What is Obsessive-Compulsive Disorder (OCD)?

Obsessive-compulsive disorder (OCD) is an often misunderstood diagnosis. It’s common for people to use the label of OCD as a shorthand way to describe perfectly normal, even adaptive forms of organization or cleanliness. Indeed, the phrase “I’m so OCD” seems to have become so ingrained in our colloquial language that its meaning has become almost entirely diluted. If you find a level of satisfaction keeping the volume on your TV at an even number, or become distressed when you come home to find a mess, or even wash your hands frequently, then, according to pop psychologists on TikTok, you might have OCD.

Cultural Shifts

This phenomenon of reducing diagnostic categories to everyday experiences represents a single iteration of a broader, somewhat alarming trend on social media: diagnostic categories are now treated like personality traits, adopted and regarded as one might another’s star sign, or Enneagram type. In what is likely a well-meaning effort to be non-pathologizing and accepting of the rich tapestry of human experience and neurodiversity, having normalized these issues so comprehensively, everybody is now self-diagnosing conditions like OCD, ADHD & autism, personality disorders, and so on.

This trend, however, is not without its drawbacks. Having adopted these diagnostic labels as qualities of one’s identity, they become a kind of self-fulfilling prophecy. People who struggle to regulate intense emotions suddenly believe they have bipolar, for example, and then will use this label as an excuse rather than take accountability to do the hard work of learning to self-regulate (which is available even to those who struggle with bipolar)!

Diagnostic categories are not meant to be identities or destinies; they’re meant to guide the treatment planning process. Overusing diagnostic language risks obscuring what are still real, treatable issues. And it leaves those truly dealing with these issues feeling even more atypical, misunderstood, and isolated, as their experience becomes stripped of any potency by a public conversation that trivializes what they deal with daily.

All of this is quite a shame, since the broadening understanding and acceptance of mental illness has also been an enormous benefit to society in many ways. As awareness and stigma have improved, accessibility has improved in tandem. Perhaps more so than ever, people are getting connected with the help they need, rather than being told to “get over it.”

And yet, as the conversation around mental illness becomes more normalized, more of our experiences are pathologized by pop psychologists on the internet. If you have a niche passion or feel socially awkward, you have autism. If you struggle to focus, you have ADHD. If you treat people poorly, you’re a narcissist. And if you’re more organized than I am, you have OCD.

Okay, So What is OCD?

OCD is a disorder that involves a feedback loop between obsessions and compulsions. Obsessions are experienced as highly distressing, intrusive thoughts that provoke high levels of anxiety. Compulsions are often ritualistic, compensatory behaviors (or thoughts) that an individual feels they must engage in to reduce this intense anxiety.

If an individual is not able to act out a compulsion, they face high levels of anxiety or panic. As such, OCD becomes a self-reinforcing disorder. The compulsive behaviors provide temporary relief, but they exacerbate the disorder in the long term, as individuals learn to rely on them.

Common OCD Themes

Common obsessions and their corresponding compulsions include the following:

• Contamination/Cleanliness
  • Excessive handwashing, even to the point of drawing blood.
  • Constant cleaning and disinfecting, often of the same surfaces, many times consecutively.
  • Showering for long periods, sometimes involving rough, excoriating scrubbing.
  • Repetitive rituals to prevent contamination.
• Constant Checking, often related to perceived danger.
  • Repeatedly checking things like locks, stoves, lights, alarms, etc.
  • Persistent reassurance-seeking from others to ensure things are correct or in place.
• Symmetry/Order, also known as “Just Right” OCD. Involves an overwhelming need for things to be perfectly aligned, organized, balanced, or symmetrical to avoid distress.
  • Constantly arranging and re-arranging objects until they feel perfectly aligned.
  • Feeling compelled to repeat certain actions a specific number of times, such as tapping or counting.
• Harm, often involving distressing, intrusive, and intense thoughts about harming oneself or others. Harm OCD is typically ego-dystonic, which means that the intrusive thoughts run contrary to the individual’s values. This is an important concept to understand, since people who struggle with this form of OCD often become deeply distressed by ruminating on what these thoughts mean about them and their desires. However, it is important to understand that Harm OCD thoughts do not make someone a bad person. The thoughts reflect intense fear of harm, rather than a desire for it.
  • Avoiding situations that trigger these thoughts.
  • Seeking constant reassurance from others to feel more confident that they will not cause harm.
  • Mentally reviewing past actions to ensure no harm was done in neutral situations.
  • Performing “neutralizing” thoughts or rituals.

