OCD Myths: Debunked

OCD is an extraordinarily misunderstood illness with the general public assuming it’s something it’s not (and discrediting its seriousness in the process). This misunderstanding is due to the misconceptions about the illness (of which there are many).

Some of the most common include:

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People Who Say They’re “So OCD” Have OCD

Most people with OCD don’t go around advertising it and, instead, hide their thoughts and compulsions from others. People who experience the tabooer types of OCD (such as Harm OCD or Pedophilia OCD) may experience intense shame about their disorder, further compounding their secrecy.

As a result, those who profess that they’re “so OCD” tend to be people who prefer organization, like tidiness, or want things a certain way. This is not a result of a mental disease but fallout from their innate personality or their natural preference for things. In order for someone to have OCD, their compulsions must be based on anxiety (not preference) and they must interfere with the person’s life and ability to function. OCD does not simply annoy or irk a sufferer; it tortures them.

The problem with the “I’m so OCD” statement is that it minimizes a serious disorder, links it to cleaning or organization as a rule (when it may or may not involve these things) and paints it as something it’s not. This perpetuates misinformation and leads to more problematic misinterpretations about the condition.

OCD is a Quirk or Cute

OCD, especially when it comes to its portrayal in movies and TV shows, is sometimes characterized as quirky or cute. It may be depicted as something that makes people favor a certain number or knock three times before walking through a doorway. Usually, sufferers are shown to be neurotic in a way that is humorous and harmless.

However, off the Hollywood screen, OCD is no laughing matter. It’s not a personality trait or a personal preference; it’s a mental illness. Rather than being a once-in-a-while or minor thing, OCD is a life-interfering and time-consuming disorder that is highly disabling. The disorder is marked by frequent, terrifying, and egodystonic thoughts that startle the sufferer and detailed, lengthy, and laborious rituals aimed at controlling the anxiety.

But performing the rituals once, twice, or seventeen times isn’t enough for OCD, which is why sufferers engage in cycles of obsessions and compulsions: Once isn’t enough to sate the endless doubt.

An OCD cycle goes as follows: The sufferer experiences an intrusive thought (for example, they may touch a faucet in a public restroom and then fear they touched someone else’s blood). As a result of this intrusive thought, they’ll wash their hands thoroughly (they may use scalding water or bleach).

After washing, the sufferer will experience a momentary sense of relief but it’s always short-lived. The anxiety comes back eventually, either because the sufferer engages in another triggering act (such as touching something else that they perceive as contaminated) or because of the fear that they didn’t perform their original compulsion thoroughly enough (they may question if they washed their hands adequately enough to move all possible contaminants, for example).

The end result is an illness that controls the sufferer’s life.

OCD is Always About Cleanliness

Many people assume that OCD involves a preference for organization or cleanliness. This is thanks in part to Hollywood and compounded by self-diagnoses among people who don’t have OCD. But OCD has nothing to do with how someone wants things and is instead a neurobiologically-based mental illness that involves intrusive, egodystonic, and terrifying thoughts (obsessions) that cause intense anxiety and compulsions (rituals) the sufferer engages in as an attempt to modulate their discomfort.

Sometimes, people with OCD suffer from Contamination OCD, which manifests as a preoccupation with organization and cleanliness. This preoccupation is not based on preference but fear. Someone with Contamination OCD does not spend three hours cleaning every inch of the kitchen because they like it when their house sparkles; instead, they do it because they think if the kitchen isn’t perfectly cleaned that something bad might happen to a loved one or their child might eat a toxin off the floor and die.

But Contamination OCD is only one type of OCD. There are several other types that have nothing to do with organization or cleanliness and people who suffer from other flavors of OCD may be messy or full-on slobs. Or they may be clean because they simply enjoy cleanliness.

For example, someone with Scrupulosity OCD may suffer from a fear of yelling obscenities inside a church or intrusive thoughts about having sex with Jesus – this is their OCD. They may also enjoy a tidy house – this is unrelated to their OCD. Sometimes, people may suffer from more than one type of OCD, such as Contamination OCD and Scrupulosity OCD. In these instances, cleaning reflects OCD (when it’s done compulsively and due to anxiety). But Contamination OCD must be present in order for that to be the case.

In sum, OCD, regardless of how its symptoms manifest, is about anxiety, fear, and distress and not a desire to have wrinkle-free sheets on the bed or all the cans in the pantry organized by food group.

