Ran back in the house to make sure you unplugged your curling iron? Drove around the block again to check that the garage door was closed? Felt unsettled until you arranged your bedside table exactly as you like it? Prepared for a future conversation by rehearsing it in your head?
All of these can be symptoms of obsessive-compulsive disorder, or OCD. And truthfully, many of us do some of the behaviors that are characteristic of the mental health disorder—and that can be quite natural.
However, if you’ve found that these things have become distressing, are a burden on your life, or take up significant time to complete, it’s reasonable to wonder if you have OCD. In this article, we’ll talk about the criteria for OCD diagnosis, how a diagnosis is made, and what to do if you think you may have OCD.
What is OCD?
OCD is a chronic mental health condition that affects about two to three million adults in the United States, according to the International OCD Foundation. People who have OCD are stuck in a cycle of obsessions (unwanted, distressing intrusive thoughts, images, or urges) and compulsions (behaviors done to neutralize those distressing feelings).
One major problem that has historically faced people with OCD is that the condition is underrecognized and not swiftly diagnosed. Though OCD often initially appears in children, adolescents, and young adults, there is a significant delay in diagnosis. In fact, it takes an average of 14-17 years for someone to start to receive the correct diagnosis and effective treatment after they begin experiencing OCD symptoms. And believe it or not, the older someone was when symptoms started, the longer it takes to receive a diagnosis.
That all speaks to the importance of understanding what OCD is, recognizing the symptoms, and seeking assessment from a specialty-trained clinician if you suspect you may have OCD. You don’t have to suffer from the disorder in silence—certainly not for a decade and a half.
Symptoms of OCD
When you’re thinking about what OCD is and if you have it, the first step is understanding that OCD has two hallmark features:
- Obsessions: These are intrusive, repeated, or unwanted thoughts, images, sensations, or urges.
- Compulsions: These are physical and/or mental behaviors performed in response to obsessions in order to reduce distress or prevent a bad outcome from happening.
While OCD might be called obsessive-compulsive disorder, that doesn’t mean that both always occur together. “Technically, you only have to have obsessions or compulsions for an OCD diagnosis, but it’s well accepted that both features are present in some respect, even if they’re not always obvious,” says Mia Nuñez, PhD, Regional Clinical Director for NOCD. Often, when someone doesn’t appear to engage in compulsions, they are instead experiencing mental compulsions, which can make it appear that they only have obsessions.
The key distinguishing factor for obsessions is that they must be unwanted and distressing. You might ask yourself “why are these thoughts in my head?” and you may also feel shame or guilt for having these thoughts, as they often oppose your values, identity, or intentions. “OCD attacks the things that are most important to you, which is why obsessions have extra weight and are particularly scary, when compared to other, typical intrusive thoughts,” Nuñez explains. OCD will take a neutral, meaningless intrusive thought and insist that it must mean something, that it must be dangerous—that’s where the disorder really takes hold.
If recurring thoughts are in line with your beliefs and values, then they’re not connected to OCD. “Repeated thoughts or behaviors relating to a topic that you’re comfortable with and not bothered by is not an obsession in OCD,” says Nuñez. Even if you have repeated thoughts that are socially unacceptable and you agree with these thoughts, then this is not OCD.
When it comes to the compulsion component of OCD, it also helps to understand what “counts,” especially because if these are things you’re doing regularly, it may be so etched into your everyday life that it doesn’t feel like there’s anything going on. Compulsions can be both physical and mental, including:
- Hand washing
- Cleaning or arranging household objects
- Checking
- Ruminating
- Replacing “bad” thoughts with “good” thoughts
- Seeking reassurance
- Counting
- Avoidance
- Self-reassurance
- Excessive prayer
- Memory hoarding
- Tapping
Compulsions will often—though not necessarily always—bring you relief from the distress that comes from your obsessions, but their effects aren’t long-lasting. “In the short-term, the urge to do a compulsion will come right back,” says Nuñez. What’s more, the more often you perform compulsions, the stronger the obsessive-compulsive cycle will become.
While symptoms of OCD may be straightforward, “how someone interprets their own symptoms may not be, especially with the low level of awareness in the media and general population about what OCD can look like, beyond just hand washing or symmetry,” says Nuñez. In short: many people experience symptoms that are upsetting and distressing, but have not fully considered OCD as a potential underlying cause.
Criteria for an OCD Diagnosis
There are important criteria that clinicians screen for when considering OCD. In order to be diagnosed with OCD, you need the following, according to the American Psychiatric Association:
- Obsessions and/or compulsions that:
- Are time-consuming so as to take up at least one hour per day (that said, OCD symptoms can wax and wane, notes Stanford Medicine, so there is leeway in this aspect of OCD),
- Cause significant distress, or
- Impair your ability to function at work or in social situations
In terms of the last item in the criteria—impairment—this can emerge in a variety of ways. One common way is via avoidance. “You might avoid anything that will trigger an obsession—going to school, work, social engagements—making your life really small,” says Nuñez. Someone with Harm OCD, for instance, might avoid being around loved ones altogether out of the fear they might hurt someone.
