The experience of OCD: Same patterns, different content

This post is for informational purposes only, and should not be considered professional psychological advice

If you were to imagine the experience of someone with OCD, what would you picture? One of the most well-known obsessional themes is the fear of contamination, for example, someone who is afraid of catching an illness and constantly washes their hands or avoids leaving their home. This theme is often portrayed in media, and although it is a common one, the list of ways OCD can manifest is nearly limitless. It can be challenging for people to know when they are experiencing OCD, both because obsessions can feel so urgent and convincing, and because of the limited depictions in our media and culture. It doesn’t help that the phrase “I’m so OCD” is frequently used to describe tendencies to be tidy or particular.

In the last post, we went over the pattern of obsessions and compulsions. Fear of contamination demonstrates this pattern well. A fear of germs or contamination often leads to behaviours like handwashing, avoiding places that seem “dirty”, and monitoring whether someone nearby is coughing. Contamination can feel like a serious threat for a few reasons; first, the stakes can be high (e.g., risks of disability or death or passing these on to others), and second, we can never be totally sure we haven’t been in contact with microscopic organisms like dangerous viruses and bacteria. The combination of high stakes and doubt is powerful, and doubt is even more likely with themes that are unlikely to be black or white (e.g., they involve subjective experience or opinion). There are countless other themes that fit these criteria, including:

·      Fear that you unknowingly said or will say something offensive (obsession and doubt) which could mean that you be ostracized or fired from your job (high stakes), so you re-read texts and emails, seek reassurance from others, check your memory, and avoid posting comments publicly online (compulsions/avoidance)

·      Fear that you will realize you are gay even if this is quite unlikely (obsession and doubt) which could mean losing your relationship (high stakes), so you constantly check that you are attracted to your partner, avoid movies and shows with LGBTQ+ content, and watch videos of people coming out as gay to make sure they don’t resonate with you (compulsions/avoidance)

·      Fear that you unintentionally cheated or will cheat on your partner (obsession and doubt), which could mean losing your relationship or being a bad person (high stakes), so you avoid interactions with people you think are attractive, or confess to your partner every time you think you might have done something wrong (compulsions/avoidance)

·      Fear that you accidentally hit or will hit someone with your car (obsession and doubt), which could mean legal consequences and intolerable guilt (high stakes), so you circle back to check every time you go over a big bump, check the news for stories of a hit-and-run, and avoid driving in busy areas (compulsions/avoidance)

This last example mentions intolerable guilt, which alludes to another important component for some people with OCD. Sometimes the feared outcome is not really that something bad will happen externally, but that without doing a compulsion, they will not be able to tolerate intense feelings like anxiety, disgust, or guilt and this could ruin their lives or cause them to go “crazy”. In these cases, people are often likely to experience what we refer to as a need for things to be “just right”.

There was no way we could cover every possible obsessional theme in one blog post. I tried to pick a few that come up often with my clients and are not immediately recognizable to them as OCD. If you are reading this and feeling some sense of relief because you are able to put a name to what you are experiencing, I’m so glad! Of course, I would also encourage you to seek professional help if these symptoms are getting in your way. Reading things online about OCD can be incredibly helpful, but there is a lot out there that provides temporary reassurance or is downright harmful. Next time, we’ll discuss how to navigate resources, particularly online resources, when you have OCD.