Myth vs. Reality: OCD Edition

Examining common misconceptions about OCD and it’s treatment

Our national conversation about mental health has been shifting. People often feel more comfortable sharing their experiences with less concern about facing stigma than in the past (although there is still ample room for progress). Unfortunately, obsessive-compulsive disorder (OCD) has not figured into the dialogue as much as other conditions or topics bringing folks to therapy. This leaves many with incomplete or inaccurate ideas about it, leading to piecing together a picture based on stereotypes or questionable media portrayals. My goal here is to debunk some widely held misconceptions about OCD to begin to shift and complete this picture. 

With that being said, OCD looks different for everyone. Therapy can help an individual understand how OCD uniquely shows up for them in order to manage symptoms more effectively. It can also assist loved ones of someone with OCD in learning how to best support their friend, partner, or family member.

Myth

Behaviors related to OCD can always be seen.

Reality

Compulsions can include physical behaviors or mental actions completed with the goal of reducing anxiety created by intrusive thoughts or images. Sometimes an onlooker could witness someone with OCD performing a compulsion, such as repeatedly checking that they turned the stove off before leaving home. However, other times compulsions are not perceivable to an observer. For example, the person could instead repeatedly mentally review the steps they took while leaving home to ensure they turned the stove off. Mental compulsions can take many forms and are important to identify during the course of treatment to ensure that a person with OCD is not unknowingly performing compulsions that may hinder their progress.

Myth

People with OCD simply value organization.

Reality

Khloe Kardashian’s “KHLO-C-D” videos highlight her home organization system, serving as an example of how this misconception has become widespread. Obsessions and compulsions related to ordering and arranging can be present for someone with OCD, but their existence is not a requirement. In cases where someone with OCD does experience this, compulsions may need to be done until it feels just “right” or done out of fear that something bad may happen if they are not done, and these greatly impair one's functioning (Foa et al., 2012; International OCD Foundation, n.d.).

Ordering and arranging is just one of many themes that OCD can manifest as. Contamination OCD is another commonly known presentation that the media often focuses on, such as the character Emma Pillsbury on Glee. But like ordering and arranging, it is not necessary for diagnosis.

One example of a not-often discussed theme is harm OCD, which involves fear that one could cause harm to themselves or others. One commonality amongst different themes is that the content of obsessions goes against the person’s values, meaning that a person with harm OCD does not want to hurt anyone and is in fact terrified of it.

Myth

OCD should be treated in the same fashion as generalized anxiety.

Reality

Generalized anxiety involves worry related to several areas of life that causes distress and gets in the way of functioning. It is quite common for someone with OCD to have obsessions and compulsions that fall under several different themes and for these themes to jump around over time. A main distinguishing factor between generalized anxiety and OCD is the attempted use of compulsions to reduce anxiety in the latter (which ultimately creates a vicious cycle). 

Despite this and other differences between these two conditions, a standard cognitive-behavior therapy (CBT) approach is used by some to address OCD symptoms. One reason that standard CBT is not optimal in this case is because challenging the content of obsessions can give them validity where none is warranted. Exposure and Response Prevention (ERP) is a top evidence-based treatment for OCD that does not vary based on the content or theme(s). Instead, it helps clients change the way they respond to obsessions and grow their confidence in tolerating anxiety and uncertainty overall (Foa et al., 2012).

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Accurate information about OCD is becoming more accessible through reputable online sources like the International OCD Foundation. But, continuing to spread awareness is essential to ensure that OCD symptoms are being recognized, as this is the first step toward appropriate treatment. Therein lies the hope and potential for people with OCD to live in a way more aligned with their true values and less subject to the OCD cycle.

Please feel free to reach out to schedule a free 15-minute phone consultation if you are interested in using an approach grounded in ERP to address OCD symptoms.

Kari Savoie, MC, LAC

Licensed Associate Counselor

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References

Foa, E. B., Yadin, E., & Lichner, T. K. (2012). Exposure and response (ritual) prevention for 

obsessive-compulsive disorder: Therapist guide. Oxford University Press.

International OCD Foundation. (n.d.). About OCD. https://iocdf.org/about-ocd/