“The chicken smells delicious.”

“I know, I marinated it 24 hours.”

“That’s amazing. I think they’re ready to be flipped.”

“OK, let me do it. The lines need to be perfectly crisscrossed,” she laughed, “it’s my OCD.”

Obsessive-Compulsive Disorder is a mental illness characterized by obsessions, a specific type of thought that occurs over and over, and compulsions, repeated rituals or activities that typically relieve anxiety associated with obsessions. Now, before you realize that you definitely have thoughts that won’t go away, and self-diagnose yourself with OCD, you probably don’t. In fact, only about two and a half percent of the population (2.5%, or 5/200) in North America will experience true OCD at any point in their lifetime.

So what’s going on? Before we talk about what OCD is, lets talk about what OCD isn’t.

OCD is not rumination

“Ugh, I can’t believe he said that to me!”

“I know, what a dick.”

“I’ve been thinking about it all day… all I can see is his face…”

We’ve all been in an argument. A heated one. Probably with a relative. If you’re unlucky, maybe even a mother-in-law. These things are upsetting, and they’re part of life. But they also suck. It can be difficult, and is certainly common, to find yourself ruminating about a fight, a conflict, or other sources of stress like a work problem or a death in the family.

OCD is not rigidity

“Make sure you have the papers on her desk laid neatly.”

“What do you mean?”

“She’ll freak out, she likes everything neat, she’s so OCD.”

A feature of true OCD is how unmovable many of these behaviours seem to be at the surface. Someone with severe, untreated OCD may find themselves incapable of leaving the house without checking the stove one hundred and twenty nine times. They may find the alternative, leaving without doing this, intolerable. This is an example of a rigid behaviour.

There are other examples of rigidity, as described in the example above with the desk and the papers. If people have high standards, or are very anxious, they can often have similar intolerance towards certain aspects of their life being altered. For example, if you are a perfectionist, you may have intolerance towards a messy desk, and therefore be very rigid when it comes to desk tidiness. If you are very anxious, you may have to leave for work twenty minutes earlier than you have to, despite getting there thirty minutes early, every morning. You may find leaving later intolerable. This might even cause conflict with more laid-back loved ones.

OCD is kind of getting a song stuck in your head – forever.

If you’re lucky, it’s a song you like. All the same, it can be annoying to get a song stuck in your head. It’s also quite common.

Current psychiatric opinion supports that this phenomenon is similar, or maybe even the same, to many true obsessive thoughts. The main difference between getting a song stuck in your head and OCD? Impact and duration.

The single most important feature of OCD is that it causes a functional impairment. As a physician, I’m not in the business of judging you, your thoughts or your behaviours. When a behaviour begins to cause functional impact, and impair your quality of life, it becomes a disorder. True OCD also taks up a significant amount of time, which is in part how it causes a functional impact. Yes, “Hey Ya!” by Outkast is annoying, but getting it stuck in your head on July 1 is not the end of the world. True OCD, can be debilitating.

 

So what is OCD?

A twenty three year old female law student. She’s spends six hours, every evening, after a long day at the university, studying. She does this for weeks and finally writes her exams. She fails miserably, and it’s devastating. She comes into your office complaining of depression and you start to talk about the exams. “I couldn’t study everything, I never had time.” “How is that possible, you studied so much!” “I couldn’t get past the first chapter. Every time I read a paragraph, I freaked out and was worried I forgot it, so I had to repeat it over and over and over until I had it perfectly memorized.”

A eight year old boy is seen standing in the corner of the house before he leaves for school. His mom notices he’s muttering under his breath for a few minutes and finally he leaves for school. That night, before bed, she asks him about the muttering. He finally opens up. “Every time before I leave for school I have to say, ‘Mommy loves me,’ one hundred times before I go or you’ll die.”

A thirty year old man lives at home with his parents. He’s brought in to the psychiatric emergency by his father one evening. His father discloses that his son has been unwell and has been unable to wash or clean himself. He has an intense fear that his left index finger will cause AIDS, and has been unable to touch anything, or anyone with it. Including himself. He’s required his family to bathe him.

These are all examples of real people I have met – with their stories heavily altered, though the principles remain – with true OCD, functional impact is real. To be fair, these cases were pretty straight forward, and not everyone is so lucky OCD can go undiagnosed and missed for decades, resulting in real people having real suffering for unnecessary reasons.

What about the example above?

Well, it depends. This person probably does not have OCD. When I hear a comment like this, I immediately suspect “OCD” is being substituted for “rigid behaviours,” due to the behaviour being fairly unusual for typical OCD. There are forms of OCD which focus on symmetry (stay tuned!), though I suspect this is not the case here, because the person is laughing about it. Remember, it’s only OCD if it’s significantly inhibiting your function!

Editor’s Note: Stay tuned for What to do about OCD, and The four kinds of OCD.

Dr. Travis Barron is a resident physician in Toronto, Canada.