Having obsessive compulsive disorder (OCD) isn’t easy. The condition, marked by uncontrollable thoughts and behaviors, strikes about 2% of the general population—a figure that in the U.S. alone means nearly 6.5 million people. If you’ve made it past young adulthood without developing any symptoms, you’re likely in the clear.
You wouldn’t know that to hear people talk, however. In recent years, OCD has become the psychological equivalent of hypoglycemia or gluten sensitivity: a condition untold numbers of people casually—almost flippantly—claim they’ve got, but in most cases don’t. Folks who hate a messy desk but could live with one for a day do not necessarily have OCD. Nor do those who wash their hands before eating but would still have lunch if there was no soap and water nearby. Yet the almost sing-songy declaration “I’m so OCD!” seems to be everywhere.
Some of the confusion is understandable. The Diagnostic and Statistical Manual (DSM)—the field guide to psychological conditions—lists OCD among the anxiety disorders, and nearly everyone has experienced anxiety. The thing is, though, you’ve experienced headaches, too, but that doesn’t mean you know what a migraine feels like unless you’ve had one. Same with the pain of OCD, which can interfere with work, relationships and more.
“The brain is conditioned to alert us to anything that threatens our survival, but this system is malfunctioning in OCD,” says psychologist Steven Phillipson, clinical director of the Center for Cognitive-Behavioral Psychotherapy in New York City. “That can result in a tsunami of emotional distress that keeps your attention absolutely focused.”
No single fear defines the condition. There are familiar obsessions like washing your hands or checking the stove. But there’s also hoarding, hypochondria or a terrible fear you’re going to harm somebody. People with a common type of OCD can even have paralyzing anxiety over their own sexual orientation.
As with any mental illness, only a trained clinician can offer a reliable diagnosis. But here are a few behaviors that experts say can be genuine symptoms of OCD.
It’s common for people with OCD to believe that if they check the stove just once more, or Google just one more symptom of a disease they’re convinced they’ve got, then their mind will be clear. But OCD typically reneges on the deal. “The brain becomes biochemically associated with the thing you fear,” says Phillipson. “Performing the ritual just convinces it that the danger is real and that only perpetuates the cycle.”
Feeling compelled to perform certain rituals
Could someone pay you $10—or $100, or whatever is a relevant sum of money to you—not to do a ritual like checking the front door twenty times before leaving for work? If your anxiety can be bought on the relative cheap like that, you may have an idiosyncrasy—you worry about burglary a little too much, perhaps—but you probably don’t have a disorder, Phillipson says. For the person with OCD, he explains, the brain is signaling what feels like a life and death risk, and it’s hard to put a price on survival.
Being tough to reassure
For people with OCD, the phrase “yes, but” may be a familiar one. (Yes, your last three blood tests for this or that disease were negative, but how do you know they didn’t mix up the samples?) Since absolute certainty is rarely possible, almost no reassurance clears the yes, but hurdle, and that keeps the anxiety wheels spinning.
Remembering when it started
Not all people with OCD can point to the exact instant the disorder first struck, but many can, says Phillipson. OCD is a sort of free-floating anxiety before the initial symptoms strike, but then it alights on a particular idea—the fear you’re going to lash out at somebody with a knife when you’re making dinner, for example. These experiences tend to roll off of most people. But for someone with OCD, the bottom falls out, Phillipson says. “It’s the moment when a panic marries a concept,” he says. Like most bad marriages, it’s hard to end.
Feeling consumed with anxiety
OCD is a matter of degree, especially since there are real-world risks associated with nearly all obsessive-compulsive triggers. Houses do burn down, and hands do carry germs. If you can live with the uncertainty those dangers can cause—even if they make you uncomfortable—you likely don’t have OCD, or at least not a very serious case of it. If the anxiety is so great it consumes your thoughts and disrupts your day, you may have a problem. “The D stands for disorder, remember,” Phillipson says. “OCD causes your life to become disordered.”
There are proven treatments available for OCD. Medications, including certain antidepressants, are often a big part of the solution, but psychotherapy—especially cognitive behavioral therapy (CBT)—can be just as effective. One potent type of CBT is a protocol known as exposure and response prevention (ERP). As the name suggests, ERP involves gradual exposure to increasingly provocative situations—under the guidance of a therapist—while avoiding any rituals to undo the anxiety. Begin by touching a doorknob without washing your hands, for example, progress up the ladder of perceived danger—a handrail on a bus, a faucet in a public bathroom—and slowly the brain unlearns the fear.
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