Do you wonder whether you may suffer from undiagnosed OCD?
You may have intrusive thoughts and maybe even some rituals, but your room is unbelievably messy, and you don’t feel you have to wash your hands all the time. And even though your thoughts are driving you nuts, they are actually about realistically dangerous things, things that most people would be scared of happening. And nobody even notices your rituals.
But yet, you find yourself being consumed by those thoughts. And as if it’s not bad enough, the thoughts are so embarrassing that you prefer to suffer alone than to tell anybody about them.
Given the relatively high prevalence of OCD (about 2.3% lifetime prevalence), it is unfortunate that this disorder is still largely misunderstood. This confusion seems to be one of the factors leading to people with OCD not being properly diagnosed and not seeking treatment.
Here are some of the main factors contributing to the confusion about this common yet mysterious disorder:
1. The difference between the everyday use of the word “obsessed” and its meaning in the context of the disorder.
When somebody says they are depressed, we all know what they mean, even though that person may be just feeling sad. But it’s nothing like that with the word “obsession.” When we say we are obsessed with our new friend, or a podcast, or the new shoes, we mean that we can’t get enough of that, we love it, and derive great pleasure from thinking about, listening to, wearing, or otherwise indulging in our “obsession.”
This feeling could not be more different for a person who experiences obsessions as part of their OCD. Those (true) obsessions are totally unwanted and disturbing intrusive thoughts, images, or urges. The key word here is unwanted. Far from being pleasurable, those thoughts or images cause OCD sufferers great distress, anxiety, disgust, or shame.
As you can see, our everyday use of the word “obsession” is actually the opposite of what people with OCD experience.
2. The persistent image of people with OCD being clean freaks or neat freaks.
This is a tricky distinction as people suffering from OCD do often engage in excessive cleaning or organizing. But not all people who wash or clean excessively suffer from OCD. And not all people with OCD feel the urge to clean (as explained in the next section).
Let’s say friends tease you about “being so OCD” (which, by the way, is a totally wrong statement on so many levels – grammatically, conceptually, and in terms of lack of sensitivity to sufferers from this pretty horrific disorder). How do you know whether you may have OCD?
To answer this question, think about the reasons you wash or clean and how you feel after you are done washing or cleaning. If you take great pride in being a neat and organized person, feel a sense of accomplishment after you are done, and secretly suspect (or openly declare) that others are just clueless in matters of personal hygiene and housekeeping, chances are you do not suffer from OCD.
If, on the other hand, your urge to clean is a response to a strong feeling of fear, distress, or disgust and you feel that you just have to do it – otherwise you won’t be able to go on with your day, - then it may be a sign of OCD.
It is, of course, important to get properly diagnosed by a psychologist or a medical doctor to know for sure.
So we established that being an overzealous organizer, washer, or cleaner by itself does not mean that you have OCD. But can a person have OCD if they are messy or if they don’t care much about being clean?
3. The idea that a messy person can’t have OCD.
As discussed above, a common misconception is that a person with OCD is a super-organized perfectionistic clean freak preoccupied with everything being sterile and in place.
This is a misunderstanding I witness quite frequently in family members of a newly diagnosed OCD sufferer. A typical dialogue is:
Me: Your son’s symptoms are consistent with Obsessive Compulsive Disorder – OCD.
Patient’s mom: This just can’t be! You gotta see his room! And I have to make him shower, otherwise he won’t!
The fact is – the diagnosis of OCD has nothing to do with cleanliness per se. Even though a fear of contamination is a common obsession in OCD, other obsessions include:
- Fear of harming self or others or being responsible for causing some horrible event or making a dreadful mistake.
- Unwanted sexual thoughts - often about changing sexual orientation or fear of being a pedophile.
- Scrupulosity or religious and moral obsessions – fear of religious blasphemy, offending God, being an immoral sinner or otherwise unscrupulous evil person.
- “Just Right” obsessions and awareness of an object or behaviour not being symmetrical, or not being “right” or “correct”.
- Sensorimotor or hyper-awareness obsessions – fear of being unable to stop attending to blinking, swallowing, breathing, body positioning, physical sensations, memories or thoughts.
Basically, OCD “attacks” anything and everything that may be of high value to a person- their morality, religious beliefs, their loved ones, their health, - even their relationships (this is also a common obsession – fear of the relationship being a “wrong one,” or falling apart).
You may have one (or more) type of obsession, and not have the others. That means that you may be preoccupied with doubts whether you may be gay, or whether you are likely to accidentally stab a family member with a knife, or if you were involved in a hit-and-run accident and drove away without noticing – and have absolutely no concerns about cleanliness.
4. The fact that many of the thoughts that OCD sufferers experience as obsessions are the same as occasional thoughts that people without OCD may have.
The examples of such intrusive thoughts are:
- What if I drop my newborn baby down the stairs?
- I must always tell everything to my mother. If I don’t – that means I must be an immoral person.
- If I come close to the railing of the balcony, I may jump.
