I grew up tortured by anxious, intrusive thoughts. I coped in the best way I could: In elementary school, there was a period when I had to close my closet door the “right way” so my grandma wouldn’t die.
As I got older, I found relief in a new way. I began confessing my thoughts to those closest to me. If I couldn’t remedy them on my own, reassurance from my loved ones was the next best thing.
I continued this obsessive thought-confession-repeat cycle for a few years. All the while, I assumed my obsessions were either related to the anxiety diagnosis I received in high school, or worse, that I was a horrible person.
It wasn’t until I was 27 that I learned that seeking reassurance could be a compulsion, a key component of obsessive-compulsive disorder. I made an appointment with a licensed professional counselor and got confirmation that my symptoms were indeed consistent with OCD.
My diagnosis changed everything. I was finally able to get the help I needed — and my quality of life improved. I’m telling my story to create more awareness around a disorder that is frequently misrepresented in our culture.
The danger of ‘I’m so OCD’
Today, phrases like “I’m obsessed,” or “I’m so OCD” are commonly used to express approval for something or to show a preference for cleanliness or organization.
These statements can be detrimental to people who live with OCD because of how narrowly they portray the wide range of OCD subtypes. In fact, in a 2013 study in which participants heard a short story describing someone with OCD, two-thirds of respondents could not correctly name OCD symptoms.
About 2 million to 3 million Americans struggle with the disorder. While OCD can present at any age, most cases appear by early adulthood. OCD can also be confused with other mental health conditions including schizophrenia or generalized anxiety disorder, says Kristina Orlova, a licensed marriage and family therapist who specializes in anxiety and OCD. Some research shows it can take an average of up to 17 years for someone to get appropriate OCD treatment.
OCD is characterized by obsessions and compulsions, says Martin Seif, a psychologist and co-author of Overcoming Unwanted Intrusive Thoughts: A CBT-Based Guide to Getting over Frightening, Obsessive, or Disturbing Thoughts.
“An obsession is a thought that arrives with a ‘whoosh,’ feels repugnant in some way [and] has some desire for action,” says Seif. “A compulsion is something that we do to try to reduce the distress that’s caused.”
While everyone has distressing thoughts and obsessions at times, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) differentiates OCD as being particularly “time consuming” and leading to “clinically significant distress or impairment.”
Obsessions vary from person to person and can be influenced by factors such as familial upbringing, stressors and value systems. Obsessions aren’t always thoughts, they can also be unwanted urges, feelings or impulses. And many times, they can be taboo. Some might have thoughts about germs and contamination, while others might have fears of committing violence.
“It’s really a disorder in which our imagination beats us up,” says Seif.
Likewise, compulsions can take on numerous forms. These can be external, like avoiding triggers, sanitizing or seeking reassurance from friends or family. They can also be internal, like counting, praying or performing other similar rituals.
Breaking the cycle
To treat OCD, medical providers help their patients break the obsessive-compulsive cycle.
This can be accomplished through a variety of therapies, many of which fall under the category of cognitive behavioral therapy, which aims to help patients understand and modify unhelpful thought patterns.
One type of CBT that is especially useful for treating OCD is exposure response prevention. In ERP, patients are exposed to obsessions, and the goal is for them to accept discomfort, let time pass and get back to the present moment without performing a compulsion. Over time, ERP can reduce the anxiety associated with thoughts that trouble someone with OCD.
Acceptance and commitment therapy is another approach that focuses on helping a patient develop a willingness to sit with uncomfortable feelings and emotions without acting on them. Orlova says these therapies complement each other and intend to help patients “no longer fall into the bottomless hole of compulsions and get stuck in OCD Land.”
Someone with OCD may try these therapies on their own, or with the help of a therapist who specializes in OCD. Orlova notes that most clients seek professional assistance when their OCD symptoms begin to interfere with daily life.
When therapies are not effective on their own, treatment may be supplemented by medication.
While you may associate selective serotonin reuptake inhibitors with treating anxiety and depression, they can also treat OCD. I treat my disorder with an SSRI and work with a therapist on ERP exercises.
One form of ERP that has been especially helpful for me is creating so-called imaginal exposure stories. I write a short script featuring the worst possible outcome of one of my intrusive thoughts. Then, I read the script over and over, and sit with any discomfort that arises. At first, I was too scared to even write down some of my most extreme obsessions, but as I practiced, I was surprised to find my worries started to feel boring. By leaning into discomfort, Seif says, you can build neural pathways that make it easier to deal with distressing thoughts.
Life outside of ‘OCD Land’
While it can be incredibly hard to talk about OCD, it’s important for me to discuss my own experience in the hope that fewer people will suffer in silence.
Through this process, I’ve realized that everybody has thoughts they don’t like sometimes. It is how you respond — or more appropriately, don’t respond — that makes a difference. Learning more about OCD has also helped me understand myself and my values more clearly.
Like Orlova says, successfully managing OCD doesn’t mean you never have an intrusive thought again, but instead “when you do fall, being able to get up, take that next step, or two, or three, and move on.”
As I continue learning how to live with OCD, I am focusing on doing just that.