Take a Minute to Consider These Questions

• Are you frequently late because you must check the stove eight or nine times to ensure it’s off before leaving your house?  
• Do you wash your hands often, trying to get them clean, but never really feel they are?  
• Are you unable to throw anything away because you think it may be useful at some point in the future?  
• Do you become worried that you will somehow lose control of your behavior and hurt someone, even though you never have?  
• Do you perform a verbal or physical ritual that you feel helps ensure that people you are close to stay healthy and safe? 
• Do you find it hard to let go of certain thoughts, finding them so intrusive and persistent that you cannot get other important tasks done? 

 If you answered yes to any of these questions, you may suffer from OCD – or obsessive-compulsive disorder. This illness is not rare; it affects at least four million adults in the United States and is the fourth most common psychiatric illness in this country.

How Can OCD Impact Your Life?

OCD is a disorder that is often progressive and can become crippling. Some OCD sufferers never leave their homes because of the various rituals they need to perform. Others can’t function at work because they spend so much time secretly engaged in various rituals. 

Many obsessive thoughts and rituals are completely mental, not physical, so the illness can be almost invisible to everyone close to the person affected.   

As the name suggests, OCD has two parts: obsessions and compulsions.  Many people suffer from obsessions only, but a good number eventually develop compulsions.

Obsessions

Obsessions are the thoughts, ideas, or impulses that repeatedly well up in the mind of the person with OCD. They may feel a need to do things almost too perfectly, an unreasonable concern about becoming contaminated by germs, or a persistent fear that harm may come to themselves or loved ones.

Compulsions

Compulsions are the behaviors that are done in reaction to this thinking, usually to try to gain some control over the uncontrollable. Following a behavioral routine gives the sufferer temporary relief through a false belief that the ritual can ensure that something unwanted will not happen. 

Usually, the person with OCD is fully aware that their thinking is irrational, but this does little to stop the behavior.  The obsessions and compulsions often lead to an unbreakable cycle including severe anxiety.

When is OCD a Problem?

Most people experience obsessive thoughts or compulsive behaviors at one time or another, but the actual disorder of OCD is not present until the thoughts and rituals have become dominant features in their lives and some aspect of the person’s work, family, or social life is affected.  

Once the full criterion is met, OCD will often not go away, and therapy is needed before there are irreversible effects on a person’s social, academic, or work life. 

The good news about OCD is that it has a very positive prognosis – OCD is very easily overcome through therapy.  Most therapists use what is called cognitive behavioral therapy to bring about relief from OCD symptoms. Clients learn to monitor their thoughts and recognize the connection between their thinking, feeling, and behavior.

The therapist acts as a “behavioral coach” and often gives a lot of homework between sessions. Progress can be slow, but gradually clients learn to separate their thoughts from their behaviors. Once behavior changes even a little bit, there is a strong likelihood that things will get much better sooner than later. You’ll come away with a toolbox you can use to manage your symptoms in real time!

The bad news is that the isolation, embarrassment, and self-loathing caused by OCD can prevent some people from seeking help. They may be afraid that their thoughts or compulsions are so “crazy” that they’ll get laughed at or labeled as strange.  

 Find a Therapist

If you suspect you are suffering from OCD, consider finding a therapist. Be confident that they know that this problem is unpreventable and biological, just like an allergy or sight impairment.  You don’t have to be a prisoner of OCD.

The combination of therapy, sometimes along with medication, usually provides effective treatment. You can make a life-changing decision by recognizing the problem and having the courage to seek help. 

 You are not alone if you suffer from OCD, even though you may suffer in silence. Therapy can truly help and give you the resources to stave off relapses should they begin to come on in the future.

In fact, cognitive behavioral therapy often provides tips and techniques you can use to manage many kinds of anxiety, so it can often have lasting effects beyond OCD.

Dr. Alan Jacobson is a Licensed Psychologist who has been in practice for over 20 years. He has helped many adolescents and adults who suffer from OCD and other challenges with anxiety.  

The GoodTherapy Registry might be helpful to you. We have thousands of therapists listed with us who would love to walk with you on your journey. Find the support you need today.  

