The Many Faces of OCD

OCD: The Unmasking of a Complex Psychological Compulsion

When you hear the term OCD what happens in your mind? Does it conjure up an image of someone washing their hands repeatedly, constantly checking if a door is locked, or lining up their belongings on a table? In this article, I’ll be discussing the many faces of OCD in the hope that you can recognise its many forms and show empathy and compassion for those struggling to overcome it.

OCD Is More Common Than You Might Think

Obsessive-compulsive disorder (OCD) is a complex and frequently misunderstood psychological compulsion affecting millions globally. According to recent statistics, OCD is the fourth most common mental health disorder, following depression, anxiety, and substance use disorders. In the United States alone, it is estimated that 1 in 100 adults and 1 in 200 children have OCD (1).

Research suggests that OCD may be even more prevalent in Europe, with some studies estimating that up to 2% of the population may be affected (2). However, despite its relatively high prevalence, OCD is often under-diagnosed and under-treated, in part because of the stigma that surrounds mental illness.

Despite its reputation as a “quirky” or “cleanliness” disorder, OCD is much more than that. It is a serious condition that can cause significant distress and interfere with daily life. Let’s explore six of the many faces of OCD, from Contamination OCD to Harm OCD, and offer insights into the underlying thought processes and behaviours that drive this complex mindset.

Six of The Many Faces of OCD

Intrusive thoughts OCD
Hoarding OCD
Symmetry and order OCD
Cleaning or Contamination OCD
Checking OCD
Harm OCD

The clients I’ve worked with most commonly present intrusive thoughts, hoarding, checking and contamination OCD.

Intrusive Thoughts OCD

Intrusive thoughts OCD, also known as Pure-O OCD, is characterised by unwanted, intrusive thoughts or mental images, causing significant distress and anxiety. These intrusive thoughts often involve themes of violence, sexuality, or religious blasphemy, and involve “taboo” or “forbidden” thoughts. This may be caused by an imbalance of serotonin and other neurotransmitters in the brain.

Unlike other types of OCD, individuals with intrusive thoughts OCD may not exhibit obvious physical compulsions or behaviors. Instead, they may engage in mental compulsions, such as seeking reassurance, constantly analysing their thoughts, or avoiding triggers that may cause intrusive thoughts. They may appear ‘lost’ in thought.

A good example of this is the 2015 film “The Bronze” starring Melissa Rauch, where she plays a former Olympic gymnast who suffers from intrusive thoughts related to harming herself and others.

Intrusive thoughts can be very distressing for individuals, causing feelings of guilt, shame, and anxiety. They may also worry that they are capable of acting on their intrusive thoughts, leading to social isolation and avoidance of certain situations or people.

Hoarding OCD

Compulsive hoarding, involves persistent difficulty in discarding or parting with possessions, regardless of their actual value or usefulness. This results in excessive clutter that can make living spaces unusable and unsafe. Overwhelming clutter can be a barrier to cooking, cleaning, and personal hygiene due to the clutter.

Strugglers feel a strong emotional attachment to their possessions, and may fear that they will need them in the future or that they will be lost or stolen. They may also experience significant anxiety or distress when faced with the prospect of discarding their belongings, leading to avoidance.

If you’ve seen “Matchstick Men” (2003) Roy Waller exhibits symptoms of Hoarding OCD. This type of OCD has significant social and emotional impacts. Individuals may avoid inviting guests into their homes, and may become isolated from family and friends. They may also experience feelings of shame or embarrassment about their living conditions.

Understanding the underlying thought processes and behaviours that drive hoarding OCD is crucial in delivering the appropriate treatment.

Symmetry & Order OCD

Symmetry and order OCD, also known as arranging and counting OCD, triggers a compulsion for alignment, precision, and exactness. It is thought to be related to a combination of genetic, environmental, and psychological factors.

Sufferers feel compelled to perform rituals such as arranging objects, counting, or checking to make sure that everything is in its “right” place.

If you’ve seen the film “Sleeping With The Enemy” (1991) you’ll remember Julia Robert’s character becoming aware that her ex-husband had found here when she noticed her towels had been re-positioned in the bathroom and the labels on the food in her kitchen cupboards were aligned. This is a good representation of symmetry and order OCD. Many people also believe Nikola Tesla struggled with this type of OCD.

A individual struggling with this might spend hours arranging and rearranging objects until they are in the “perfect” configuration. They may also feel compelled to perform these rituals a certain number of times, such as arranging objects in sets of three. People feel distress or anxiety when they are unable to perform their rituals or when they perceive that something is “out of place.” They may also experience procrastination, completion, or making decisions due to their need for their model of perfection.

