Five Things to Know About OCD

Despite widespread usage of the word OCD in the media, obsessive-compulsive disorder is arguably one of the most misunderstood mental health conditions. The disorder gets characterized as a love of organization and cleaning or a personality trait that everyone lives with, which is inaccurate on all accounts.  

In instances where OCD is portrayed correctly, we typically see a sliver of what the disorder entails: a person with contamination obsessions followed by hand-washing and other visible compulsions.  

This article discusses five important facets of OCD that you should know.

Loving to Organize Is Not a Symptom of OCD

While Khloe Kardashian is not the first or last person to misrepresent the reality of OCD, her direct quote below highlights one of the most common misconceptions about the disorder: OCD is synonymous with a desire to organize. In a video uploaded to her “Khlo-C-D” series on her app, Khloe stated: "Normally, I think areas [to organize] like this for a homeowner are intimidating. For me, like a garage and a pantry get me really horny.”

It’s clear that Khloe is excited by the prospect of organizing large spaces, which indicates that the organization is ego-syntonic—a psychological term used to describe thoughts, feelings, and behaviors that are acceptable to a person. The person does not find such stimuli as problematic, but rather as a part of oneself that they align with. 

OCD is an ego-dystonic disorder. Obsessions (recurring intrusive thoughts, images, sensations, and urges) are experienced as disturbing and unwanted. The person with OCD does not enjoy performing compulsions (physical or mental acts a person carries out in response to obsessions) but feels like they have to in order to alleviate anxiety, prevent something bad from happening, seek certainty about obsessions, etc.

Why People Think That People With OCD Love Organization

Where does the idea that people with OCD love to organize come from? It is due, in part, to a misunderstanding of the actual symptoms of OCD.

A person with OCD might experience “just right” or symmetry obsessions in which they feel the urge to do things/place things in a manner that feels internally “right” or “perfect” to them. This might look like a person “needing” to place a book in the “right” place, which usually causes them to compulsively move it again and again until they reach an internal feeling of “rightness.”

This can be anxiety-provoking, time-consuming, and painful. Standing in front of the mirror and pulling one’s socks up over and over and over again until they feel symmetrical, or moving and re-moving objects on one’s desk is anguishing to the person with OCD. Such behavior is far from enjoyable.

For people with OCPD, their beliefs and behaviors align with their sense of self and are not viewed as problematic, which is the opposite of the person with OCD who is distressed and impaired by their symptoms.

Everyone Is Not “A Little Bit OCD”

While we all experience an odd, unwanted thought from time to time or perform a behavioral ritual here and there, we do not all meet the criteria for OCD.

Those with OCD do not experience just a passing intrusive thought but recurring intrusive thoughts, images, and urges that stick because of how their brain is wired. They also feel a strong urge to perform compulsions in the face of obsessions that the everyday person does not experience. 

OCD Is Not Only About Contamination Concerns and Compulsive Hand-Washing

People with OCD can experience obsessions that center around a fear of contamination, but many with OCD do not. Obsessions of OCD can center around anything (quite literally, anything can become an obsession) and often pertain to taboo content. Some examples include (but are not limited to):

• Unwanted intrusive thoughts about sex with children (e.g., What if I’m a pedophile?)
• Unwanted violent thoughts about harming others (e.g., intrusive images of stabbing someone)
• Unwanted intrusive thoughts about harming one’s newborn baby (e.g., What if I throw my baby down the stairs?)

Less taboo obsessions include (but are not limited to):

• A hyperawareness of automatic bodily sensations like blinking and breathing
• Unwanted intrusive thoughts about a romantic partner (e.g., What if I don’t actually love them?)
• Existential obsessions (e.g., What if I’m living in a dream?)

While excessive hand-washing is a compulsion that people with OCD perform, it is one of a variety of mental and physical compulsions carried out. Avoidance of feared stimuli, reassurance-seeking about obsessions, confessing of obsessions to others, compulsive prayer, mental compulsions, and other physical compulsions are common.

Mental Compulsions Exist

In the same manner that people perform physical behaviors in response to obsessions, those with OCD perform mental behaviors as well.

A lack of understanding about mental compulsions can also have adverse therapeutic consequences if the therapist is not addressing them through response prevention.

Examples of mental compulsions include:

• Thought neutralization: replacing unwanted thoughts with more desirable thoughts
• Rumination to analyze or solve the obsessions
• Mentally reviewing past experiences
• Mentally checking one’s feelings and bodily sensations
• Purposely bringing on a thought to test one’s response to it

ERP Is a Frontline Treatment for OCD

Exposure and Response Prevention (ERP), a behavioral therapy under the CBT umbrella, is the frontline treatment for OCD.This entails facing one’s fears head-on through exposure and eliminating compulsions performed.

Therapy should be behaviorally-oriented, as one’s response to obsessions—compulsions—is the crux of the problem. We are not in control of what pops into the mind (obsessions) but are in control of what we are doing in response to them (compulsions).

Compulsions reinforce obsessions as important and dangerous, when they are unimportant false alarms, and reinforce the false notion that the only way to manage obsessions is to carry out compulsions and people with OCD get trapped in a debilitating cycle.

Compulsions are also excessive, fruitless, and unhelpful. They are not necessary to carry out, despite how strong an urge the person with OCD experiences and how real obsessions can feel. 

If the behavior is not targeted in therapy, the person may remain trapped in their symptoms. Traditional talk therapy is not indicated for OCD for this reason, along with the fact that talking about the content of one’s obsessions and trying to find meaning in them can be compulsive in and of itself.

Mindfulness skills training, acceptance and commitment therapy (ACT), and cognitive-behavioral therapy (CBT) can be helpful adjunctive treatments.

It is important to note that for some people, OCD is so severe that the individual cannot tolerate CBT without some help in reducing the intensity and severity of their symptoms. Medication can be utilized, which would be prescribed by a psychiatrist or medical doctor.

A Word From Verywell

If you are experiencing symptoms of obsessive-compulsive disorder, there is help. Finding a therapist who truly specializes in the treatment of the disorder and understands how to treat it effectively is an important next step. The International OCD Foundation (IOCDF) has a Find Help directory that lists OCD specialists in your area.