By Gary Trosclair, DMA, Licensed Clinical Social Worker

Do you really have OCD? Or is it OCPD?

OCD has become a household term we casually use to refer to anyone who needs to have things a certain way. As a casual term, it works well. It gives us a general sense of what’s being described. But if it’s used as an actual diagnosis to determine therapeutic treatment, it can cause problems. People who we might casually say have OCD may actually have a different condition, and the differences between these conditions call for a different approach to treatment.  

OCD, Obsessive-Compulsive Disorder, may look similar at first to a different condition, OCPD, Obsessive-Compulsive Personality Disorder, which is often overlooked and even misdiagnosed by clinicians. But OCD is an anxiety disorder, while OCPD is a personality disorder.

Diagnostic Difficulties

Far fewer people have OCD than have OCPD: 1.2% of the population has OCD,[1] while as much as 7.9% has OCPD.[2]   

About 20% of the people who have OCD also have OCPD,[3] making it difficult to distinguish between the two. And both diagnoses can be either severe or less-debilitating. Many people have some traits of Obsessive-Compulsive Personality Disorder but do not meet the full diagnostic criteria. These individuals can be very productive and fairly well-adapted socially.

Proper diagnosis should be completed by a licensed mental health professional. But following are some fundamental differences that may help you to better understand yourself in either case.

Symptoms: Specific vs. Generalized

People with OCD have specific obsessions (thoughts that are intrusive, involuntary, repetitive, irrational, and anxiety-provoking) and specific ritualistic compulsions (repetitive behaviors they can’t stop, such as checking and washing). On the other hand, the entire personality of someone with OCPD is affected by an overwhelming need to prioritize control, perfectionism, and order.

While people with OCD may try to control very particular things in order to quiet their obsessions, people with OCPD tend to be controlling universally. It’s as if the space they need to control is much larger. It’s not just the cupboards, it’s their entire world, and they can become very rigid about it.

Emotional Differences

People with OCD are more likely to feel anxious when specific things aren’t the way they want them to be. People with OCPD are more likely to feel angry if things aren’t the way they believe they should be.  

For instance, Angie, who suffers from OCD, is concerned about how the dishes get washed because she feels anxious if they aren’t absolutely clean.

But Arthur, who suffers from OCPD, insists that the correct thing is to have the entire house in order all the time. People with OCPD may justify their efforts to control by trying to prove that their way is the right way. They feel that they are trying to do the right thing to make life better for everyone, and their efforts can be helpful. But in many cases, they may become rigid in their actions, and, contrary to their motivations, they can make things more difficult for others.

People with OCD don’t necessarily restrict their emotions. However, they do try to control their thoughts (which can range from mildly uncomfortable to very disturbing) by doing compulsive things, such as repetitive and ritualistic cleaning and checking. 

But people with OCPD often try to control their emotions as well as their environment. They’re known for delaying gratification. They often give priority to their work, neglecting relationships and their own wellbeing. The emotions they are most aware of are anger, frustration, and resentment. They are more reluctant to be vulnerable than those with OCD, and may not even be aware of any underlying anxiety.

Angie gets anxious if the top is off the toothpaste tube because she fears germs. Arthur gets angry because it’s wrong to leave it off.

Shame or Pride about Their Condition

People with OCD don’t like their obsessions and compulsions and willingly seek help.

People with full-blown OCPD, because they try so hard to live their lives according to moral principles, are very proud of the way they live and don’t understand that they have a disorder. They tend to seek help only when forced to do so by a partner or when they become so depressed from trying to live with such demanding standards that they can’t go on that way any longer.

Motivations

People who have OCD are motivated to stay safe and to prevent catastrophes. People with OCPD are more motivated by rules and perfectionism. While they may justify their control by pointing to possible catastrophes, their underlying motivation often has more to do with wanting to avoid chastisement, blame, or failing to fulfill their responsibilities.

People with OCD are more clearly motivated to relieve their anxiety. While people with OCPD may also have underlying anxiety or a fear of being abandoned, their conscious concern is that they want to be respected rather than criticized.  

Behavioral Differences

While people with OCD may often behave in an insecure way because of their obsessions and compulsions, people with OCPD may become domineering, trying to hide their insecurities from themselves and others.  

