What is Obsessive-Compulsive Disorder (OCD)?

OCD is a term you’ve likely heard before. It’s frequently used by people to describe their preferences for cleanliness, particular ‘quirks’ they might have or specific rules — “I’m a bit OCD about this...”, “Oh you are so OCD!”. In movies and TV shows, characters with OCD are often depicted as eccentric, or their symptoms are played for laughs. Unfortunately, using this term incorrectly or lightly can be problematic for those who actually do suffer from Obsessive Compulsive Disorder (OCD), as it can perpetuate misunderstandings about the disorder and trivialise their experiences. The light-hearted portrayals of OCD in media can also create an impression that OCD is a harmless personality quirk, rather than a serious mental health condition that can significantly impair a person’s quality of life.

 what is OCD?

OCD stands for Obsessive Compulsive Disorder, a mental health condition characterised by intrusive, unwanted thoughts, images or impulses (obsessions) and repetitive behaviours (compulsions or rituals) that a person feels driven to perform. These obsessions and compulsions take up at least 1 hour each day (sometimes > 8 hours); cause high levels of distress and can impact functioning across all life areas. The World Health Organisation once rated OCD in the top 10 most disabling illnesses, which gives you an idea of the impact this disorder can have on an individual’s life. 

Many people tend to associate OCD with contamination fears, including worries about germs or catching a specific illness. However, there are many other themes of intrusive thoughts that people with OCD might struggle with, which can be just as distressing and disruptive to their lives.

What are some common obsessions of OCD?

Common obsessions include concerns about contamination, illness, symmetry, harm to oneself or others, and taboo thoughts or impulses. Some examples could be: “What if I get sick from touching that?”, “Maybe I didn’t lock the door”, “What if I hit someone while driving and I don’t remember?”, “What if I blurt out something inappropriate?”.

Some examples of compulsive behaviours include excessive cleaning, hand-washing, checking, ordering and mental rituals (anything people think or perform in their mind to try and feel better). Compulsions typically serve to try and avoid the feared thoughts or scenarios, or act as a form of reassurance. For example, someone with obsessive concerns of catching an illness might avoid settings they deem as risky (e.g., crowds, public bathrooms) or they might try and gain reassurance from rituals such as googling different symptoms or checking themselves for signs of sickness. While these rituals are performed with the aim to feel better, feel sure, or to feel safe, they end up only feeding back into the cycle of OCD and making the symptoms worse. Individuals with OCD will typically find themselves performing more and more rituals over time; becoming increasingly preoccupied with the intrusive thoughts, which then also become more elaborate and more frequent over time.

What are some key characteristics of OCD?

A key characteristic of OCD is that the obsessive thoughts are often what we call “ego-dystonic” thoughts.

Ego-dystonic thoughts, images or impulses are inconsistent with a person’s self-concept or values, they go against how a person views themselves. These thoughts are often experienced as unwanted, and it’s for this very reason they can cause so much distress. Examples of ego-dystonic thoughts in OCD can include thoughts of harming others (including children or loved ones), sexual thoughts including violent or graphic images, and thoughts around religion, morality, and ethics.

People with OCD may experience intense guilt or shame about these thoughts, or fear they may act upon them, even though they are not consistent with true beliefs or desires. Unfortunately, this is why many people with OCD will delay seeking help as they may believe they are responsible for their thoughts, or believe their thoughts reflect their true selves, even if they know the thoughts are irrational or unwanted. People with OCD commonly fear they will be judged or misunderstood for their symptoms and sadly these fears contribute to individuals not getting the help they deserve.

What does OCD treatment look like?

CBT-Exposure and Response Prevention (ERP) therapy is the first line and standardised psychological treatment for OCD. As the name suggests, ERP involves helping people to gradually expose themselves to the things that trigger the OCD, and then preventing or reducing the compulsive behaviours over time.

This therapy helps people to learn that the intrusive thoughts do not have to be taken so seriously and further that they can cope with the anxiety, or discomfort, or doubt, without giving in to compulsions. Evidence has shown that ERP can be effectively delivered in person and online.