What is OCD? A psychologist answered all of our questions about this misunderstood disorder
Nearly everyone has heard about obsessive compulsive disorder (OCD), but not many people truly understand this mental health condition. OCD is perhaps the most-joked-about mental illness in pop culture—Joan Crawford in Mommie Dearest, frantically cleansing her skin every morning, comes to mind. Yet what’s portrayed is a far cry from what people with OCD actually experience.
About 2.2 million adults in the U.S. (1% of the population) have OCD, and it’s a chronic disorder that can consume a person’s life. As the National Institute of Mental Health reported, more than half of adults with OCD stated that their condition severely impaired their functioning when it came to their work or school responsibilities, home/family life, and social life. So it’s beyond time for the rest of the population to realize OCD is no joke.
HelloGiggles asked psychologist Dr. Jenny Yip every question about OCD that we could think of in hopes of wiping away some of that stigma and misunderstanding. Dr. Yip is a specialist in OCD who founded the Renewed Freedom Center in Los Angeles, an OCD and anxiety-focused treatment facility. Along with providing patient treatment, Dr. Yip shares her expertise on social media and in her podcast, The Stress-Less Life, to help end the stigma surrounding mental illness. Our conversation with her not only provides information about this commonly misrepresented condition, it also highlights why education about OCD is so essential.
Whether you know someone with OCD, want general information, or have (or think you may have) OCD yourself, this Q&A with Dr. Yip outlines all the basics you need to know about this mental health disorder.
What is obsessive compulsive disorder?
“OCD is a type of mental illness. It affects at least 1 in 100 people, yet it’s one of the most misunderstood conditions. OCD has two parts: obsessions and compulsions. It can affect anyone, at any time, regardless of age, gender, race, or socioeconomic status.”
How are obsessions and compulsions defined?
“Obsessions are unwanted, intrusive thoughts, images, or sensations that repeatedly appear in your mind against your will. It is similar to a nightmare that keeps replaying like a broken record, completely involuntarily.
Compulsions are actions that we perform, whether behaviorally or mentally, in order to escape from the discomfort that the obsessions produce. The relief is only temporary before another obsession quickly returns that requires the sufferer to perform further compulsions. Giving into these compulsions can be crippling, and severely impair daily life.
The cycle between obsessions and compulsions becomes stronger and stronger over time, to the point that it becomes very difficult to break.”
What are the symptoms of OCD?
“Signs that you or a loved one may be suffering from OCD can include anxiety, guilt, depression, intense fear, or having ruminating thoughts. There are physical symptoms, too, such as severe fatigue, restlessness, lack of concentration, insomnia, avoiding certain foods, and nausea.”
What are some common obsessions and compulsions?
“Common obsessions tend to be fears of the following: germs, illness, harming yourself or others, acting socially inappropriate, making mistakes, inappropriate religious thoughts, and forbidden sexual thoughts. Obsessions can also involve a need for symmetry, exactness, order, or having things ‘just right.’
Common compulsions can include washing, cleaning, checking, repeating, counting, arranging things in a particular order, hoarding, praying, retracing past memories, and seeking reassurance.”
Are there different types of OCD, and what are they?
“There are many subtypes of OCD, many of which are outside the most ‘common’ forms, which is why it can be a difficult mental illness to diagnose. Obsessions can manifest in unpredictable ways, not just as the hand-washing behavior most of us have seen in the movies or on TV.
A few types of OCD include: scrupulosity, which involves fear of sin and obsessions over morality; symmetry and evenness OCD, involving the need for exactness and order; harm OCD, in which the sufferer has fears of causing harm to themselves or others; counting and ordering OCD, characterized by the need for things to feel ‘just right.’”
Is it common to have other mental disorders accompany OCD? What are they?
“Yes, there are many mental disorders that can often accompany OCD, some of which include depression, social anxiety, panic disorder, trichotillomania [compulsive hair pulling], body dysmorphic disorder (BDD), and olfactory reference syndrome (ORS) [unfounded belief that you’re emitting an offensive body odor].
In children, OCD often co-occurs with separation anxiety, school refusal, tics, behavioral disruption or oppositional defiance, ADHD, and autism.”
Are there other mental disorders that may seem like OCD but aren’t?
