OCD Awareness
The second week of October is OCD Awareness week. This makes this a great time to talk about this much misunderstood diagnosis.
Obsessive compulsive disorder, or OCD, is a complicated condition that has made its way into popular culture. Unfortunately, much of what gets labeled “OCD” behavior simply doesn’t reflect the realities of the condition itself. So before we talk about what OCD IS, let’s look at what it ISN’T.
What is not obsessive compulsive disorder
If you are the type that needs things to be deeply orderly—your candies grouped by color, or your desk needs to be arranged in a very specific way—it is not likely that you are “OCD.” This is especially true if arranging your candy or tidying your desk seems to “solve” some problem.
If you are in this category, you MAY be quirky, or a stickler for cleanliness. This is not OCD. You may even have Obsessive Compulsive Personality Disorder (OCPD), but despite a similar name, this isn’t OCD either.
As Healthline puts it, “Obsessive-compulsive personality disorder (OCPD) is a personality disorder that’s characterized by extreme perfectionism, order, and neatness. People with OCPD will also feel a severe need to impose their own standards on their outside environment.” And while this sounds like how OCD is presented in popular culture; it simply is not what OCD looks like in reality.
Those with OCPD generally don’t recognize that their compulsions are obsessive. Instead, they believe their need to order the world in their particular way is rational and logical, and those with OCPD will work hard to impose those patterns of organization upon the world.
It’s in this lack of recognition of disordered behavior that the biggest differences with OCD lie.
What is obsessive compulsive disorder?
Where OCPD is a personality disorder, OCD is an anxiety disorder. According to the DSM-5, an individual can be diagnosed with obsessive compulsive disorder if they experience:
“Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive, unwanted, and that in most individuals cause marked anxiety or distress.”
And
“The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some thought or action (i.e., by performing a compulsion).”
Generally speaking, a person experiencing OCD will acutely understand and be able to identify that their intrusive thoughts are causing distress, and will attempt to make them stop.
The International OCD Foundation lists several common categories of obsessions that those with OCD may experience:
Contamination
Sexual thoughts
Violence
Religion or morality
Responsibility
Identity
Compulsions, the International OCD Foundation says, are “repetitive behaviors or thoughts that a person uses with the intention of neutralizing, counteracting, or making their obsessions go away. People with OCD realize this is only a temporary solution, but without a better way to cope, they rely on compulsions nonetheless.”
Some common compulsions include:
Washing and cleaning
Mental compulsions (such as praying, reviewing, counting, or replacing a “bad” word with a “good” word)
Checking repeatedly
Repeating behaviors
OCD and other diagnoses
It is not uncommon for those with OCD to have other mental health diagnoses. These may include mood disorders, depression, and substance abuse disorders. We also see OCD often related to eating disorders.
Those with eating disorders will frequently develop obsessions related to food, or to their physical appearance, and compulsions will often follow. And, fitting the diagnostic criteria for OCD, eating disorders are highly disruptive to the lives of those who experience them.
Treatment for OCD
Occasionally, treatment for OCD will focus on addressing the obsessions. But challenging the thoughts, or addressing the compulsions, without examining the past experiences or traumas that have contributed to the anxiety causing them often results in a treatment merry-go-round. A patient may improve while in treatment, but then return to a cycle of anxiety, intrusive thoughts, and compulsive behaviors.