People who have OCD spend much of their time in compulsive rituals such as cleaning and organizing. People with OCPD spend more time planning and working.

OCD efforts are usually maladaptive, except insofar as it helps them to maintain good hygiene. In contrast, some OCPD traits can be adaptive in a practical way, allowing them to succeed in the outer world, even if it makes them very unhappy. Because they are very conscientious, meticulous, energetic, and committed, they can make significant contributions in many fields, from art to public service to accounting. Most successful performers and athletes are compulsive to some degree.

Differences Among Compulsive Personalities

There are wide variations in the degree of unhealthiness among people with compulsive personalities, based on how controlling, perfectionistic, and rigid they are. Some, who don’t technically have OCPD but only have some compulsive traits, have very few maladaptive symptoms and can be very helpful in planning, organizing, and getting things done.

And there are wide variations in the style of compulsive personality: some are domineering, some are workaholics, some are compulsive people-pleasers, and others are so obsessive about getting things just right that they can’t get anything done.

Treatment

There is significant research to demonstrate that targeting the specific symptoms of OCD, as short-term Cognitive Behavioral Therapy (CBT) does,[4] can be effective for treating OCD.

There is far less research regarding the treatment of OCPD. In fact, according to psychologist and researcher Anthony Pinto, “there is no empirically validated gold standard treatment for OCPD.”[5]

However, there is reason to believe that approaching OCPD treatment by targeting specific symptoms may not be as effective as it is for OCD because of the pervasive nature of personality disorders. OCPD may benefit from a longer course of treatment in psychodynamic or expressive therapy.[6] This approach can help the individual to understand the possible benefits of their inherent personality style and to understand how those same traits can turn destructive when taken to extremes. Psychodynamic therapy can help them develop a better relationship with their emotions and use their need for control and perfectionism in a healthier way.

Getting to the Root Causes of OCPD

The causes of OCPD include genetic, environmental, and dynamic factors. These dynamic factors include the strategy the individual unconsciously adopted to cope with their particular combination of inherited traits and family situation. We can refer to these dynamic factors as old tapes, triggers, complexes, schemas, or patterns that they play out unwittingly, as if they were still living in the past with their families.

Attempting to treat the systemic, unconscious, and underlying character organization of OCPD by targeting just its external manifestations may not shift the underlying causes.

For example, some compulsives cope with their anxiety by externalizing, by getting those around them to do what they think should be done so that they feel safer. Other compulsives cope by internalizing, by taking too much responsibility on themselves and becoming people-pleasers to avoid a feared abandonment.

In most cases, people with OCPD feel a great need to prove themselves, and they attempt to do so with perfection, order, and control.  

Whatever the underlying dynamic, a therapeutic experience that gives the individual a chance to identify their specific coping strategy by seeing their old tapes play out in session with a therapist can be very effective. Does the client try to control the therapist? Does the client try to control his own emotions in session? Do they try to prove to the therapist that they are ethically good? This process often requires patiently developing awareness of emotions and the capacity to tolerate them in session, rather than reacting to them by trying to control themselves or the therapist.

The Potential Benefits of Compulsive Personality

If your basic character style is compulsive by nature, you won’t be able to change that. But you can begin to use your natural meticulousness, conscientiousness, and tendency to plan in a healthier, more conscious way that works well for you and the people around you. This can’t happen if efforts to change includes only trying to eradicate symptoms.  

I have referred to anxiety and a need for respect as motivations for the individual with OCPD. But on an even deeper level, they are motivated by a desire to help, plan, and repair in ways that can benefit everyone. Finding that original motivation can equip the OCPD sufferer with insight and direction, which can help them to heal and to be more helpful to those around them.

Footnotes

[1] National Institute of Mental Health website. Obsessive-Compulsive Disorder. https://www.nimh.nih.gov/health/statistics/obsessive-compulsive-disorder-ocd.shtml. Retrieved 12.23.20.

[2] Burkauskas, J. F., Naomi. (2020). History and Epidemiology of OCPD. In J. E. Grant, Anthony Pinto, Samuel Chamberlain (Ed.), Obsessive-Compulsive Personality Disorder (pp. 1-16). Washington, D.C.: American Psychiatric Association Publishing.

