Is It Just About Being Tidy? The Myths About OCD
“I’m a little OCD…” We hear that from time to time, don’t we? Especially from family members or friends who explain that they enjoy having their belongings tidy and well-organised. The term is also used a lot in movies and on TV, when a character seems overly rigid about things being a certain way. But what actually is OCD?
The (mostly) simple definition
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), when we talk about OCD, or Obsessive-Compulsive Disorder, we are referencing a group of symptoms that involve both obsessions and compulsions.
Obsessions are persistent thoughts, sensations, or images that keep appearing in our brains, causing us to feel like we can’t escape them.. An example of an obsessive thought could be “Touching this doorknob will make me sick” or “If I don’t skip every second step when climbing the stairs, someone close to me will get hurt”. Some common worries that affect people with OCD are contamination fears (being afraid of becoming ill because they came in contact with something they see as dirty), harm-related fears (hurting themselves or someone close to them), or checking fears (being a victim of a break-in due to leaving doors unlocked). On one hand, these thoughts are not that unusual. We all sometimes worry about acting responsibly when it comes to our health or sensitively towards our loved ones. The trouble with OCD is that these thoughts are very stubborn and keep popping up in the brain, causing constant worry or sometimes even intense fear!
Now comes the second part - to deal with the scary thoughts and feelings, a person with OCD will come up with something to do (kind of like a ritual), to make them go away. They will do a behavior, such as washing their hands constantly, re-arranging items on their desk, or repeatedly checking the doors to make sure they are locked. This is what we call a compulsion - an action taken specifically because of an obsession, that helps to feel less stressed or worried. Unfortunately, this only works short-term - the obsession will come back again. Each time the cycle repeats, with the thought causing fear, and the compulsion lowering it, the obsessive thought will pop up quicker the following time. Eventually, the person suffering from OCD will feel like the cycle of obsessions and compulsions is constant, making it very difficult to get anything done during the day.
Okay, but how does a psychologist figure out if someone has OCD?
This brings us to a good rule-of-thumb that is often used by therapists when they notice that a client may be struggling with a certain behavior. A therapist will ask questions to understand the reason why someone might feel that they need to do something and try to figure out what effect this might have on everyday functioning. Let’s look at two examples:
Amy likes to tidy up their desk before starting work as it helps her feel calmer, more organized, and more able to find the items she needs for work easily. Amy takes a few minutes at the beginning of the day to arrange her papers, pens, set up the computer, and her daily schedule, and then begins working.
Barry needs his desk to be clean all the time. When one of the pens is crooked, he cannot hear himself think, and he is overcome with worry that his work will be a complete failure if the area is not perfectly organized. He spends a few hours of his day going back and forth, moving different things to make sure they are in an ideal place, and almost never manages to get his tasks finished because of it.
Both Amy and Barry prefer having a tidy environment; however, it’s clear that for Barry, the cleaning is a compulsive response that not only harms his work but also happens because of an obsessive fear of failing. At its core, OCD is not about being a person who simply enjoys organization or good hygiene; it’s all about intense anxiety that’s very difficult to cope with.
So, what can be done to help?
There are a lot of things that can help to manage and decrease the symptoms to stop them from interfering with day-to-day life. Therapy can be very important in treatment, as it gives time and a safe space to examine the obsessive-compulsive patterns, learn skills to identify intrusive or obsessive thoughts, and gradually build resilience in tolerating these, without engaging in compulsions. Methods such as Cognitive Behavioral Therapy or Acceptance & Commitment Therapy are often very useful in increasing these kinds of coping skills. Mindfulness practice can also be a very helpful tool. Trying out meditation and breathing techniques teaches how to simply observe what is happening in the body and mind without interfering or acting on a given thought. In some cases, particularly when the symptoms are more intense and disruptive, it is a good idea to consult a psychiatrist. We know that different types of medications can be an effective addition to managing OCD.
Finally, for parents of children who experience obsessive-compulsive tendencies, it is important to consider how different responses to their behavior may interact with symptoms. For example, most children with OCD will ask for reassurance - a looooot. This will include variations of the question “Will everything be okay if…?”. Although the impulse might be to immediately say “Yes, of course!”, this can actually keep the obsession-compulsion cycle going, as getting reassurance can become a form of compulsion in itself. By noticing together that a worry has come up, parents can model the skill of tolerating uncertainty, which is very important in OCD management.
So, what we learned is that Obsessive-Compulsive Disorder can be a really challenging mental health condition and that it’s about so much more than neatness or good organization skills. Although it can make everyday life very difficult, there are many treatment options that can help decrease the symptoms and improve well-being. For anyone struggling with OCD symptoms, know that you are not alone - EKC is here to help! Our dedicated therapists would love to share knowledge and experience, and find out how we can best support you on your journey to healing.