OCD is one of those psychological terms that’s commonly used in casual conversation. Usually it implies that someone is overly neat, a perfectionist, orderly, or perhaps a bit finnicky in the way they like things. “Would you stop telling me how to load the dishwasher correctly?? You are so OCD!” So how you do know if you truly have obsessive-compulsive disorder?
As the name implies, OCD is characterized by “obsessions” and “compulsions.” In this case, obsession does not refer to an out-of-reach love interest or the latest show you’ve been binge watching. “Obsession” refers to a fear or anxiety that runs through your mind over and over again. The fear could be a lot of things. It could be a fear of germs, fear of contamination, fear of getting sick, fear of someone breaking in your house, fear of your house burning down, fear of hurting someone else or yourself, fear of being a bad person, fear of being homosexual, fear of going crazy, or fear of not being able to sleep at night. Sometimes these fears are accompanied by vivid and frightening images of catastrophes and worst-case scenarios that won't stop.
Just having the fear is not enough. To be considered OCD, the obsession has to be accompanied by “compulsions.” Compulsions refers to rituals or actions that serve to lessen the anxiety around the obsession. The compulsion may be checking that the doors are locked a certain number of times, washing your hands in a prescribed way, checking that the stove is off a number of times, counting to 7 (or another “special” number), or repeating a certain phrase or prayer to yourself in a set way. These rituals serve to lessen the anxiety for a short time, until it resurfaces, and the ritual has to be done again. OCD becomes an endless cycle of fear and efforts to manage the fear.
For OCD to be considered a “disorder,” the obsessions and compulsions need to be distressing to you and causing disruption in your life. The obsessions and compulsions may be affecting your ability to function, your quality of life, or may take up a large amount of your time (e.g. more than an hour per day).
Typically, a person with OCD knows the fear and rituals are somewhat irrational, but feels it is out of their control. Often, people struggling with OCD say something to me like, “I know this is silly, but I can’t stop. I feel like I must be crazy.” The good news is that you’re not “crazy.” Your brain is just stuck in a pattern of becoming anxious and then using what has worked before to calm the anxiety temporarily. You can get unstuck by learning to disrupt the cycle in counseling.
Exposure and response prevention from cognitive-behavioral therapy (CBT) is the gold standard treatment for OCD. I use this method along with mindfulness and EMDR to make a powerful combination against OCD. Exposure and response prevention consists of learning not to act on the urge to do a ritual to manage anxiety. Instead, we look for other ways to manage the anxiety, including mindfulness skills. This way, you disrupt the OCD cycle. Meanwhile, we use EMDR to get to the root of where the fear or anxiety began. That way we can stop it from surfacing so much in the first place.
For a head start on this type of therapy, start reading The Mindfulness Workbook for OCD by Jon Hershfield and Tom Corboy. This book combines the power of CBT and mindfulness, and can provide a great foundation for starting counseling. You can read more about EMDR here.