Some of the confusion regarding the above is the result of people mixing up Obsessive Compulsive Disorder (OCD) with Obsessive Compulsive Personality Disorder (OCPD). OCPD is a personality disorder that involves a need for order, neatness, rigidity, and perfectionism. Unlike OCD (which is marked by anxiety), OCPD is marked by the need for control and the desire to have things a specific way. People with OCPD don’t believe they are doing anything wrong and tend to force their standards onto others. They take a “my way or the highway” approach and may have a hard time forming or maintaining relationships because of this.

These disorders are often confused, likely because of their similar names. Anyone who maintains an extremely organized or clean household because they enjoy their things in a particular order is more likely to have OCPD than OCD. While someone like this saying “I’m so OCPD” is not accurate (as OCPD is much more complicated than that), it is more accurate than “I’m so OCD.”

People with OCD are Germaphobes

OCD sufferers may be fearful of germs if they suffer from Contamination OCD, a type of OCD that focuses on cleanliness, communicable disease, viruses, bacterium, and carcinogens. But only about a third of people with OCD have Contamination OCD; the rest have other “flavors.”

In truth, an OCD sufferer can have OCD about anything (including whether or not they’re actually alive or they really have OCD). In addition to Contamination OCD, some of the most common subtypes include:

  • Harm OCD: The OCD sufferer experiences intrusive thoughts about harming others.
  • Self-Harm OCD: The OCD sufferer experiences intrusive thoughts about harming themselves.
  • Scrupulosity OCD: The OCD sufferer experiences intrusive thoughts about disappointing God, going to Hell, or thinking about God, Jesus, or the Virgin Mary (or other religious figures) in ways that are inappropriate.
  • Sexual Orientation OCD: The OCD sufferer experiences intrusive thoughts about their sexual orientation, leaving those who are straight to fear they are gay and those who are gay to fear they are straight.
  • Pedophilia OCD: The OCD sufferer experiences intrusive thoughts about sexual aggression, molesting children, or inappropriately touching children (either accidentally or intentionally).
  • Existentialism OCD: The OCD sufferer experiences intrusive thoughts that they’re not living in reality or that they might not exist.
  • Relationship OCD: The OCD sufferer experiences intrusive thoughts that their relationship will end.
  • Health-Anxiety OCD: The OCD sufferer experiences intrusive thoughts about their health, believing – for instance – that a slight headache is the sign of a tumor and requesting an MRI to check.

The point is that OCD is much more complex than a fear of germs and, while some sufferers do possess a fear of germs, others don’t care about germs any more than the general population.

Not only that, but people can be afraid of germs without having OCD. Mysophobia (a term for germaphobia) is present in people in the absence of OCD (though those with OCD are at higher risk of developing it). Some people may have mysophobia because of specific phobias, past traumas, or the way they grew up. For example, someone whose parents were especially messy may appreciate cleanliness in a way others do not.

The big difference between someone with mysophobia (without OCD) and someone with mysophobia (with OCD) is that regular germaphobes clean to get rid of germs. Those with OCD clean to get rid of anxiety. Someone without OCD will likely stop scrubbing and wiping once whatever they’re cleaning is clean. Someone with OCD is never sure it’s “really” clean, which is why they engage in repetitive and compulsive behavior even after the threat (i.e., the germ) is long gone.

OCD is Caused by Potty Training or Dominant Child Rearing

It was once believed that OCD was a result of potty training, especially if the child was subject to a dominating or controlling parent. However, that has now been proven to be a myth with parents not culpable in the development of OCD other than through the genes they pass down.

While the exact cause of OCD remains elusive, scientists and doctors believe it’s a combination of genetics, structural abnormalities in the brain, and problems with communication among certain parts of the brain. Lower-than-normal levels of specific neurotransmitters (serotonin and dopamine) influence the disorder as well.

Things like abuse, trauma, and environment can play a role in OCD but typically the sufferer also has a preexisting disorder or a genetic predisposition or susceptibility. Even so, it’s possible to develop OCD without a genetic predisposition just as it’s possible to evade it when a predisposition exists.

