“I’m so OCD”.  We hear and use this phrase commonly (and jokingly) to describe a love for cleaning or an appreciation for having things neat and organized.  Unfortunately for those suffering from OCD, it is much more challenging.

What exactly is OCD?  Obsessive Compulsive Disorder is a serious mental health disorder that affects about 1% of the population.  OCD is believed to be neurobiological and genetic in nature and manifests in a cycle of obsessions and compulsions.  Obsessions are unwanted, intrusive, often disturbing thoughts that trigger severely distressing feelings.  Compulsions are the behaviors an individual engages in to try to alleviate these disturbing thoughts.  Most of us have obsessive or disturbing intrusive thoughts at some point in our lives.  The difference is that in individuals with OCD, this cycle of obsessions and compulsions is so severe that it consumes an excessive amount of time, causes significant distress, and interferes with daily functioning at work, school, social, and family relationships. OCD can vary in terms of severity (mild, moderate, severe, extreme).  Those with mild forms of the disorder may spend an hour on their obsessions/compulsions each day and it may not impact functioning as much.  Those with severe OCD may get disturbing thoughts constantly throughout the day and it can have a tremendous impact on day-to-day functioning (in some cases an inability to leave the house or requiring hospitalization).

While the most common perception of OCD is fear of contamination (with hand washing as the compulsion), there are actually an infinite number of ways that OCD can manifest in an individual and not all compulsions are shaped by the nature of the obsession.  For example, a person may feel obligated to walk in and out of a doorway a particular number of times or else a family member may die.  This thought is so recurrent, so disturbing and so strong, that even though these individuals are often very smart and rational people, it “feels so real that it must be true”.  OCD becomes a brutal cycle because while performing the compulsion or ritual may alleviate the distress for a short period of time, doubt plays an enormous part in OCD.  Because the individual can never feel 100% certain (that the door was locked, that they dressed in the “correct” order, that they didn’t touch the railing on the subway, that they said “I love you” the right amount of times), they become trapped in a spiral of repeating the compulsions over and over.

How is OCD treated?  OCD is chronic, meaning individuals with this disorder can get it under control with treatment (oftentimes a mix of therapy and medication is called for), but there is no cure.  While OCD falls under the umbrella of Anxiety, it is different from Generalized Anxiety in that traditional treatments for anxiety will not be helpful.  At this time, Exposure & Response Prevention (ERP) is considered the most effective treatment for OCD.  The goal of ERP is to help individuals with OCD learn to live with uncertainty.  ERP consists of gradually confronting fearful thoughts and situations (exposures) while resisting performing these compulsions.  The goal of ERP is to stay with the disturbing thought long enough to develop a tolerance.  While tremendously effective, exposure work is extremely challenging.  An exposure will start with a fear that is a lower level (distressing, but manageable) and will work up in small increments to higher level fears.  When done in this way, the individual is working at desensitizing and sitting with the discomfort. For example, a child who is getting intrusive thoughts that a family member will die if he looks at a cemetery might work on exposures starting with glancing for one second at the cemetery.  The child would then work incrementally (over days, weeks, or months) to staring at pictures of a cemetery, visiting a cemetery, going into the cemetery and touching a gravestone.  As one OCD expert described it: “To get a sense of how an exposure exercise might feel, imagine yourself standing on the railroad tracks as what appears to be a speeding train bears down upon you, and as it is about to hit you, choosing NOT to step off of the tracks”.

What can we do?  As we can see, OCD is not a joke, but is a relentless, serious mental health disorder that impacts a person’s quality of life and occupies an incredible amount of their thoughts each day.  In honor of OCD Awareness week (October 13-19), we can all help by simply changing our mindset and usage of “OCD”.  Dictionary.com has already started by proposing a great list of words to use in place of OCD when we are talking about something other than the psychiatric condition: pedantic, precise, fastidious, finicky, and fussy.

If you think you or a family member may have OCD, it is important to find a therapist who specializes in Exposure and Response Prevention.  Because there is no cure, ERP is a tool that many individuals with OCD will use on a daily basis to cope with their symptoms in order to live successful and happy lives.

For more information on OCD, please check out the resources below:





OCD is not a joke, but is a relentless, serious mental health disorder that impacts a person’s quality of life.

Brett Vasquez, LPC