What OCD is
Somewhere this week, someone probably described their tidy desk as “so OCD.” Meanwhile, across town, someone else spent forty minutes standing in their hallway, unable to leave the house, checking a stove that was never turned on in the first place. Both reached for the same three letters. Only one of them has the disorder.
Subtitles
1. The three letters everyone misuses (and what they actually mean)
2. Why “I’m so OCD” and having OCD are two different sentences
3. Checking the lock again? Here’s why that never feels like enough
A bit about me:
I’m a Clinical Psychologist, I trained and practice in London, England, where I work with people from all backgrounds, faiths and socio-economic situations. The range of ways that humans have thought about the mind has always fascinated me and so I wanted to dive deeper. How might societies across the world conceive of ‘madness’? Is anxiety thought of in Uganda as it is in Ukraine? What wisdom might we glean from cultures across the world that could change our lives for the better? Let’s see what we find.
Photo by Mica Bassa
Let’s start with what OCD is actually made of, because the popular version and the clinical version have almost nothing in common. Obsessive-compulsive disorder has two parts, and you need both to understand either. The first is obsessions: intrusive, unwanted thoughts, images, or urges that arrive uninvited and cause real distress — not preferences, not quirks, but thoughts the person did not choose and cannot simply set down (Sawalha, 2022; Singh et al., 2023). The second is compulsions: repetitive behaviours or mental acts, carried out according to rigid rules, aimed at neutralising the anxiety the obsession created (Sawalha, 2022). Checking the stove five times is not really about the stove. It is an attempt to buy a few minutes of relief from a thought that will not leave quietly.
Here is the detail that gets lost every time OCD becomes a punchline: people with OCD almost always know their thoughts and rituals are irrational. Clinicians call this egodystonic — the symptoms feel foreign to the person’s own values and sense of self (Singh et al., 2023). That awareness does not loosen the grip. If anything, it tightens it, because now there is a second layer of suffering stacked on the first: distress about the thought, and shame about being unable to stop responding to it.
Here is the detail that gets lost every time OCD becomes a punchline: people with OCD almost always know their thoughts and rituals are irrational. Clinicians call this egodystonic — the symptoms feel foreign to the person’s own values and sense of self (Singh et al., 2023). That awareness does not loosen the grip. If anything, it tightens it, because now there is a second layer of suffering stacked on the first: distress about the thought, and shame about being unable to stop responding to it.
This is not a rare quirk. The World Health Organization has ranked OCD among the ten most disabling conditions worldwide, contributing significantly to the global burden of disease across every income bracket (Singh et al., 2023). Depending on the country and the study, somewhere between 1 and 3 percent of adults will experience it — 1.2 percent in the United States, 3 percent in Singapore and Pakistan, roughly 2 percent in Australia (Ilyas et al., 2024; Sawalha, 2022). Up to 2.5 percent of people will meet criteria at some point in their life (Singh et al., 2023). That is not a handful of unusually tidy people. That is tens of millions of people carrying a genuine psychiatric illness that most of the world still treats as a personality trait.
Why saying ‘I’m so OCD’ and having an OCD diagnosis are different?
The forms it takes are broader than most people assume. Checking is the most common presentation worldwide, followed by hoarding, then contamination fears, then symmetry and ordering, then intrusive thoughts around harm, morality, or taboo subjects (Sawalha, 2022). None of these are about being careful or clean. Disordered levels of anxiety is has produced these manifestations.
Here’s an example: Lin and Gao (2022) published a paper about a Chinese woman who was diagnosed with OCD “A 27-year-old woman named Laura came to our clinic in 2009, stating that she was quite anxious due to preparing for the national postgraduate entrance exam. She gradually manifested the symptoms of feeling compelled to turn pages over and over again, to rearrange objects in order on her desk, and to repetitively check whether doors and lamps were closed before going out. She did not resist these behaviors or feel miserable, but these behaviors were quite time-consuming and obviously interfered with her studies. She sought help from a psychiatrist in our department. After finishing laboratory and imaging tests, which ruled out physical disease, as well as psychiatric interviews and psychological assessments [she scored 21 on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Obsession-7, and Compulsion-14; she scored 72 on the Self-rating Anxiety Scale (SAS)], she was diagnosed with OCD.”
OCD’s intrusive thoughts can echo the language of mood disorders, and because shame keeps so many symptoms hidden from the very people meant to catch them, OCD is one of the most reliably misdiagnosed conditions in psychiatry — mistaken for generalised anxiety, depression, and in some historical cases, described alongside schizophrenia, a confusion dating back to Kraepelin and Bleuler (Singh et al., 2023). Every one of those misdiagnoses delays the specific treatment — usually a combination of medication and exposure and response prevention therapy — that actually works.
“The disease is not well understood by the general public or the professional community, and feelings of guilt and shame frequently accompany the symptoms, so evaluations that fail to consider these subtleties will frequently overlook OCD”
Summary
OCD looks biologically similar wherever you find it — but as we will see in the rest of this series, the clothes it wears, and whether anyone recognises it for what it is, depend enormously on where in the world a person happens to be diagnosed.
Take away
If a myth in this piece surprised you, hit reply and tell me which one — I read every response. And if you know someone who still uses “OCD” as an adjective for tidiness, this is the edition to forward them.