People have called me "so OCD" for most of my life. The tics, the habits, the way I can lock onto one thing and not let go. They meant it as a joke, or as a polite way of saying weird. I laughed along. I didn't know what OCD actually was, and it turns out neither did they.
Let me be clear up front. I have ASD, diagnosed late. I don't have an OCD diagnosis. This post comes from the questions I've had to ask myself, and from reading what the people who treat OCD actually say.
And the first thing they say is that OCD is mostly not about cleaning. The International OCD Foundation lists contamination as one theme among many. The others include fear of hurting someone, unwanted sexual thoughts, religious or moral fear (often called scrupulosity), a need for things to feel exactly right, an exaggerated sense of responsibility for disasters, and doubts about your identity. A lot of people with OCD never wash their hands more than anyone else.
So what is OCD, really?
Two parts. Obsessions are unwanted thoughts, images or urges that keep pushing into your head and bring anxiety, disgust or dread. Compulsions are what you do to make that feeling go away. The NHS gives a plain example: someone terrified of being burgled who has to check the doors and windows over and over.
The trap is that the compulsion works. For a minute. The dread drops, so the brain learns "that saved us", and the next time the thought shows up the urge to do it is stronger. Round and round.
The types people don't recognise
Here are the ones that surprised me, in no particular order.
Harm. Thoughts of hurting someone you love, or of losing control and doing something terrible. People with this kind of OCD are usually horrified by the thought, which is the whole point. I wrote a separate post on what intrusive thoughts mean, and don't mean.
Checking. The stove, the lock, the email you sent, did you hit someone with the car on the way home. Checking feels responsible. Then the doubt comes back the moment you walk away, and you check again.
Scrupulosity. Fear of having sinned, lied, cheated, or been a bad person, even by accident. Some people confess things over and over that barely happened.
"Just right." Things need to be even, symmetrical, done in a certain order, or repeated until they feel right. Nothing terrible is necessarily feared. It just feels wrong in a way that won't let go.
Relationship and identity doubts. Do I really love my partner? What if I'm not who I think I am? Endless analysing that never lands.
The compulsions can be completely invisible. HereToHelp BC lists mental rituals, like repeating a word or phrase in your head, right next to washing and checking. Mentally replaying a conversation to make sure you didn't say something awful counts. So does asking people for reassurance, again, for the fifth time today.
Why it matters that people get this wrong
When OCD gets reduced to tidy desks and hand sanitizer, people with the harder, quieter kinds don't recognise themselves. Or they do, and they're too ashamed to say what the thoughts actually are. The IOCDF says it takes over seven years on average to get an accurate diagnosis. Seven years is a long time to think you're a monster.
HereToHelp says about 1 to 2% of people in Canada will deal with OCD at some point. It's treatable. The main treatment is a specific kind of therapy called exposure and response prevention, and I explain how OCD is actually treated in its own post.