Q&A: Obsessive-compulsive disorder, what it is — and is not

Q: What are common misconceptions about obsessive-compulsive disorder?

A: OCD is an anxiety disorder consisting of a cycle of intrusive, unwanted obsessions, recurring thoughts, ideas, or impulses, and subsequent compulsions, strategies or rituals used to lower distress brought on by the obsessions. Rituals to reduce distress include overt behavior such as repetitive washing, covert behaviors such as seeking reassurance, or mental acts such as replaying events or repeating words to one’s self.

Everyone experiences intrusive thoughts now and then, especially when it comes to perfectionism. Many of us have heard someone say they’re “a little OCD” about cleaning or other habits. But for OCD sufferers, the thoughts are so intrusive that they can impair quality of life and cause extreme distress.

There are different types of obsessions that are incredibly common, but much less understood or discussed.

For example, harm obsessions are characterized by thoughts, ideas, or impulses of hurting oneself or others. One of the biggest misunderstandings is that sufferers are not actually suicidal, homicidal, or aggressive. In fact, these obsessions terrify them. Sufferers might avoid objects that could produce harm or stop interacting with other people, as OCD convinces them that avoidance is the only way to ensure safety. This obsession often leads to social isolation and depressive symptoms.

Sexual obsessions are also extremely common. Sufferers might experience thoughts related to their sexual orientation, sexual aggression, or pedophilia, all of which are not congruent with what they find sexually arousing. These obsessions typically produce an excessive amount of anxiety, shame, and embarrassment. Many of these OCD sufferers judge themselves harshly and believe they are terrible people. However, these obsessions are merely a symptom of the illness and have no implications on their character.

OCD can also manifest as a pathological level of guilt related to moral or religious issues. OCD often “attacks” what people care about, so it is not uncommon for this to manifest in those who care deeply about faith or take pride in being a moral person. Successful treatment does not erase religion and morality, but rather shows they can exist in a way that is rooted in fulfillment and not fear.

Finally, one of the most misunderstood types of OCD is the need for things to be “just right.” This can go unnoticed because perfectionism is often normalized and sometimes even praised in our culture. In the case of OCD, however, perfectionism becomes an impairment and can result in excessive tardiness, missed deadlines, or avoidance because a task or situation did not feel “just right.” Many individuals with OCD experience reluctance to seek help because they attribute their successes to this “thoroughness.” The irony, however, is that it often results in recurrent failures and incomplete tasks.

OCD specialists are trained in a specific type of cognitive-behavior therapy, called exposure and response prevention, that can help sufferers overcome this illness by leaning into their fears. No one has to suffer with OCD forever. It is treatable and the gains are life changing.

Jenna DiLossi is the cofounder of the Center for Hope & Health in Ardmore and specializes in cognitive-behavior therapy for eating disorders and anxiety disorders.