“I’m so OCD.” How often have you heard this phrase in the media, on social media platforms, or in a casual conversation between peers? Claiming one has OCD has become the latest trend to characterize when one is ‘particular’ about things, such as organizing their space, not wanting other opinions to interfere with their own perspectives, or at times an excuse for one to be blunt. However, the aforementioned social portrayal of OCD is not an accurate depiction of the disorder and the daily struggle that those diagnosed with OCD or OCPD (we will define that later in this blog) experience.
Today’s informality with nonchalantly incorporating the term OCD as a ‘buzz word’ in conversations has become disrespectful and is undermining for those who struggle with the diagnosis on a daily basis. Evidently, those who do suffer from OCD, hide in the shadows not wanting to draw attention due to the embarrassment and shame they could be feeling. Instead, if they have access, they work privately with their clinical care team to build skills, strength, and perseverance through their diagnosis and try to lead everyday ‘normal’ lives.
With just that in mind, next time be mindful before you’re going to casually toss the term around when trying to describe you like things a certain way; may I suggest saying you’re ‘particular about things.’ This can avoid the possibility of insulting others.
Let’s delve into what OCD and OCPD are and stand for
OCD is the abbreviation for Obsessive-Compulsive Disorder, which is the presence of obsessions, compulsions, or both (American, 2022).
Obsessions
An obsession is one or various recurrent and persistent thoughts, urges, or mental images a person with this diagnosis experiences. These thoughts are intrusive and unwanted causing marked anxiety or distress (American, 2022). These thoughts typically evolve from an experience where a disturbance had taken place and creates a taboo like association for the experiencer.
For example, one could be innocently watching the news and overhearing a broadcast of a plane crash (the stimuli) and then have an emotional response to it (the disturbance). Then if that person takes a flight, that same news may pop up in their mind and a sense of panic may overtake the body. This can make it feel fearful of life if they were to stay on the plane (start of obsession). This cause and effect model can create a correlation with the unrelated broadcasted plane crash and an association to feeling a threat of doom on future flights one may be on without ever personally experiencing it. This is similar to how vicarious trauma is manifested; however, the differentiation is the symptomatic evolvement of obsessions and compulsions versus symptoms that align more with Acute stress disorder or PTDS.
In such case, the individual will avoid going on flights at all costs and can experience psychosomatic symptoms such as heart palpitations, sweaty palms, panic attacks, etc. If untreated, this can lead to avoidance of flights all together and the possibility of extending a correlation of other forms of transportation as a threat, such as trains, buses, cruises, etc.
Compulsions
The second component of OCD is compulsions, which are attempts to ignore or suppress intrusive thoughts. Intrusive thoughts are unwanted thoughts that pop up in our minds and cause marked distress. Compulsions are repetitive behaviors (e.g., hand washing, keeping objects orderly, checking urges) or mental acts (e.g., praying, counting, repeating words silently) that the experiencer feels driven to perform in response to an obsession or according to “rules” that must be applied rigidly (America, 2022).
These behaviors or mental compulsions are aimed as a preventer to anxiety or distress caused by the obsession; to prevent the dreaded events or situations, and these rules are self-made out of fear by the individual. They have no rationality nor correlation to the triggering intrusive thought and are not productive solutions to prevent the situations it is intended to.
The compulsion is an association the individual creates to sooth their own feelings and to receive instant gratification that is short lived, and once it wears off the cycle of obsessions and compulsions reignites. Seeking out reassurance and validation, an individual can be engulfed in the cycle for various rounds to make sure they achieve that gratification or ‘just right’ feeling before moving on. Compulsions are very time consuming and can impede on one’s commitments such as making them late for work or class due to the need to achieve the “right” level of relief.
An example of a compulsion can be tied back to the earlier mentioned plane crash example. A compulsion in response to wanting to remove the thought of crashing from one’s mind can be snapping your fingers four times in a row as a means to prevent the unwanted thought and maladaptively self sooth. As you can tell, snapping your fingers four times will not prevent a plane crash, however for the experiencer it can be associated with temporary achieving relief. Again, the compulsion doesn’t have to be productive, but just has to make sense to the experiencer.
Insights
Many diagnosed with OCD are aware that outside of the triggering ‘moment,’ their compulsions are not rational. However, in the moment the obsession is so engulfing that it is real to them; it’s not just a feeling, but it becomes their reality. Having that coupled with the overwhelming anxiety it brings, makes the ability to remove the thought difficult for them. Difficult yes, impossible no.
Typically, one suffering from OCD will go to their loved ones or a ‘safe person’ to seek out reassurance, which can cause an emotional toll on that relationship. The experiencer is not doing this to get a rise out of their loved ones nor push them away, but rather a way to maladaptively anchor themselves. However, this is a slippery slope for the loved ones involved. If they give in time and time again it will enable the validation seeking behavior. Once this cycle starts, it normalizes an unhealthy pattern of reassurance seeking behaviors where the experiencer will repeatedly seek out validation from their loved one; exhausting that resource. We will soon discuss ways to effectively support our love ones and not enable them, so hang tight.
