Understanding OCD: It’s not just liking things orderly

Have you ever joked that you’re “so OCD” because you like things a certain way or are exceptionally tidy? If so, your “witty” comment may be at the expense of someone who has a serious and often debilitating mental health disorder.

“Liking things a certain way is a preference, not OCD,” says Anna Morgan, LCSW, a therapist with the Cognitive Behavioral Therapy Program at Sharp Mesa Vista Hospital.

Obsessive-compulsive disorder (OCD) is driven by distressing, intrusive thoughts or obsessions that create anxiety, often around a specific fear or value, Morgan explains. The compulsive behaviors or mental compulsions that follow — like cleaning a kitchen counter 10 times a day – aren’t done for enjoyment or preference, but to relieve anxiety or prevent a feared outcome.

“For example, someone might think, ‘If I don’t clean this counter again, my family might get sick and die.’” Morgan says. “The compulsion temporarily reduces their fear, but the cycle keeps repeating and gets more intense.”

Common OCD themes

According to the International OCD Foundation (IOCDF), common OCD obsessions are related to:

• Contamination — Fear of coming into contact with perceived contaminated substances

• Violence or harm — Fear of acting on an impulse to harm oneself or others

• Responsibility — Fear of being responsible for something terrible happening

• Perfectionism — Fear of making mistakes or having things out of order

• Sex — Unwanted thoughts or mental images related to sex

• Religion or morality — Fear of offending God or doing something immoral

• Identity — Excessive concern with one's sexual orientation or gender identity

• Relationships — Excessive concern about the status of personal relationships

“While there isn’t necessarily one type of OCD that we see most often, we do tend to see certain themes show up more in higher levels of care, like the Cognitive Behavioral Therapy Program,” Morgan says. “Typically, when an obsession is tied to the safety of self or others, the symptoms can feel especially urgent or distressing. Because of that, we often see harm OCD and contamination OCD more frequently.”

In her private practice, Morgan says she sees a wide range of OCD themes. “OCD can really attach to anything a person cares deeply about, which is part of what makes it so challenging and diverse in how it shows up,” she says.

Compulsions are the actions and thoughts a person with OCD engages in to relieve distress related to obsessions or to prevent bad outcomes. These may include excessive washing and cleaning, checking, repeating routines, specific prayers, counting and seeking reassurance.

The OCD cycle of obsessions followed by compulsions can make a person’s day-to-day functioning deeply challenging.

Is it OCD?

If you’re concerned that your thoughts or behaviors may be signs of OCD, Morgan recommends asking yourself, “What would happen if I didn’t do this behavior or ritual?”

If the answer feels extreme or irrational, like “Something terrible will happen to me or someone I love,” but emotionally, feels impossible not to act on it, she says that could be a sign the thought is OCD-driven.

It’s then essential to seek care. The first step would be to talk with your doctor about your concerns and discuss how you can access a thorough assessment and appropriate treatment from a therapist who specializes in OCD.

“The IOCDF website is a great resource for finding trained providers,” Morgan says. “It’s important to really understand the OCD cycle — how obsessions create anxiety, and compulsions temporarily relieve the anxiety but keep the cycle going.”

Treating OCD

Exposure and response prevention (ERP), a form of therapy that helps people gradually face their fears without engaging in compulsions, is what Morgan calls the “gold-standard treatment” for OCD. “It’s challenging work but highly effective,” she says.

Medication can also help manage symptoms. In fact, the IOCDF reports that people with OCD who take OCD medication regularly and as directed by their doctor typically see their OCD symptoms reduced by 40% to 60%.

If you notice signs of OCD in another person, Morgan recommends approaching them with compassion and curiosity. Avoid minimizing their experience or offering reassurance, which can unintentionally feed the OCD cycle.

Instead, Morgan suggests gently sharing resources and assuring them. Let them know that even if you don’t completely understand their experience, you recognize it’s difficult for them and believe in their ability to engage in the treatment that can help them heal.

“OCD is treatable,” she says. “With the right support, people can reclaim their lives.”

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