4 Common OCD Misconceptions

We’ve all heard them before, perhaps even said them ourselves… 

“I’m so OCD about my kitchen.”

“She’s super OCD when it comes to cleaning.”

“I get really OCD about ______.”

These casual comments reflect our culture’s misperceptions about the nature and severity of suffering found in Obsessive-Compulsive Disorder (OCD).

Despite the recent increase in diagnostics and treatment protocol, OCD continues to be one of the most misdiagnosed, under-diagnosed, and misunderstood diagnoses in the mental health field. 

Heartbreakingly, studies estimate that it takes an individual who suffers from OCD an average of “anywhere between 7 to 17 years” to receive an accurate diagnosis (NOCD).

People with OCD are often misunderstood - sometimes even by the clinicians and loved ones trying to help them. These misunderstandings can perpetuate and prolong suffering, so getting this right matters for supporting those we love with OCD and helping guide them to proper care.

As a clinician who specializes in treating OCD, I’d like to suggest and correct four common misconceptions about OCD and those who have it.

1. OCD is primarily found in fear of germs or a need for symmetry. 

OCD is often classified by its subtype, often referred to as an “OCD theme.” While it is true that the themes of Contamination OCD and Symmetry OCD are quite common, these are only two of the dozens of subtypes, including Harm, Relational, Religiosity, Scrupulosity (Morality), Sexual (most commonly Pedophilia or Sexual Orientation), and Pure-O OCD to start.

2. Compulsions are always observable. 

Compulsions, most often referred to as the behavioral mechanism that temporarily calms an anxious urge or intrusive thought or memory, are often observable. 

We may see this in patterns of checking behaviors (e.g. checking that the oven is off five times before we can go to sleep), or “just right” behaviors (e.g. turning off and on the light switch until something in our somatic system informs us that it's been turned off “just right”).

However, compulsive behaviors are not always observable. Just as common as those listed above are silent or mental compulsions, such as neutralizing thoughts (e.g. if I hear a bad word, I may intentionally think “pure thoughts” in order to neutralize its effect), or even prayer (e.g. if I think a bad thought, I may directly turn to prayer in order to “rewrite” that thought such that no one gets harmed).

These invisible compulsions are easy to miss, but just as persistent, and therefore essential in receiving holistic treatment. 

3. The content of the obsession and/or compulsion informs us about people’s character or desires. 

The truth of OCD’s nature is the inversion of this statement. What I have consistently witnessed in treating OCD is that an individual’s obsessive content typically reveals the inverse of their desire.

OCD informs us of their fear, and thus highlights what they value.

I’ll give a personal example of one of my own experiences with OCD tendencies that I’ll never forget.

For years, when poolside with young littles around, I couldn’t stop the intrusive thoughts from flying in: “What if I pushed them in?”

My body would shudder, thinking about the danger this could pose - freaked out by the simple power I held in that with one little push, a child could be in grave danger.

It wasn’t until one summer, poolside with my friend’s children, that her two-year-old daughter fell into the pool without her floaties.

Without second guessing, fully clothed and phone in the back pocket, I dove in after her and brought her up out of the water.

What could’ve been a day marked by tragedy thankfully turned to a short, scary moment for that sweet girl.

That’s when I realized: I imagine those dangers because there is little I value more in life than protection of the innocent – protecting those who cannot protect themselves. 

OCD takes what we value and twists it backwards - only to tell us that what we care about most is at danger (and the danger is us). 

Realizing this was deeply relieving for me, and helping those with OCD understand this helps in separating themselves from the content of their intrusive thoughts.

4. The goal of treatment with OCD is to eliminate intrusive thoughts.

Our brains are wired for survival. So then why would we pretend that our brains wouldn’t look for patterns of danger everywhere we go? 

The crux of OCD treatment is this: we can withstand uncomfortable things without taking action.

This does not mean that the scary thoughts will always disappear. The hope, indeed, is that they minimize as we treat them with compassion and a values-based approach…but this does not promise extinction.  

Ultimately, OCD treatment seeks to empower people to notice and tolerate distressing thoughts without having to rely on repetitive behaviors and thought patterns that offer a temporary façade of safety. 

Ultimately, we are helping people learn to be still again.