If your boss insists on organizing their desk in a very specific way or your roommate is meticulous
about scrubbing the kitchen until it shines, you may have described them as being “so OCD.” But OCD
isn’t really an adjective you should casually lob at someone.
The initialism stands for “Obsessive Compulsive Disorder”—and it’s a mental health condition,
not a quirky character trait.
Hi I’m Justin Dodd, welcome to Misconceptions. The idea that OCD is a character trait is just one misconception about the disorder
we’ll go over today, from its cause to its treatment, and everything in between.
Let’s get started.
There are a number of ways obsessive compulsive disorder is different than having a Type A
personality. A person with OCD becomes stuck in a cycle of obsessions and compulsions. Obsessions
are unwanted, intrusive thoughts that are often repetitive. They can be intense and
alarming. Compulsions are the behaviors a person does to drive the obsessions away.
As Dr. Elizabeth McIngvale, the founder of a non-profit organization for people with OCD,
told Baylor College of Medicine in 2017, “with OCD, it is something that individuals don’t
enjoy – there’s nothing they like about it, they are doing it because they feel like they have to
in order to get rid of the intrusive thought or fear. It is debilitating and draining and
not something that makes the individual feel better and more productive when they are done.”
Often, people assume those with OCD are clean
freaks or germaphobes. You may imagine someone vigorously scrubbing their hands
or mopping their floors until they shine. Or maybe you picture OCD as someone organizing
their closet by color or ensuring their pens and pencils are always perfectly lined up.
But not everyone with OCD has the same obsessions or compulsions.
"It's the processes that are at the root of OCD that appear to be similar,
despite the nearly infinite ways that OCD might manifest itself," Larry Needleman,
a psychiatrist at The Ohio State University Wexner Medical Center, told Self Magazine in 2016.
People with OCD have unwanted intrusive thoughts about a variety of things, such as religion, sex,
self-harm, or the harm of a loved one. This in turn can lead to a variety of compulsions meant
to combat the obsessions. According to the Anxiety and Depression Association of America, people’s
compulsions will generally manifest as specific rituals. Sure, some with obsessions related to
contamination may wash their hands a lot or keep a super clean house, but others may repeat certain
behaviors based on their individual triggers that may not make sense to onlookers, like sitting down
and standing up a set number of times; avoiding certain places or objects; or getting dressed
in a set, specific way. Hoarding, though it’s now classified as its own disorder, can also be
a symptom of OCD—so no, not everyone with the condition keeps their spaces spick and span.
Some people may not have visible compulsions at all. If their rituals mainly take place
internally, such as counting to a certain number or doing a mental body scan, they’re sometimes
described as having “purely obsessional OCD.” A lot of experts have a problem with that label,
though, as it seems to suggest that mental compulsions are somehow less real than ones we can
see. So while I wouldn’t say “Pure-O OCD,” as it’s often referred to online, is a diagnosis a doctor
is likely to give out, the point remains that OCD can present itself in very different ways.
Some people with OCD may get stuck in the same cycle of obsessions and compulsions,
where they focus on the same thing and perform the same rituals.
But others may have a variety of triggers, or their obsessions may change over time.
As Owen Kelly, a clinical psychologist, explained for Very Well Mind in 2020,
a person’s original obsessions can shift. The change likely won’t be drastic:
It would be uncommon for someone with intrusive thoughts about cleanliness to suddenly develop
sexual obsessions and compulsions. But someone with obsessions related to food-borne illnesses
could later develop intrusive thoughts about other contamination-related issues.
And a person’s symptoms may ebb and flow over time, as things like stress and even a lack of
sleep are known to worsen OCD.
It’s likely that you yourself have experienced
some sort of intrusive thought—something unwanted that seems to just sort of pop into your head.
That’s totally normal: According to a 2014 study from Concordia University,
94 percent of people have at some point. If you’re part of the 6% who haven’t,
please teach me your secrets I am begging you. But not everyone who experiences intrusive
thoughts has OCD. As study co-author Adam Radomsky said, "most people who have an intrusive thought
about jumping off a balcony or a metro platform would tell themselves that it’s a strange or
silly thing to think, whereas a person with OCD may worry that the thought means they’re
suicidal. OCD patients experience these thoughts more often and are more upset by them, but the
thoughts themselves seem to be indistinguishable from those occurring in the general population.”
