions are actions or mental habits that people engage in an effort to alleviate the anxiety triggered by their obsessions. Compulsions can manifest as either observable behaviours, such as washing hands or checking locks, or internal habits, like counting or mentally repeating specific words. Regrettably, engaging in these rituals only provides momentary respite from the anxiety. Over time, the pattern of fixations and urges can become uncontrollable and extremely disruptive, significantly interfering in everyday functioning.
Below are a few typical illustrations of compulsions:
Monitoring: Continuously monitoring items such as locks, appliances, or personal possessions for safety or accuracy.
Washing and Cleaning: Extensive washing of hands, taking showers, or cleaning surroundings to avoid contamination – to the point hands are raw and skin is peeling/sore.
Counting or Performing Actions Repeatedly: Engaging in tasks for a set number of repetitions, like toggling a light switch multiple times before being able to exit a room.
Looking for Reassurance: Continuously seeking affirmation from others that nothing negative will occur, or that they have completed a task correctly.
Compulsions are Not Done for Enjoyment or Fulfilment: they serve as a way to alleviate the high levels of anxiety triggered by obsessions. Despite knowing that their compulsive behaviours are irrational, individuals with OCD struggle to control or stop them.
Misconceptions Regarding OCD
Several misunderstandings about OCD may hinder individuals with the condition from seeking assistance or feeling validated. The following are some of the most common misconceptions:
- OCD isn’t just limited to being clean or orderly. While a few individuals with OCD may focus on cleanliness or organisation, many others deal with obsessions and compulsions unrelated to these themes as outlined previously above. OCD can present itself in different forms, such as fears of harm, contamination, intrusive thoughts, or unwanted sexual or religious obsessions.
- Individuals suffering from OCD are able to cease their symptoms by exerting significant effort. OCD is a psychological disorder, not a behaviour that can be stopped at will. People with OCD feel intense anxiety and a strong need to reduce their distress, which leads them to engage in compulsive behaviours. For most people, just “quitting” is not a viable choice without receiving appropriate therapy and support.
- OCD is a characteristic or peculiarity of one’s personality. OCD is frequently downplayed as a personality characteristic, like being “a bit OCD” when it comes to being tidy or studiously on time. In reality, Obsessive Compulsive Disorder is a severe mental health condition that can greatly hinder everyday activities. It is not a characteristic of personality but a condition that needs adequate diagnosis and treatment.
How OCD Affects Daily Activities
Dealing with OCD can feel like too much to handle. Obsessive thoughts and repetitive behaviours consume a substantial portion of one’s time every day, frequently causing individuals to feel imprisoned within their own thoughts. This might result in feelings of frustration, fatigue, and hopelessness. A lot of individuals who have OCD also suffer from other mental health problems like depression or generalised anxiety disorder.
Obsessive Compulsive Disorder can impact upon relationships and in social interactions as well. Family and friends may not grasp the seriousness of the condition or could become irritated by the behaviours they see. In certain instances, people with OCD may steer clear of social gatherings or crowded areas due to a worry that their obsessions or compulsions will be activated, resulting in seclusion / embarrassment.
How OCD Affects Everyday Life
Living with OCD can feel like a lot to handle. Obsessions and compulsions consume a considerable amount of time, frequently causing individuals to feel trapped in their own thoughts. This often could result in feelings of irritation, tiredness, and occasionally despair. Many individuals with OCD also deal with additional mental health conditions concurrently, which only serves to exacerbate their situation, interfering in their ability to try and function. Frequent comorbidities with OCD include:
Generalised Anxiety Disorder (GAD): Individuals with OCD often face elevated levels of anxiety that go beyond their repetitive thoughts, leading to an overall feeling of apprehension and stress.
Depression: Continuously struggling with unwanted thoughts and behaviours can result in feelings of despair and fatigue, eventually leading to a diagnosis of clinical depression.
Hoarding Disorder: Hoarding disorder is a mental health condition in which individuals struggle to part with possessions, even if they are no longer useful or necessary.
Panic Disorder: People with OCD may experience panic attacks due to the intense distress brought on by their obsessions.