[3] Mancebo, M. C., Jane L Eisen, Jon E. Grant, Steven A. Rasmussen (2005). Obsessive Compulsive Personality Disorder and Obsessive Compulsive Disorder: Clinical Characteristics, Diagnostic Difficulties, and Treatment. Annals of Clinical Psychiatry, 17(4), 197-204. doi:10.3109/10401230500295305

[4] Foa, Edna B. (2010). Cognitive behavioral therapy of obsessive-compulsive disorder. Dialogues in Clinical Neuroscience. Jun; 12(2): 199–207.

[5] Pinto, A. (2020). Psychotherapy for OCPD. In A. P. Grant JE, Samuel R. Chamberlain (Ed.), Obsessive-Compulsive Personality Disorder (pp. 143-178). Washington, D.C.: American Psychiatric Publishing.

[6] Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98-109. doi:10.1037/a0018378

To find a therapist in your area who can help you work through the concerns in your life, click here.

Editor’s note: Gary Trosclair, DMA, LCSW is a private practice psychotherapist and Jungian analyst in New York City and Westchester County, New York. His continuing education presentation for GoodTherapy, titled “The Healthy Compulsive: Treating Obsessive-Compulsive Personality Disorder,” will take place on March 27, 2020 and is eligible for two CE credits. This event is available at no additional cost to Premium and Pro GoodTherapy Members (Basic Members and mental health professionals without membership can view this event live for $29.95). Learn more and register here.

If your partner is controlling, rigid, perfectionistic, and preoccupied with work and orderliness, they may have OCPD, or obsessive compulsive personality disorder. While even many therapists are unfamiliar with this diagnosis, it’s the most common personality disorder found in the United States, at a rate of about 7.9% of the population (Sansone & Sansone, 2011).

But it’s also the most unrecognized (Koutoufa & Furnham, 2014).

OCPD vs. OCD

Many people, even clinicians, confuse OCPD with OCD, obsessive compulsive disorder. While there is some overlap in symptoms, OCD is significantly different and is characterized by more specific problems such as repetitive hand-washing, locking and unlocking doors, the need to have everything clean and orderly, and intrusive thoughts.

People with OCPD, on the other hand, have issues that affect the entire personality. And this can have a more devastating impact on relationships.

One of the defining distinctions between OCD and OCPD is that people with OCPD tend to be good at delaying gratification—often too good.

One of the defining distinctions between OCD and OCPD is that people with OCPD tend to be good at delaying gratification—often too good. To understate the case, they’re not typically known for being fun-loving.

The Continuum of Compulsive Personality

Many people have just traits of OCPD, not full-blown OCPD. That is, they may struggle in some of the ways that people with OCPD do but don’t meet all of the criteria for the diagnosis. In fact, compulsive traits are found on a continuum—from healthy and adaptive to unhealthy and maladaptive, from conscientious and productive to rigid and destructive.

Partners with a compulsive personality style can be loyal, hard-working, reliable, productive, meticulous, conscientious, and dependable.

Still, even people who have just some traits of OCPD can be difficult to live with. They may insist on having things their way because they’re convinced their way is the right way. They can be very critical and domineering. They may emphasize work over relationships. And they can get so caught up in rules and schedules that they lose the point of whatever they’re doing.

For instance, they may often forget the point of a vacation. They tend to keep working the whole time and are prone to getting upset when things don’t go exactly as planned.

OCPD and Relationships

The same can be said for how people with OCPD handle their relationships. Doing things right can become more important than being happy together. As someone who frequently writes about OCPD, much of the correspondence I receive comes from partners of people with OCPD asking desperately for advice about how to live with them.

You can’t always work out relationships with people who have full-blown OCPD. If they refuse to go to individual therapy or couples therapy if they are unwilling to acknowledge that their life is out of balance, and if they don’t take responsibility for how they treat you, there may be little you can do but protect yourself.

Improving a Relationship with an OCPD Partner

Some relationships with OCPD partners can improve. Their compulsiveness can be enlisted in the service of the relationship.

But in this article, I want to focus on what partners of individuals with OCPD can do to improve the relationship.

