OCDSymptoms and Diagnosis Five Things to Know About OCD ByAlegra Kastens, LMFTAlegra Kastens, LMFTAlegra is a psychotherapist specializing in the treatment of obsessive compulsive disorder, anxiety disorders, body-focused repetitive behaviors, and body dysmorphic disorder.Learn about our editorial processPublished on June 23, 2022Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MDMedically reviewed byDaniel B. Block, MDLinkedInTwitterDaniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.Learn about our Medical Review BoardPeopleImages / Getty Images Table of Contents View All Table of ContentsLoving to Organize Is Not a Symptom of OCDEveryone Is Not “A Little Bit OCD”It's Not Just About Hand-WashingMental Compulsions ExistERP Is a Frontline Treatment for OCD Despite widespread usage of the word OCD in the media, obsessive-compulsive disorder is arguably one of the most misunderstood mental health conditions. The disorder gets characterized as a love of organization and cleaning or a personality trait that everyone lives with, which is inaccurate on all accounts. In instances where OCD is portrayed correctly, we typically see a sliver of what the disorder entails: a person with contamination obsessions followed by hand-washing and other visible compulsions. Erroneous and stereotypical presentations of OCD in popular culture contribute to the misdiagnosis of OCD in therapy offices across the world and prolonged suffering for those experiencing symptoms not typical of what people often hear about the disorder. This article discusses five important facets of OCD that you should know. Loving to Organize Is Not a Symptom of OCD While Khloe Kardashian is not the first or last person to misrepresent the reality of OCD, her direct quote below highlights one of the most common misconceptions about the disorder: OCD is synonymous with a desire to organize. In a video uploaded to her “Khlo-C-D” series on her app, Khloe stated: "Normally, I think areas [to organize] like this for a homeowner are intimidating. For me, like a garage and a pantry get me really horny.” It’s clear that Khloe is excited by the prospect of organizing large spaces, which indicates that the organization is ego-syntonic—a psychological term used to describe thoughts, feelings, and behaviors that are acceptable to a person. The person does not find such stimuli as problematic, but rather as a part of oneself that they align with. Ego-syntonic vs. Ego-dystonicEgo-syntonic describes thoughts, feelings, and behaviors that someone feels in alignment with. Ego-dystonic describes thoughts, feelings, and behaviors that someone does not feel in alignment with. OCD is an ego-dystonic disorder. Obsessions (recurring intrusive thoughts, images, sensations, and urges) are experienced as disturbing and unwanted. The person with OCD does not enjoy performing compulsions (physical or mental acts a person carries out in response to obsessions) but feels like they have to in order to alleviate anxiety, prevent something bad from happening, seek certainty about obsessions, etc. In simplified terms, people with OCD do not enjoy their symptoms. Why People Think That People With OCD Love Organization Where does the idea that people with OCD love to organize come from? It is due, in part, to a misunderstanding of the actual symptoms of OCD. A person with OCD might experience “just right” or symmetry obsessions in which they feel the urge to do things/place things in a manner that feels internally “right” or “perfect” to them. This might look like a person “needing” to place a book in the “right” place, which usually causes them to compulsively move it again and again until they reach an internal feeling of “rightness.” This can be anxiety-provoking, time-consuming, and painful. Standing in front of the mirror and pulling one’s socks up over and over and over again until they feel symmetrical, or moving and re-moving objects on one’s desk is anguishing to the person with OCD. Such behavior is far from enjoyable. People Confuse OCD and OCPDIt is also due, in part, to confusion between symptoms of obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD). People with OCPD might be preoccupied with orderliness and have a rigid set of rules they apply to themselves and others, but the key difference is that people with OCPD are OK with their behavior and typically believe it to be acceptable. For people with OCPD, their beliefs and behaviors align with their sense of self and are not viewed as problematic, which is the opposite of the person with OCD who is distressed and impaired by their symptoms. Learn the Difference Between Obsessive-Compulsive Personality Disorder and OCD Everyone Is Not “A Little Bit OCD” While we all experience an odd, unwanted thought from time to time or perform a behavioral ritual here and there, we do not all meet the criteria for OCD. OCD Is Not an AdjectiveOCD is not an adjective to describe being tidy or organized, but a noun that indicates a disorder someone lives with. To meet the criteria for the disorder, someone with OCD must experience obsessions and/or compulsions for at least an hour every day and have impairment in functioning because of the pervasiveness of their symptoms. Those with OCD do not experience just a passing intrusive thought but recurring intrusive thoughts, images, and urges that stick because of how their brain is wired. They also feel a strong urge to perform compulsions in the face of obsessions that the everyday person does not experience. Saying that everyone experiences OCD minimizes the severity of the disorder. OCD Is Not Only About Contamination Concerns