“Many anxiety disorders may seem like OCD. For example, generalized anxiety disorder (GAD) can often be confused with OCD in the sense that both conditions involve experiencing intense anxiety. The difference between GAD and OCD is that OCD involves involuntary, intrusive thoughts that are often irrational along with compulsions that serve as relief from these thoughts. Someone who has GAD, on the other hand, usually will have intense worries and anxiety about everyday life without specific compulsive behaviors to gain relief.
OCD is often mistaken and misdiagnosed for attention-deficit/hyperactivity disorder (ADHD) because from the outside, symptoms can often appear similar. Someone with OCD can appear unfocused, forgetful, and have impaired ability to make decisions because obsessions and compulsions can be extremely distracting. Imagine needing all the pencils and papers on your desk to be aligned perfectly before starting a paper, for example. That would take a lot of time and would certainly be distracting! The difference is that a person with OCD will often be extremely cautious and need to perform rituals according to a specific set of rules, whereas someone with ADHD is generally more impulsive and struggles to focus on details.”
How can OCD impact a person’s day-to-day life?
“I think what a lot of people don’t understand about OCD is how debilitating it can be. It can completely deteriorate a person’s life and daily activities. A sufferer is no longer able to function. He or she can’t go to school or work. OCD can get so bad that the sufferer begins to avoid family, friends, social experiences—everything.
OCD has been minimized for years and years as a ‘joke.’ A lot of movies depict OCD as a light, comical disorder. What the audience sees is just the external behavioral presentation of the compulsions—for example, they see a character going back and forth, repeating themselves, or acting in quirky ways. It might seem funny on the outside, however, the audience isn’t privy to the struggles and internal torment that the person has to keep reliving, again and again. It’s a constant invisible battle inside a sufferer’s mind.”
Do we know what causes OCD? Is it genetic?
“Researchers don’t know the exact cause of OCD. What we do know is that it has to do with a chemical imbalance involving serotonin in the brain. Although OCD does run in families and genes play a role, environmental factors such as having an illness or undergoing stress also contribute to the onset of OCD.”
Is there a way to prevent OCD?
“There is no way to prevent OCD.”
What are some signs that I should speak to a medical professional?
“If you feel that your symptoms are taking over your life and preventing you from enjoying daily activities, it’s time to seek professional help. More signs include withdrawal from social situations, repeated thoughts of death, and feelings of hopelessness. Getting treatment as soon as possible for OCD is crucial. Especially for children, early intervention is so important because it’s easier to learn how to manage OCD at an early age before symptoms become worse over time. At any age, however, seeking help from an OCD specialist is crucial because OCD is a treatable mental illness and can be overcome.”
What are some common treatments?
“The evidence-based treatment for OCD is exposure and response prevention (ERP), which is a form of cognitive behavior therapy (CBT). This is not simply the traditional talk therapy or play therapy. In CBT, you learn specific tools that you must practice to become skilled at defeating OCD thoughts and behaviors. Part of CBT involves recognizing the faulty thinking patterns that fuel the fears of OCD. Like any new skill, you will learn by practicing CBT to discredit distorted thinking patterns so that your thoughts will reflect reality more accurately. It’s like exercise for your brain.
A patient going through ERP treatment will be introduced to exposures to the thoughts, images, or fears that trigger anxiety and start the cycle of compulsions. This trains you to confront fears gradually, so you learn that they’re actually not so threatening. You also learn to disobey OCD rules in order to weaken the compulsive behaviors. Rather than giving into your fears, in ERP, you’ll be able to recognize the irrational urges to engage in compulsions and, under the guidance of an OCD therapist, make the choice to not give into compulsive behaviors.”
What should I look for in a therapist?
“First, find a licensed therapist who has experience treating OCD successfully. An OCD specialist will have specific training and experience in utilizing ERP. Be forewarned that not every CBT therapist knows ERP, which is a very specific type of treatment. An experienced OCD therapist will initially conduct an evaluation to determine the exact triggers to your anxiety and resulting compulsions, and formulate a hierarchy of exposures in your treatment plan. Unlike talk therapy, effective OCD treatment is usually short-term, lasting months with follow-up maintenance. Interview therapists and ask questions to find the right fit for you. Not every therapist is right for every person, and again, but be sure they are trained in treating OCD.”
How can medication help OCD?
