For the record: Having OCD is not a personality trait. It is more than just the preference for cleanliness and order.
“I would hold a baby and imagine throwing it out of the window, dropping it. But it was almost like in that millisecond, your body just fills with anxiety, that you feel you may have actually done it, or you may be in the process of doing it and you may have no control of your limbs.”
This fairly shocking quote was uttered by Aaron Harvey in episode 134 of The OCD Stories. Aaron Harvey is a mental health advocate as well as Co-founder and Executive Director of the Made of Millions Foundation. Having battled with OCD for over 20 years, he is on a mission to change the world’s perspective on mental health.
Of course, Aaron (pictured above) didn’t actually do what he imagined doing. But the urge to do it felt all too real. And that’s just a glimpse of an entire spectrum of what OCD is and how it can manifest across individuals.
OCD, or obsessive-compulsive disorder, is a term dropped into everyday conversations – whether it’s a casual comment to assert someone’s preference for order, or how it’s portrayed in the media as someone who’s a “neat freak” or “germaphobe” who can’t stand contamination. Trust me, as someone who struggles with this daily – and was officially referred to a clinical psychiatrist in June 2020 – the disorder is a far cry from that.
But before we talk about OCD, let’s talk about anxiety – the focal point of most OCD types – because at the end of the day, we all have anxiety to a certain degree. It’s the mind’s natural response to keep us safe from danger when faced with real threats. So, feeling anxious and worrying about an imminent problem is perfectly normal, right? But why can it become a problem?
According to Still Waters Psychology’s clinical psychologist Janet Chang, anxiety becomes a problem “when it happens too intensely and frequently, in the absence of real threat and danger and to the point it causes distress and affects one’s daily life.”
That’s where OCD comes in.
If you’d like to better understand this frequently misunderstood disorder or maybe even get help for yourself or a loved one, read on about the following…
- What is OCD?
- What causes OCD?
- Types of OCD manifestations
- OCD “triggers” and why not to ignore them
- Seeking professional care
- Helpful DIY, self-help options to support recovery
- Living with OCD
What is OCD?
Obsessive-compulsive disorder is an anxiety-related disorder motivated by worrisome, obsessive thoughts that result in an urge to engage in compulsive actions to reduce those worries. “Although OCD is not diagnostically classified in the same category as anxiety disorders, anxiety is a central part of OCD,” notes Janet.
OCD comprises two key behavioural components: obsessions and compulsions.
An obsession can be understood as a thought (which can be a worry, too). A person with OCD might ruminate and obsess over these thoughts, often uncontrollably. When traced, these often reveal deep-seated fears an individual may have. Some examples include worries about getting sick, public humiliation, abandonment and more. In Aaron’s case above, these thoughts can also be highly violent and graphic, often involving imagined scenes of murder and mutilation that come on involuntarily.
These thoughts – especially those regarding sickness – are of course valid, given that we’re living in the midst of a global pandemic. But how do OCD thoughts differ from regular worries? The difference is when the obsessions are “recurrent, persistent and are experienced as intrusive and unwanted,” leading to “repetitive behaviours or mental acts to neutralise the persistent thought,” explains Chad Yip, a clinical psychologist at Noah & Zoey. This then brings us to compulsion.
A compulsion is a physical act one repetitively engages in to quell or reassure oneself of the absence of a potential “threat” identified by the aforementioned thought. In the case of Aaron, because of his highly graphic thoughts, he constantly worries about his potential “threat” to the people around him. This results in him repetitively turning down social events and other gatherings for the fear of him actually doing it – even if it was all in his mind.
That’s one end of the spectrum OCD can result in – a compulsive avoidance to prevent the occurrence of an imagined threat. On the other end, OCD can also result in a compulsive act of “checking” – e.g., recurring and unwarranted doctor visits (even when one has been termed medically healthy) to rule out the likelihood of contracting a “potential” disease, causing one to persistently engage in symptoms-checking.
