We’ve all heard people casually attribute certain behaviors to “being OCD.” But are perfectionism, attention to detail or extreme neatness really signs of obsessive-compulsive disorder?
It all depends on how much these actions affect your daily life, says Erica Morris, licensed clinical social worker at BlueCross BlueShield of Tennessee.
“Obsessive-compulsive disorder is a condition that revolves around unwanted, intrusive thoughts that cause anxiety and distress,” she says. “These obsessions trigger compulsions, or behaviors intended to quiet that anxiety but which actually prolong the cycle.”
What is the clinical definition of obsessive-compulsive disorder?
Morris: Obsessive-compulsive disorder is a severe, chronic form of anxiety that interferes with daily activities. While many people experience anxiety, in order to be classified as obsessive-compulsive disorder, it must be so extreme that it consumes a lot of time and impairs the daily activities of life.
OCD has two components:
- Obsessions: Recurrent intrusive thoughts, images or urges that cause anxiety or distress, which drive a person to perform
- Compulsions: Repetitive mental acts or behaviors that are intended to bring a sense of “completeness,” but only if done according to rigid, self-imposed rules
OCD vs. obsessive-compulsive personality disorder
Morris: It’s important to understand that OCD is different from “being obsessed” with something, and from obsessive-compulsive personality disorder (OCPD).
“Being obsessed” with shoes or music or food is a figure of speech. While you may enjoy the thing you’re “obsessed with,” true obsession from OCD indicates a preoccupation with something that’s so intense and unhealthy that it disrupts your life and causes distress.
If you suffer from obsessive-compulsive personality disorder, you may feel:
- An overwhelming need for order
- A need to adhere rigidly to rules and regulations
- An unwillingness to yield or share responsibilities with others
- A sense of righteousness about the way things “should be done”
Most people with OCPD don’t think anything is wrong with them, and they may even experience success in work or school due to their fixation with perfection. Often they only seek treatment once OCPD hurts their interpersonal relationships, at which point medication, therapy and relaxation treatments may help.
What are the signs of obsessive-compulsive disorder?
Morris: The signs of OCD can be broken into obsessions and compulsions.
Common obsessions include:
- Contamination: Fear of germs, body fluids, environmental or household contaminants
- Losing control: Fear of horrific images in the mind, harming oneself or others, stealing or blurting out obscenities
- Responsibility for harm: Fear of causing something terrible to happen by not being careful enough (starting a fire, spilling something someone will slip on)
- Perfection: Concern about exactness, having all the information or throwing things away that you might “need” later; Inability to complete a task when their own overly strict standards are not met; Fixating on small details to the extent that the main point of an activity is lost
- Unwanted sexual thoughts: Perverse sexual thoughts (incest, pedophilia)
- Religious concerns: Offending God, blasphemy, being overly preoccupied with morality
- Other: Sexual orientation, fixation on getting a disease (cancer), extreme superstition
- Washing and cleaning: Excessive hand washing, showering, grooming, cleaning
- Checking: Checking that nothing terrible happened, that you didn’t make a mistake, that everything’s okay with your body and your loved ones, etc.
- Repeating: Rereading, rewriting, tapping, doing activities in multiples (3 times) or repeating routine activities (opening and closing cabinets)
- Mental: Reviewing or praying to prevent harm, counting to end on a “right” number, hoarding money for future disasters
- Other: Arranging things until they “feel right,” confessing things to get reassurance, avoiding situations that might trigger obsessions
When does OCD typically start?
Morris: OCD often starts in the late teens or early twenties — the average age of onset is 19 — and lasts throughout a person’s life. A quarter of cases occur by age 14, and 1/3 of adults with OCD first experience symptoms in childhood.
Are some people more likely to have OCD?
Morris: OCD affects more than 2 million adults in the U.S., or roughly 1%. OCD is equally common among men and women. It’s caused by genetics (a family history of the disease) as well as environmental factors such as a stressful event in the teen years (a loved one passing, the COVID pandemic, etc.).
OCD can occur in children who have a history of streptococcal infections and develop antibodies that adversely impact brain functioning. Their treatment may involve plasmapheresis, a procedure that removes the problematic antibodies from the blood. Children who have OCD may exhibit the same symptoms as adults, as well as:
- Separation anxiety
- Anorexia or disordered eating
- Urinary frequency
- Handwriting difficulties
OCD is also common in people who have:
- Anorexia (both conditions are related to control)
- Tourette Syndrome
- Bipolar disorder
What’s the best way to get help for OCD?
Morris: OCD isn’t something you can handle on your own, but there are many helpful treatment options:
- Talk to a therapist, mental health specialist or social worker.
- They may suggest cognitive behavior therapy (CBT), which can help you learn to identify and change your negative thought patterns, including exposure response prevention (ERP). ERP works well for OCD because it exposes people to distressing situations and teaches them how to deal with them rather than running away.
- There are also medications, such as serotonin reuptake inhibitors (SRIs), that have proven very effective in treating OCD.
If you’d like to help a loved one who may be struggling with OCD, encourage them to find a mental health professional trained in treating OCD. Educate yourself on the disorder, urge them to try to live life as normally as possible, and help them embrace uncertainty along the way.
Get more information about specific health terms, topics and conditions to better manage your health on bcbst.com. BlueCross BlueShield of Tennessee members can access wellness-related discounts on fitness products, gym memberships, healthy eating and more through Blue365®. BCBST members can also find tools and resources to help improve health and well-being by logging into BlueAccess and going to the Managing Your Health tab.