Behavioral conditioning, while not the cause of OCD, plays a role in whether the disorder truly takes hold. The compulsions OCD sufferers engage in (i.e., the behavioral conditioning) effectively lock in the disorder by teaching the sufferer that their rituals reduce anxiety (although their compulsions worsen their anxiety and the disorder in the long run). Without engaging in this conditioning, OCD may never truly manifest.

People with OCD Aren’t Aware They’re Being Irrational

Unique to many other mental illnesses, people with OCD understand that they’re acting illogical. While they react to their intrusive thoughts – performing compulsions as a way to moderate their anxiety – they don’t believe in those intrusive thoughts entirely. In other words, deep down they know they’re being irrational. The problem is that OCD demands 100% certainty – even if the sufferer is 99% sure that their thoughts aren’t real, the remaining 1% leaves enough anxiety to cause them to doubt reality and engage in rituals just in case. It is this never-ending doubt that perpetuates the OCD cycle.

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OCD is Limited to Specific Demographics

There is occasionally a misconception regarding what demographics are affected by OCD with some erroneously believing that affluent people are most impacted. In reality, OCD transcends cultures, genders, and ethnicities, appearing essentially equal among different people from different walks of life.

Still, some of the misconception around affluency is understood because people from higher income levels may be more likely to be diagnosed with OCD since they don’t face accessibility or financial barriers to proper mental health care.

There is also a discrepancy among cultures and genders in regard to the willingness to seek therapy. For instance, Asians may be less likely to seek it than Caucasians and men may be less likely than women, resulting in a lower diagnosis rate. As the stigma around mental illness changes, this will hopefully change as well.

OCD is an Obvious Disorder

Because so many make the mistake of thinking that OCD is always defined by washing or compulsive organizing, people believe it’s an obvious disorder. Sometimes, compulsions are clear and it’s apparent that the person with OCD is in distress or engaging in a ritual. But this isn’t always the case.

On one hand, OCD sufferers are extremely clever and good at hiding their compulsions from their loved ones. They may engage in them in a way that makes it look as though they’re engaging in everyday behavior. In addition to this, OCD compulsions might not always be physical; some people engage solely in mental compulsions. This type of OCD – Pure O OCD – involves compulsions such as mentally counting, praying, or thinking “good” thoughts, words, or numbers. Pure O is entirely invisible to onlookers.

Many people with OCD have both physical and mental compulsions, alternating between them to reduce their stress.

People with OCD are Violent

Some subsets of OCD may involve thoughts that are violent in nature. Harm OCD, for example, can involve intrusive thoughts around running over pedestrians, smothering children, or pushing an elderly lady down a flight of stairs. Pedophilia OCD can involve intrusive thoughts around molesting children or behaving in a sexually inappropriate manner.

But these thoughts are not fantasies (not even deep down, subconscious ones); rather, they are entirely egodystonic, which means they go against the sufferer’s genuine character, their true nature, and their real desires. That is why OCD latches onto these areas: To torment and terrify the sufferer.

People with Harm OCD or Pedophilia OCD are not any more likely to commit violent acts than the general population. In fact, because they are so disgusted by these thoughts, so afraid of them, and feel so much guilt because of them, OCD sufferers are actually less likely to be violent. Many people with these types of OCD have issues expressing anger because they’re so tormented by their thoughts.

Despite its portrayal in pop culture and in the news media, mentally ill people, on the whole, are far, far more likely to be victims of violent crime than perpetrators of it. According to the US Department of Human Services, only between 3-5% of violent crimes in the nation are committed by those with a mental illness. This number is so low that crime experts have repeatedly said that mental illness isn’t really a factor in violence in the country.

Everyone’s a Little Bit OCD

Similar to the “I’m so OCD” statement uttered by people who don’t have OCD, the idea that everyone is a little bit OCD minimizes the disorder as well. It’s akin to suggesting that everyone is a little bit bipolar because they suffer from the good and bad moods brought on by everyday life.

In order to be diagnosed with OCD, intrusive thoughts and compulsions must cause extensive interference with the sufferer’s life. Those with OCD face significant impairment and disability without treatment, making it worlds apart from those who may be somewhat irked by a crooked picture frame or a bathroom sink filled with globs of toothpaste.

OCD is Common

Despite neat freaks labeling themselves “so OCD” or the propensity for people to claim they’re “so OCD” because they don’t like when someone drinks from their soda can, OCD is not a very common illness.