Putting them together, OCD is a constant tug-of-war between the real and unreal: imagining “real threats” and engaging in compulsive physical checks to ensure the absence of a threat. For instance, if an individual is constantly worried about getting sick, this person may frequently engage in compulsive “checks” like taking temperatures or washing hands multiple times a day (despite not actually being “sick”) in order to quell his or her worries.
Chad adds, “Regular worries are usually in response to real-life concerns, whereas obsessions of OCD are usually not related to real-life concerns, but are usually irrational or even magical.” Another way to understand obsessions is the idea of “catastrophizing” a worry to expect (and believe) the worst is to happen. Or, as Aaron describes it, “My brain is always f***king with me. [It’s] going to take every beautiful moment and make it negative or make it scary.”
What causes OCD?
As an anxiety-related disorder, there are many factors that culminate in a manifestation of OCD. Janet elaborates: “Some likely causes can be genetics (a family history of anxiety disorders), physiological factors like chemical imbalances in the brain caused by prolonged stress, environmental factors like trauma during childhood or adulthood as well as stressful ‘triggering’ events in one’s social life. The factors can also be personality-related, for example: people with anxious, perfectionist personalities, those who lack self-esteem or those who value control and certainty in their lives.”
She adds it is important to note that anxiety disorders are not caused by a single factor, but rather a combination of various factors that lead to its development. Chad concurs, “Most of the time, it may not be possible to identify the exact causes of anxiety as it is usually caused by several factors interacting with one another.”
Types of OCD manifestations
Although OCD can manifest itself in many forms, it has been traditionally considered that an individual’s OCD will fall into one of these five main categories, with themes often overlapping between categories, too. “Usually in psychology and psychiatry, we only identify 5 groups of OCD manifestations,” Janet adds.
Here are the 5 main categories of OCD as noted by OCD UK:
- Contamination / Mental Contamination
- Symmetry and ordering
- Ruminations / Intrusive Thoughts
Cleaning and contamination: This type of OCD involves a tendency to engage in compulsions like washing and cleaning in order to cope with persistent, obsessive thoughts of feeling dirty and/or unclean (physical or mental). People who have this may also tend to wash and clean “contaminated” items like their hands or surfaces for the worry of contracting germs and viruses, which will, in turn, make them sick.
Symmetry and order: People who have this type of OCD may display an extreme need to be in control of their environment, and thus require things to be in order and symmetry. This results in a compulsion to constantly organise, arrange and align things.
Forbidden thoughts (also known as Harm OCD): Some common symptoms of Harm OCD involve frequent intrusive thoughts that are usually taboo in nature. These include sexual, violent and blasphemous thoughts. This results in compulsions like hiding objects around you that you could potentially use as weapons, avoiding people, seeking constant reassurances (e.g., praying) that you’re not “an evil person”, or like Aaron – frequently retracing your daily activities just to make sure you haven’t hurt anyone.
Hoarding: Symptoms in this category often include an extreme fear that letting go of something or someone might bring harm to them or make them feel incomplete. This results in a compulsion to acquire more possessions to bring them comfort, or a need to constantly check that their possessions are still safe and present.
Sexual orientation: Sexual orientation OCD is a subtype of OCD that is characterised by intrusive thoughts and compulsive behaviours that revolve around an individual’s sexual orientation. People with this type of OCD often experience intrusive thoughts, urges, denial and/or confusion about their true sexual orientation. Some examples include: A fear they might be perceived as a sexual orientation that’s not heteronormative and hence engage in compulsions that convince them (and/or others) otherwise. A person with this type of OCD may analyse their own behaviour very earnestly and diligently, even to the extent of being excessively concerned that their behaviours align with society’s expectations of what a particular sexual orientation should be.
Paedophilia: This OCD subtype often involves intrusive, obsessive thoughts about images and impulses that involve children. For an individual with paedophilia OCD, the idea of harming a child is very terrifying, and so this causes them to engage in compulsive behaviour to alleviate this fear, such as seeking excessive reassurances that they are not a paedophile or avoiding the company of children altogether.
