What Is Obsessive-Compulsive Disorder (OCD)?

Obsessive-Compulsive Disorder (OCD) is an anxiety spectrum disorder (a mental illness) that affects about 1.0% of the population of the U.S. As Boston, MA has a population of about 700,000 people, on average, Boston likely has about 7,000 people with OCD living in the city and surrounding areas.

OCD can take numerous forms, making it difficult for individuals to diagnose on their own. It is generally recommended that you seek a psychiatrist to receive a clinical diagnosis of OCD if you believe you suffer from this mental illness. As the term is often misused in modern society, many people may believe they are OCD when in fact they are not.

You may have heard people say that they are “a little OCD” or that they are “so OCD,” but this is often said by individuals who are merely detail-oriented or perfectionists. These traits may be present in those with OCD, but they may not be. Obsessions that center around details and perfection of work are only one possible symptom of the numerous possible symptoms of OCD.

What Defines OCD?

One of the difficulties with diagnosing OCD is that both obsessions (obsessive thoughts) and compulsions can take numerous forms. Here’s the difference:

“Obsessions are thoughts, images or impulses that occur over and over again and feel outside of the person’s control [and often interfere with daily life]… [compulsions] are repetitive behaviors [or rituals] or thoughts that a person uses with the intention of neutralizing, counteracting, or making their obsessions go away.” —International OCD Foundation

Another definition from the National Institute of Mental Health: “Obsessive-Compulsive Disorder (OCD) is a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and/or behaviors (compulsions) that he or she feels the urge to repeat over and over.”

What defines OCD is not a particular set of behaviors, but rather the nature of those behaviors. From our definition, we can see that the commonality here is that the obsessions are unwanted thoughts. Someone with OCD feels driven by these obsessions. This contrasts strongly with the need to do well at a task or to keep a room neat and clean. Those behaviors are wanted and are considered positive.

The reason this is difficult for those without OCD to understand is that the results of these behaviors often appear to be positive. For example, those who have obsessions about being contaminated by germs on their hands, paired with compulsive hand washing, will appear to be health-conscious individuals.

However, to the individual who is experiencing this, the excessive hand washing (and the obsession with getting germs on their skin) will not be an enjoyable experience. They will not want to constantly wash their hands or think about germs, but will do so anyway, often to the point that this time-consuming behavior affects their life.

Types of OCD and OCD Symptoms

OCD can fall into several categories, including but not limited to:

Obsessions with being contaminated or fear of contamination (this includes the classic obsession with germs but can also include obsessions with getting cancer or getting an STD).
- This is often paired with a compulsion to clean oneself or surfaces to prevent contamination or the avoiding of activities that might lead to contamination, like visiting a hospital.
Obsessions with damage or harm that leads to the compulsive behavior of checking.
- Checking may include checking a door over and over to ensure it is locked, or checking a gas pump to ensure it has been removed from the car.
Obsessions with order/symmetry that include the classic example of counting something—whether it be steps taken or pages written or miles run—and a compulsion to have those numbers look a certain way (for example, they may need to be even numbers, or they may need to reach a certain threshold).
- This can also include tidying/cleaning and rearranging items to ensure they are in a particular order (books arranged A–Z, for example).

There are many other types of OCD, but these are some of the more familiar types. As you can see, they all include the commonality of potentially causing damage to a person’s life.

For example, someone who is obsessively counting, say, ounces of water that they’ve had to drink for the day, and who wants to reach a certain amount that must be even, may end up drinking far more water than is healthy if they keep drinking an odd number of ounces accidentally.

Similarly, a compulsion to check a door over and over to see if it is locked can cause someone to be late to work or school, to the point that it might cause them to get in trouble in school or lose their job for tardiness.

The compulsions listed here may sometimes have a positive effect. Checking to ensure a gas pump has been removed from a car is positive, but if it begins to detrimentally affect a person’s life, then therapy or medication may be indicated, or possibly other therapies, like transcranial magnetic stimulation, exposure-and-response therapy, or deep brain stimulation. Many of these have been found to be effective treatments for obsessions and compulsions.