and Compulsive Hand-Washing People with OCD can experience obsessions that center around a fear of contamination, but many with OCD do not. Obsessions of OCD can center around anything (quite literally, anything can become an obsession) and often pertain to taboo content. Some examples include (but are not limited to): Unwanted intrusive thoughts about sex with children (e.g., What if I’m a pedophile?)Unwanted violent thoughts about harming others (e.g., intrusive images of stabbing someone)Unwanted intrusive thoughts about harming one’s newborn baby (e.g., What if I throw my baby down the stairs?) Less taboo obsessions include (but are not limited to): A hyperawareness of automatic bodily sensations like blinking and breathingUnwanted intrusive thoughts about a romantic partner (e.g., What if I don’t actually love them?)Existential obsessions (e.g., What if I’m living in a dream?) While excessive hand-washing is a compulsion that people with OCD perform, it is one of a variety of mental and physical compulsions carried out. Avoidance of feared stimuli, reassurance-seeking about obsessions, confessing of obsessions to others, compulsive prayer, mental compulsions, and other physical compulsions are common. Why Loss of Control in OCD Is Commonly Misunderstood Mental Compulsions Exist In the same manner that people perform physical behaviors in response to obsessions, those with OCD perform mental behaviors as well. It is possible for a person with OCD to experience obsessions and compulsions completely in their mind, making their suffering covert and invisible to others. They might not recognize that they are living with OCD if they believe the common misconception that compulsions are only physical (hand-washing, tapping, etc.). A lack of understanding about mental compulsions can also have adverse therapeutic consequences if the therapist is not addressing them through response prevention. Examples of mental compulsions include: Thought neutralization: replacing unwanted thoughts with more desirable thoughtsRumination to analyze or solve the obsessionsMentally reviewing past experiencesMentally checking one’s feelings and bodily sensationsPurposely bringing on a thought to test one’s response to itHow to Distinguish Pure O From Other Forms of OCD ERP Is a Frontline Treatment for OCD Exposure and Response Prevention (ERP), a behavioral therapy under the CBT umbrella, is the frontline treatment for OCD.This entails facing one’s fears head-on through exposure and eliminating compulsions performed. Therapy should be behaviorally-oriented, as one’s response to obsessions—compulsions—is the crux of the problem. We are not in control of what pops into the mind (obsessions) but are in control of what we are doing in response to them (compulsions). Compulsions reinforce obsessions as important and dangerous, when they are unimportant false alarms, and reinforce the false notion that the only way to manage obsessions is to carry out compulsions and people with OCD get trapped in a debilitating cycle. Obsessive-Compulsive CycleObsession: The person experiences an obsession (e.g, thought, mental image, urge)Anxiety: The person experiences anxiety, discomfort, disgust, and/or guiltCompulsion: To relieve anxiety, attempt to seek certainty, or prevent something bad from happening, the person performs a physical or mental compulsionTemporary Relief: Performing the compulsion may bring relief and reinforces that the compulsion is helpful and that the obsession is importantRepeat: The cycle repeats Compulsions are also excessive, fruitless, and unhelpful. They are not necessary to carry out, despite how strong an urge the person with OCD experiences and how real obsessions can feel. If the behavior is not targeted in therapy, the person may remain trapped in their symptoms. Traditional talk therapy is not indicated for OCD for this reason, along with the fact that talking about the content of one’s obsessions and trying to find meaning in them can be compulsive in and of itself. Mindfulness skills training, acceptance and commitment therapy (ACT), and cognitive-behavioral therapy (CBT) can be helpful adjunctive treatments. It is important to note that for some people, OCD is so severe that the individual cannot tolerate CBT without some help in reducing the intensity and severity of their symptoms. Medication can be utilized, which would be prescribed by a psychiatrist or medical doctor. 4 Things Your OCD Therapist Should Avoid in Treatment A Word From Verywell If you are experiencing symptoms of obsessive-compulsive disorder, there is help. Finding a therapist who truly specializes in the treatment of the disorder and understands how to treat it effectively is an important next step. The International OCD Foundation (IOCDF) has a Find Help directory that lists OCD specialists in your area. The Impact of OCD on Your Sex Life 3 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Refinery29. What Khloé Gets Wrong About OCD—Because Almost Everyone Else Does Too.Brock H, Hany M. Obsessive-Compulsive Disorder. In: StatPearls. Treasure Island (FL): StatPearls Publishing; February 10, 2022.IOCDF. How Is OCD Treated? Additional ReadingIOCDF. About OCD.By Alegra Kastens, LMFT Alegra is a psychotherapist specializing in the treatment of obsessive compulsive disorder, anxiety disorders, body-focused repetitive behaviors, and body dysmorphic disorder. See Our Editorial ProcessMeet Our Review Board Share FeedbackWas this page helpful?Thanks for your feedback!What is your feedback? Other Helpful Report an Error Speak to a Therapist for OCD Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.