Obsessive-compulsive disorder (OCD) is widely misunderstood. Diagnosis can take years—if you’re properly diagnosed at all. Beyond the depictions in pop culture of someone avoiding shaking someone’s hand, locking their door a certain number of times, or being a general “germaphobe,” OCD is a disorder that can show up in dozens of ways and often has grave implications for someone’s life and well-being.
Whether you have OCD yourself, know a loved one who does, or you just want to learn a little more about it, read on to learn more than a dozen interesting facts about the condition that affects 2.5 million adults in the United States. We talked to Patrick McGrath, PhD, Chief Clinical Officer at NOCD, to get the scoop on what you need to know about OCD:
1. Obsessions and compulsions are not the same thing
One of the most important things to understand is exactly what OCD is. There are two main features of OCD: obsessions and compulsions. Obsessions are distressing unwanted thoughts, images, feelings, sensations, or urges. Compulsions are the repetitive behaviors (which can be both mental and physical) that you do in order to relieve the distress that comes from your obsessions or to prevent something unwanted from happening. They might involve repeating a certain phrase, excessive hand washing, desperately seeking reassurance, or avoiding certain situations altogether, among many others.
2. People with OCD recognize (to some degree) that their thoughts are not logical
This is called having insight. Unfortunately, it’s not enough to manage OCD: “Adults who have OCD might recognize that their thoughts are ridiculous–but they’re still afraid to not do their compulsions,” says Dr. McGrath. “They feel as if their compulsions keep them safe from something bad happening. Each time they think: ‘What if [my fears] really are true?’”
For example, Jim knows that tapping on his car hood 5 times before getting in doesn’t really prevent him from getting into an accident—but every time he starts to resist his ritual, the thought inevitably comes: “What if I do get in a crash?” The anxiety triggered by his fear and uncertainty feels like too much to handle, and so the compulsion sticks, growing ever stronger. At the same time, Jim would never try to convince other people that they have to tap on their hood to prevent an accident. Those compulsions are only centered around himself.
3. Nature and nurture can both play a role in the likelihood of developing OCD
It’s true that OCD has a genetic component. If your parent or sibling has OCD, especially if they developed the disorder as a child or adolescent, your risk of developing it is much higher. However, that does not mean that you will have OCD for sure, because both genetics and environment play key roles. “We all have certain predispositions, but we need the right stressors at the right time to kick them off,” says Dr. McGrath. “We’re a product of both our genetic code and the environment in which we were raised,” he adds. It’s also important to realize that if you or your child has OCD, it’s not anyone’s fault. The development of mental health disorders is complex and multifaceted, but know that you did not bring this upon yourself.
4. Sometimes, there’s no clear cause of OCD
And that brings us into a really important point: Sometimes, OCD doesn’t run in your family and you haven’t had a major stressor or other identifiable triggering event. That’s because there’s no single cause of OCD. In addition to the factors mentioned above, brain biology (neural activity and serotonin levels, for example) also plays a role in development. Major cultural factors can also influence the development of OCD, such as fears about contamination during the COVID-19 pandemic.
5. Stress or trauma can increase your risk for OCD
One-quarter of people who have post-traumatic stress disorder (PTSD) also have OCD, according to Baylor College of Medicine. “OCD is a ‘glom-onto’ disorder,” says Dr. McGrath. “Different sorts of stressors or traumas can contribute to it.” OCD will jump at the first sign of trauma and tell you that it knows how to prevent bad things from happening again—and that’s through compulsions, McGrath explains.
6. OCD can develop in childhood or adulthood
OCD is most commonly diagnosed by age 19, according to the National Institute of Mental Health (NIMH). Boys typically develop OCD at an earlier age than girls. It is, however, possible to develop OCD as an adult. All that is to say that if you’re experiencing symptoms of OCD at any age, talk to a professional so you can get the help you need.
7. Talk therapy is ineffective for OCD
Although therapists have your best interests in mind, it’s inappropriate to use talk therapy in the treatment of OCD. “General therapists can provide a lot of things that become compulsions,” says Dr. McGrath. This happens unintentionally; for example, if you have an intrusive thought, your therapist might suggest replacing it with a good thought. Or you might picture a stop sign in your head when you have a distressing thought. The bad news is that “thought replacement” can quickly become a compulsion that becomes further ingrained via therapy, and only reinforces the distress that their obsessions bring about. The gold standard treatment for OCD is exposure and response prevention therapy (ERP), a type of therapy that was developed specifically for OCD. With OCD, you cannot just talk or think your way out of it—you must act your way out of it.