Other Common Themes

Other commonly encountered obsessions include:

• Religious scrupulosity: obsessive preoccupation with religious rituals, often involving compulsive prayer, confessions, or excessive concerns with blasphemy or sin.
• Relationship insecurity: Persistent, intrusive doubts about the stability or suitability of a relationship. Often involves constant reassurance-seeking from one’s partner.
• Sexual orientation: Obsessive concern with one’s sexuality, even despite clear evidence contrary to one’s concerns. Often involves compulsive reassurance or testing behaviors.
• Pedophilia: Highly distressing, intrusive, and unwanted sexual thoughts about children. (Note: As it relates to OCD, pedophilic thoughts are often considered ego-dystonic, rather than reflecting true feelings of attraction or intent.)
• Memory reliability: Frequent doubting of past events. Worrying whether certain events happened or not.
• Existential rumination: Obsession with the meaning of life, the universe, or one’s purpose. Characterized by constant rumination and worry that becomes debilitating.
• Sensorimotor awareness: Obsessive preoccupation with normal bodily functions such as blinking, breathing, swallowing, one’s heartbeat, etc. Often involves compulsive checking (e.g., “Am I still breathing?”)
• Magical Thinking: Irrational worries that neutral signs or thoughts might provoke real-world, intensely negative consequences.

OCD: In Summary

OCD causes high levels of anxiety that cause significant interference with one’s personal, social, and occupational functioning. People who experience OCD often deal with multiple forms of obsessive and compulsive patterns, and these patterns may shift over time. As a result, without treatment, people with OCD lead lives that involve a lot of restriction, since these behavioral patterns take up so much time.

Alright, We Get It. What Does Treatment Look Like?

The gold standard treatment for OCD often involves a combination of a therapy called Exposure Response Prevention (ERP) and anti-depressants (SSRIs).

ERP is a structured collaboration between a therapist and a client, and is a form of exposure therapy informed by cognitive behavioral therapy (CBT). It begins by (1) pinpointing an individual’s specific triggers for compulsive behavior. (2) Having identified these triggers, the focus turns to organizing them into a distress hierarchy, where an individual assigns each trigger a level of distress that it poses. In ERP, the therapist works with the client by (3) exposing them to progressively more intense triggers while preventing their ordinary compulsive response. (4) In place of the ordinary response, the therapist works with the individual to substitute more adaptive responses.

This process can be quite challenging, since it essentially involves building a level of distress tolerance over time. However, in treating OCD, it’s essential to break the feedback loop between obsessive thoughts and the compulsions that ultimately maintain them. With treatment, people with OCD learn that it’s possible to experience a distressing thought without needing to engage with it or indulge it any further.

Closing Thoughts on OCD

Obsessive-compulsive disorder is difficult to deal with, but viable treatments are available. If you or a loved one struggles with anxiety or unwanted, distressing thoughts, consider reaching out to a licensed mental health professional. Try to avoid self-diagnosing or relying on AI to help understand your experience, as this can lead to worsening anxiety or spiraling.

Remember that not everybody who experiences unwanted thoughts or anxious fears has OCD. Regardless, if you’re struggling, your experience deserves attention. This is what mental health TikTok gets wrong: a diagnosis doesn’t validate or decide whether you deserve treatment. You can make that choice!