Relationships: Relationship OCD is a subtype characterised by intrusive thoughts surrounding the uncertainty of a relationship. Some obsessions often include doubting thoughts accompanied by little evidence supporting those doubts – like an indication that the relationship may be ingenuine or flawed in one way or another. The compulsions manifest in an act of assurance-seeking – either from one’s partner or friends – about the certainty of the relationship.
Health: Health OCD, or hypochondria, is a subtype of OCD that predominantly revolves around the fear of getting sick. Individuals with this OCD are often checking themselves for “symptoms”, either physically or via search engines. This often leads to a compulsion of catastrophizing common, benign symptoms, which can then cause the person to self-diagnose (or completely avoid the doctor altogether for a fear of diagnosis).
Other compulsions include assurance-seeking acts like repeated doctor’s visits (to one or many doctors) or going for countless scans despite being cleared as medically healthy. Individuals with hypochondria often fear the worst and have little to no trust in their doctor’s advice or the results of their scans. This causes them to believe there is something inherently “wrong” with them and, while there’s nothing wrong now, it’s just a matter of time when the feared disease gets discovered.
One thing to note: OCD tends to fixate and latch onto what is most important to an individual. For instance, an individual who has obsessive thoughts of cleanliness and order may value control, while someone who worries about his or her sexual identity may feel acceptance and belonging are most important to them. On the other hand, someone with paedophilia OCD may actually place a child’s well-being and safety as paramount – but OCD does what it does best: taking what people hold closest to their hearts and messes it up.
It’s therefore important to understand OCD is not merely a sweeping general assumption of a need for order. Its manifestations are unique to an individual based on what they value in their lives.
OCD “triggers” and why to not ignore them
“Triggers” (or trauma triggers) are psychological stimuli that cause an individual to recall a traumatic or distressing situation which can, in turn, induce an emotional or physical reaction (or both). These can take on many forms and are unique to each individual. There is a near-infinite number of things that can trigger someone. It can be thoughts, something or someone they’ve seen or heard, sensations, specific events and many more.
Learning what your triggers are is the first step to recovery. For me, it was the most crucial step. I’ve always known I was a paranoid person because I worry a lot. The only difference was: I used to worry about real threats, but now, not anymore. Now, I anticipate them and catastrophize possibilities.
I fell really sick over the new year back in 2019 when I was studying on an exchange programme overseas. It was New Year’s Eve and I wanted to have a good time. (In other words, there was lots of alcohol.) The next day I woke up with a burning fever and a huge, painful swelling lump on my right underarm. Because it was the new year, no clinics or hospitals were open and I was left alone with my idle mind and endless possibilities of what this could be. I did what most curiosity-driven digital natives would do: I turned to Google. And that was the start of everything. I typed “alcohol fever swelling lump what is it”, and judging from the search results, I was convinced I was dying. I booked an appointment online with the nearest hospital but the earliest scheduled appointment time wasn’t until days later. And so I went into three very dark and harrowing days of coming to terms with my imminent “death”. To add, the confirmation appointment text alert from the hospital (which, mind you, read: BREAST AND ENDOCRINE SURGERY/ONCOLOGY DEPARTMENT) absolutely did not help. This is it, I thought. This became the triggering event.
Thankfully, it was just a bad case of infection and antibiotics did the trick. However, I’ve since felt like something in my mind switched, and I could never go back to how I was before. Even months after returning home, I constantly found new triggers and I was somehow always convinced I might be dying.
In my very first stages of treatment, trigger avoidance helped me cope with the anxiety attacks – it helped lower my anxiety levels and bring my mind back to a calmer state. While this was helpful at the start, it was not the most ideal long-term.
Over time, I’ve discovered learning to face my triggers was vital to accepting that my fears weren’t all that bad and I had much more power over them. This is called Exposure and Response Prevention (ERP), a type of Cognitive Behavioural Therapy (CBT) commonly known to treat OCD.