In the US, only about 2.3% of the adult population is diagnosed (and 1 in 100 children). This makes OCD less common than social anxiety disorder, PTSD, bipolar disorder, clinical depression, and eating disorders.

OCD Stays the Same

OCD is not often a disease that stays the same. By a rule, it ebbs and flows in terms of severity, usually worsening in times of stress and transition. It’s a progressive disease, which means it grows more severe overtime (at least without treatment).

But the above isn’t the only way it evolves. The content of the obsessions and compulsions can change over time too. For instance, someone with Contamination OCD may fear that using public restrooms will expose them to communicable diseases when they’re younger. Once they reach adulthood and become sexually active, they may begin to obsess about sexually transmitted diseases rather than – or in addition to – public restrooms.

In addition, the subtype of OCD can change. Someone with Contamination OCD may develop Harm OCD or Relationship OCD or another subtype. They may then have co-occurring subtypes or one may trump the other.

OCD isn’t Treatable

OCD is not a curable disorder but it is treatable. With proper treatment, sufferers can live relatively normal lives. A combination of medication and therapy is typically used during treatment. Medication doesn’t act as a cure-all but is instead designed to make therapy easier. Usually SSRIs, which increase serotonin, are used first but tricyclic antidepressants and off-label medication may be used alternatively.

 

Some of the medications that are prescribed include:

  • Lexapro
  • Prozac
  • Luvox
  • Zoloft
  • Celexa
  • Paxil
  • Cymbalta
  • Pristiq
  • Effexor
  • Anafranil
  • Risperdal
  • Haldol
  • Tramadol
  • Seroquel
  • Zyprexa
  • Abilify
  • Valium
  • Xanax
  • Buspar
  • NAC
  • Ketamine

Medication doesn’t work for everyone as some people have genetics that change their level of responsiveness. Ultimately, about 70% of people experience some relief with meds. When it does work, it must be combined with therapy in order for treatment to be most effective.

The types of therapy used include:

Cognitive Behavioral Therapy with Exposure Response Prevention (ERP): This is considered gold standard treatment and involves the sufferer exposing themselves to their intrusive thoughts (i.e., obsessions) and then refraining from engaging in their rituals (i.e., compulsions). While this is very hard for the sufferer to do (as it causes all sorts of anxiety), when completed successfully, ERPs take power away from the OCD thoughts, reducing symptoms in the process.

Acceptance and Commitment Therapy (ACT): While ERP is the preferred treatment, ACT is used too (and increasingly so). In ACT, the sufferer is encouraged to accept their intrusive thoughts without judgement or reaction. They may be encouraged to picture their thoughts on billboards, televisions, or in books as a diffusion trick.

Mindfulness Techniques: Mindfulness may be combined with ERP therapy because of the regulation and relaxation it offers. Sufferers might be encouraged to engage in yoga and meditation as well.

Group Therapy: Individual therapy is usually used for OCD but group therapy is helpful for some. It can offer sufferers emotional support, normalize their experiences, and hold them accountable when they practice ERPs.

All Therapists are Qualified to Treat OCD

The misconceptions surrounding OCD are not limited to laypeople and unfortunately seep into the clinical world as well. As a result, many therapists treat OCD even though they are not professionally trained in it.

If the OCD sufferer has less stereotypical OCD symptoms (aside from the handwashing, cleaning, or organizing that is well known), this can prove especially problematic. If the sufferer has Harm OCD, Self-Harm OCD, or Pedophilia OCD, a lack of understanding on the clinician’s part can leave the sufferer traumatized, dealing with the police, questioning their character, and considering (or committing) suicide.

For example, it is not unheard of for people with Harm OCD to have their children taken from them because a clinician erroneously believes their intrusive thoughts reflect intent or desire. It is not unheard of for people with Self-Harm OCD to be hospitalized against their will because a clinician erroneously assumes they are genuinely suicidal. And it’s not unheard of for people with Pedophilia OCD to be labeled “pedophiles” by clinicians who don’t truly grasp the nature of OCD and the egodystonia it involves.

The above means that anyone with OCD must choose their therapist carefully. A therapist who lists OCD as a condition they treat should only do so if they have specific training in the disorder and, ideally, sufferers should look for therapists who specialize in OCD. The International OCD Foundation’s directory of providers lists clinicians by zip code or city who have completed the necessary education.

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