Do I have OCD?

With depictions from TV shows and movies, some people believe OCD is when you are a “germophobe,” getting way too concerned about getting sick or feeling covered in germs. With phrases like, “I am so OCD,” others adopt the idea that having OCD is about having a lot of daily structure or being very persnickety. While there are seeds of truth in these stereotypes, OCD can take on many different subtypes that I will provide more information about at the end of the post.

While there are several criteria to diagnose someone with Obsessive Compulsive Disorder in the DSM-V (the manual therapist use to form their diagnoses); I focus heavily in helping my clients understand their obsessive compulsive symptoms through the lens of the OCD cycle. This cycle has four stages, each leading to the next, in a self-perpetuating system that can be found in all OCD disorders, regardless of the specific obsession.

The first stage is the Obsession Stage, this starts with a triggering event that brings on the obsession. For example, using someone else’s pencil. The obsession could be the thought, “This pencil is covered in another person’s germs, I might get sick.”

The second stage is the Anxiety Stage, this is where someone continues to ruminate on having been in contact with someone else’s germs, usually catastrophizing the consequences (i.e. “I’m going to get sick and die” or “I’ll never be able to enjoy my life feeling dirty”).

The third stage is the Compulsion Stage, where someone uses either an internal behavior (i.e. thoughts, prayers, counting, ruminating) or external behavior (i.e. handwashing, using hand sanitizer, blinking, or tapping) to protect themselves from what they imagine the consequences to be in the previous stage. For example, someone could think, “If I wash my hands, then I will get rid of the germs I got from touching the pencil and not get sick or feel dirty.”

The four stage is the Temporary Relief Stage, where someone feels relief from their anxiety symptoms; believing they have successfully protected themselves from the perceived threat. This momentary relief unfortunately perpetuates the OCD cycle, convincing people that if they want relief from anxiety or safety from their obsessions coming true, they need to continue to complete compulsions. I often use the analogy of a dehydrated person believing drinking saltwater is helping them because they feel temporary relief from their dry throat. So the person with OCD trusts their compulsions are making their situation better, all the while reinforcing that they need to perform compulsions to stay safe.

As referenced earlier in the post, OCD can have lots of different subtypes, meaning that people can have OCD and are not worried about germs or their items being arranged in a particular order. Below is a a few examples of common OCD subtypes I work with my clients on along with typical obsessions and compulsions

Moral OCD: common obsessions are fear of being a bad person; common compulsions are confessing perceived faux pas including thoughts and feelings

Relationship OCD: common obsessions are being in the wrong relationship or being trapped in a relationship; common compulsions are constant checking on your feelings toward the partner and evaluating the relationship as well as looking online or talking with friends or family about the relationship to get reassurance

Harm OCD: common obsessions are fears of hurting yourself; common compulsions are constantly introspecting wondering why you want to hurt yourself or confessing to others your fear of inevitably not being able to stop yourself from hurting yourself.