OCD: What is it?

OCD.
For people outside of the realm of mental health, I’ll bet ten dollars that the first images to come to their minds are germophobes washing their hands and refusing to touch doorknobs.

How many of you owe me money? Be honest.
While I would not call this an incorrect image of OCD, it is grossly oversimplified and also highly specific.  Obsessive compulsive disorder is an anxiety disorder in which a person has specific fears (or obsessions) and performs tasks or takes certain actions (compulsions) to alleviate those fears.  Excessive hand washing is, admittedly, an easy example to understand. 

Person A: “I’m afraid my hands are dirty and I might get sick!”
*Washes hands*
Person A feels better now, so the next time that Person A is worried his hands are dirty, he will wash them to feel better again.

Okay, this seems fairly normal.  Our hands get dirty, and we wash them to stay clean and healthy.  One of the main factors that distinguishes obsessive compulsive disorder is that the symptoms negatively impact the quality of one’s day to day life.  Everyone has a different level of normalcy for hand washing and other hygiene habits.  Perhaps you wash your hands 10 times a day.  Your friend washes their hands 20 times a day.  Does this automatically make your friend a germophobe?  Of course not! It’s the same with behaviors of OCD.  There is no number or anything that constitutes a habit of OCD.  What is abnormal to a specific individual?  When does it start to interrupt one’s day and negatively impact it?

Person B: “I’m afraid my hands are dirty and I might get sick!”
*Washes hands*
Person B feels better now, so the next time that Person B is worried his hands are dirty, he will wash them to feel better again.
7 minutes later…
Person B: “What if my hands are still dirty?”
*Washes hands*
Person B feels better now, so the next time that Person B is worried his hands are dirty, he will wash them to feel better again.
4 minutes later…
Person B: “What if my hands are dirty again?”
*Washes hands*

With this example, we see how person B spends an unreasonable amount of time washing his hands.  In this case, Person B feels compelled to wash his hands.  He knows he just washed them a few minutes ago, and logically knows they are clean.  But he feels the need to do it again.  This is one of the other main factors to identify obsessive compulsive disorder.  People with OCD know that what they are doing does not make sense, is not rational or reasonable, but they feel like they have to do it anyway.  They don’t want to do these things.  They feel compelled by fear.
That fear is real.  That fear is deep-seated.  That fear is the essence of the illness.  If I don’t do this, something terrible might happen.
Over time as compulsions are repeated, just like any other habit, they become harder to stop.  Person B might spend 2 hours of his day washing his hands.  He could have other habits too.  Maybe he spends an hour of his day showering.  Perhaps he washes his clothes twice just to be certain they are clean. 
This is where we shift our focus away from the hand-washing/fear of germs example.  I think that this is the go-to example for OCD for a few different reasons:
1. It’s easy to understand.
2. It’s relatable—we all wash our hands.
3. It was probably one of the first types of OCD to be identified.
Fear relating to contamination, however, is just one type of OCD.  Normally, OCD can be broken down into 5 or 6 different subcategories.  I am not sure if there is a definitive breakdown, especially since obsessions are so vast and dynamic.  This, however, is the categorization that I find to be most accurate:

Contamination—the individual is afraid of things being dirty or unclean leading to illness/harm in self or others
Scrupulosity—the individual is afraid of being a bad or evil person or doing something that is bad or evil; sometimes linked to religion
Unwanted thoughts or images—the individual has unwanted recurring thoughts or images of harming themselves or others
Hoarding—the individual feels the need to keep belongings to the point of excess just in case they are needed
Checking/Repetition/Perfectionism—the individual repeats actions many times until something is just so or feels right
Pure O (Obsession)—the individual has recurring thoughts which cause discomfort or distress but no linked compulsion intended to alleviate these fears

I will provide examples for each of the categories in which I hope to highlight the obsession, the compulsion, and the consequences for each situation. Please note, these are not exact definitions.  As I stated before, OCD is a dynamic disorder and no two cases are the same.  Two people might both have OCD and experience fears of hoarding, but have totally different obsessions and compulsions.  I think that is what makes OCD, and well, truly any mental illness difficult to understand at times.    One would think that if two people have the same illness, that they could understand each other’s conditions.  That’s not always the case.  Personally, I have seen this firsthand as an immediate family member of mine also has OCD, but our obsessions and compulsions are very different.   Once again, these are examples to inform and generalize—not to define exactly.