“Patients who take medication for OCD often show some improvement, however, when you’re solely dependent on medication as a solution for OCD, symptom reduction is often minimal. Medication can reduce anxiety, but it doesn’t take away obsessions. Rather than putting a Band-Aid on the problem, the recommendation by OCD experts is to engage in CBT and ERP treatment alone or in combination with medication for the most effective benefit. The treatment process can be extremely challenging while you’re learning to confront OCD fears, however, experiencing the short-term discomfort has a long-term, lasting payoff.”
Are there ways to manage my OCD on my own?
“It depends on the severity of your OCD, although generally I recommend seeking treatment in order to receive the best recovery possible. Plus, the sooner you learn the tools to defeat OCD, the less opportunity there will be for OCD to become stronger and worsen. If you have OCD, you will have intrusive thoughts your whole life. The difference is whether you choose to act on the thoughts or not. It takes time and practice to recover from OCD, but there are many supplemental tools available, like the nOCD app, that can help you beat the OCD Monster while going through treatment.”
I’m worried I may hurt myself or others. What should I do?
“The most important thing to do is seek help. To start, it can be as simple as looking online to learn more. There are plenty of professional resources available with information about OCD, anxiety, and mental health in general, a few of which include the International OCD Foundation, the Anxiety and Depression Association of America, the Association for Behavioral and Cognitive Therapies, the Child Mind Institute, and the Renewed Freedom Center.”
Will my OCD ever go away?
“OCD is a lifelong, genetic disease, however, that doesn’t sentence you to a lifetime of suffering. When you are able to gain the tools and learn how to manage OCD, you can break the chains that OCD has on your life. OCD can be overcome by going through ERP treatment and with practice, symptoms will minimize and be manageable.”
Are there things I should avoid if I have OCD?
“No—avoiding your fears only gives credence and reinforces your fears more. Under the guidance of a trained therapist, the battle against OCD can be overcome by slowly exposing yourself to your fears.”
What should I do if I think a loved one has OCD?
“If you think someone you love has OCD, approach them from a position of compassion, yet learn to set appropriate boundaries so that you’re not also imprisoned by their OCD. They may not be able to recognize the signs themselves, or they may be aware and feel too afraid to talk about it. There are many resources from the websites above that you can download and share with your loved one. Approach the topic from a positive, supportive point of view. Tell them how much you care about their health and well-being, and how you want to help.”
How can I support a friend or family member who has been diagnosed?
“The most important part of supporting a friend or family member is to establish boundaries. Let your loved one know that you care for them and are there to support them—not their OCD.
Your loved one may constantly seek reassurance from you and ask questions: ‘Did I check the stove?,’ ‘Was my hair straightener off?,’ ‘Could I have cancer?’ Don’t placate them by reassuring them that they turned off the stove, unplugged the hair straightener, or that they don’t have cancer. The person with OCD will seek absolute certainty, which doesn’t exist. As Benjamin Franklin once said, the only certainty in life is ‘death and taxes.’ The best thing you can do is help him or her tolerate the uncertainties of life instead of giving into their doubts.”
What are some common assumptions about OCD that aren’t true?
“All too often, society makes OCD into a joke. Sometimes it’s the phrase, ‘I’m sooo OCD,’ or sometimes it’s a Christmas sweater that reads, ‘Obsessive Christmas Disorder.’ The fact is, we wouldn’t put cancer, diabetes, or autism on a sweater and laugh about it. We can’t do that with OCD. Making light of a serious illness that debilitates millions only makes it more difficult for sufferers to have the courage to seek help.”
I’m ashamed to talk about the fact that I have OCD. Is there any reason to feel embarrassed?
“There’s no reason to feel embarrassed about having OCD, and in fact, OCD is way more common than we realize. The fact is, the stigma surrounding OCD is what prevents so many from speaking out about their experience and seeking the help they need. It can take 14 to 17 years for someone suffering to receive an accurate diagnosis and effective treatment.”
How can I make people understand my diagnosis—and me—better?
“While you can’t ‘make’ anyone understand OCD, what you can do is talk to the people you trust in your life and share your experience with them. You can also try sharing an informative news article, social media post, or something else if you feel it accurately represents your experience. Remember that although your friends or family in your life may not understand the struggle you’re going through, they can empathize and express support. In fact, they might even surprise you by how much they truly empathize and understand. And the reality is that many of us know at least one person in our lives with OCD. Imagine the change we can make in these sufferers’ lives if we were all more open to sharing our experiences.”