What is OCD?

 What is OCD? Great question, because it turns out that not many people know what OCD (Obsessive-Compulsive Disorder) actually is, how to identify it, and even sometimes, which is really saddening, how to properly treat it without accidentally making it worse. And that’s a problem because it’s one of the most common mental health disorders, and it is debilitating if someone’s got it and it’s misidentified and unmanaged.

So, let’s start with the basics.

1. OCD, or Obsessive-Compulsive Disorder, is a mental health disorder located within the Obsessive-Compulsive spectrum of disorders. Not the Anxiety spectrum of disorders. So let me say this very, very clearly.

OCD IS NOT ANXIETY.

While it’s tempting to mix the two because they seem very similar, this is what often leads to a misdiagnosis and then therapeutic treatment that, while well-intentioned, CAN MAKE OCD WORSE. OCD is not anxiety and should not be treated like anxiety because anxiety coping skills often become compulsions OCD will happily use against someone with OCD. OCD is an entirely different type of disorder than the anxiety spectrum of disorders. OCD is not anxiety.

2. There is an obsessive component to the experience.

Now we define what we mean by obsessive here, because obsession can look different and be treated in a lot of different ways. Artists can be obsessive. Athletes can be obsessive. Politicians can be obsessive. Individuals with neurodivergence can have special interests/hyperfixations that appear obsessive. How are these different from OCD obsession?

They’re different in big ways. An artist or an athlete or a politician or a person with neurodivergence often want to fall into the obsessive experience and don’t necessarily think of it as a problem. It’s also aligned with what they want to do/value.

OCD OBSESSION IS AN IRRATIONAL PERSISTENT UNWANTED INTRUSIVE THOUGHT THAT CAUSES EXPERIENCES OF FEAR/DISCOMFORT.

Someone who has OCD has an obsessional thought that terrifies/horrifies/disgusts/disturbs them, usually to an extreme degree, and it can be about anything. There is nothing they like or want about this thought. What happened is the brain just produced the most horrifying thing it could conceive of, and then scared you with the possibility that maybe, just maybe, you’ll do it. Even though it’s the last thing you would ever do.

And the worst part is, in most cases, people with OCD know the obsessional content is irrational and illogical, but the level of fear/discomfort they experience in response to the obsession is so intense that rationality doesn’t remotely matter. They are horrified and terrified and willing to do anything to make it go away or disprove the fear. Which leads us to the next point:

3. There is a compulsive part to the experience.

Ah yes, the compulsive experience. This is the part where people get extremely confused because what counts as a compulsion? Is it just checking and counting and cleaning, like media likes to focus on/make fun of? Is it only something that can be seen? What counts as a compulsion?

The short answer when it’s OCD? Anything can count as a compulsion if it’s a highly repetitive behavior attempting to get rid of the obsessional content/irrational thought. And I mean it when I say anything.

A COMPULSIVE EXPERIENCE IS A HIGHLY REPETITIVE BEHAVIOR, THAT COULD BE AN EXTERNAL REPETITIVE VISIBLE BEHAVIOR OR AN INTERNAL REPETITIVE MENTAL BEHAVIOR. OR BOTH.

Could the compulsion be checking? Sure. Can it be counting? Sure. Cleaning? Sure. Those are the easy ones. But how about intense reassurance seeking with a loved one that’s slowly destroying the relationship? Yes. Repeated and deep-dive consulting and research with Doctor Google or ChatGPT regarding health fears? Yes. Mentally replaying the same situation over and over and over again for hours? Yes. Drinking or substance use? Yes. Avoidance so strong that you can’t leave your room anymore? Yes. Filling your mental thoughts with songs you sing to yourself as a distraction to force out the obsessional content? Yes. Telling yourself in your head that “I’m fine” over and over to reassure yourself? Yes. Napping? Yes.

I mean it when I say anything can be a compulsion if it’s being used to avoid the obsessional content.

4. The compulsion is the problem.

THE MORE YOU ENGAGE IN THE COMPULSIONS, THE WORSE THE OCD GETS.

None of my clients like hearing this because, in the short term, doing a compulsion feels good and like it gets rid of the obsessional discomfort. And it does. Momentarily. For a brief moment it feels good to do the compulsions, but what’s accidentally happened is that you’ve fed the OCD, which feels like it’s gone away, but it’s not gone. It’s just done tormenting you for the moment. When it comes back, however, because it will, it expects you to compulse again so it gets fed.

5. OCD is endlessly hungry.

YOU CAN NEVER COMPULSE ENOUGH TO SATISFY THE OCD.

The OCD is going to tell you so many sweet, sweet lies. It will make you feel, think, and emote whatever it wants in order to scare you. It will do anything to get you to do one thing.

Compulse.

Compulsions are what keeps the OCD strong and active, and anytime it’s hungry, it’s going to try to scare you to get you to compulse. This is why OCD is so debilitating and destructive to someone’s life. Once OCD has a strong, horrible obsessional thought that’s caught your attention, and you start doing things to try to avoid it or make it go away without directly confronting the discomfort, it eats and eats and eats, and gets hungrier and hungrier and hungrier, and bigger and meaner and more demanding until it consumes everything. Someone with OCD lives a terrorized life that loses everything they love and value, and it isolates them until all that’s left is them and the OCD, with what feels like no way out.

Again, this disorder is debilitating.

6. Despite the horror of everything I talked about above, OCD is actually very treatable. We have the treatment. It works. It’s the gold standard. The way back to your life is possible.

THERE IS HOPE.

But I’ll be so real with you, the treatment is called Exposure and Response (or Ritual) Prevention (ERP). And it sucks. Because, spoiler, the way to treat OCD is by exposing yourself to the obsessional fear and resolutely choosing not to compulse internally or externally. Even when you want to. Even when your body and your brain are screaming at you to compulse.

And you’ve got to do it over and over and over again until you learn you can tolerate the discomfort of the obsessional thoughts.

But it’s highly effective when done properly. And if you’ve been terrorized by OCD for long enough that you’re willing to do anything to get it under control so you can get back to living your life, ERP tends to be the way.

*I’ve written this article using “you” pronouns as if I am speaking directly to someone who suspects/knows they have OCD. If you do not have OCD, please know that the “you” is not meant to imply that you have OCD.