This article will cover the following points:

• What are common misconceptions about OCD?
• Why are these misconceptions dangerous?
• What is OCD really?
• What are the causes of OCD?
• Can OCD be treated?

What are common misconceptions about OCD?

There is a common trend to label people as OCD when they engage in certain behaviours, such as constant hand-washing, cleaning or organising. While these behaviours are often exhibited by people diagnosed with obsessive-compulsive disorder (OCD), simply having a preference for a clean and organised space is not sufficient to diagnose someone with OCD.

Research has shown that around 46.5% of people think that there is no difference between being obsessive-compulsive and having OCD [11], even though they are two separate things. A person can exhibit perfectionism and preoccupation with orderliness without actually suffering from OCD. 

Moreover, OCD is a very heterogeneous mental disorder and symptoms and their severity vary from person to person [1]. However, it has been found that the general public tends to associate certain symptoms with OCD a lot more than others. For example, fear of responsibility and other aggression-related symptoms are more ignored [8, 5] even though they are often exhibited by people with this disorder. 

But why are misconceptions dangerous? The largest problem is stigmatisation. People exhibiting OCD symptoms receive more negative attitudes from the public, which can have detrimental impacts on their well-being, and add on to their suffering[8, 5]. Stigmatisation leads to another big problem – seeking proper treatment. Approximately 50% of people with OCD feel ashamed to ask for help[6] and as a result, they might delay help-seeking! Because of this, it is very important that we all educate ourselves and raise awareness on what OCD really is, which is proven to significantly reduce stress among those affected by it[15]. 

What is OCD really?

Now that we have established what OCD is not, let’s look at what it actually is. The DSM – 5, the manual for diagnosing mental illnesses, defines OCD as the presence of obsessions and/or compulsions [1]. Obsessions refer to persistent and recurrent thoughts, images or urges that are perceived as intrusive and unwanted [1]. These obsessions can include concerns about contamination, fear of harm to loved ones, aggressive impulses or need for symmetry [1, 2, 13]. Compulsions are repetitive mental acts or behaviours that the individual feels forced to perform to reduce the distress created by the obsession. However, the two are not necessarily connected in any logical way [1]. These behaviours can include the already mentioned hand-washing, cleaning, organising but also other behaviours such as checking, ordering, hoarding or touching things in a specific way [1, 2, 10]. Mental acts can include counting, praying or repeating certain words [1, 2, 10]. Most of us exhibit some of these behaviours from time to time, for example double-checking if we locked the door, however for people with OCD these obsessions and compulsions are excessive, time-consuming and distressing  [1]. Engaging in certain rigid behaviours or mental acts can alleviate the anxiety by making people with OCD think that they are preventing feared events from happening. So, contrary to popular belief, these people do not engage in such behaviours out of pleasure, but rather because they have an uncontrollable urge to do so [1]. Moreover, people with OCD often recognize that their obsessions are irrational, but they simply cannot control them [9, 13].

What are the causes of OCD?

Causes of OCD have not yet been fully established. However, several risk factors were discovered and it is most likely the combination of these factors that contributes to the development of OCD [14]. Recent investigations show that genetics might play a role, as people with first-degree relatives affected by OCD are more likely to develop it compared to the general population [2, 13].  Additionally, serotonin also seems to play a part in OCD. This neurotransmitter acts as a “mood, appetite and sleep stabilizer” and individuals with this disorder often present a dysfunctional serotonin system. Consequently, their emotional and mental states might be deeply compromised, leading them to experience obsessions and compulsions[12]. Finally, environmental factors such as exposure to traumatic events have also been linked to OCD, but research is inconclusive. 

Can OCD be treated?

OCD is associated with disrupted quality of life and social and occupational functioning [1], therefore an effective treatment is crucial. While there is no ultimate cure for OCD [14], there are several ways that OCD symptoms can be reduced. 

One type of Cognitive-Behavioural Therapy (CBT) proven to be effective in alleviating the symptoms is Exposure and Response Prevention (ERP)[3]. It exposes the individual to their fears (obsession) while preventing their response (compulsion), hence an individual who has germ contamination phobia will be asked to shake hands with someone (exposure) without washing their hands after (prevention). This leads to the habituation of the fear, which gradually decreases its anxiety, showing the patient that acting upon their impulses is not necessary. As for pharmacological treatment, Selective Serotonin Reuptake Inhibitors (SSRIs) can help reduce OCD symptoms by regulating the serotonin levels in the brain previously mentioned. Lastly, a recently-developed treatment approved in 2018 is the transcranial magnetic stimulation (TMS), a non-invasive procedure that stimulates cells in the central nervous system [14].

In conclusion,

contrary to popular belief, OCD is much more than just cleanliness. OCD is a debilitating mental disorder affecting approximately 2.5% of the population. People with OCD experience intrusive and uncontrollable thoughts (obsessions) and engage in a variety of rigid behaviours (compulsions). They do not do it out of pleasure but simply because they feel a strong urge to do so. It is very important to eliminate the widespread misconceptions surrounding OCD as they can have a negative impact on people with OCD.