In order to jump-start that process, you may need to consider that they don’t cause all the problems on their own. Conflict in relationships is most often an issue of fit and chemistry. And there are two sides to every story. As people with high levels of compulsiveness can become very adamant about being right, it can be hard not to get caught up in the same approach. This can lead to defending yourself rather than seeing what you might do differently to help the relationship get back on track.

Getting out of “right and wrong” thinking will probably take initiative on your part. And if you see that you have some role in the conflicts, you have more power to start the process of change.

Even if you don’t have a role in the problems, you may be the one who needs to instigate change. It’s not fair. But it just may be the reality of your situation.

Keys to Change in OCPD Relationships

Here are some things you can do if you want to stay in the relationship and try to make it work.

I will address these in three separate categories: how you see and treat your partner, how you communicate with your partner, and how you take care of yourself. Any one of these keys will probably not be enough in itself to initiate change. However, the three together can make a significant impact on the quality of your relationship.

Perspective

• Despite how they come across, your partner likely wants to do the right thing. When they become mean and rigid, it’s often because their anxiety is very high. This insecurity can lead them to be defensive. Work, perfection, control, and rules may be their way to try to protect themselves against shame.
• Do what you can to lower their anxiety, which could in turn help them lower their demands.
• Ask yourself if you play any role in their anxiety. If they feel they have to be responsible for getting everything done, they are likely to become angry and resentful because they may fear they won’t get it right, and they will be blamed.
• Reflect on whether you’ve allowed a situation to develop in which you allow them to do most of the work or take most of the responsibility because it’s easier for you. This would not be obvious, conscious, or intentional on your part. But it may still be part of the equation.
• Appreciate what they do well and tell them about it. Notice what their temperament contributes to the relationship, such as being loyal, reliable, conscientious, and hardworking.

While it may have become skewed, the original intention of their rules was likely to make things safe for people.

Communication

• Reassure them that they don’t have to be perfect, and point out how their perfectionism is hurting them.
• Let them know the effect they have on you with “I” statements (not “you” statements). People with OCPD tend to be so consumed with getting projects done and with doing them in a particular way that they may lose track of the effect they have on others.
• Ask them to attend couples therapy with you. Remind them that therapists are cheaper than divorce attorneys.
• Encourage them to go to individual therapy for their own benefit. They’re probably hurting themselves living the way they do. Find a way to describe this that will not raise their defenses. (Hint: Telling them they have obsessive compulsive personality disorder or that they are a “control freak” probably won’t help. Telling them they are “driven,” a “workaholic,” or “type A personality” might work.)
• Set appropriate boundaries. Just because they feel that the house should be vacuumed every day doesn’t mean you have to do it.

Self-Care

• Partners of people with OCPD often have a sense of being “under” the person with OCPD, of being dominated by them. While this is often an accurate assessment, if you can recognize that it is their anxiety that leads to their need to control and that they actually need what you have to offer them, you may be able to get out from “under” them and forge a more equal relationship.
• Reflect on whether your own personality style (e.g. easygoing, people-pleaser, or submissive) makes it difficult to be on more equal terms. If you don’t own your power, your partner will.
• Remember that despite the way they act, they still have a need for love, and probably a need for a connection with you. There is likely something you have that they lack and need from you—humor, kindness, sensitivity, generosity, or the ability to loosen up and play.
• Protect yourself and find support with family, friends, groups, and a therapist. If your own personality style makes you vulnerable to their domination, it will be especially important to get support in shifting the balance in the relationship.

While some relationships with partners who have OCPD may not be viable, others can improve with psychotherapy and a different approach from you, their partner. This will take heroic initiative on your part, but it may be worth it.

References:

1. Koutoufa, I., & Furnham, A. (2014, January 30). Mental health literacy and obsessive–Compulsive personality disorder. Psychiatry Research, 215(1), 223-228. doi: 10.1016/j.psychres.2013.10.027
2. Sansone, R. A., & Sansone, L. A. (2011). Personality disorders: A nation-based perspective on prevalence. Innovations in Clinical Neuroscience, 8(4), 13–18. Retrieved from www.ncbi.nlm.nih.gov/pubmed/21637629

“I need to go organize my planner. I’m so OCD.”

