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Published on July 20, 2021

obsessive compulsive woman straightening pencils

OCD: What It Is and What It Isn’t

It’s common for anyone to experience times when something in the environment isn’t perfectly straight or color-coded or complete. It aggravates our natural need for order, so we casually say, “It’s my OCD!”

But is it really obsessive compulsive disorder? In most cases, probably not.

“OCD is an anxiety disorder that involves distinct obsessions and compulsions,” said J. Chris Nordgren, PhD, psychologist at Avera Behavioral Health Center. “An obsession is a mental impulse, or intrusive thought, that causes distress. The compulsion is an outward action the person must engage in to relieve the discomfort.”

Types of OCD, Signs and Symptoms

There are five main types of OCD:

  • Contamination – feeling overwhelmed by perceived germs, dirt or dangerous chemicals in the environment
  • Concern of causing harm to others – an excessive fear of accidentally hurting someone, or losing control and hurting someone
  • Repeating things – worrying that if an action isn’t repeated a certain number of times, something bad will happen
  • Obsession of symmetry, order and arrangement – needing things to be balanced and even
  • Hoarding – the extreme accumulation of stuff, which may include trash (sometimes classified as OCD and sometimes not)

OCD comes in pairs: the obsessive mental impulse and the compulsive behavior.

The difference between common emotional distress and true OCD is that the person with OCD will spend an excessive amount of time neutralizing the discomfort through compulsive behaviors.

“For example, if they’re worried they accidentally hit someone while driving, they might drive around the block over and over, check the car when they get home, and watch the news to see if there was a local hit and run,” said Nordgren.

OCD sufferers might spend time ensuring the hangers in their closet are evenly spaced, walk through a doorway again and again, or wash their hands repeatedly. Or, if they touch something with their left hand, they may then touch it with their right to maintain balance.

What OCD Is Not

There are other disorders sometimes mistaken for OCD. They are like OCD in that have some element of obsessive thinking or compulsive behavior; however, they are different from OCD in that they do not have the distinct presence of both obsessions and compulsions. They also all have different treatment procedures than are used for OCD.

These disorders include:

  • Obsessive compulsive personality – a personality disorder characterized by perfectionism, order and tidiness
  • Trichotillomania – a disorder characterized by the urge to pull at hair
  • Excoriation disorder – a disorder of picking at the skin
  • Tics – an involuntary physical or vocal response to a buildup of stress
  • Illness anxiety disorder – an excessive concern about physical symptoms

OCD Treatment: There Is Hope

“The best part about treating OCD is that there is solid hope for the one who is struggling,” said Nordgren. “In my practice, patients who put in moderate effort and do their homework have always seen significant improvement.”

Treatment often begins by addressing non-OCD symptoms that lower the person’s ability to fight their OCD. These might include stress, anxiety or depression. Medication or cognitive behavioral therapy may be recommended to reduce those symptoms.

Then a technique called “exposure plus response prevention” takes place. The person is introduced to moderately uncomfortable obsession triggers while, at the same time, resisting the compulsion. This treatment makes the obsessions and compulsions diminish.

“Going straight to the most stressful situation could cause a person to abandon treatment,” explained Nordgren. “Victories build confidence.”

Talk to your primary care provider if you’re experiencing thoughts or behaviors that are disruptive. Check with your insurance provider to learn if you need a referral or how specialized care is covered.

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