Here at Shrink it Out, we believe that sharing this information is the first step to change the public beliefs about OCD and therefore we highly encourage you to talk to your friends and family and share what you have learnt!

Some extra sources for those who would like to learn more:

1. OCD diagnosis: https://www.youtube.com/watch?v=b74FCw2TvdU

2. Living with OCD (a): https://www.youtube.com/watch?v=TD-xPiwtyHA

3. Living with OCD (b): https://www.youtube.com/watch?v=xhPB5psHdwk

4. I have severe OCD - Lele Pons: https://www.youtube.com/watch?v=USfoQp_Py4I&vl=it 

5. Podcast about OCD - interviews with professionals and people affected by OCD:

https://open.spotify.com/show/13YuzynkMsgjtR3K3Brhle?si=QhSLNflDQ8a9CSzbwU8vfQ

References

1. American Psychiatric Association. (2013). Diagnostic criteria and codes. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

2. Anxiety and Depression Association of America (n.d.). Obsessive-Compulsive Disorder (OCD). Retrieved January 30, 2021, from https://adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd

3. Björgvinsson, T., Hart, J., & Heffelfinger, S. (2007). Obsessive-compulsive disorder: update on assessment and treatment. Journal of Psychiatric Practice®, 13(6), 362-372. doi: 10.1097/01.pra.0000300122.76322.ad 

4. Fawcett, E. J., Power, H., & Fawcett, J. M. (2020). Women Are at Greater Risk of OCD Than Men: A Meta-Analytic Review of OCD Prevalence Worldwide. The Journal of Clinical Psychiatry, ­­81(4), 0-0. doi:10.4088/JCP.19r13085 

5. García-Soriano, G., & Roncero, M. (2017). What do Spanish adolescents think about obsessive-compulsive disorder? Mental health literacy and stigma associated with symmetry/order and aggression-related symptoms. Psychiatry research, 250, 193-199.

6. García-Soriano, G., Rufer, M., Delsignore, A., & Weidt, S. (2014). Factors associated with non-treatment or delayed treatment seeking in OCD sufferers: a review of the literature. Psychiatry Research, 220(1-2), 1-10. doi:10.1016/j.psychres.2017.01.080 

7. Koutoufa, I., & Furnham, A. (2014). Psychiatric literacy: Lay beliefs of obsessive–compulsive personality disorder. Counselling Psychology Quarterly, 27(3), 277-289. doi:10.1080/09515070.2014.897598 

8. McCarty, R. J., Guzick, A. G., Swan, L. K., & McNamara, J. P. (2017). Stigma and recognition of different types of symptoms in OCD. Journal of Obsessive-Compulsive and Related Disorders, 12, 64-70. doi:10.1016/j.jocrd.2016.12.006 

9. Phillips, K. A., Pinto, A., Hart, A. S., Coles, M. E., Eisen, J. L., Menard, W., & Rasmussen, S. A. (2012). A comparison of insight in body dysmorphic disorder and obsessive-compulsive disorder. Journal of Psychiatric Research, 46(10), 1293-1299. doi:10.1016/j.jpsychires.2012.05.016 

10.  Simpson, H. B. (2020). Obsessive-compulsive disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis. Retrieved January 30, 2021, from https://www-uptodate-com.eur.idm.oclc.org/contents/obsessive-compulsive-disorder-in-adults-epidemiology-pathogenesis-clinical-manifestations-course-and-diagnosis#H1058857261

11.  Stewart, E., Grunthal, B., Collins, L., & Coles, M. (2019). Public Recognition and Perceptions of Obsessive Compulsive Disorder. Community mental health journal, 55(1), 74-82. doi:10.1007/s10597-018-0323-z 

12.  Reuman, L., & Abramowitz, J. (2019). Obsessive-Compulsive and Related Disorders. In B. Olatunji (Ed.), The Cambridge Handbook of Anxiety and Related Disorders (Cambridge Handbooks in Psychology, pp. 603-623). Cambridge: Cambridge University Press. doi:10.1017/9781108140416.022

13. The National Institute of Mental Health (2019) Obsessive-Compulsive Disorder. Retrieved January 30, 2021, from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

14.  U.S. Department of Health and Human Services, National Institute of Mental Health (2020). Obssessive-Compulsive Disorder: When Unwanted Thoughts or Repetitive Behaviours Take Over. (NIH Publication No. 20-MH-4676). Retrieved from  https://www.nimh.nih.gov/health/publications/obsessive-compulsive-disorder-when-unwanted-thoughts-take-over/index.shtml

15.  Warman, D. M., Phalen, P. L., & Martin, J. M. (2015). Impact of a brief education about mental illness on stigma of OCD and violent thoughts. Journal of Obsessive-Compulsive and Related Disorders, 5, 16-23. doi:10.1016/j.jocrd.2015.01.003