Obsessive Compulsive Disorder: More than a Preference

Your friend, Rachel, doesn’t let her wife fold her laundry because she is “so OCD about it.”

Watching an HGTV show, one of the cast members says he is “so OCD” about having the two windows perfectly symmetrical to one another.

“I am so OCD.”

This is a ­saying that we often hear circulating among social circles or in pop culture references. By now when we hear this saying, we assume that the person delivering the message is indicating they have a strong preference or specific way of doing something. We can make this interpretation because “I am so OCD” has become a way to signal preciseness or peculiar ways of behaving. For example, we can assume that Rachel from the above passage, has a specific way of folding her laundry despite her not having a formal diagnosis of OCD. In addition to not making grammatical sense (we cannot BE Obsessive-Compulsive Disorder), saying “I’m so OCD” is flawed and problematic for many other reasons.

So, what is Obsessive-Compulsive Disorder?

Obsessive-Compulsive Disorder (OCD) is a mental health disorder in which an individual experiences distressing cycles of obsessions and compulsions. Obsessions are any unwanted thoughts, images, ideas or urges that frequently emerge in the mind despite an individual’s attempt to control or stop them. They are automatic, intrusive and typically cause intense distress and anxiety when experienced. Compulsions are the behaviors done in effort to get rid of the obsessions. An individual engages in compulsions because they usually provide temporary relief from anxiety caused by obsessions. However, in the long run, compulsions only reinforce the anxiety and maintain the cycle of OCD.

More than a preference

The cycle or “dance” between obsessions and compulsions is what separates OCD from just having a strong preference or specific way of doing something. Someone who is diagnosed with OCD is not able to choose whether an obsession pops up in their mind. Contrastingly, preferences are voluntary and can be forgone. For example, the HGTV cast member might not like asymmetrical windows, but since he does not have OCD, it is unlikely that he would be caught up in a distressing cycle of compulsions or experience an intense onset of anxiety because of them.

In order to receive a diagnosis of OCD, not only does an individual have to meet criteria for obsessions and compulsions, but they also have to be time-consuming (ex: take more than one hour per day) or cause distress and significant impairment in a person’s daily functioning; OCD is more than a preference.

Misunderstood & Overlooked

Although roughly 2.3% of all adults in America will meet diagnostic criteria at some point in their lives, OCD is often misunderstood in our society.¹ Close to 5 million Americans will experience OCD, but they might not know they meet criteria. In part, this is due to society’s perception that symptoms of OCD are limited to only contamination fears or fixations about ordering or arranging objects. Unsurprisingly, countless movies and television shows help contribute to these stereotypes. When a main character in a movie or on a show has OCD, customarily they will engage in compulsive hand washing or have a specific and rigid daily routine. While contamination and symmetry obsessions are common subsets of Obsessive-Compulsion Disorder, they are by far not the only.

Not only is OCD misunderstood, but it is also unfortunately often not diagnosed. Take for example, one subset of OCD: Relationship Obsessive Compulsive Disorder (ROCD). People with ROCD have distressing obsessions such as the degree of “correctness” of their romantic relationship or whether their partner is absolutely, without doubt, “the right one.” Since OCD is more than a preference, an individual with ROCD finds themselves in a complicated and distressing cycle of obsessions and compulsions about their relationship. For example, in response to an obsession of doubt as to whether their partner “is the one,” a person with OCD might engage in a compulsion of excessively comparing their partner to others via social media or other people in their lives. The person in this scenario is attempting to gain absolute certainty that their partner is indeed “the right one.” We can see how these behaviors might lead to relationship strain and have a negative impact on their relationship since there is no clear way to know with 100% certainty that someone is “the right one.”

Clients with ROCD often report that their previous therapists or primary care provider chalked up their obsessions about their romantic relationship to normative relationship doubts. We cannot blame them, for ROCD is an example of the reality that when OCD is only prorated as a struggle with contamination or symmetry, we miss opportunities to identify OCD and intervene. With more education and research being done about other manifestations of OCD, we can remain optimistic that OCD will be more understood across the health field, media and greater society.

OCD & COVID-19

The global pandemic — and its ever-changing landscape — continues to challenge all of us to be more comfortable with uncertainty. For individuals with OCD, this task might be particularly hard considering uncertainty helps fuel OCD and keeps its cycle active. Whether it is experiencing job loss, working from home, missing visits to our loved ones or any of the other factors that completely shook up one’s daily routine, people have had to adapt to completely new ways of living. Considering the pandemic, individuals with OCD may notice an increase in their obsessions, experience an increased difficulty in resisting compulsions or see that their obsessions have shifted to something new altogether.

How can therapy help?

Research consistently indicates that Cognitive Behavioral Therapy (CBT) is the most effective therapy in the treatment of OCD.^{2 3} Specifically, Exposure and Response Prevention (ERP), one type of behavioral therapy, has the most substantial body of research to support its efficacy in treating OCD.^{4 5} The fundamental purpose of ERP is for the client to face their obsessions head on and slowly work towards reducing their compulsions. The client expands their tolerance for uncertainty and feels empowered in knowing they can break their cycle of obsessions and compulsions.

Learn more about CBT

Additional information on OCD

• Stieg, C. (2019, July 16). “What Is ‘Relationship OCD’ & How Can You Tell If You Have It.” Refinery 29.
• The OCD Stories Podcast
• Grayson, J. (2014). Freedom from obsessive-compulsive disorder: A personalized recovery program for living with uncertainty. New York, NY: Berkley Books.
• UNSTUCK: An OCD Kids Movie Documentary