“ERP is a type of psychotherapy that involves exposing the patient to the feared object or situation and preventing them from engaging in their usual compulsions,” shares Janet, who goes on to explain: “The aim of these exercises is to help the patient learn they are able to tolerate the anxiety or distress, without having to engage in compulsion. With repeated exposure, habituation occurs [and] the same stimulus (trigger) does not evoke the same level of anxiety/stress anymore.”
For the same reasons, Aaron forced himself to confront the extremities of his own mind when faced with his own triggers. In the same podcast episode mentioned at the start of this article, Aaron talked about his experience visiting his sister who just gave birth to a baby boy (warning: graphic details follow), saying…
I walked by [the hospital] security and they didn’t ask for my ID. And I was like ‘hmm that’s weird, it’s one o’clock in the morning why are they letting me up here without checking?’. And that sent me into this insane avalanche that I was coming to kill the baby, kill my sister. And it got to the point [where], as I’m entering the room, I’ve already made concessions: 1) I’m not going to hold the baby – it’s too much risk [and] It’s going to be easier if I don’t. And 2) I’m going to limit my stay [since] it’s late, and just use that as a reason to quickly say ‘hi’ and leave. And I was like, ‘you know what? F*** all this noise. This game is bullsh*** and I’ve played this a thousand times and I’m NOT playing it right now. I want to go hold my nephew and chill.’ So I actually went in the other room, I literally did like a 10-minute forced exposure where I sat in another room and I mutilated my nephew [in my head], I killed him in like 20 different ways, I killed the whole room: my sister, my brother-in-law, I just mutilated them – pure massacre. And then I walked into the room, held the kid and everything was fine.”– Aaron Harvey, on how he dealt with one graphic episode of irrational thinking
Seeking professional care
While the self-treatment options (see below) can help to support recovery, it’s important to know when to seek professional care. “It is normal to have periods of our lives when we feel more emotionally or moody than other days and get on with daily functions of life. [However], it is time to seek help when the emotional upheavals become persistent, impede growth or affect daily functioning. It is absolutely necessary to seek immediate treatment when there are suicidal thoughts or behaviours,” shares Michael Gabriel Pillai, an Executive Director and therapist of WINGS Counselling Centre.
Should you decide to seek professional care, there are multiple online and in-person counselling and therapy options for you to choose from. Do note: Finding a good counsellor or therapist can take time. Go ahead and try them out. Tip: Go with someone you feel comfortable, and most importantly, safe with.
Helpful DIY, self-help options to support recovery
Consider trying out these resources to start your journey to better mental health management:
Spotify alone has a wealth of podcasts that discuss mental health. Hosted by individuals from all walks of life, these podcasts aim to destigmatise mental illness while also providing guidance and comfort.
Listening to such podcasts has played a huge part in his recovery, shares 24-year-old Jackson Wang, a current university student in Singapore. Having struggled with situational depression and anxiety between the ages of 18 and 20, he was referred to therapy. However, he had a different therapist each time he went. Over time, he found it draining having to repeat his story. He eventually sought help from various podcasts, in particular, one called The Life Coach School Podcast with Brooke Castillo. “I learned a model on how to handle my depression and anxiety through this life coach. The model is to first identify the situation, assess your thoughts about the situation and then assess your emotions regarding it.” Because of this, Jackson says he is better able to manage his mental health, including his tendency to overthink.
When it comes to OCD, I have personally found that mindfulness is a useful way to train the mind to focus on what it can control – the present. On his must-listen podcast Essential Teachings with Oprah Winfrey, spiritual visionary Eckhart Tolle teaches there is nothing but the “now”. To paraphrase his approach, when we worry about the past, we do it now; when we worry about the future, we also do it now. All living experiences take place in the present, and there’s nothing we can do but to accept it.