“I’m obsessed with color-coding my pens and ordering my books by size and color. That’s my inner OCD talking.”

OCD, short for obsessive compulsive disorder, is a widely misunderstood condition. It has become synonymous with a quirky preoccupation with order. Television characters such as Monk use their apparent OCD like a superpower that helps them solve crimes, see things other people can’t, and access a superior form of consciousness. Needless to say, these stereotypes are not an accurate depiction of OCD.

Turning OCD into a joke or superpower can trivialize the lived experiences of people with the condition. OCD affects about 2% of Americans at some point during their lives. Symptoms can be a source of embarrassment and fear. They can also interfere with daily life.

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When myths drown out the voices of people with OCD, this diagnosis can be stigmatized. Jokes can be hurtful to people with OCD. They may create false expectations in family and friends. Stigma may even deter people from seeking treatment.

Top 10 Myths About OCD

So if OCD isn’t a quirk or crime-solving skill, what is it? Below are 10 common myths and the facts to debunk them.

Myth #1: OCD is a mental superpower that can make you a brilliant doctor, detective, or inventor.

Fact: OCD is not a superpower. It often gives a person racing, uncontrolled thoughts rather than superhuman logic.

In movies and television, people with OCD have laser-sharp focus on tiny details. This helps them work harder and smarter. It is true that some people with OCD focus on unusual details. This is because of the anxiety that drives OCD—not a mental superpower.

OCD involves recurring, intrusive thoughts called obsessions. These obsessions may cause someone to worry about details other people would ignore. Someone with OCD often tries to control their obsessions with mental or physical rituals (compulsions).

For instance, a parent may worry constantly about their child getting into an accident. To calm themselves down and control their thoughts, the adult performs a compulsion. This behavior could be checking door locks or rearranging toys to be exactly symmetrical.

These actions can feel irresistible. Those who try to resist compulsions may feel overwhelming panic. Intrusive thoughts may make it difficult to focus on outside tasks until the compulsion is complete. Compulsions and panic attacks can both consume a person’s time.

People with OCD can be brilliant and often thrive in various careers. Yet “genius” is not a feature of OCD. In many cases, OCD is an impediment to success for an otherwise brilliant or capable person.

Myth #2: All people with OCD obsess about cleaning.

Fact: Cleaning is just one of many OCD-related compulsions.

Many people with OCD have fears of contamination. They may worry about getting sick or exposing themselves to germs. To relieve these fears, some people with OCD compulsively wash their hands, use sanitizing sprays, or clean their homes to excess.

People with OCD engage in compulsions to reduce anxiety caused by obsessions. Not all people with OCD have obsessions about cleanliness. In fact, the DSM-5 does not even list fears of contamination as diagnostic criteria for OCD. Research from 2010 found compulsive checking, not cleaning, is the most common symptom of OCD. Among study participants, 79.3% reported having a checking compulsion at some point in their lives. Meanwhile, only 25.7% of participants reported contamination symptoms.

People with OCD may even be messy. The same 2010 study found 14.4% of people with OCD engage in compulsive hoarding. Someone who hoards collects objects without throwing anything away. A person who hoards likely has a disorganized home.

Some people with cleanliness obsessions only fear certain types of contamination. They may fear using public restrooms but be fine with a dirty car.

Likewise, not all people who fixate on cleanliness have OCD. Other diagnoses—such as mysophobia, a fear of germs—can also cause people to fixate on cleanliness. In many cases, a desire for a clean or organized space is merely a personality trait or a way to manage stress. Cleanliness often has nothing to do with OCD or any other diagnosis.

Myth #3: Someone with OCD will have the same obsessions their entire life.

Fact: The themes of OCD symptoms can change over time.

People with OCD engage in compulsions to reduce anxiety caused by obsessions. Both compulsions and obsessions can change with time.

The underlying emotions—fear and anxiety—remain the same even as symptoms shift. In most cases, a person with OCD continues to experience fears across a common theme. Age, culture, and life experiences can affect these themes.

For example, a 12-year-old with OCD may be plagued by thoughts of their parents dying. At 25, that same person may fear the loss of their spouse. The specific worry has changed, but the underlying fear (losing a loved one) has not. The compulsive behaviors used to reduce anxiety can also shift.

