With over 3 million Americans affected, Obsessive Compulsive Disorder (OCD) is more intricate than common stereotypes suggest. If you think OCD is only about cleanliness, you might be missing the broader picture. Learn why it’s vital to understand the complexity of OCD and how seeking the right help can change lives.
OCD Myths and Realities
I’m so messy, so how can I still have obsessive compulsive disorder (OCD)?
Can you even have OCD without being neat? The media often portrays OCD as this quirky trait where people are overly organized, with their lives neatly arranged into color-coded perfection.
What if we told you that OCD is far more complex than just being a neat freak? In fact, many people may not realize they have OCD because they don’t fit the stereotype.
OCD is a condition characterized by a pattern of distressing thoughts and compulsive behaviors meant to neutralize the thoughts. OCD isn’t a rare phenomenon –an estimated three million Americans are diagnosed with the condition – but it remains misunderstood, often leading to people not receiving the necessary diagnosis and support. This can lead to ineffective forms of treatment including talk therapy, psychological treatments that haven’t been researched, and antipsychotic medications. While these therapies are often administered with good intentions, they are very often ineffective for treating OCD.
In contrast, a proper understanding of OCD symptoms and effective OCD diagnosis can pave the way for evidence-based therapies.
The hidden struggle: What delays an accurate OCD diagnosis?
Research shows that it takes an average of 10 years for most people to receive a proper OCD diagnosis. This is due to several factors, including a lack of understanding of OCD among the general population and health care professionals (Stnke, 2021). Physicians misdiagnose 50% of OCD cases, and this rate is even higher when someone presents with OCD that isn’t related to contamination or symmetry (Glazier et al., 2015).
This was the case for Lily, a resident of Old City. For a decade, Lily worried that she didn’t turn off the stove and had to double check before she left the house, she also had thoughts that she blacked out while driving, hit someone, and had to check the news to make sure there was not a hit and run in her area.
Lily had been in and out of therapy, received multiple diagnoses and attended multiple forms of therapy, including talk therapy, reassurance, Eye Movement Desensitization and Reprocessing (EMDR), and Brainspotting,– none of which helped. For Lily, getting an OCD diagnosis was surprising, but the more she learned about the diagnosis the more sense it made to her. She is now receiving Exposure and Response Prevention (ERP), and for the first time in 10 years she is feeling like herself.
Lily’s story is a testament to the effectiveness of exposure and response prevention for OCD and other forms of cognitive-behavioral therapies, which are often a key component of successful OCD therapy
Understanding the difference: Is it OCD or OCPD?
The distinction between Obsessive-Compulsive Disorder (OCD) and Obsessive-Compulsive Personality Disorder (OCPD) is often blurred by a common misconception that those with OCD are inherently detail-oriented and rigid in their behaviors and thinking. While OCD and OCPD may sound similar, they’re notably different in nature.
As we’ve mentioned, OCD is characterized by unwanted, intrusive thoughts and repetitive behaviors aimed at alleviating the anxiety stemming from these obsessions. On the other hand, OCPD embodies a pattern that digs deeper into an individual’s personality traits, often showcasing extreme perfectionism, a need for control, and a lack of flexibility in various aspects of life.
Individuals with OCPD may indeed be meticulous to the point of perfectionism and exhibit a rigidity in routines and inflexibility in their standards. However, this is not indicative of OCD itself. In this blog post, we focus on clearing up the misunderstandings surrounding OCD—particularly the false notion that OCD is synonymous with being hyper-organized or excessively conscientious about details.
For those interested in further exploration of the nuances between these conditions, we provide in-depth analysis and resources in our separate blog post, dedicated to unraveling the complexities of OCD and OCPD.
Could this be OCD? Recognizing the signs
It’s not uncommon to question whether certain thoughts or behaviors might be symptoms of OCD. Recognizing these signs is the first step towards understanding and managing OCD. If you’re in this stage of self-reflection, know that you’re not alone. Many people have begun their journey to clarity and assistance with a similar sense of curiosity and concern.
Our goal is to demystify OCD by providing clear, accessible information and resources. We strive to offer insight into the true nature of OCD and support that empowers you to seek help. At our Philadelphia clinic, you will find a wealth of information on effective OCD treatment through cognitive-behavioral therapy and exposure and response prevention and OCD-related resources designed to aid in the understanding of obsessive compulsive disorder and guide you through the initial steps of acknowledging and addressing your experiences.
Now let’s tackle some common myths about OCD. These myths can give people the wrong idea about what it’s really like to have OCD and can even get in the way of finding the right help. We’re going to clear up three big myths and show you what OCD is actually all about. It is our hope that recognizing OCD signs and symptoms can lead you to seek evidence-based OCD treatment sooner.
Debunking OCD Myth #1: OCD is About Being Clean and Organized. I’m Messy So How Can I Have OCD?