In addition, though anxiety isn’t part of the diagnostic criteria for OCD, “you’d expect someone to experience physiological arousal that goes along with anxiety. You’d find that OCD makes you feel very fearful and anxious,” Nuñez says. Some of those physical manifestations of anxiety include an elevated heart rate, chest tightness, headaches, and sweating. For some with OCD, an OCD trigger can cause full-blown panic attacks.
What if You’re Not Sure You Have OCD?
You are not responsible for your own diagnosis—that’s where a trained therapist should step in.
Whether or not you have OCD, there’s no harm in seeking out an opinion from a professional. “If you’re asking the question, there’s a good chance that it’s worth your time to go talk to someone,” says Nuñez.
If you are distressed in your everyday life—even if only mildly so—you deserve to address that and develop the skills and tools to overcome it. “Why not go have a professional assess you and see if treatment is something that you can benefit from and will improve your life?” she says.
What’s more, there are a variety of disorders that are related to OCD, and some can share overlapping symptoms with OCD, sometimes making diagnosis challenging, says the International OCD Foundation. These include:
- Hoarding Disorder (HD)
- Body Dysmorphic Disorder (BDD)
- Body Focused Repetitive Behaviors (BFRBs)
- Olfactory Reference Syndrome (ORS)
- Emetophobia (Fear of vomiting)
Seeking out a diagnosis from a trained therapist can help determine if you have OCD, an OCD-related disorder, or something entirely different, such as an anxiety disorder.
Are There Any Tests Used to Diagnose OCD?
No, there are no conventional tests—blood test, brain scan, X-ray, or physical exam—that will diagnose OCD.
OCD is assessed using what’s called a semi-structured interview. This is a type of exchange between a clinician and client where your clinician would ask you a set of predetermined questions, allowing for your responses to take them down different paths to get at the heart of the matter. “Clinicians use this type of assessment to conversationally walk through and investigate the different criteria to see if OCD is present,” says Nuñez.
During your assessment, your clinician will ask about the presence of obsessions, as well as if you perform compulsions to neutralize them, explains Nuñez.
Clinicians commonly use the Yale-Brown Obsessive Compulsive Scale (Y-BCOS) or the Dimensional Obsessive-Compulsive Scale (DOCS), two diagnostic tools developed specifically to assess OCD symptom severity by identifying one’s OCD symptoms, how much distress they’re causing, and the impact of them on one’s day-to-day functioning. These scales can also be used to help patients recognize which of their thoughts and behaviors are symptoms of OCD, and clinicians can then determine if treatment is likely to be effective as a next step.
If you suspect that you have symptoms of OCD, you should consider being evaluated by a trained professional who specializes in OCD treatment.
Treatment for OCD
Treatment for OCD can involve medication, most commonly selective serotonin reuptake inhibitors (SSRIs), a specific form of therapy called exposure and response prevention (ERP), or a combination. SSRIs alone are effective for 40 to 60% of patients, while ERP leads to significant improvement for around two-thirds of people with OCD.
When you do ERP with a trained professional, you will be exposed to the things that trigger your obsessions and bring you distress. However, once you feel that distress and anxiety wash over you and feel the need to do a compulsion for quick relief, it’s time for the response prevention portion of treatment, in which you’re guided by your therapist in resisting the urge and instead sit with your distress while it fades away over time. Ultimately, you’ll learn that you can tolerate uncomfortable feelings related to your obsessions, and that the anxiety will eventually dissipate.
It’s important to do this with a trained therapist in ERP who can help provide a safe environment for you to sit with and manage your distress. Over time, your brain will learn to no longer see your intrusive thoughts, images, or urges as a threat—in turn, your distress will become less intense and frequent. In short, you will gain tools & experience that empower you to manage and reduce OCD symptoms long-term.
Another thing to keep in mind is that if your psychiatrist has prescribed medication for your OCD, you may be able to make the most out of treatment by adding on ERP. One meta-analysis of 21 studies on more than 1,000 patients concluded that medication plus ERP therapy was significantly better than medication alone, and this combination also improved levels of depression.
Can Telehealth Help?
Absolutely. The great thing about seeking out teletherapy is that it can be done in the comfort of your own home, and with no commuting time necessary, treatment is more accessible than ever before. In the case of ERP, teletherapy platforms can provide even more appropriate formats for treatment, as exposure exercises can be done in the actual environments where triggers occur in daily life.
NOCD is one platform that can connect you to mental health professionals who are specifically trained in ERP. You’ll have face-to-face virtual appointments, plus ongoing support between appointments for the times when you need it most.
What’s more, if while exploring a diagnosis, you are diagnosed with a different condition related to OCD, NOCD may also be able to help. NOCD offers treatment for these related disorders, such as body-focused repetitive behaviors (BFRBs), hoarding disorder, and skin picking (dermatillomania).
To schedule your free 15-minute call with NOCD, visit treatmyocd.com.