Questions and Answers about OCD

October 14-20 is OCD awareness week, so it seemed timely to discuss some common myths, misconceptions, and questions people have about obsessive-compulsive disorder. OCD is a mental disorder which can take many forms, and may look very different from person to person. Generally, the two major features which define OCD are obsessions and compulsions. Obsessions are recurrent, involuntary, and unpleasant thoughts. We often use the clinical term “intrusive” to describe these thoughts, because they intrude on a person’s consciousness and rarely respond to attempts to make them go away. Compulsions are behaviors which are done to reduce the anxiety created by these thoughts. These behaviors may be repetitive or ritualistic, and are sometimes even thoughts themselves (we call these “mental rituals”).

Often, people living with OCD have both obsessions and compulsions, but this is not always the case. The obsessions and compulsions may be restricted to a very specific part of a person’s life, or may occur in many different situations. Probably the most common example that is used (and often over-used) is a contamination obsession. A person who has obsessional thoughts about being dirty or contaminated may engage in compulsive cleaning or washing behaviors to attempt to get rid of these thoughts. They may also avoid situations they feel would cause them to become contaminated (such as riding the bus, or doing yardwork). It is important to remember that OCD looks very different from person to person, and not all people have contamination obsessions or cleaning compulsions.

Now let’s look at some common questions:

I like things to be clean, and I wash my hands a lot. Do I have OCD?

It’s always possible, but simply cleaning a lot or liking things to be organized does not mean you have OCD. Only about 1% of the population has OCD, and people living with the disorder who clean a lot usually have strong, unpleasant thoughts about contamination or uncleanliness. Simply preferring a clean home is very different. The term OCD gets thrown around a lot in this way. (Have you ever heard someone say “I’m so OCD” because they’re very organized or tidy?) This is not what the disorder actually it, and can even be offensive to people living with it.

Can OCD lead to violence?

It’s not likely. Some people with OCD have intrusive thoughts about hurting themselves or others. A rather common obsession involves a person worrying that they have hit someone while driving (even when there is no evidence they have). These kinds of thoughts can be frightening to hear about, but it is very important to remember that these thoughts are not urges or desires to hurt anyone; they are just thoughts. In fact, the person most frightened by them is often the person having them. Imagine what it would be like if you thought you ran over a child every time you hit a pothole in your car.

Is OCD treatable?

There are treatments available for OCD which are helpful in many cases. The gold standard is called Exposure with Response Prevention (ERP), which involves the person exposing him or herself to the situation which triggers their obsessional thoughts, and then not engaging in the compulsive behaviors. In the example of contamination and handwashing above, this might involve touching things that the person thinks are dirty, and then not washing their hands afterwards. It is important to note that this is done in a graduated manner, with a clinician who is trained in ERP. Some people may choose to include medication in their treatment plan as well. Certain kinds of antidepressants (remember: just because it’s called an antidepressant does not mean that it is only taken by people with depression) as well as other drugs have been shown to be helpful for people with OCD. For people who have more severe OCD, which seriously limits their ability to function on a day to day basis, inpatient or residential treatment may be recommended.

What can I do if I think I might have OCD?

Fortunately, there are many resources available for people living with OCD and their loved ones. The International OCD Foundation (IOCDF) is a good place to start. It’s a large non-profit organization which advocates for better understanding and treatment of OCD. If you think that you might have OCD, it is also a good idea to meet with a licensed mental health professional to discuss your symptoms and possible treatment options. When looking for a clinician, be sure to ask if they have training and experience working with OCD, and also what kind of treatment they recommend. If a prospective clinician tells you they do not use ERP, consider finding one who does. IOCDF has a much more in-depth guide to selecting a clinician for OCD treatment available here. Also, be sure to check out the Association for Behavioral and Cognitive Therapies’ fact sheet about OCD.

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