Remember the hit TV show Friends? Monica Geller, played by Courteney Cox, is often seen obsessively cleaning and organizing her apartment. While her character is meant to be funny and endearing, we recognize that this portrayal can contribute to misconceptions about obsessive-compulsive disorder (OCD).
Think about the last time you saw someone meticulously checking that the door was locked or washing their hands repeatedly. You might have heard someone say, “You’re so OCD!” But OCD isn’t just about being overly tidy or having a preference for order. It’s a complex mental health disorder that involves intrusive thoughts and compulsive behaviours that goes far beyond common quirks or habits.
What causes OCD?
Despite advances in research, there is no single cause that can be pinpointed. Instead, it’s believed that a combination of neurological, behavioral, and environmental factors contribute to the development of OCD.
Genetics is one piece of the puzzle. OCD is known to run in families, and studies show that having a first-degree relative with the disorder increases the risks. But genetics alone don’t account for all cases of OCD. Brain scans reveal differences in the brain structures and how people with OCD process anxiety and regulate behavior, hinting at deeper neurological factors at play. Yet, even these insights don’t offer a complete explanation.
Life experiences and environmental factors add another layer of complexity. Stressful events, major life changes, or trauma can trigger or worsen OCD symptoms, especially in those already genetically predisposed. Behavioral theories show that compulsive behaviors can develop as a way to reduce anxiety, creating a cycle that’s hard to break. This connection between genetics, brain chemistry, and environmental influences is why it’s misleading to say we know exactly what causes it.
Here are five common misconceptions about OCD to better understand the reality behind this often-misunderstood condition.
01
People with OCD Obsess Over The Same Thing
While some people with OCD do get stuck in repetitive cycles, it’s not true that their obsessions stay fixed on the same issue forever.
OCD is highly individualized, and the nature of a person’s obsessions and compulsions can evolve. A person might start with one set of fears, like contamination, and later develop worries related to safety or even religious beliefs. This shift can be influenced by various factors, including stress levels, life changes, or new experiences. For example, a person who was once preoccupied with arranging items symmetrically might find themselves later fixated on the fear of causing harm to others, leading them to repeatedly check if they locked the door to prevent an intruder from entering. This change in obsessions doesn’t mean the OCD has gone away, rather, it shows how the disorder can evolve, with different fears taking center stage depending on what’s happening in their life.
02
There’s Just One Type of OCD
When people think of Obsessive-Compulsive Disorder (OCD), they picture someone who is obsessed with cleanliness—constantly washing their hands or meticulously organizing their belongings. This narrow view is widespread and reinforced by media portrayals that focus on these visible behaviors. OCD manifests in various forms and mental rituals. It’s a disorder that can latch onto almost any thought or fear.
Imagine someone who can’t stop thinking about whether they accidentally harmed someone or might harm someone in the future, intentionally or not. These distressing thoughts can lead the person to engage in compulsive behaviors, such as repeatedly and mentally reviewing their day to make sure they didn’t hurt anyone. Some individuals might have compulsions that involve hoarding (another form of OCD) or collecting items, fearing that discarding something could lead to catastrophic consequences.
Another scenario might involve someone who needs to arrange their belongings in a very particular way—not because they care about neatness, but because it “feels right” or helps them avoid a sense of impending doom. For example, they might have to place their keys exactly parallel to the edge of the table, and if it’s not perfect, they might have to redo it several times. To an onlooker, this might seem odd, but for the person with the condition, it’s a way to manage their anxiety. This form of OCD doesn’t involve cleanliness or order, but it’s just as real and debilitating. There are also people with OCD who struggle with fears about religious beliefs, sexual thoughts, or the safety of their loved ones, which can also lead to compulsions like repetitive praying, avoiding certain people or places, or excessive reassurance-seeking.
03
OCD is a Character Trait
Labeling OCD as a character trait diminishes the real struggles faced by those who actually live with the disorder. People with OCD aren’t just being picky or overly meticulous, as Dr. Elizabeth McIngvale, assistant professor in the Menninger department of psychiatry and Behavioral Science, puts it, “with OCD, it is something that individuals don’t enjoy—there’s nothing they like about it, they are doing it because they feel like they have to in order to get rid of the intrusive thought or fear. It is debilitating and draining and not something that makes the individual feel better and more productive when they are done.”
