Millions of people suffer from anxiety – some get it before a job interview or exam, but others have to cope with crippling anxious thoughts nearly constantly.
However, experts believe those compulsive thoughts may not be anxiety at all – they may actually stem from obsessive-compulsive disorder (OCD).
OCD is a mental health condition that causes people to experience unwanted thoughts and repetitive behaviors.
Stereotypical depictions of the disorder include excessive hand washing or repeatedly checking that you’ve locked your door.
But some of the roughly 3million OCD sufferers in the US say that is far from the whole picture. While the condition does lead to disruptive and often repetitive compulsive behaviors, it’s the persistent, intrusive thoughts that are most challenging.
Some people may have OCD tendencies – such as wanting a tidy home – but have not been diagnosed with clinical OCD. The condition becomes a concern when feelings of anxiety, disgust, or incompleteness intensify to the extent that they begin to dominate and significantly disrupt a person’s ability to live their life, doctors and patients told NPR.
There are several subtypes of OCD. They all involve obsessive and compulsive thoughts, but may revolve around different worries – such as relationships.
Washington, DC native Sarah Jaley said: ‘I was constantly thinking like, we need to break up because I’m not good enough, or maybe there’s better matches for us somewhere else. I would just spiral about that every day and I would cry about it a lot.’
Sarah Jaley, a native of Washington, DC, shared that she often thought, ‘We should break up because I’m not good enough.’ She would spiral into these thoughts daily and often found herself crying over them. Photo courtesy of Facebook
Elizabeth Vossen, a 26-year-old therapist from Boston, described her Pure Obsession OCD as ‘normal thought patterns in overdrive’. Photo courtesy of LifeStance Health
For Michael, 27, from Greenville, South Carolina, his obsessions revolve around questions like: What if I get cheated on? What if the person I’m dating isn’t a good fit? What if we don’t end up together? What if I don’t truly love them? Or, what if they don’t love me?
Both of them have relationship OCD, a form of Pure Obsession OCD, referred to Pure O in online message boards.
Pure O can be difficult to detect because, unlike the OCD that manifests physically, pure obsession OCD is often invisible. About 10 percent of OCD sufferers have this Pure O subtype.
Elizabeth Vossen, 26, from Boston, describes her Pure O as ‘normal thought patterns in overdrive.’
At first, she believed her obsessions to be helpful for her work as a therapist. They sound like, ‘Did I say the right thing? Did I do the right thing? Was I empathetic enough? Did I offer the right amount of help?,’ Vossen said.
She added: ‘And there’s always a part of me that’s like, well, isn’t that a good thing, don’t I wanna be thinking really hard to be a good therapist?’
However, these thoughts became so intense and compulsive that they went beyond ‘normal’ ruminations or concerns about past interactions or how others perceive them.
When she fixates on a past interaction, she feels compelled to analyze it thoroughly until she feels better, even if no new insights emerge.
Vossen no longer works with clients who have OCD because the compulsive thoughts had become too much for her. After one patient shared a particular obsession, she began experiencing it herself.
She said: ‘I asked about the character of their intrusive thoughts and they were like, “Oh, I imagine all of my teeth snapping. And I imagine like taking nail clippers and severing my teeth.”
‘And now every single time I trim my nails or if I’m brushing my teeth, I am thinking about my teeth breaking and I’ll even, like, clench my jaw to feel like they’re all still there.’
Meanwhile, Shaun Flores, 30, has been diagnosed with sexual orientation OCD.
People with SO-OCD may experience persistent doubts about their sexual orientation, fears of being or becoming gay, concerns about being perceived as a different sexual orientation, anxiety over how their orientation could impact relationships, and fears of being in denial about their true orientation.
It is believed to affect around 315,000 Americans.
Mr Flores: ‘I became obsessed with this idea that suddenly overnight I’d become gay.
‘So I’d avoid people, avoid men. I wouldn’t watch some of my favorite things such as boxing or martial arts because the men were half naked.’
Shaun Flores, 30, has been diagnosed with sexual orientation OCD. He explained that he became fixated on the fear of suddenly being gay. Photo courtesy of the International OCD Foundation
Everyone rethinks or double-checks things sometimes. Not all repeated thoughts are obsessions, and not all rituals or habits are compulsions
His OCD led him to believe he was HIV positive, compelling him to get tested repeatedly because he couldn’t trust the results.
Mr Flores grew up in a conservative Christian home in London where being gay was considered a mortal sin.
He said: ‘At a time, I was deeply homophobic. As I got older, I realized people can’t choose who they are. And even if they could, it’s not any of my business.
‘You learn to understand that the thoughts don’t necessarily reflect any parts of you. The brain creates random thoughts.’
OCD typically begins in childhood. Some of the behaviors associated with OCD in childhood include a fixation on germs, fear of contamination from animals or people, and a fear of touching surfaces.
It can also manifest as anxiety about accidentally hurting a family member or friend, superstitions that bad things are about to happen, and preoccupation with appearance and organization.
According to mental health experts at the NIH, everyone rethinks or double-checks things sometimes.
Not all repeated thoughts are obsessions, and not all rituals or habits are compulsions.
But, people with OCD generally can’t control their obsessions or compulsions, even when they know they’re excessive.
They usually spend more than one hour a day on their obsessions or compulsions.
They do not get pleasure from their compulsions but may feel temporary relief from their anxiety.
They also experience significant problems in daily life due to these thoughts or behaviors.
Ritualistic, compulsive behavior and obsessive thinking are physically and emotionally draining.
The condition can make social interactions, working and even eating near-impossible. People with OCD may find themselves unable to thoughtfully engage with others because they are so preoccupied by their own obsessions.
They may also be embarrassed and fearful of being judged.
People with OCD often avoid situations that will spark severe anxiety, leading to social isolation and loneliness that worsens anxiety and brings about feelings of depression and hopelessness.
Treatment for OCD typically involves cognitive behavioral therapy, particularly exposure and response Prevention (ERP), which gradually exposes people to situations that trigger their obsessions while also helping them resist the urge to engage in compulsive behaviors.
