Stereotypes About OCD Erase These Very Real Symptoms, & We Need To Stop Excusing Them
Obsessive-compulsive disorder is commonly — and harmfully — used as a shorthand for "extremely neat" or "requiring order in all things." When people use OCD as a stand-in for these two specific symptoms of the disorder, which not all people with the disorder experience, it increases stigma towards people with OCD. A whole other group of symptoms get erased when these stereotypes are repeated, and we need to stop excusing them.
But what are the symptoms of OCD that don't get talked about? The defining aspect of obsessive-compulsive disorders isn't a need to keep all your sneakers in a row. It's the underlying fear and anxiety that might make you believe that without scrubbing out the shower fourteen times you may spread disease, or that opening a door repeatedly is the only way to save your friends from danger. The behaviors are an attempt to keep the thoughts under control — but for many of us, intrusive thoughts are more common than you might realize, even if you don't fit all the criteria for OCD. Understanding these thoughts as a consequence of everyday life can help promote empathy for people who do have OCD, and hopefully reduce stigma about the disorder.
The Tie Between Obsessions & Compulsions
The basic cycle that defines many people's OCD is divided into obsessions and compulsions — hence, obsessive-compulsive disorder. MIND, a mental health charity, explains obsessions and compulsions, respectively, as intrusive, upsetting thoughts, and the behaviors that people with OCD perform to attempt to cope with or drown those thoughts out. Intrusive thoughts can take many forms; one essay published in Broadly focused on a woman's obsessive thoughts about whether she might kill her partner, a fear that came not from her own will or desires but from unbidden anxiety. The Royal College of Psychiatrists notes that the definition of intrusive thoughts is broad; they can include ideas, phrases, vivid distressing images, doubts, perfectionism, and rumination over a single topic or action for long periods of time. The key characteristic for people with OCD is that these thoughts are deeply distressing or anxiety-provoking, and cannot be calmed or banished by conventional methods.
In many circumstances, OCD UK explains, compulsive behaviors develop because the intrusive thoughts involve imagining hurt or harm to oneself or loved ones. If you don't wash your hands repeatedly, for instance, the thought insists that you might catch germs and so harm yourself or the people around you. However, the compulsive behavior doesn't serve to negate or make the fear go away; for people with OCD, it reinforces the belief and maintains anxiety levels. "For someone with OCD," OCD UK notes, "an anxiety-provoking event creates negative interpretations about what might or could happen. Even when nothing bad happens, the anxiety remains high until the person carries out their safety seeking behavior — the compulsion. Therefore because these negative interpretations still remain, the same anxiety-provoking thoughts continue to necessitate further safety-seeking behaviors, so instead of digging themselves out of a hole, they are digging that hole deeper."
Many OCD behaviors revolve around obsessions that are concerned with harm or danger, whether from hygiene or environmental risks. Psychologist Dr. Eliza M. Belle told Bustle in 2016 that people with OCD "repeatedly check things that they associate with harm or danger," from electrical outlets to locks. The dangerous objects or situations may not carry evident connotations to outsiders. OCD sufferers can develop advanced and complicated superstitions about how their actions might affect those around them; if they keep everything in the right order or perform a particular task, they'll be keeping themselves and others from harm.
If you think this sounds like keeping rabbit's feet for good luck or avoiding opening umbrellas indoors, you wouldn't be off-base. Neurologist Peter Brugger wrote in 2010 that superstitions and obsessive-compulsive behaviors seem to exist on a continuum, but that ordinary superstition takes place in an entirely different part of the brain than obsessive-compulsive beliefs about order and protective ritual. This connection between the two shows that a nuanced understanding of OCD symptoms is not all that far off, even for people without OCD.
Intrusive Thoughts Are More Common Than You Think
There are a lot of variations on OCD in the world. Some are comorbid disorders, like body dysmorphia, in which the obsessive and intrusive thoughts revolve almost exclusively around distorted self-conceptions of bodily size and shape. Others are similar in behavior but not in thought: disorders like trichophagia, which involves compulsive eating of one's own hair, can be done unconsciously without anxiety behind them. But are intrusive thoughts on their own, without compulsions attached, a disorder to be reckoned with, or just an element of normal human psychology?
Humans are naturally imaginative creatures; it's one of the features that's served us well throughout our evolution, allowing us to picture outcomes that differ hugely from what's actually in front of us and make complicated plans. However, the gift of imagination can sometimes lead to dark places.
The Anxiety and Depression Association of America notes that, for people with intrusive thoughts, "somewhere within an obsession is the flip side of a core value. If OCD taunts you with images and thoughts about offending God, then religion must be important to you. If OCD reviews all the ways your family could be hurt, then your family is clearly one of your top priorities." However, there's a large difference between casually imagining what would happen if something awful occurred and having to actively conquer those thoughts because they recur so often that they're causing you distress.
Intrusive thoughts that cause distress but don't manifest in compulsive behavior likely fit the definition of other anxiety disorders. They occur in people with generalized anxiety disorder, with specific phobias, and post-traumatic stress disorder, among other anxiety conditions. The Calm Clinic has a handy test to examine whether you might be having intrusive thoughts at a level that needs attention by a psychological professional. If not, though, relax; these sorts of thoughts likely occur to many of us at one time or another, but we just don't talk about them enough. Talking about them honestly, and without stereotypes, can help everyone — with or without OCD — navigate their symptoms and understand what's happening to them.