Monica Geller in “Friends,” Sheldon Cooper in “The Big Bang Theory,” Leslie Knope from “Parks and Recreation,” and Adrian Monk from “Monk,” are all depicted as super neat, organized individuals with strict rules. While these characters offer a glimpse into some aspects of OCD, these portrayals only capture a fraction of the OCD experience. OCD encompasses a lot beyond cleanliness and orderliness. And a critical component often overlooked in these representations is the presence of distressing thoughts.
The psychological backbone of OCD: Intrusive, distressing thoughts
A common misconception is that OCD solely concerns compulsive behaviors, such as excessive cleaning and organization. In actuality, compulsive actions like these are typically driven by pervasive, unwanted thoughts and fears. Cleaning and organizing are not due to a dislike of untidiness, but are used to quell scary thoughts and distressing feelings.
For example, Taylor has intrusive thoughts that he left something on the counter that will contaminate his family’s food. Taylor scrubs the counter for an hour each day to ensure that his family doesn’t get sick. For Taylor, and many others with contamination OCD – cleaning is not done because he doesn’t like mess, it’s done to eliminate negative, scary thoughts.
What are common OCD symptoms besides cleaning?
OCD manifests in various forms, not limited to cleaning. Some individuals grapple with fears of harming themselves or others, or experience recurring, unwanted taboo sexual or violent thoughts. Others may perform meticulous checks or follow rigid routines like performing actions in a certain way to mitigate their anxiety. Regardless of the particular content, people with OCD experience patterns of recurring intrusive thoughts (obsessions) and repetitive physical or mental actions to deal with these thoughts (compulsions), which can be time-consuming and distressing and can significantly disrupt daily life.
While some folks with OCD may have obsessions and compulsions related to cleanliness, many don’t. If you’re struggling to determine if you have OCD , comprehensive treatments for OCD and anxiety such as Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) may be effective options. Our Center offers an array of resources to support those dealing with OCD’s complexities.
Debunking OCD Myth #2: People with OCD are Rigid or Don't Try Hard Enough to Stop Doing Compulsions
Compulsions are powerful responses to overwhelming anxiety. Asking someone with OCD to just stop doing a compulsion is like asking them to ignore a fire alarm – or as Sean Patton calls it “a mafia boss” who is threatening that bad things will happen if you don’t follow the rules – it’s not easy to do.
Doing compulsions isn’t about laziness, rigidity, or lacking self-discipline; these behaviors are incredibly challenging to stop. Compulsions help to neutralize intrusive, scary thoughts and alleviate distress. Often, compulsions become reinforced, you keep doing them because they make you feel better.
This was the case for Todd. Todd worried that he didn’t lock the door before going to bed and had a scary image of someone breaking into his home in Rittenhouse Square, he went to check the door and the thought went away. The next night, Todd had the intrusive thought of someone breaking in again – he remembered what made the thought go away last night – and went to check the door. At first, checking the door didn’t impact Todd’s life much; however, over time he started to get up out of bed multiple times a night to check the door and make the intrusive thought of someone breaking in go away.
How do I stop doing compulsions?
Many people want to stop compulsions but struggle, and that’s completely normal. Through research and extensive experience, we know that certain strategies can help you be successful in lessening your compulsions.
- Identify Triggers: Figure out what situations, thoughts, or feelings lead to you feel the urge to do compulsions.
- Delay Compulsions: When you feel the urge to do a compulsion, try to delay it a few seconds or minutes. Start to allow yourself to sit with that anxiety (it feels uncomfortable!). Over time, you may find that the urge starts to lessen.
- Create a hierarchy: Not all thoughts or compulsions are created equal. Some compulsions are easier to not do than others. Start by delaying compulsions that are less anxiety inducing.
- Use Coping Strategies: Identify the obsession you feel compelled to respond to and see if you can recognize it as just a thought, not a fact. Try to concentrate on the present and immerse yourself fully in what you’re doing in the moment. Remind yourself of your values and motivation for resisting compulsions, even though it’s hard. (Our clinic director, Dr. Chazin, refers to this approach as ‘double-sided empathic coaching,’ emphasizing the importance of understanding and compassion in the process of managing compulsions).
OCD support from others may help
Friends and family are often good sources of support, and chatting about your struggles with those who know and care about you can be comforting. However, you may feel like you need support and guidance from a professional, this is where mental health care providers come in. Our clinic team can provide you the support you need to reach your goals. Reach out to us for more information about the services we offer.
Debunking OCD Myth #3: Unveiling the Truth About Therapy vs. Medication
It’s a common belief that medication is the only effective treatment for Obsessive-Compulsive Disorder (OCD), but this myth ignores the powerful impact of therapy. Various therapeutic approaches offer substantial benefits for individuals with OCD. Let’s take a closer look at how these therapies contribute to managing OCD and compare their effectiveness with medication within treatment plans.
What therapeutic approaches can help with OCD?