Myth #4: Bad parenting causes OCD.

Fact: A complex interaction of factors cause OCD. Bad parenting is rarely the cause.

Like most mental health conditions, OCD is a complex diagnosis with many potential causes. Research suggests OCD often has a strong genetic component. If a person has a parent or sibling with OCD, they are twice as likely to have OCD themselves. Environmental factors such as trauma can also contribute to obsessions and compulsions.

Typical parenting—even when it’s imperfect—does not cause OCD. Using daycare services or gentle discipline will not cause obsessions or compulsions. Parents do not need to blame themselves for their child’s OCD. Attempts to blame a parent can undermine treatment by making both the parent and child feel guilty.

While typical parenting does not cause OCD, abuse might. People with a history of trauma and neglect are more likely to be diagnosed with OCD. Therapists who treat OCD may wish to ask about a person’s experiences with abuse. When a child with OCD is living in an abusive home, treatment may require removing the child from the home.

Myth #5: OCD only shows up in privileged people who have too much time or too few problems.

Fact: OCD exists across cultures, classes, genders, and ethnicities.

OCD appears in cultures across the world (although some symptoms are more common in different nations). In the United States, OCD has roughly the same prevalence rate across ethnicities. It is slightly more common in women than men.

People with higher social classes may be more likely to be diagnosed with OCD. This is less because they are more likely to have OCD and more because they face fewer barriers to mental health care. People with less resources can experience more risk from potential stigma and thus avoid getting help.

Myth #6: If people with OCD understand their actions aren’t rational, they’ll stop doing the compulsions.

Fact: Many people with OCD already understand their actions don’t have a “logical” basis.

Compulsions are a way to temporarily alleviate anxiety. Most people with OCD realize their actions are irrational and won’t prevent a tragedy. Instead, compulsions often serve to reduce anxiety about obsessions. In other words, someone with OCD may do a compulsion because they believe it is easier than enduring their intrusive thoughts.

Many mental health conditions cause people to behave in ways that seem illogical from the outside. Pointing out that a behavior is irrational does little to help. Criticizing a person with OCD for being “irrational” may make them ashamed or self-conscious. The person may become reluctant to discuss their symptoms further. Stigma is often a barrier to mental health treatment.

Myth #7: People with OCD are nit-picky and controlling.

Fact: OCD is a mental health condition, not a personality trait.

People with OCD struggle to and control their own thoughts and emotions. Their compulsions are an outward manifestation of this struggle. A person may try to control their environment in order to do compulsions.

OCD is a mental health diagnosis. Describing OCD as a personal quirk or a joke ignores the very real needs of people with this condition.

For example, a person with OCD might rearrange furniture to address their symmetry obsession. Another person might slow down a group tour because they’re busy counting bricks. Such behaviors do not come from a desire to control others. They come from a person’s desire to control themselves.

A similar-sounding diagnosis, obsessive-compulsive personality (OCP), does manifest as a fixation on control and order. In OCP orderliness and perfectionism can become a person’s most visible traits. They may fixate on rules to the point that they do not complete tasks. People with OCP may struggle to cooperate with others who don’t share their strict standards.

People with OCD have a wide range of personalities. Some are stubborn and controlling with others. Other people with OCD are easy-going around others and strict only with themselves.

Myth #8: It’s obvious when people have OCD.

Fact: Compulsions are not always visible to others.

Not all compulsions are visible. Mental compulsions include behaviors done within one’s mind. They may include praying, counting, repeating a phrase, or avoiding specific thoughts. A person who seems distracted to others may be very focused on mental compulsions.

Even when a person’s compulsions are physical, others may not see them. People with OCD often feel ashamed of their symptoms. They may avoid doing compulsions in public, even if the delay causes intense anxiety.

Myth #9: People with OCD are dangerous.

Fact: People with OCD are not any more likely to commit crimes than anyone else.

People with OCD often have intrusive thoughts which appear seemingly without cause. Sometimes, these thoughts are about a forbidden act. For instance, a religious person may have intrusive thoughts about cussing inside a house of worship. Another person may worry about injuring a loved one.