Contamination
Example 1: A man just finished his morning shower.  He begins to dry himself off with a towel.  As he is doing so, he worries that he is not clean enough.  He tries to shrug off the thought, but he feels a sense of dread as he continues to dry his body.  Reluctantly, he hangs up his towel, steps into the shower, and proceeds to shower for a second time.  He feels better as he leaves the shower this time.  He hopes he can get to work on time.
Obsession: Fearing that his body is unclean
Compulsion: Taking a second shower

Example 2: A boy is listening to his coach explain the drill for basketball practice.  It is time to start and everyone else grabs a basketball.  He stares at the ball.  He thinks about how many people have touched it and how dirty it must be.  He knows that if he touches the ball that he will be dirty too.  He does not get a ball.  He tells his coach that he is not feeling well, and asks to sit out.  He watches as his friends practice the drill.
Obsession: Fearing that the ball is dirty
Compulsion: Does not touch the ball (avoidance can be considered a compulsion since it is a conscious choice and is in direct response to the obsession)

Scrupulosity
A woman is writing her grocery list for the week.  “Hm, what the hell am I gonna cook?”
Oh no.  I said hell.  I swore.  Crap.  No.  I didn’t mean that.  I hope the kids didn’t hear.  Swearing is wrong.  Bad people swear.  I’m not a bad person.  I’m not.  I’m not.  I didn’t mean to.  What if this makes me evil now.  No!
She prays and asks for forgiveness.
Obsession:  Fearing that swearing makes her a bad person
Compulsion: Praying for forgiveness

Unwanted thoughts or images
A man is cooking dinner with his girlfriend.  She asks him to pass her a knife as she chops vegetables.  The man looks at the knife and pictures cutting his girlfriend’s arm.
No!  Shit!  I would never do that.  I love her.  I wouldn’t hurt her.  I mean, I could if I wanted to but I’d never want to or do it.  What if I cut her without meaning to?
“Uh, I need to use the bathroom,” he says and leaves the kitchen.
Obsession: Fearing he could cut his girlfriend
Compulsion: Does not touch the knife

Hoarding
A man is dressing for the day, and notices a large hole in his t-shirt.  He takes the shirt off and moves to place it in the trash.  He hesitates.
I do really like this shirt though.  I could just wear it around the house.  Or maybe use it for a rag.  It’s just one hole.  But… I have so many.  Do I need this one? 
He tries again to place it in the trash.
But what if I need it?
He folds the shirt and places it in a cardboard box filled with other damaged clothing.
Obsession: Fearing he might need the item
Compulsion: Keeps the item

Checking/Repetition/Perfectionism
A girl is getting ready for bed.  She brushes her teeth, turns off the bathroom light, and returns to her bedroom.  She turns off her bedroom light and lays down. 
Did I turn off the light?  I think I did…
The girl gets up, turns on her bedroom light, and walks to the bathroom to confirm that the light is off.  She turns the bathroom light on and then off again, just to be sure. She turns off her bedroom light and lays down.
What if the switch isn’t completely off?
She stands, and repeats this process 5 more times before she feels comfortable.
Obsession: Fearing that she forgot to turn off a light
Compulsion: Checking that the light is off and turning it on and off

Pure O
A woman calls her boyfriend.  She asks about his day and they make plans to go see a movie on Friday night.  She hangs up the phone.
I remembered to say, “I love you,” right?  Yeah…and he said, “I love you,” back to me.  He meant it right?  He sounded kind of bored today.  I hope he isn’t mad at me about anything.  That was nice he offered to pay for the movie.  He said it was $11 each.  So that’s $22 for the movie.  He offered…or did I ask him?  Did I offer?  Should I have offered?  I should have offered.  He always offers.  Maybe he is mad I didn’t offer to pay.  Dammit.  The theater near the mall is cheaper.  Maybe we should go there instead.  I know he prefers not to drive as far though.  Would he rather drive farther or spend less money on tickets?  I hope he isn’t mad we didn’t consider the other theater.  I could call back and offer to pay and ask which theater.  No, that theater is fine.  But I should really offer to pay.  No, it’s fine.  He offered.  I didn’t.  Maybe next time I should offer to pay.  It’s fine.  No.  It’s not.  Is it?  It’s fine.  I’ll offer next time.  That’ll be fine.  Things are fine. 
Obsession: Fearing something is wrong and thinking about the scenario again and again when nothing is wrong

While sometimes incorrectly identified as “germophobia” and excessive hand-washing, OCD is clearly a broader and more complex disorder than some people realize.  I hope this explanation provides a basic understanding of the disorder, and broadens the scope of what it entails.

3 thoughts

  1. So many people have such a huge misconception of what OCD is- for me, it’s a lot of thought patterns and impulsions such as, “if you don’t run down the stairs right now, someone in your family is going to die” and a lot of ruminating thoughts. Thanks for sharing and for bringing light to what is it like to live with this disorder!

    Like

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