In addition, Eckhart’s podcast ventures into deep-seated questions and issues regarding the human condition. It is an extension of the ground-breaking book, A New Earth: Awakening to Your Life’s Purpose, he wrote in 2005, which addressed pathways to end suffering by unlocking a new human consciousness within. Now, 15 years later, this piece of work not only resulted in many accolades, it also went on to help many in need of guidance – including Oprah Winfrey, who joins him in the audio guide to discuss the chapters of the book. The podcast also answers questions from readers worldwide, and covers topics – in addition to mindfulness and living in the present – like debunking the ego, religion and more.
Another podcast that is a great option to practice mindfulness: Niall Breslin’s Wake Up and Wind Down, which includes twice-a-day meditative plus reflective episodes to help you centre your thoughts to the immediate present.
Alternatively, OCD Straight Talk, The OCD Stories (where Aaron’s story was from) and Owning It: The Anxiety Podcast are helpful podcasts that discuss not only what OCD is, but also feature real people coping with the disorder. For live examples of therapy sessions, Where Should We Begin? With Esther Perel is a profound series that comforts as much as it teaches.
1. First We Make The Beast Beautiful by Sarah Wilson
This book has been praised for its well-researched and compassionate angle on how to live with anxiety. It is also a book about self-love. As the title suggests, you may just learn to dance with your demons.
2. How It Feels To Float by Helena Fox
With this book, Helena Fox gives a powerful portrayal of mental illness and its adverse effects on daily life. Trigger warning: The writing can get very raw and vulnerable, and it’s known to make readers empathise pain in the same way its protagonist does. Read with care if you must, but this book reveals what it’s like to struggle keeping afloat when your mental illness is doing everything it can to sink you.
3. The Power of Now by Eckhart Tolle
By spiritual leader Eckhart Tolle (mentioned above), this self-reflective book is premised on the formation of the self and how to get rid of pain by removing all superficial associations of the self from the past and future, and to focus solely on the now. This book is deeply spiritual, drawing from various traditions adopted by Buddhism, mysticism and even the Bible. Note: It might be a hard read at first, but take the time to digest it. You might just experience an epiphany yourself. (I know I did!)
4. Reclaim Your Brain by Joseph A. Annibali, M.D.
Written by clinical psychiatrist Dr. Joseph Annibali, who has decades of experience treating patients who suffer from overstimulated brains, this book is a prescriptive guide to restoring calm in the mind. Ideal for individuals who feel like their brains won’t “switch off”, in the book Dr. Annibali discusses practical strategies, explanations and techniques to help readers reclaim a sense of control in their lives.
5. The Man Who Couldn’t Stop: The Truth About OCD by David Adam
This book was awarded the International OCD Foundation’s Illumination Award and the Medical Journalists’ Association’s Tony Thistlethwaite Award. Accomplished science writer and editor David Adam is a fellow sufferer of OCD for 20 years, and The Man Who Couldn’t Stop is his genuine attempt to understand the condition via his own experience. The book blends science, history and memoir to explore weird thoughts that exist in every mind, and David explains it drives millions towards obsession and compulsion. Amazon sums it up best, “The Man Who Couldn’t Stop is a haunting story of a personal nightmare that shines a light into the darkest corners of our minds.”
6. The Woman Who Thought Too Much by Joanna Limburg
This literary memoir tells of Limburg’s life as a sufferer of OCD, taking its readers on a personal, honest and sometimes shocking journey to understand what it’s really like to live with a mind that catastrophizes every thought. The book also seeks to reassure its readers about the persistence and courage of the human spirit in the face of mental illness.
Social media pages + online communities
Living with OCD or any other form of mental disorder is no easy feat. Talking to someone about it has to be done with care, too, lest it invites scathing remarks, commiserations or platitudes that give little to no help. This is why communities are so important – it makes the journey a little better knowing you’re not alone.
These Instagram accounts offer comfort and information in many ways: daily affirmations, informative discussions, deadpan humour and even memes.
