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Daniel Katz, M.A., Psy.D.
• April 15, 2024

1. OCD is not simply a matter of being overly neat or organized

It is a complex anxiety disorder characterized by intrusive thoughts (obsessions) and repetitive behaviors or rituals (compulsions) aimed at reducing distress. There are a number of OCD “themes.” Themes refer to the specific types of intrusive, distressing, and repetitive thoughts, images, or urges that individuals with OCD experience. These themes often revolve around fears, worries, or concerns that cause significant distress and interfere with daily functioning. OCD themes can vary widely from person to person, but some common themes include: contamination, health anxiety, religious or moral obsessions, intrusive thoughts of violence or harm, questions of sexuality or sexual orientation.

2. OCD is not always just “in your head” 

Having OCD doesn’t preclude the possibility of there being a real and/or serious underlying issue. Let’s provide an example using the theme of health anxiety OCD. Health anxiety OCD is a starkly different condition from what was once referred to as hypochondria but has since been broken up into two possible classifications: somatic symptom disorder and illness anxiety disorder. Unlike the hypochondriac, the individual with OCD might focus on a very real issue, such as one’s acute bronchitis. However, the individual with bronchitis might have an obsessional fear that this condition will never improve. Relatedly, they might ritualistically fixate on sensations in their respiratory system and compulsively search internet forums for information about the condition and other people’s experiences with it. They might call friends to ask about their own experiences with bronchitis, avoid going outside due to fear of the exacerbating effects of automobile exhaust, and repeatedly measure the air quality of their apartment. More and more of the individual’s life begins to be governed by a control agenda aimed at monitoring and improving the bronchitis condition. OCD, like most mental illnesses, meets criteria for diagnosis when the obsession and its corresponding compulsive behaviors impair functioning, greatly distress the individual, and are time-consuming.

3. Compulsions do not always refer to observable behaviors

Rather, compulsions can just be “in your head”. More specifically, compulsions can be purely mentalistic, cognitive processes. Let’s take the example of an OCD theme often referred to as sexual orientation OCD. In this case, the individual often obsesses over the question of whether he is gay. The individual anxiously monitors his arousal when looking at other men. He mentally revisits past sexual experiences with women and analyzes whether he felt attracted to them. He constantly ruminates on the question of his sexuality and tries to notice whether he thinks about women and men differently throughout the day. These are all examples of the individual’s compulsive search (within his own head) for answers to the question of his sexual orientation.

4. OCD is not a personality trait

It is a mental illness and a serious, often debilitating, one at that. OCD, when left untreated, tends to persist and even worsen throughout one’s life. The OCD sufferer often acknowledges that their obsessive and compulsive tendencies are illogical but is nonetheless unable to break free from these cognitive behavioral tendencies. An OCD diagnosis correlates with a markedly increased risk for substance addiction, major depression, and suicide. Reducing OCD to a personality quirk undermines the significant distress and impairment it can cause in daily life, often necessitating professional intervention and evidence-based treatment approaches. Thus, understanding OCD as a genuine psychiatric condition is crucial for accurate diagnosis and effective management.

Daniel Katz, M.A., Psy.D.

Postdoctoral Clinical Fellow

There is a solid base of empirical evidence supporting that psychodynamic psychotherapy, mindfulness-based cognitive interventions, and acceptance and commitment therapy effectively treat an array of conditions. Though Dr.