A person with OCD, for example, might spend hours checking locks or washing their hands, not because they want to but because of an overwhelming fear of contamination or intense need to do so. This level of anxiety and the compulsions that come with it are far more severe than simply liking things clean.
Moreover, reducing OCD to a character trait can prevent those who need help from seeking it, misunderstanding as just a personality quirk could make people feel embarrassed or think they don’t need professional treatment. In reality, OCD is a treatable condition.
04
OCD Can’t Be Treated
OCD may be a chronic condition that’s challenging to manage, that doesn’t mean there are no effective treatments available to take control of their condition and improve their quality of life. Cognitive-behavioral therapy (CBT), particularly a specific type known as exposure and response prevention (ERP), has been shown to be highly effective in reducing OCD symptoms. ERP involves gradually exposing individuals to their fears and teaching them to resist the urge to engage in compulsive behaviors. With consistent practice and support, many people with OCD see significant improvements in their symptoms.
Medication can also play a crucial role in managing OCD. Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, are commonly prescribed to help reduce the severity of obsessive thoughts and compulsive behaviors. For some people, combining medication with therapy provides the best results. And you might need to work closely with a healthcare provider to find the right treatment plan, as what works for one person might not work for another. Ongoing research continues to explore new treatment options, offering hope for even more effective solutions in the future. While OCD may not be curable, it is certainly manageable, and those affected can find relief and support through appropriate treatment.
05
Anyone With Intrusive Thoughts Has OCD
False. Intrusive thoughts are a normal part of the human experience and can happen to anyone. According to a 2014 study in Science Direct, 94 percent of people have at some point.These thoughts can be unsettling, disturbing, or just plain odd, but having them occasionally does not mean someone has OCD.
What differentiates those with OCD?
Someone who is just having an intrusive thought can tell themselves it’s a silly or odd thought and dismiss it, whereas someone with OCD experiences the intensity and the cycle of these thoughts and the compulsive behaviors they feel compelled to perform in response to them. These thoughts can be all consuming that it can stream into their daily activities, leading to anxiety and distress.
Obsessions are persistent, unwanted thoughts, urges, or images that cause anxiety or distress. Compulsions are repetitive behaviors or mental acts that an individual feels driven to do in response to an obsession, in order to reduce anxiety or prevent a feared event. It’s this ongoing cycle that differentiates OCD from simply having occasional intrusive thoughts.
While intrusive thoughts can be a symptom of OCD, they are not exclusive to it. Other conditions, such as anxiety disorders, depression, and post-traumatic stress disorder (PTSD), can also involve intrusive thoughts. Understanding this distinction is crucial for providing appropriate support and treatment. Mislabeling someone as having OCD simply because they experience intrusive thoughts can lead to misunderstandings and inappropriate treatment strategies.
Can OCD Be Properly Diagnosed?
When it comes to diagnosing OCD, it’s not as simple as noticing a few odd habits. According to The National Institute of Health (NIH), therapists look for specific signs to see if a person has persistent obsessions and compulsive behaviors that interfere with their day to day activities and social life. But having a random intrusive thought now and then isn’t enough to diagnose someone with OCD.
Getting an accurate diagnosis is challenging, not just because of the difficulties many people face in accessing mental healthcare. The National Institute of Health notes that it can take, on average, between 14–17 years for someone to be properly diagnosed and start getting the right treatment. Some people might hide their symptoms, making it harder for therapists to grasp, while others might be misdiagnosed. Even though brain scans can show differences in the brains of people with OCD compared to those without it, a brain scan alone can’t confirm a diagnosis. As noted by Christopher Pittenger from the Yale School of Medicine, brain scans can give doctors some insights, but they’re not enough to determine if someone has OCD. In fact, many people with OCD have brain scans that look completely typical.
While brain scans can provide useful information, they aren’t enough to make a diagnosis on their own. In fact, many people with OCD have completely normal brain scans.
If you’re concerned you might have OCD, it’s best to see a trained therapist who can properly evaluate and diagnose the condition. Trying to diagnose yourself using online searches alone won’t give you the accurate answers you need.
