We all know someone who says they’re ‘so OCD’ about cleaning their house or washing their hands. The good news is, they’re probably wrong.
‘Just because you like things orderly and wash your hands a little bit more than the average person doesn’t mean you have obsessive-compulsive disorder (OCD),’ says Jon Abramowitz, PhD, director of the UNC Anxiety Clinic who specializes in OCD treatment.
OCD can be broken down into two major components. The first consists of obsessive thoughts that provoke high anxiety. The second is compulsions, which are urges to do rituals or practice certain behaviors to try and control those thoughts and anxieties.
That’s where the excessive hand-washing comes into play. ‘That fear of contamination is a very cliched type of OCD because it’s the one many people are familiar with and assume all people with OCD do,’ says Fred Penzel, PhD, executive director of Western Suffolk Psychological Services in New York. ‘They really don’t. It’s only just a percentage of people with OCD who do that.’
So what else should you watch out for? Here are the six most common signs you might actually be dealing with OCD.
You often think about harming yourself or someone else
For most people, there will be times where we’ll get angry or upset and might have a fleeting image of hurting ourselves or hurting the person who caused that emotion. But for the majority of us, we see these thoughts as just that: thoughts. We recognize them as being fleeting and unrepresentative of our character, and we don’t have the urge to actually do the harm we imagine. For people with OCD, they worry that they might actually act on those thoughts.
These are called aggressive compulsions. They can present as you thinking about jumping in front of a subway train or out of a window, for example. Or, you might think about pushing someone else in front of that subway train or out of that window.
‘One of the things that’s important to understand with OCD is it knows just what to exploit in the particular individual,’ says Carrie Holl, PsyD, a Washington, DC-based clinical psychologist who specialises in OCD treatment. So for someone who’s normally gentle, OCD might present itself in aggressive thoughts, which causes incredible distress for that person.
‘It’s like if you’re on a bike, if you start pedalling, it moves the bike along,’ says Holl. ‘Compulsions are what keep the OCD moving along.’
You constantly seek reassurance in your relationships
Although it’s normal (and even healthy) to check in and question certain aspects of your relationships, if you’re spending a lot of time either seeking reassurance from your partner or questioning whether that person is right for you, it can signal relationship OCD.
In relationship OCD, people find themselves repeatedly asking questions like: do I really love this person? Is there someone else out there for me? A lot of this questioning will happen internally, but relationship OCD can also rear its head through people asking their partners similar questions: Do you really love me? Do you think I’m a good mum?
This crosses the line into OCD territory if you find yourself incessantly asking those types of questions either to yourself or to your partner, and it begins to interfere with you being able to go through life (and your relationship) in a healthy way.
‘It can be sort of a mental review,’ says Ozge Gurel, PhD, assistant professor at Georgetown University School of Medicine’s Department of Psychiatry. ‘It comes from a place that makes sense. Everybody wants to have some sort of certainty. It’s just an exaggerated form of it.’
You experience unwanted sexual thoughts
Once again, it’s common for everyone to have unwanted sexual thoughts every now and then, but for most of us, we can brush them off. We don’t take those thoughts literally; those with OCD do, and fear that having those thoughts makes them a bad person.
‘The most common one I see is that a person fears they’re a paedophile,’ says Holl. So even though that person doesn’t have any actual desire or impulse toward children, they might fear that impulse or desire will occur.
‘These are not people who are actually paedophiles,’ says Janice Krasnow, PhD, a clinical psychologist at the OCD Clinic at Johns Hopkins University. ‘These are people with intrusive thoughts, and they become afraid that it means they’re a pedophile. For a person with OCD, this is a horrible, terrible thought. There’s no sexual interest at all.’
You might also worry about your sexual identity, have sexual thoughts that contrast with your values, or mentally see graphic sexual images appear out of the blue.
You freak out when things aren’t symmetrical
Although this is most commonly present in children with OCD, the need for symmetry can be carried into adulthood. For a person with the condition, this could mean doing things on both sides of the body the same number of times, or lining things up in a specifically organized way. The key indicator of OCD here is that you feel like you have to keep doing the same behavior until it feels right, or until it gives you a feeling of balance and relief from the anxiety.
‘We talk about this a lot with OCD, that sometimes people act on compulsions until it feels better or more right inside,’ says Holl.
Being organised and appreciating structure doesn’t necessarily raise a red flag. It’s when that behaviour crosses into a repetitive need that you might start to worry. ‘That’s different from people who sit down at desk and straighten up,’ says Krasnow. ‘If you can do that and be done, that’s not OCD.’
You worry about catching a specific disease
Thinking about your health is a good thing. But if you start to worry incessantly about catching a certain disease – like HIV, for example – and begin avoiding things like public restrooms in order to prevent that disease, this could signal OCD behaviour.
‘A person really becomes preoccupied with notions such as this, and it begins to interfere with their sense of well-being and relationships,’ says Holl. This is called somatic OCD, and it manifests as constantly having health-related concerns. But these fears of disease, like any other forms of OCD, can change with time as certain diseases are cured or others are found.
‘In the 1970s, gonorrhoea was a big STD that people were worried about and lots of people had OCD about that,’ says Abramowitz. ‘Then in the 80s, when HIV and AIDS started appearing, then you saw people worrying about HIV and AIDS. It’s very clear that learning plays a role because the things that people obsess about change over time.’
You excessively double-check everything.
This kind of OCD behavior can present itself in tons of different ways, whether that be for safety or perfectionism. ‘If it’s around safety, it can be lots of checking if the baby’s alive, locking the doors, checking over and over,’ says Gurel.
Yes, it’s normal to twist your doorknob to make sure it’s locked before leaving the house. But the important thing to note is that someone with OCD can’t help but allow that need for double-checking to interfere with how they’re spending their time. ‘These compulsive behaviours are very excessive relative to what most people would do,’ says Abramowitz.
For example, you might worry that you ran over your kid in the driveway who was playing outside. For someone with OCD, they might go back home, check for 20 minutes that they didn’t run over anyone, and thoroughly check that their car didn’t have any blood on it. For someone without OCD, they’ll brush this thought away knowing they waved goodbye to their kid as they pulled away.
Could you have OCD?
The key in differentiating between OCD behavior and that of the average person’s is how much time and energy you’re spending on indulging in intrusive thoughts or going through your compulsive rituals.
‘Typically what I ask is, if you didn’t worry about it – if you didn’t have these intrusive thoughts, if you didn’t have to do these acts – what would you be doing?’ says Gurel. ‘Would you be doing something else? If you’re like, “Yeah, tons of stuff. I’d be going to this vacation, I’d be going to bed earlier.” That’s a sign.’
The more you assess your own behaviour and keep track of how heavily it’s interfering with your daily life – and whether that interference is in your control or not – the more successful you’ll be in identifying whether or not you might be a silent sufferer of OCD.
If you identify with one or more of these signs, talk with an OCD specialist about whether you might be a fit for treatment options. You can find an expert near you through the International OCD Foundation.
