When people think about OCD, the focus typically lands on the stereotypes: handwashing, organizing, or needing things to feel “just right”. OCD has become slang, everyday language used to describe someone who’s neat and tidy. It’s laughed off as a silly rigidity someone may have, or just someone who is particularly detail oriented. However, the true struggles that exist within OCD are often overlooked and underrecognized.
What are Obsessions?
Obsessions that exist in OCD go beyond what a layman’s definition may be. Obsessions are intrusive, unwanted thoughts, images, urges, or visuals and images that intrude in someone’s mind (International OCD Foundation). They are often deeply uncomfortable and target the things a person cares about or values the most. They are not a true, honest reflection of the person who is experiencing them, even though they are persistent.
Common obsessions include:
- Fear of harming yourself or other
- Anxiety and worries about contamination or illness
- Extreme violet or sexual thoughts
- Intrusive doubts about morality or character
- Intense uncertainty about actions, thoughts, or emotions
Why are Obsessions so Distressing
You and I likely experience uncomfortable or distressing thoughts from time to time. I know my distressing thoughts often occur if I’ve been cut off in traffic, or when I have to pay $18 for a single movie ticket. They’re annoying and maybe a bit rude, but they generally don’t cause any harm. The difference between those thoughts and obsessions is the way the brain responds to them. In a brain without OCD, it’s easy to brush them off as a fleeting thought. In an OCD brain though, these obsessions are seen as threats (International OCD Foundation).
Intrusive thoughts come with questions like “What if this thought means something about me?” Or “What if I act on this thought?” Or “What if this thought never goes away?” For individuals suffering from OCD, these obsessions are rarely just rain that passes, but entire storms that envelop the mind. The reaction to these obsessions often creates shame, guilt, or anxiety (Singh et al., 2023). The brain wants relief and certainty, which can be nearly impossible in obsessions based on “what ifs”.
Where do Compulsions Come in?
Compulsions are used to provide that relief from the feelings obsessions cause, designed to neutralize or escape the distress. They do not look the same for everyone, with some being mental and some visible. People often recognize the visible compulsions first, things like handwashing and organizing to be “just right,” but the mental compulsions, things like reassurance seeking or repeating phrases, are just as prevalent for people trying to escape obsessions (Singh et al., 2023). Most people do not choose their compulsions because it’s not about preference, it’s about relief.
Compulsions reduce anxiety for a moment, giving the brain something else to focus on besides the distressing obsession. However, this creates a vicious cycle where the mind is being taught to continue to fear obsession (Cleveland Clinic). It’s how OCD tightens its grip: obsession leads to anxiety, which is temporarily relieved by a compulsion and reinforces the idea that the obsession should cause anxiety.
The Quiet Form of OC
Sometimes, it’s difficult for individuals to recognize that they may have OCD because their obsessions and compulsions don’t follow the stereotypes they’re given. Mental obsessions without a direct compulsion, taboo thoughts, or constant doubt often go unnoticed or categorized as general anxiety, even going as far as to viewing them as moral failings or personality flaws.
People struggling with this quiet form may believe people will judge them if they tell or that because they’re having the thought, something is wrong with them. In reality, the opposite is true. People with OCD find these obsessions so distressing because it goes against values and morals that they care deeply about. It’s a reflection of how much they care, not who their character is.
Treating The OC
Effective OCD treatment focuses on changing the relationship with intrusive thoughts, not necessarily trying to eliminate them. Approaches like Exposure and Response Prevention (ERP) and Acceptance and Commitment Therapy (ACT) help individuals learn that thoughts don’t require action, certainty, or control (Cleveland Clinic).
I’ve found that helping individuals recognize their values and morals through ACT allows them to understand why these obsessions are so uncomfortable. When I’ve used ACT and ERP in tandem, it’s clear to see that addressing the compulsions must first start with understanding the obsessions. The goal isn’t to get rid of the “OC,” but to stop letting it run the show.
OCD goes beyond just a silly quirk; it’s a disorder rooted in fear and uncertainty, not preference. Understanding the OC helps reduce shame, challenge stigma, and move the conversation beyond jokes about neatness.