1. The Mantra Co
2. OCD Recovery UK
3. The OCD Truth
4. The Obsessive Mind
5. My Therapist Says
6. The OCD Project
7. New Happy Co
Alternatively, these online websites and communities also offer useful information and resources: Mind, To Write Love On Her Arms, International OCD Foundation, Health Unlocked (My OCD Community) and The Tribe Wellness Community.
Schedule a “worry” or “crying” session
Michael recommends scheduling a stipulated amount of time each day (or as needed) to let your worries and obsessions go on overdrive. This means, putting aside a “worry” session and leaving all your worries to that session. If you’ve scheduled a “worry time” for 10 minutes at 8 p.m. that night, leave whatever worries you have till then and go on with your day as needed. Come 8 p.m., you then open the floodgates and let your mind worry about everything you’ve repressed in the day. “It’s like telling your worries, ‘Come at me. Hit me with your best shot,’” explains Michael. This way, you’re denying these worries the power to take control of your day. Instead, you’re telling it, “Hey, I see you and hear you. But now’s not the time. I’ll come back to you later.”
Personally, I’ve found this method to be best at confronting absurd thoughts. Once you address all your worries altogether, you’ll start to realise most of the thoughts are often irrational and catastrophized by the brain. I recommend writing or typing these worries during your scheduled “worry sessions”, too. This method helped me to remove myself from the situation and view my thoughts from an objective perspective, which made it a lot easier to challenge it and conclude that it’s not as bad as I initially thought it was.
Another university student, Jaime, 24, concurs. As someone who struggles with depression and anxiety (that stems from post-traumatic stress disorder), the worrying never stops for her. “I schedule a cry session once a month. Crying is so important [to me because] I used to only cry when I was angry. I had to unlearn it all [because] I only understood crying as an angry emotion. I associated sadness with anger so that I could cry, because I could only cry when I’m angry. So the scheduled crying time is for me to get in touch with my emotions so that I healthily process it.”
Journalling is also known to be extremely calming and self-reflective. Whether it’s simply writing about something you’re grateful for or an emotional dump, journaling can go a long way to improve your mental health. Read this article to learn how to start your journalling journey.
Living with OCD
Depending on the nature of the disorder and the individual, OCD can be treatable. However, for some of us like myself, OCD inevitably becomes a part of our lives, and the only way to go forward is to make peace with our minds and learn to manage intrusive thoughts. There’s no shame in that. If it can’t be treated, it can be managed. Just some examples mentioned in this story: Alex – from The OCD Stories podcast – used ERP to manage his disturbing thoughts, Jackson gleaned lessons from the situational model he heard out in a podcast and Jaime’s scheduled monthly “cry sessions” have helped her as well.
Personally, I’ve come to accept I will probably have to live with OCD (at least for now). I’ve even given my OCD a name, just so I can call her out whenever she’s being annoying and making me second-guess my every move. (Yes, Beatrice. I’m talking about you.)
And perhaps, it’s not all that bad. OCD is a common disorder, and several celebrities have even come forward admitting that they cope with it. Think Howard Stern, Leonardo DiCaprio, Justin Timberlake and Howie Mandel.
When it all comes down to it, you’d be surprised at how persistent and strong the human spirit is. If you’re struggling with OCD, do not feel ashamed. I’ve been there (and still am), and you’re not alone. If your mind is strong enough to get you in, rest assured it’s strong enough to get you out. But there’s no shame in needing a little help, too. The first step? Acknowledging you need some help.
And now that you’ve started to scratch the surface in understanding what OCD is, the next time someone passes an inaccurate remark (innocent or not), practice calling them in. Rather than to shame and “call out”, “calling in” is to benevolently and compassionately bring to attention learning lessons that someone else may not be aware of. By calling in, we are acknowledging that everyone makes mistakes. Not everyone is educated on what OCD truly is – so let us help them understand us.
By Willaine G. Tan, October 2021