What exactly is Obsessive Compulsive Disorder, and how is it different from pop culture representations of it?
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Pop culture conflates neuroticism with OCD. For example, a TV character is very particular about their closet being organized by color or having all their books lined up by size.
In reality, OCD is an anxiety disorder marked by obsessive thoughts (usually a feeling of danger but the source can’t be identified) and behaviors developed to self-soothe that become a ritual that one feels compelled to follow to ward off danger.
Here’s how the behaviors usually develop:
Person A feels a sense of unease. Trying to identify why they feel uneasy, they start trying to guess the source. “Did I lock the door? I’d feel better if I go check.” They feel better. Next time they feel uneasy, they go check the door. It’s unlocked. They lock it. They feel better. The feeling returns, so they check the door. It’s locked. To make themselves feel better, they unlock it, then lock it again “just to make sure.” The feeling returns, so they check the door. It’s locked… But is it? Twist the handle and tug the door. Yup, it’s locked. They feel better… for a bit. Then they start to think “What if I forget to lock it? I’ll make sure that never happens, I’ll check it every night before bed and every time I wake up.” So, every morning they check the lock, unlock it, lock it again, twist the door handle and tug.
After a while, Person A forgets the original thought, but the body has committed to memory the sense of relief whenever they follow the steps of going to the lock, unlock and lock, twist the door handle and tug. It’s as ingrained as a normal person’s instinct. It’s no longer about making sure they don’t forget to lock the door, they’re subconsciously trying to prevent the sense of unease from returning. They’re afraid of feeling afraid, and that fear drives them to seek out safety, and the ritual provides relief but also reinforces the feedback loop. Even when Person A wants to stop, they can’t. There’s this intense feeling that if they don’t complete the ritual, something bad will happen.
Effective treatment to break the feedback loop is to trigger the fear and then not allow performing the ritual. Through repeated exposure and response prevention (ERP), Person A starts to erode the pathways that connected the ritual from a sense of relief. A new ritual can develop, so other effective maintenance treatments are anti-anxiety medication and/or cognitive behavioral therapy to help OCD sufferers calm their anxiety before it spirals.
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