Obsessive compulsive disorder: A severe disease often trivialised into a trend

“I’m so OCD!” – why cleaning your house often does not qualify you as a person with a debilitating disorder   

Writer: Viktorija Vaitkeviciute and Eugenia Wong
Editor: Ebani Dhawan
Artist: Lucie Gourmet

The term obsessive compulsive disorder (OCD) may conjure Instagram-esque images of organised desks, shelves and houses, tagged #ocd, in your mind. You might have even been greeted with a cacophony of people crying out “I’m so OCD!” when reorganising their house to resemble an Ikea showroom or making colour-coded notes. The reality is that this is not a trend for people who have had this real, debilitating illness throughout their lives. OCD affects 1–4% of the world population, and about 4 in 10 people with OCD develop it as a chronic condition. It is an illness that stays with you for life; the symptoms rarely completely go away, even after successful treatment. 

An offhand comment like “I’m also a little OCD!” from someone who just likes an immaculate home is incredibly discouraging and belittling for those who have been living with harrowing intrusive thoughts and compulsions throughout their lives. OCD has been trivialised for years and educating ourselves is essential to help and understand those suffering from this disorder.

Intrusive thoughts and compulsions

There are two main components to OCD: obsessive thoughts and compulsive behaviours. The thoughts induced by OCD are incredibly unpleasant and completely irrational. They can include hurting or killing a loved one, getting very sick, or picturing an aggressive sexual act, often depending on what the person is scared of or disgusted by. Most people without OCD do not put importance on such thoughts, and understand that thinking about something does not mean that it will happen or that it reflects their true intentions. However, people with OCD have a very strong association between thought and reality. They require some sort of action to ‘clean’ their brain and ensure that their thoughts do not come to life. This may be achieved by trying to force the brain to “not think about it” or repeating compulsive behaviours. The paradox of OCD is that trying to not think about something makes you think about it even more, which is why OCD results in so much distress. In order to feel safe from their thoughts, people with OCD use compulsions, which are rituals repeated until the person believes that the thoughts will not affect their life. 

Types of OCD

There are broadly 4 types of OCD, categorised by symptom dimensions: unacceptable thoughts, doubt about unintentional harm, fear of contamination/ cleaning rituals, and symmetry obsessions. 

Cycle of OCD. Taken from Helpguide.

Unacceptable thoughts OCD is characterised by invasive religious, violent, sexual thoughts, despite having zero desire or intent to act on these urges. However, those  within this symptom dimension find it difficult to separate such thoughts from reality, placing significant importance on them. This results in them exerting strenuous mental effort to try to suppress these thoughts, as though to clear their mind of them. 

Fear of harm OCD is associated with intrusive thoughts and fears about harming others due to carelessness. For example, people may persistently envisage hitting a pedestrian while driving a car, or leaving an electrical device on and inadvertently causing a fire. These thoughts are often accompanied by further feelings of fear, dread and uncertainty. In an attempt to fight these thoughts and feelings, people resort to repetitive checking behaviours to prevent their dreaded events from taking place.

Fear of contamination OCD is associated with overwhelming worry about contracting an illness, being physically unclean or feeling mentally polluted. There is a wide range of  feared contaminants, such as germs, dirt, blood and sticky residues. In order to avoid contamination, people with this type of OCD tend to avoid situations and places linked with these feared contaminants, like  public bathrooms and crowded gatherings. They may feel compelled to carry out protective rituals; disinfecting and sterilising, discarding ‘contaminated’ things and frequently swapping out clothes. 

Symmetry obsessions OCD is related to a compulsive need for perfectionism in the form of order, symmetry and exactness. People with this type of OCD typically exhibit behaviours such as repetitive arranging, organising and lining up of objects until they meet the person’s own subjective requirements in order to placate their anxiety or discomfort. 

Current treatment 

The exact neural mechanisms that underpin the pathology of OCD remain unclear. It is hypothesised that the serotonin, dopamine and glutamate neurotransmitter systems may be key contributors. 

Psychological and pharmacological approaches comprise the current first-line treatment of OCD. Cognitive behavioural therapy, a psychological approach, is delivered in the form of exposure and response prevention. This entails exposing the patient to fear-triggering stimuli and subsequently restraining them from enacting their compulsion. For example, the patient may be encouraged to touch taps in a public bathroom that they would otherwise avoid, and see that their feared consequences do not materialise. Drugs such as selective serotonin reuptake inhibitors (SSRI) are also given to patients to alleviate their symptoms. SSRIs increase the synaptic concentration of serotonin by inhibiting the serotonin transporter, which removes serotonin from the synapse. This means that serotonin can continue to stimulate the receiving neuron for a longer period of time. However, the role of serotonin in OCD is unclear and almost half of OCD patients fail to fully respond to first-line treatments.

SSRI mechanism of action in the brain. Taken from OCD UK

Life with OCD

This disorder can be very distressing and seriously affect people’s quality of life. It can take simple daily life tasks and make them dreadful. One doctor had two patients with the same obsession of picking the ‘right’ clothes in the morning. They feared that something bad would happen to their families if they wore the ‘wrong’ clothes, and each of them could recall situations when something bad did indeed occur on a ‘wrong clothes’ day. They would spend hours in the morning trying to pick the clothes that just felt ‘right’, which could depend on style or colour. The suggested treatment was for the patients to force themselves to pick the ‘wrong’ clothes. The treatment worked for one of the patients, but the other could not do it. This clearly demonstrates how the treatment of OCD is not a ‘one size fits all’ solution ‒ the effectiveness of the therapy used varies wildly from person to person.

The endless onslaught of lifestyle organisation posts tagged with #ocd, the ease with which people diagnose themselves with the disorder based on their fondness for a pristine environment, and baseless representation of OCD in popular culture, have twisted and distorted this illness into an unrecognisable shadow of itself. Those with OCD live in anguish daily, spending countless hours helplessly repeating their compulsions ‒ and they are under even more pressure to do so in a way that others cannot notice, lest to be pointed at and scrutinised. Educating ourselves about OCD is essential as misconceptions about it can result in grievous consequences. People with an actual disease may be less inclined to speak up or seek treatment due to their disorder being made into a trend and joked about. The stigmatisation of OCD runs in a similar vein to other mental illnesses, except this particular one has become an object of crude derision. OCD is not an ‘in thing’, nor a subject of mockery; the least we can do is to offer some sympathy and kindness, rather than uttering another “I’m also a little OCD!”.

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