8. A person with OCD is not just “quirky” or a “perfectionist”
The way TV shows and movies have portrayed people with OCD is often with funny little habits that are of no consequence to their lives. Look how silly they are to turn the lights on and off! Look how they go through a door in a very specific way! Even more common is when the term OCD is used casually in conversation: “Oh, I’m so OCD—I have to make my bed every morning.”
“Hearing these things diminishes the symptoms of OCD for the people who have it,” says Dr. McGrath. The difference is that if someone simply checks their locks or makes sure their garage door is closed, those habits don’t usually interfere in their life. They make that quick check and then move on with their day. For someone with OCD, they’re spending the equivalent of over an hour a day in their obsessions and compulsions, consumed with distress and fear.
9. Exposure and response prevention (ERP) therapy can work fast
ERP therapy is an evidence-based OCD treatment. Along with a trained therapist, you will confront your obsessions and make the conscious choice not to engage in compulsions. Overtime, the cycle of obsessions and compulsions dissipates, loosening its grip on your life.
Although the treatment itself can involve anxiety and discomfort, it’s extremely effective. “We see real, meaningful change after about 12 sessions,” says Dr. McGrath. In the beginning, twice-weekly sessions may be recommended, followed by weekly visits, and then moving on to a maintenance plan determined by you and your therapist.
10. OCD is friendly with depression and anxiety
“It’s common to have multiple, co-occuring issues, and some of those things might mask the OCD,” says Dr. McGrath. For example, due to the extreme toll OCD can have on your life, you may also have depression. “One of the definitions of depression is having lost interest and pleasure in the things you once enjoyed. Well, OCD attacks the things that you love, and because of it, you avoid doing those things. Why wouldn’t you feel depressed?” he says. NOCD’s research has shown that treating OCD not only decreases OCD symptoms, but it’s also been shown to reduce anxiety, stress, and depression by significant amounts.
11. Your OCD can change over time
OCD is an opportunistic disorder, and one that wants to survive. As such, it can morph as the months and years go by. “I’ve rarely met someone who’s had OCD for more than five years and has had the same obsessions and compulsions,” says Dr. McGrath. All it takes is one news story, one intrusive thought, or one uncomfortable experience to convince you that something else is a threat that needs all of your attention. OCD will then redirect its focus, changing your obsessions and heightening your anxiety.
12. Even after remission, OCD can return
There is no cure for OCD. This can be scary to think about. Once you realize how treatment gives you your life back–and you’re out there enjoying the world again–it’s frightening to think that OCD can creep back in. But knowing this is actually critical to long-term remission. “OCD is a chronic condition, just like substance use,” says Dr. McGrath. It’s entirely possible that something could come along and trigger a compulsion, but the proper treatment can give you the tools you need to manage new OCD episodes in the future.
13. It’s also called the “doubting disorder”
OCD goes after what you love the most. “OCD isn’t just about cleaning and checking the locks. It’s about the doubt and uncertainty of anything you hold dear,” says Dr. McGrath. A bump on the road isn’t a pothole–it could be a child you just hit. So you go back to check. If you don’t say a prayer perfectly, your higher power could reject it, and you won’t reach the afterlife. So you say it again. And again. “We call this the doubting disorder. Everyone has doubts, but doubts in OCD are on steroids,” he says.
14. It’s most effective to confront your fears—carefully
OCD is based in emotion more than language, says Dr. McGrath. As a result, you can’t be talked out of your fear—your brain just won’t respond. Instead, your brain is more influenced by actual behaviors. That’s why ERP therapy will guide you to do things that trigger your obsessions. It’s not all at once–you’ll “dip your toe in the water to see what happens,” he describes. If things are okay, then it’ll be two toes, and so on from there. The goal will be to confront your fears slowly. After that, you’ll see that OCD begins to lose its control.
15. OCD doesn’t actually care about you
OCD promises you safety against the things that you fear the most. And that can make you think it’s just trying to protect you. The reality is much darker. “OCD doesn’t care about your life. All it will tell you is that the most important thing is that you do everything it tells you to do. This becomes more important than work, school, or your relationships,” says Dr. McGrath. That’s why the disorder is such a destructive force that has the power to take over your life.
But you can do something about it. If you have OCD, you can connect with licensed therapists who are especially trained in ERP therapy, which is the most effective treatment. Through virtual one-on-one sessions, your therapist will provide support to help you move through and conquer your OCD, plus in-between session support. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment.