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What obsessive-compulsive disorder really is

Obsessive-compulsive disorder is not just the urge to be clean and tidy. It causes enormous distress to sufferers, but it is treatable.

There are a lot of things that obsessive-compulsive disorder (OCD) is not. Having a tidy desk or liking a clean kitchen is not OCD in and of itself. Dressing up in your Brad Thorn-autographed Crusaders jersey to watch the game every weekend or collecting teaspoons isn’t necessarily OCD, either. Wanting the same hairstyle as the celebrity you follow on Twitter is not automatically an obsessive compulsion. And putting “I’m so OCD right now” on a meme is almost certainly not OCD.

Suggesting this is the case, without good reason, will probably frustrate people who either experience clinical OCD or care about someone who does.

There are also a variety of ways that OCD manifests. These include, but aren’t limited to: checking things repeatedly, ordering things, worrying about and avoiding contamination, hoarding and having intrusive thoughts – usually about checking, ordering, contamination or hoarding. Again, though, even extreme hoarding isn’t necessarily OCD – something I point out to my family when they suggest I need to clear out the garage.

Importantly – and this is one of the things that differentiates OCD from a preference for tidiness or fondness for back issues of the Listener – is the distress factor. If OCD involves repeatedly checking the lock on the door, it’s not because you really can’t remember if it’s locked, but because you feel compelled to do so and the thought of not doing it is distressing – impending-doom distressing.

In the most recent edition of the Diagnostic and Statistical Manual of Psychological Disorders, obsessive-compulsive disorders are a category in their own right and include more than “just” the OCD I’ve described, but also disorders such as trichotillomania (in which someone can’t resist the urge to pull out their hair) and body dysmorphia (pathological and extreme belief that there’s something wrong with how a part of the body looks). Importantly, these things have been separated from “straight” anxiety disorders (though they also involve anxiety) and trauma-related conditions such as post-traumatic stress disorder (PTSD).

Why does OCD happen? As usual, it’s complicated. There appears to be a genetic component – it can run in families – meaning that a person with a relative experiencing OCD is about four times more likely to also experience it. As with many things, a genetic propensity isn’t enough to make OCD a dead cert among family members of a person diagnosed with the disorder, but it does mean that environmental factors such as stress can trigger it in those with a predisposition.

Something that I’ve come across as a potentially important part of the equation, and that appears to be associated with severity of OCD, is “thought-action fusion”. Someone who exhibits this cognitive distortion experiences thinking about an action as equivalent to carrying it out. Have you ever had the feeling, in a lecture or public event, that you could just stand up and scream at the top of your lungs? Well, thought-action fusion means that just having that thought is as bad as actually doing it.

Not only is this distressing, but it means that many people with OCD have the strong feeling that thinking about something bad can make it more likely to happen. An overreaction to this, because it’s so distressing, might be to suppress the thought. This ultimately backfires because deliberately not thinking about something makes it more likely to come back and intrude on your thoughts.

Thankfully, this presents an opportunity for intervention. Talk therapies might invite a person with OCD to reality-test this idea: was there actually a volcanic eruption when you thought about there being a volcanic eruption? This makes it sound easier than it is, but the thing to remember is that OCD is treatable.

If this sounds like you, or someone you care about, good places to look for information and support include your GP (for a referral) and the Ministry of Health and Mental Health Foundation websites.

This article was first published in the August 3, 2019 issue of the New Zealand Listener.