People with OCD often feel guilt and shame for having these thoughts. Even if they have no intent of doing these actions, they may worry about “losing control.”

Yet people with OCD are no more likely than others to hurt people or commit crimes. In many cases, obsessions stem from a desire to protect others. Intrusive thoughts cause distress because they often go against deeply-held morals.

Research consistently shows people with mental health diagnoses, including OCD, are over 10 times as likely as the general population to be crime victims. People with mental health diagnoses commit only 3-5% of violent crimes. Those with OCD are only a fraction of that statistic.

Myth #10: OCD will never get better.

Fact: OCD is very treatable.

It’s true that OCD probably won’t get better on its own. People with OCD can’t think or will their way out of their feelings and compulsive actions. Yet there are many treatments that can help with both obsessions and compulsions. These include:

• Psychotherapy: Therapy can help a person with OCD understand why they have intrusive thoughts. It can also help people reduce their anxiety.
• Cognitive behavioral therapy (CBT) teaches people to recognize automatic thoughts and counteract them. People may also learn how intrusive thoughts affect their behavior.
• Exposure therapy exposes a person to something they fear in manageable doses until the fear becomes less potent.
• Relaxation techniques: Relaxation can help people with OCD resist their compulsions. When obsessions cause less anxiety, the urge to do compulsions often fades.
• Group Therapy: Some people find talking to others with OCD helps them feel less alone. Group therapy can offer people social support and reduce stigma for intrusive thoughts.
• Medication: Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), may help with symptoms of OCD. People with OCD may need a higher dose than people with depression.

Some people with OCD may wish to combine multiple treatments. A mental health professional can help someone create a comprehensive treatment plan for their unique needs.

The Problem with Saying “I’m OCD” When You Know You’re Not

OCD is a mental health diagnosis. Describing OCD as a personal quirk or a joke ignores the very real needs of people with this condition. Consider some reasons not to use OCD as a joke:

• Symptoms which may look funny or quirky from the outside may be a big source of stress for the person experiencing them. A “harmless” joke may unknowingly use a person’s suffering for amusement.
• You never know someone else’s history. A person with OCD may hear the joke and wonder if you really feel that way about people like them.
• OCD jokes create false perceptions about OCD. Stereotypes can make it harder for people with OCD to recognize their symptoms and get help.
• Jokes about mental health can promote stigma. Stigma is linked to discrimination and can be a barrier to treatment.

What if You Think You Have OCD?

It is very difficult to accurately diagnose OCD over the Internet. If you think you have OCD, you may wish to find a therapist. A professional can determine whether your symptoms represent OCD or another condition.

People who have OCD symptoms likely need treatment. A self-diagnosis will not give you access to that. If you think you have OCD, you can contact a family physician or mental health provider for help.

References:

1. Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
2. DSM-IV and DSM-5 criteria for the personality disorders [PDF]. (2012). American Psychiatric Association. Retrieved from http://www.nyu.edu/gsas/dept/philo/courses/materials/Narc.Pers.DSM.pdf
3. Mental Health Myths and Facts. (n.d.). Retrieved from https://www.mentalhealth.gov/basics/mental-health-myths-facts
4. Obsessive-compulsive disorder: Overview. (n.d.) National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml
5. Obsessive-compulsive disorder: When unwanted thoughts or irresistible actions take over. (n.d.). National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/publications/obsessive-compulsive-disorder-when-unwanted-thoughts-take-over/index.shtml
6. Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2010). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry, 15(1), 53-63. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797569
7. Simpson, S. B. (2017, October 17). Obsessive-compulsive disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis. Retrieved from https://www.uptodate.com/contents/obsessive-compulsive-disorder-in-adults-epidemiology-pathogenesis-clinical-manifestations-course-and-diagnosis
8. Treatments for OCD. (n.d.). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd/treatments-for-ocd
9. Williams, M.T., Chapman, L.K., Simms, J. V., & Tellawi, G. (2017.) Cross-cultural phenomenology of obsessive-compulsive disorder. In The Wiley Handbook of Obsessive Compulsive Disorders, (pp. 56-74). DOI: 10.1002/9781118890233.ch4