Do you really have OCD, or is it something else?

“I can’t sleep without turning the light on and off three times. I’m OCD!”

“I hate the colour yellow, it’s my OCD coming out.”

It’s such a common turn of phrase that most of us aren’t aware that obsessive-compulsive disorder (OCD) is really a psychiatric disorder. It’s characterised by obsessions and compulsions, which mean that unwanted ideas, thoughts, impulses and images repeatedly play on the mind and manifest in your behaviour at times.

What is OCD is NOT…

  • Being organised and methodical about everyday routines and having set habits is NOT obsessive-compulsive disorder.
  • Washing your hands every time you go the bathroom is not OCD; that’s just good hygiene.
  • Having a few quirky personality traits.

People with OCD may be obsessed with cleaning for example, but it’s not an “enjoyable” obsession. Their obsession doesn’t make them happy; rather it causes stress and anxiety – very different from simply washing your dishes before bedtime. As explained by the International OCD Foundation, “If it’s a personality trait, you have control — you can choose to do it or not. If you have obsessive compulsive disorder, you’re doing it out of unrelenting debilitating necessity.”

Some of us might find it annoying when a picture frame is skew, or we would get stressed when dishes aren’t packed in a certain way. However, someone with OCD is so plagued by this stress, that they cannot function without controlling these parts of their environment.

What causes OCD?

OCD is an anxiety disorder. There’s no single, proven cause of OCD. Research shows that it can stem from genetic and environmental factors. The simplest explanation is that OCD is related to faulty communication between the front part of the brain (the orbital cortex) and deeper structures (the basal ganglia). These brain structures use serotonin, a neurotransmitter (chemical “messenger” between nerve cells). Another theory is that OCD involves various autoimmune reactions (in which the body’s disease-fighting mechanism attacks normal tissue). Evidence to support this is that OCD sometimes starts in childhood in association with strep throat.

Am I at risk for OCD?

OCD is common, affecting up to three percent of people, but as it’s not linked to stress or psychological issues, it’s hard to predict who might be vulnerable. It’s likely that OCD can occur along with depression and bipolar affective disorder; manic depression.

OCD usually involves obsessions and compulsions, although in rare cases, one may be present without the other.

  • Obsessions are defined as recurrent and persistent thoughts, impulses or images that you feel unable to control or prevent. You will usually experience these as senseless, disturbing and intrusive, and try to ignore or suppress them. Obsessions are often accompanied by anxiety, fear, disgust or doubt.
  • Compulsions on the other hand, are defined as repetitive and ritualistic behaviour or mental acts, often performed according to certain “rules”.
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Common obsessions:

  • Worrying excessively about dirt or germs and that you may become contaminated or contaminate others.
  • Imagining you’ve harmed yourself or others; having doubts about safety issues (if you’ve turned off the stove).
  • Fearing something terrible will happen or that you will do something terrible.
  • Preoccupations with symmetry, or a need to have things “just so”.
  • Intrusive violent or repulsive images.
  • Excessive religious or moral doubt or guilt; intrusive blasphemous images.
  • Excessive doubting or indecision: “Should I, Shouldn’t I?”
  • A need to tell, ask or confess.

Common compulsions:

  • Washing or cleaning, showering repeatedly or washing your hands until the skin is red and painful.
  • Repeatedly checking the doors, windows, and so on.
  • Repeating, such as repeating a name or phrase many times to ease anxiety.
  • Completing; performing a series of steps in an exact order or repeating them until you feel they are done perfectly.
  • Repetitive ordering, arranging or counting of objects.
  • Hoarding, collecting useless items you may repeatedly count or order.
  • Excessive and repetitive praying.
  • Repetitive touching.

OCD tends to be underdiagnosed. Because of the stigma of mental illness, people may hide symptoms and avoid getting help. People with OCD may also be unaware that they have a recognisable and treatable illness. Unfortunately, there are no laboratory tests for OCD; diagnosis is based on an assessment of your symptoms. Your doctor will ask you, and often people close to you, about your symptoms, and pose specific questions about the type of obsessions or compulsions you experience. Your doctor will also check that a medication or drug is not making your symptoms worse.

Getting help

Combining antidepressant medication and cognitive behavioural therapy (CBT) has been found to be the most effective treatment for OCD. Both kinds of treatment may take a few months to be effective, but a good response is often seen in time. If you suspect you have OCD, it’s worth having a talk with your doctor. Don’t simply think of it as quirky habits. OCD is stressful, and can really impact the quality of your life. Get help, sooner than later.