- I just admired a picture of a same-sex person; therefore, I might be gay.
- What If I swerve the steering wheel onto the oncoming traffic?
We all may sometimes have those thoughts. Usually, they will be related to the things or people we value and cherish the most.
So what is the difference between people with and without OCD with regard to those thoughts?
It’s pretty simple. If a person without OCD experiences a thought like that, they will probably shrug, think, “well, that was one weird one,” and forget about the thought pretty quickly.
When a person with OCD has a thought, they will likely become very concerned, wondering why on earth they would have a thought like that. They’ll think, “Oh no! What does that mean? Does it mean that I may harm my baby? This is very dangerous! I should probably not be left alone with the baby as it is not safe.” They may then put precautions in place to prevent the catastrophe from happening, avoid being left alone with the baby or stay away from the stairs. They may try to neutralize the thought by thinking a “good” thought. Or they may engage in all kinds of rituals that calm them down and prevent anything bad from happening.
The bottom line is, therefore, that it is not the content of the thought that distinguishes between people with and without OCD. The thoughts are the same thoughts, even though some of them may be pretty idiosyncratic. It’s the interpretation you give to the thought that matters. If you shrug an intrusive thought off (maybe even thinking – wow, even a good person like me can have a weird thought like that) – you do not have OCD.
If, on the other hand, those thought cause you extreme anxiety and you start engaging with the thought and taking various precautions and this takes a great deal of your time and energy – you may have OCD.
5. To make matters even more complicated some of the compulsions also can be seen as regular everyday behaviours.
Compulsions are behaviours or thoughts that people with OCD use to reduce their distress.
Any common daily behaviours, such as washing, praying, dressing, driving, apologizing, drinking water, counting – anything at all - can be compulsions. Or not.
So how do you know?
If those behaviours are a part of your daily routine and you feel productive, or at least neutral doing them – those are probably not compulsions.
If, however, you are doing them in order to find relief from your distress or anxiety, you’d much prefer not doing them, and they take a great deal of time – those are likely compulsions.
But what if you experience unwanted intrusive thoughts, which cause you enormous distress, but you don’t have any behaviours to reduce the distress? You don’t clean, wash, knock, tap, check, or repeat. Does it mean it’s not OCD?
6. This is actually a very common misconception even among doctors and mental health professionals: If a person does not have any rituals, they don’t have OCD.
The absence of visible rituals does not mean the person does not have OCD. Often, people may have frequent intrusive disturbing thoughts that cause anxiety and they cope with their distress by “invisible means” such as:
- Avoiding places, objects or situations that may lead to distress. You may avoid children if your obsessive fear is being a pedophile. Or avoid pictures of attractive same-sex models if you are afraid you may be gay. You can avoid knives (so you don’t stab), heights (so you don’t jump), being alone with kids (so you don’t harm them), etc.
- Mental review – trying to gain certainty about things, going back in memory checking to make sure no harm was caused.
- Reassurance seeking – asking for people’s opinions, or surfing the internet trying to figure out whether the fears are justified.
- Thinking a positive thought in order to “neutralize” or “cancel out” a bad thought.
Here it is important to mention another common misconception:
7. The Pure-O myth.
This term is popular over the internet and is sometimes used to describe individuals with OCD that do not have compulsions. In some way, this is the opposite of #6.
It is true that theoretically it is possible to have just obsessions and no compulsions and be diagnosed with OCD. According to the DSM-5, the diagnosis requires the presence of obsessions, compulsions, or both.
I have to say, thought, that I have yet to see a person that has no compulsions whatsoever. Usually, after a closer investigation, numerous subtle hidden mental rituals surface.
8. If a person with OCD can be convinced that those rituals are just silly, he or she will stop doing them.
This misconception can, of course, only be held by a person who never experienced the agony, horror, unbearable anxiety, never-ending distress, and shame that people with OCD struggle with daily.
Most people with OCD recognize that the rituals (visible or mental) do not make much sense. They would like nothing more than to become free from being consumed by compulsions. Telling them to just stop is not going to work. They need a specialized treatment program called Exposure and response Prevention (ERP) administered by a skilled professional.
If you think that you (or somebody you know) may have OCD, it is important to get properly diagnosed by a professional. Please do not allow the above misconceptions stand on your way. And please don’t let the shame or embarrassment stop you from seeking help.
If you are a parent of child suffering from OCD, please read our blog Don’t Argue With a Brain Glitch. (10 Do's and 5 Don'ts for Parents of Kids with OCD).
Anna Prudovski is a Psychologist and the Clinical Director of Turning Point Psychological Services. She has a special interest in treating anxiety disorders and OCD, as well as working with parents.
Anna lives with her husband and children in Vaughan, Ontario. When she is not treating patients, supervising clinicians, teaching CBT, and attending professional workshops, Anna enjoys practicing yoga, going on hikes with her family, traveling, studying Ayurveda, and spending time with friends. Her favorite pastime is reading.