The International OCD Foundation notes that when evaluating a patient, a therapist will look to
see if the person has obsessions and acts out compulsive behaviors. They’ll also assess whether
the obsessions and compulsions are taking a lot of time away from a person’s regular activities such
as school, work, and socializing. The occasional intrusive thought isn’t enough to warrant a
diagnosis. According to the Cleveland Clinic, OCD is “a mental illness, with a chronic…state
of anxiety. It traps people in a constant cycle of repeated obsessions and compulsions.”
Getting an official diagnosis can be tricky—and not just because of the
barriers to mental healthcare many people face, financial and otherwise. It can take between 14
to 17 years, on average, for a person to get the right diagnosis and treatments. Some people
may hide their symptoms; some therapists may misdiagnose the condition. And though
the brain of someone with OCD actually can look different than someone who is more neurotypical,
a brain scan still isn’t enough to make a diagnosis. As Christopher Pittenger wrote for
the Yale School of Medicine, brain scans can offer scientific insights—some of which we’ll get into
later—but they’re not diagnostic tests. The scans don’t really allow doctors to make predictions
about an individual person. Most individuals with OCD actually have completely typical brain scans.
Only a trained therapist can diagnose OCD, so it’s probably best to avoid Dr. Google. Oh and
unrelated, I sneezed kinda funny this morning and according to the internet,
I have a few days to live so, this very well might be my last video. It's been an honor.
Though I said before that stress can make
symptoms worse, we don’t actually know what causes OCD. According to the National
Institute of Mental Health, there are a variety of risk factors that could make
a person more susceptible to the disorder. Genetics could play a role, since studies
have shown that people with immediate relatives who have OCD are more likely to develop it.
Brain structure could also be to blame. PET imaging has revealed that in some cases,
a person with OCD may have increased activity in certain parts of their brain. As the Yale School
of Medicine puts it, the positive feedback loop between a person’s cortex, striatum, and
thalamus—the brain circuit in charge of executing movement and forming habits—goes into overdrive.
The anterior cingulate cortex, anterior thalamus, and insula may also be hyperactive. Additionally,
OCD has been shown to reduce gray matter—the stuff that helps you process information—in
sections that deal with impulse control.
If you’re a fan of the TV show Monk, you may have unconsciously absorbed the idea that OCD gives people some kind of super abilities. In the show,
cutie patootie Tony Shalhoub plays Adrian Monk, a detective with severe OCD. And though Monk is
often hampered by stereotypical compulsions, like cleaning and counting, the show also sort
of portrays his disorder as giving him an edge as a detective. In one controversial episode,
he loses his detective skills while on medication for OCD. Sure, it’s just a show,
and I doubt many people actively think the condition makes someone a super-detective.
But there are lots of examples in pop culture of portraying mental illness, on some level, as some
kind of superpower, and these misrepresentations could very well subtly shape our attitudes.
The reality of OCD is that it can be debilitating, and is much more likely to be a source of intense
anxiety and anguish than something people cherish on any level. People with OCD have
higher rates of suicidal ideation. Research has shown that two-thirds of people with the disorder
have had thoughts of death or suicide. People with OCD also have higher rates of disordered eating,
and about one-quarter of them experience major depressive episodes. Now, I don’t want to go too
far in the opposite direction and suggest an OCD diagnosis is some kind of death sentence, but it
can be quite a serious condition, and I think it’s worth thinking about how pop culture influences
our attitudes towards it. As someone with a handful of mental illnesses, I generally find
it helpful to talk to a therapist or professional about this kind of stuff, not base everything on
the latest exploitative Netflix teen drama.
I’ll leave you with this: Though there’s no cure for OCD, that doesn’t mean things can’t
get better. People can learn to manage their symptoms. There are several things someone
with OCD can do to mitigate the disorder. Cognitive Behavioral Therapy, particularly
Exposure and Response Prevention, is one method. With this type of therapy, patients begin to face
the situations they typically avoid and attempt to stop their compulsive rituals. Medicine is another
option that can help ease OCD symptoms for some people. With the right treatment and management,
it’s entirely possible for someone with OCD to lead a typical life. According
to the International OCD Foundation, 7 out of 10 people with OCD have improved their symptoms with
medication or ERP. Those who take medication often have their symptoms reduced by up to 60 percent,
and CBT has a success rate between 65 and 80 percent for kids and adolescents.
What misconception did we leave out? Comment below with something you think people get wrong
about OCD. And real quick, if you’re struggling with any kind of mental illness or disorder,
there’s absolutely no shame in reaching out. Getting professional help was one of the best
decisions I ever made, and I do highly recommend talking to a therapist, even to those who think
they are perfectly healthy. Thanks for watching, and I’ll see you next time.