Cleaning & Contamination OCD

Individuals with contamination OCD often feel intense anxiety and distress when exposed to objects, people, or environments they perceive as dirty or contaminated. Often triggered by be triggered by a traumatic event or experience, while for others, it may be a result of a genetic predisposition or chemical imbalance in the brain.

Common behavioral manifestations of contamination OCD include excessive cleaning, hand-washing, and avoidance of situations or objects that may trigger feelings of contamination. They often spend hours each day washing their hands or cleaning their surroundings, often to the point of causing skin irritation or other physical harm. They may also avoid public places, such as public restrooms, or refuse to shake hands or touch objects that others have touched.

Unsurprisingly, everyday tasks can become significant sources of stress and anxiety. For example, simple tasks such as preparing food or travelling to work can create a fear of exposure to germs or bacteria.

If you’ve watched “The Aviator” (2004), Howard Hughes displays symptoms of Intrusive Thought OCD, Contamination OCD, and Checking OCD.

Checking OCD

This type involves repeated and excessive checking behaviors, such as checking locks, appliances, or other items to ensure that they are secure or turned off. Unlike Symmetry and Order OCD, Checking OCD is not driven by a need for symmetry or exactness, but rather by a fear of harm or loss that might result from not checking.

The behavioral manifestations of this type can be time-consuming and interfere with daily life. For example, someone with Checking OCD might spend hours checking and re-checking locks before leaving their house, or might repeatedly check the stove before going to bed. They may also feel a strong need to ask for reassurance from others, such as asking a friend to confirm that they locked the door.

Driven by a need for protection from harm and loss, significant distress or anxiety is felt when they are unable to perform their checking rituals or when they perceive that something is not secure or turned off. They may also experience difficulty in completing tasks or making decisions due to their fear of harm or loss.

In the film “Silver Linings Playbook” (2012), the main character Pat Solitano exhibits symptoms of Checking OCD.

Harm OCD

Harm OCD, also known as violent or aggressive OCD, can involve intrusive and unwanted thoughts, images or impulses related to harming oneself or others. This type of is particularly distressing for individuals who experience it, as they may fear that they are capable of acting on their thoughts or impulses.

Behaviours vary widely and can include checking, reassurance-seeking, avoidance of certain situations, and physical or mental rituals aimed at preventing harm.

Individuals with Harm OCD may also experience significant anxiety, guilt, and shame related to their intrusive thoughts, leading to social isolation and avoidance.

It’s important to understand that having these thoughts doesn’t necessarily trigger action. The 2017 film “Menashe” is a drama film that depicts a character with Harm OCD. It tells the story of Menashe, a widowed man who struggles with obsessions related to harming his young son.

Using NLP (Neuro-Linguistic Programming) To Overcome OCD Behavioural Symptoms

Essentially, the many faces of OCD all represent a coping mechanism created by the mind to protect the individual from harm. Whether the root cause is biological, genetic, environmental, or psychological, it’s important to take the time to understand the specific purpose of the coping mechanism in the mind of the individual.

NLP language techniques are useful to fully explore how the client represents the behaviour and underlying mindset behind it. Additionally, we can use language to bring unconscious behavioural patterns and strategies into conscious awareness. Sufferers can use this conscious awareness to gain insight into the triggers, often leading to an awareness of the root cause. With consciousness awareness, individuals struggling with OCD have more choices to redirect thoughts and behaviours purposefully.

Other useful NLP & Time Line Therapy® techniques to manage and overcome OCD are negative emotion release, limiting belief release, submodalities (to change the representation of the trigger), strategy redesign, and compulsion blow out. Personally, I have found that the release of terror from early childhood (in conjunction with strategy and SMD work) can dramatically reduce the need for coping mechanisms to increase safety. When a strategy becomes futile, the mind releases it.

Conclusion

It’s important to note that OCD can be effectively treated, delivering relief to an individual struggling with OCD behaviours and a level of peace to friends and family. Treatment often involves a combination of therapy and medication.

People struggling with OCD can experience several different types of OCD and this can give clues as to the root cause of the need to create this safety mechanism.

Seeking help is an important step in managing symptoms and improving quality of life for those affected. Even more important, the more we understand the many faces of OCD, the greater our capacity to recognise the associated behaviours, the greater our ability to offer empathy and support to those struggling to overcome it.