Obsessive-Compulsive Disorder: What it is, and What it isn’t By: Dr. Nicole Biondoletti

Obsessive-Compulsive Disorder: What it is, and What it isn’t

OCD is fascinating in that it is very simple in definition but extraordinarily varied in presentation. Here is a brief discussion on the basics of OCD and some common misconceptions.

What it is: OCD is the presence of intrusive thoughts or obsessions (used interchangeably in the context of OCD) and/or compulsions. Everyone has intrusive thoughts. Everyone. These are those weird and often unpleasant or even disturbing thoughts or images that might pop into your mind from time to time. They come and they go, usually without much of a second thought. This is because you know its meaningless and nonsensical. But, for someone with OCD, these thoughts become stuck and turn into obsessions because meaning is derived from them. “What does it mean that had I this thought?” “Do I want this thing to happen?” “Am I going to act on this thought?” “Is this more likely to happen because I thought it?” “Am I a bad person?” There are common categories of intrusive thoughts (e.g., contamination, harm, order) but as alluded to above, they can be about literally anything. Significant distress ensues, leading the individual to perform a specific behavior(s) to manage the distress. Enter, compulsions.

When most people hear the word “compulsions” they envision someone who is meticulously clean and organized and usually some type of repetitive behaviors, such as flipping a light switch off and on or locking a door. Sure, this can be part of it. This is by no means the whole picture, however, and might not even be relevant in some cases. Sometimes compulsions aren’t even observable. Covert compulsions, or mental compulsions, are very common but often unrecognized. Common mental compulsions include excessive self-reassurance (e.g., “I would never do that… that’s crazy… that would never happen…,”) repeatedly replaying or reconstructing an event, such as a social interaction, or imagining various outcomes of a potential event. Others include repetition of words or phrases and thought or image replacement/”undoing.”

What it isn’t: OCD is not a trait or a personality type. Obsessive-Compulsive Personality Disorder is a thing, and although they can co-occur, they are totally separate conditions.

OCD is not “just worrying.” Generally, worries tend to be about more or less “normal” things that we all might worry about from time to time. Finances, health, relationships, work, etc. are some examples. Intrusive thoughts/obsessions can fall within these typical categories of worry, (particularly health and relationships,) but they have a different feel to them. They will have some kind of catastrophic implication or consequence and often have questionable probability. A person with OCD might even say, “I know this doesn’t make sense! But… what if?” Hence, it’s nickname, “the doubt disease.” There is also an acute spike in anxiety/distress with intrusive thoughts. Worries can be very anxiety-induing as well, but we can often see a build up of distress rather than an instantaneous spike. And then of course there will be a compulsion that follows an intrusive thought.

OCD is not pleasant. It’s not just being particular, very organized, or having quarks. It’s not desirable and it’s not a compliment. In most cases, OCD is highly distressing and causes some degree of functional impairment. Sometimes it leads to things like depression and substances abuse. The good news is that it is very treatable. If you have questions or think you may experience obsessive-compulsive symptoms reach out to a qualified treating provider.  

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