Final thoughts on OCD
The process of the obsessions and compulsions are time-consuming and repetitive. The exact cause for OCD is unknown, however it has been studied that there may possibly be a genetic factor that increases one’s chances of developing the condition from one generation to the next. Common forms of OCD are related to phobias and contamination, in addition to various themes and subtypes that will not be covered in this blog, but maybe a future one.
OCPD is Obsessive-Compulsive Personality Disorder. OCPD can easily be mistaken for OCD because of how it presents. On the surface level, both OCD and OCPD look similar with displays of rigidity, pattern following, and a sense of achieving perfectionism. However, there are significant differentials in its traits and triggers. OCPD is characterized by persistent maladaptive pattern of excessive perfectionism and rigid control without Intrusive thoughts and lacks repetition of compulsive behaviors. Those with OCPD are rule followers, when having a task with guidelines on how to complete it. They are inflexible to those rules and follow it as law; despite there being various other ways to get to the same goal (Cain, 2015). Despite there being a faster and more efficient way to achieve the same results, they will refute it as their mind is set. On the outside, they can be viewed as stubborn. They typically prefer to complete tasks on their own, as no one can do it ‘right’ like them and will only accept support from those that can match their level of rigidity.
Other aspects of OCPD are that its symptoms can span lifelong and vary in severity given the distress level of new circumstances one encounters. Those meeting the criteria can lack emotional empathy and self-awareness. It can overlap with neurodivergent disorders such as ASD due to its nature of fixation and difficulty adapting to change, however is not solely stunted to neurodivergent disorders (Gadelkarim, 2017).
Now that we have gotten a better understanding of OCD and OCPD, we can see there are various similarities among the two disorders and how they can easily be mistaken one for the other. In my time as a clinician with specialization in OCD from all levels of care, I have met with various clients that have been misdiagnosed for having OCD when they meet more of the criteria for OCPD. When seeking out treatment, always make sure you are meeting with atrained professional that specializes in your area of concern. And it wouldn’t hurt to get a psychological evaluation just to be sure your concerns align with what symptoms you are experiencing to avoid being misdiagnosed.
Support and Treatment options
Earlier, I emphasized for OCD that it is not impossible to overcome negative thoughts, however we cannot expect someone struggling to just be able to know how to help themselves or accept our biased recommendations at the drop of a hat. It’s similar to telling someone who has never ridden a bike to join a big race, by merely mentioning how to ride a bike and not allotting any time for practice. They will most likely fail and struggle even more than they were initially. Not knowing how to help themselves, they now would have to deal with the personal embarrassment and disappointing others for not knowing how to execute what comes naturally to others. The same goes for telling one with OCD or OCPD to just stop worrying and let it go.
After acceptance, the best first step for those struggling with either disorder is to start meeting with a mental health professional specialized in their area of concern. For OCD identifying a Hierarchy of Fears (intrusive thoughts) and working on Exposure Response Prevention techniques can help work to destigmatize irrational fears. This helps with working their way up to stripe the taboo associated with their intrusive thoughts. For OCPD, working with a specialized clinician that can help support them in increasing self-awareness, exposure work with letting go of rigidity and control can be useful tools. Also, it is important to identify if there was a traumatic experience where this sense of control and perfectionism is stemming from and working towards processing and destigmatizing that concern. Other skills I enjoy teaching are “Playing the tape through,” which challenges clients to experience the full thought and all its outcomes from good to bad and not just focus on the initial intrusion of it. And ‘Thought Deffusion,’ which is looking at your thoughts from a third-party perspective; looking at your thoughts rather than through them as a core belief.
When it comes to support from loved ones, it is best to create healthy boundaries and recognize signs of reassurance or validation seeking behaviors. As hard as it is, it’s best for loved ones to not provide definitive answers and encourage the experiencer to answer their own validation seeking questions. If this form of redirection does not work, it is helpful to encourage the experiencer to use their coping skills. It can get exhausting but standing your ground will ultimately help create newer and healthier patterns and help those struggling to live meaningful and less stressed lives.
References:
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.
Gadelkarim, W., Shahper, S., Reid, J., Wikramanayake, M., Kaur, S., Kolli, S., ... & Osman, S. (2017). Obsessive compulsive personality disorder and autism spectrum disorder traits in the obsessive-compulsive disorder clinic. European Psychiatry, 41(S1), S135-S136.
Cain, N. M., Ansell, E. B., Simpson, H. B., & Pinto, A. (2015). Interpersonal functioning in obsessive-compulsive personality disorder. Journal of personality assessment. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4281499/