OCD is Not an Adjective

By Jordan Mayfield, LSCSW, LCAC

OCD, or obsessive-compulsive disorder, is one of the most misunderstood mental health diagnoses. As a therapist that both treats OCD and has diagnosed OCD, I am extremely aware of the consequences of these misunderstandings on both a personal and professional level. The term “OCD” is often used as an adjective such as “I’m so OCD” in reference to being clean, organized and/or anal retentive. Not only does this use of the term invalidate a diagnosed person’s experience of the illness, but it can also result in individuals not seeking support because they have a misunderstanding of what OCD is if it doesn’t look like the general public’s idea of it.

OCD can very often be a debilitating disorder, not a quirk as so often described in popular culture. Changing the public narrative is crucial in understanding and treating this illness. The “O” in OCD stands for obsessive. Obsessions are “unwanted thoughts, images, urges or sensations” (Rethink) that are often incongruent to the person’s personality which causes the individual significant distress. Because of the disturbing nature of the obsessions, individuals often live in silent agony trying to resolve the distress on their own. Individuals often fear judgment from individuals if they were to share the content of their obsessions and therefore do not seek help, often exacerbating their symptoms.

Common obsessional themes may include:

· Fear of harming self or others

· Fear of blurting something out

· Fear of doing something embarrassing

· Fear of stealing things or doing something else impulsive

· Fear of hitting something or someone with your car

· Fear of contamination by illness, cleaning solutions, germs, and/or environmental contaminants

· Distressing sexual thoughts which might include pedophilia or incest

· Concerns of sacrilege or blasphemy

· Excessive concerns with right/wrong or following the “rules”

· Excessive concern with exactness, order, or symmetry

· Excessive concern with the health and safety of loved ones which can include pets

· Excessive concern that you are misrepresenting your sexuality or gender

· Excessive concern that you will make a mistake, lose something, or forget something

· Intrusive images, sounds, words, or music

· Excessive worry that you are in the wrong relationship, your partner(s) do not love you, or you do not love your partner(s) *without factual evidence to support this (Y-BOCS)

Obviously having intrusive and/or repetitive thoughts with any of the above content would be upsetting. Once having a thought like this an OCD individual would assign meaning to it. For example, if a person thinks “What if I grab this knife and stab someone?” they will have a follow-up thought that sounds like “Oh my gosh, why did I think that? Something must be really wrong with me.” Adding the good/bad label to the thought will result in it continuing to grow stronger and be present more often. Sometimes to the point where the OCD individual can think of nothing else.

Compulsions are the mental or physical actions taken to resolve or diffuse the distress created by the obsessive thoughts. Society often thinks of compulsions as excessive hand-washing or locking the door over and over. While these can be compulsions people participate in, many compulsions happen internally therefore are misunderstood as not being compulsions. In the above example, internal compulsions may include: not being around sharp objects, checking the reservoir of their memory bank to reassure themselves that they are not violent or conversely hyper-fixating on times they did respond in an aggressive manner toward someone as evidence that their concern is valid.

Other examples of internal compulsions may include:

· Praying repeatedly

· Repeating words or phrases that bring comfort or reduce distress

· Counting

· Reviewing/replaying memories to reassure ourselves that we did not do something “wrong”

· Rereading

· Repeatedly checking physiological symptoms to seek reassurance (i.e. checking breathing, checking a bruise/bump/abrasion) (Y-BOCS)

OCD is commonly misunderstood and misdiagnosed because a significant number of compulsions can happen internally. When researching mental compulsions, the term “pure O” is often used. However, this term is misleading. “Pure O” is the idea that an OCD individual only experiences obsessions but not compulsions. This is not the case. What is true is that the person likely has internal compulsions that they and/or their mental health provider are not understanding as compulsions. OCD, especially OCD without many visible compulsions can look like other mental health diagnoses. For example, if an individual is obsessing and performing mental compulsions in their head, they will appear disengaged and distracted like a depressed or ADHD individual. An OCD person often expresses significant worry which can also present like Generalized Anxiety Disorder.

Understanding these differences are paramount in the treatment of OCD. Because when providing treatment to an OCD diagnosed individual, but believing they have another disorder can cause significant harm to them. For instance, if an OCD individual is having obsessions about harming themselves, an untrained therapist might assume that they are suicidal. This would prompt them to complete a risk assessment and safety plan with the individual REINFORCING the idea that the individual is at risk of harming themselves and are not safe. This will result in an increase in obsessions and compulsions, not a decrease. Additionally, talking about reassuring language, statements, and facts with someone with Generalized Anxiety Disorder could be quite helpful. But if they instead have OCD then this could be reinforcing their compulsions of reassurance seeking and checking, exacerbating their symptoms.

Getting an accurate assessment and diagnosis is key in the treatment of OCD. And to do that, correct information must be accessible to the public at large. If we continue to reinforce the narrative that OCD individuals are meticulously clean or “hypochondriacs” then we are minimizing what OCD individuals experience and create additional barriers to receiving help. Next time you feel the urge to use OCD as an adjective I would strongly encourage you to reconsider. OCD can be a debilitating and frightening illness, but with the right treatment can be managed very successfully.