Myth 1: people with OCD wash their hands over and over again
Not necessarily. This is probably the biggest stereotype about OCD sufferers. Those who do have ‘contamination OCD’ and repeatedly wash themselves are the poster children of the disorder. But only a fraction of people with OCD have this particular compulsion. A man with obsessional worries that he will contract HIV might indeed scrub his hands clean again and again, but a woman obsessionally worried that she could accidentally harm her child might hide all the sharp knives in the kitchen and insist on eating out every night to avoid her fears. An overly anxious Catholic might avoid the number 66 and perform complicated mental rituals in her head, perhaps repeatedly adding or multiplying sixes to create ‘good’ numbers, thus purging Satanic content from her mind and ensuring God’s good favour. The compulsions depend on the obsession, and can be pretty much anything.
Myth 2: we’re all ‘a little bit OCD’ / it’s a spectrum
No. Just because you line your shoes up by the door or feel discombobulated by wonky photo frames on the wall does not mean that you have OCD. Nor does scrubbing your kitchen every day or being excessively clean. That’s just called being clean, or anal.
Actual OCD has two components: obsessions, and compulsions. Obsessions are often related to contamination, sexuality, harm, health and relationships, but can be more or less anything. The common thread is the intrusive, unwanted and repetitive nature of these thoughts, which create high levels of anxiety and/or emotional distress. The compulsive part of the disorder is the behaviour that a sufferer engages in in order to neutralise, get rid of or ‘disprove’ the veracity of the intrusive thoughts. Compulsions can be external (hand-washing, checking locks, asking for reassurance, etc) or internal (ruminating, substituting unwanted thoughts for positive ones, counting, checking, hypervigilance and so on).
Oh, and while we’re at it, you can’t ‘be a bit OCD’ because OCD is not an adjective. You can’t be ‘a bit depression’ or ‘a bit schizophrenia’. You have these disorders, in the same way that you have diabetes or heart disease.
Myth 3: OCD is caused by childhood trauma
There has been a lot of research in this area, and nobody really knows what causes OCD. It seems to be a combination of factors: genes, brain chemistry and life stressors. Somebody with a genetic vulnerability to OCD may never develop the disorder if they haven’t experienced trauma or emotional upheaval, for example.
To claim that OCD is caused by childhood trauma alone is too simplistic, and is not evidence-based.
Myth 4: You can cure OCD by thinking rationally
In the same way as you can’t cure OCD by communing with your inner child on the analyst’s couch, unfortunately you can’t get shot of it with rationalisation-based CBT techniques either. The core of OCD is doubt and the inability to tolerate uncertainty.
When I was unwell with it back in 2012, I was pretty convinced that I was dying of an incurable brain disease, and no amount of logical thought would put a stop to my obsessions. I’d repeatedly google symptoms and scour my body and mind for signs of my fatal self-diagnosis. Following repeated reassurance from my GP and psychiatrist that it was extremely unlikely that I had the disease in question, I would feel temporarily reassured but I’d always find a ‘what if…?’ clause: perhaps they missed something? What if I’m in that 0.0001% of people who actually do have this disease? And the checking, googling and visits to my doctor would begin all over again.
I knew I was thinking in black and white terms, catastrophising, assuming the worst, and all of those other ‘thought distortions’ that normal CBT aims to help you identify, but none of this mattered: my thoughts felt true, ergo they were true. The thought challenging just made me more stressed.
What OCD patients need is ERP, a form of CBT which, with practice, helps us to tolerate the uncertainty at the core of our fears and eventually let go of the compulsions.
Myth 5: only intelligent people have OCD
No. Research has found that there is no relationship between a high IQ and having OCD. In fact, studies have shown a slight negative correlation, in other words people with OCD perform, on average, slightly more poorly in IQ test than control groups. However, this is likely to be because the presence of OCD interferes with concentration, rather than sufferers actually having a lower IQ. In short, no research has shown that OCD patients are any more or less intelligent than anybody else. OCD is an anxiety disorder, not an intellectual one.
Likewise, rates of OCD have been found to be similar across different countries and cultures. It’s not a ‘modern’ or ‘western’ affliction. There is a relationship, however, between the form OCD takes in an individual and their cultural background. People from stricter religious communities, for example, are more likely to have a subset of OCD known as scrupulosity, which involves things like extreme doubt about one’s religious faith or fear of blasphemy.
I hope you enjoyed this post and that maybe you learnt something. If so, please share it so that we can continue to break the misunderstanding and stigma surrounding OCD.