OCD and Autism: OCD tends to be more difficult to assess in autistic than non-autistic individuals due to restrictive-repetitive behaviours (RRBs), the core feature of autism. These become so intertwined with OCD symptoms that knowing where one ends and the other begins often defies straightforward answers – even for experts.
Body Dysmorphic Disorder (BDD): Individuals with OCD can also have BDD, characterised by an excessive preoccupation with imagined imperfections in one’s body.
Eating Disorders: The inflexible, perfectionist characteristics of OCD could intersect with unhealthy eating behaviours, resulting in disorders such as anorexia or bulimia.
Body Focused Repetitive Behaviours (BFRBs): Hair-pulling disorder, Skin-picking disorder, or Dermatillomania / Excoriation Disorder. Individuals with OCD repeat these behaviours to get away from bad feelings like anxiety.
OCD and these related disorders can worsen each other, complicating diagnosis and treatment. Getting assistance from a mental health expert who focuses on these disorders is integral to addressing all facets of mental well-being.
How Is OCD Diagnosed?
OCD is typically diagnosed by a mental health professional who assesses the individual’s symptoms. They will look for three things:
- Does the individual have obsessions?
- Do they have compulsive behaviours?
- Do the obsessions and compulsions take up significant time and/or get in the way of important activities such as working, going to school, or spending time with family/friends?
OCD symptoms can vary in intensity over time and may fluctuate depending on external stressors or life events. Diagnosis and treatment by a qualified mental health professional are fundamental in managing the disorder effectively.
Treatment for OCD: Compassionate and Effective Approaches
Approaching treatment for OCD with sensitivity is pivotal, as it’s crucial to understand that each individual’s experience is one of a kind. There is no universal treatment that works for everyone, and each individual’s recovery process is unique. For a lot of people, therapy involves figuring out how to control symptoms and enhance daily performance, instead of trying to “fix” or “heal” the condition.
- Cognitive Behavioral Therapy (CBT): Particularly Exposure and Response Prevention (ERP), is a widely-recognised treatment option for OCD, having the strongest evidence supporting its use in the treatment of OCD. ERP consists of slowly confronting an individual with the cause of their anxiety, while supporting them in refraining from participating in compulsive actions. This is accomplished with care and at a speed that can be easily handled by the person. In the long run, ERP can gradually diminish the intensity of obsessions and weaken the hold of compulsions.
- Medication: SSRIs are commonly recommended to reduce OCD symptoms. Medication, when used in conjunction with therapy, often works very beneficially together in treating OCD.
- Acceptance and Commitment Therapy (ACT) works on assisting individuals in embracing their obsessions without attempting to alter them and motivates them to live in alignment with their values, even in the midst of OCD-related discomfort.
- Support Groups and Peer Support: Establishing connections with individuals facing similar challenges can play a crucial role in the journey towards healing. Support groups, either face-to-face or on the internet, offer a feeling of belonging and empathy.
Moving Forward with Compassion
OCD is not a personality quirk or a character trait — it is a very real mental health condition that affects many individuals across the world – adults and youths alike. The aim of OCD therapy is not to invalidate or diminish the struggle of people. Dealing with OCD is difficult, and therapy involves equipping individuals with the resources and assistance needed to manage the obstacles associated with the condition. It is completely acceptable to require assistance, and taking action is a necessary move towards regaining a sense of power.
Although OCD is a lifelong disorder for some individuals, it does not necessarily have to control their life. By using the appropriate treatment method, people with OCD can recover a feeling of control, lessen the severity of their intrusive thoughts and behaviours, and concentrate on their true priorities. Treatment is tailored to each individual, so what may be effective for one person may not be effective for another. However, by persevering and receiving appropriate assistance, it is feasible to lead a satisfying and complete life while managing OCD.
Stigma remains a significant challenge for those living with OCD, often perpetuated by well-meaning individuals who may not realise their words or actions are harmful. The next time someone casually refers to a person or situation as being “so OCD,” take the opportunity to start a conversation. Educate them on what OCD really entails and how such comments can trivialise the real struggles of those affected by this disorder.
Common Myths about OCD Treatment (handout from International OCD Foundation):
https://iocdf.org/wp-content/uploads/2017/08/OCD-Treatment-Myths-Handout.pdf