While medication is an important tool in managing OCD, it is by no means the only effective treatment. Research has validated several therapeutic approaches that can effectively reduce the impact of OCD symptoms. These include cognitive therapy (CT) and cognitive behavioral therapy (CBT) adapted for OCD, exposure and response prevention (ERP), inference-based cognitive behavioral therapy (I-CBT), and acceptance and commitment therapy (ACT). Exposure and response prevention for OCD was traditionally viewed as the gold standard, and while it is beneficial for many, it turns out that these other cognitive and behavioral therapies for OCD can also be tremendously helpful to a wide range of patients.
These strategies are usually offered in weekly or twice-weekly individual or group sessions with a psychologist or therapist who specializes in OCD and anxiety. And their effectiveness often increases when provided by specialists in these therapies.
How effective is therapy for OCD?
Extensive research has demonstrated that therapies like exposure and response prevention (ERP) and cognitive behavioral therapy (CBT) can be highly effective for OCD, significantly reducing the distress and disrpution caused by intrusive thoughts and compulsive rituals.
Studies show that under the guidance of skilled professionals, these therapies can produce “large” or “very large” therapeutic effects (Öst, Havnen, Hansen & Kvale, 2015; Ferrando & Selai, 2021; Reid, Laws, Drummond, Vismara, Grancini et al., 2021). Moreover, CBT and ERP are often found to be more effective than commonly prescribed OCD medications, such as SSRIs (Öst et al., 2015). This highlights the profound impact that expert therapy can have in enhancing the lives of those with OCD.
While acceptance and commitment therapy (ACT) for OCD and inference-based cognitive-behavioral therapy for OCD have less research support, studies indicate that ACT and I-CBT could be beneficial for many patients, either as a primary treatment or in conjunction with CBT or ERP (Evey & Steinman, 2023; Philip & Cherian, 2021; van Niekerk, Brown, Aardema & O’Connor, 2014).
What Can You Expect from Evidence-Based OCD Therapy?
Recognizing the benefits of therapy for OCD naturally leads to the question: how can you tell if you’re receiving high-quality care? Components of effective OCD therapy should include:
- Psychoeducation: A key part of therapy involves your psychologist or therapist providing detailed information about OCD, its persistence, the various treatment options, and a clear, understandable treatment plan, along with how this plan can positively impact your life.
- Evidence-based approaches: It’s essential for the therapy you receive to have a robust foundation in research, showing its effectiveness in reducing OCD symptoms and improving life quality. If you have doubts, it’s a good idea to inquire about the empirical support for the therapy you’re considering.
- Skill building: Regardless of the specific approach—whether it’s exposure and response prevention for OCD, cognitive behavioral therapy for OCD, or another method—your therapist should guide you in acquiring skills or understanding principles that reframe how you view and react to your OCD, aiming to reduce the impact of intrusive thoughts, doubts, and compulsive actions.
- Strong, Collaborative Therapeutic Relationship: An integral part of effective OCD therapy is the development of a strong, collaborative relationship between you and your therapist. A therapeutic partnership built on trust, open communication, and mutual goal-setting not only enhances the treatment experience but also reinforces your progress. It’s the combined effort, where the therapist’s guidance meets your active participation, that often leads to the most meaningful advancements in managing OCD.
- Personalized understanding and respect for patient experiences: Quality OCD therapy recognizes that while therapists bring their expertise in treatment methodologies, patients are the authorities on their own experiences. Valuing this expertise on both sides is crucial to the success of the therapeutic process. Expect a therapist to demonstrate a high level of awareness, understanding, and attunement to your specific challenges, which often stems from refined therapeutic skills and experience with a broad range of cases similar to yours. This deep, personalized comprehension and mutual respect are fundamental for a successful therapeutic outcome.
What does recovery look like after effective OCD treatment?
Committing to OCD treatment is a meaningful investment in your overall well-being, requiring dedication, time, and resources—but it’s an investment that often yields life-changing benefits. Although the journey is unique for everyone, with improvements varying from person to person, proper treatment for OCD can be quite impactful. Therapies like exposure and response prevention for OCD or cognitive behavioral therapy for OCD have been proven to significantly lessen the effects of OCD on professional, social, and personal life aspects of life, enabling many individuals to regain a sense of control and freedom.
Our community is rich with inspiring stories from those who have embarked on this path and found success. We warmly invite you to explore these OCD recovery stories for insight and inspiration from their experiences.
Conclusion: Beyond Stereotypes—Multiple Cognitive Behavioral Therapies Can Address Various Forms of OCD
OCD is complex and multifaceted, and it’s critical to bust myths that can hinder people from receiving an accurate diagnosis and pursuing effective treatment. There are several successful treatment options for obsessive-compulsive disorder that can significantly enhance your quality of life and provide a newfound sense of freedom.
For more insights on OCD and to explore various therapy options, we encourage you to connect with us and become a part of our social media community. Follow our updates on Facebook, Twitter, Instagram, and LinkedIn, and explore additional OCD resources in our other OCD blog posts. Share this guide to support individuals and their loved ones on their personal journeys with OCD.
This blog was brought to you by Allie Bond MA and Daniel Chazin PhD ABPP
