The untidy truth about obsessive compulsive disorder

A small hair salon in Cheshire in the UK recently posted an ad looking to recruit a new front-of-house staff member. The ad stipulated the business was looking for someone “EXTREMELY well organised/OCD”.

The use of ‘OCD’ in this off-handed way to describe tendencies towards cleanliness or organisation should shock us, but is so common-place that we rarely stop to consider how very not ‘woke’ it is to use the term like this. Would you expect to see an ad for a librarian listing “very quiet/depressed” as a desirable attribute?

OCD affects approximately 1.9 per cent of the Australian population in any 12-month period, yet may be one of the most misunderstood of all mental disorders. The World Health Organisation recognises OCD as one of the top 10 most disabling diseases affecting the human population, frequently leading to loss of income and lower quality of life.

As the name suggests, there are two critical elements to obsessive-compulsive disorder; obsessions and compulsions.

Obsessions are intrusive thoughts, urges or images that tend to cluster around five themes; causing or failing to prevent harm, symmetry, contamination, hoarding, and sex, violence or religion.

Intrusive thoughts are common, with research in multiple countries showing that they affect the majority of the population. Ever had a brief, bizarre thought that you might throw yourself, or someone else, off a building? Or floor the accelerator upon approaching a pedestrian crossing? Those are examples of intrusive thoughts. Individuals with OCD get stuck on their intrusive thoughts, with some people knowing that their thoughts are unreasonable or unlikely, and others being so convinced of their truth that the disorder can be mistaken for an episode of psychosis.

The intrusive thoughts cause such intense distress that the individual is compelled to perform seemingly pointless and unrelated behaviours, or compulsions, to reduce the distress caused by the obsession.

Compulsions tend to cluster around common themes, including; checking, ordering, counting, washing or cleaning, collecting, and reassurance seeking. Again, these behaviours fall on the normal spectrum of human behaviour. In the case of OCD though, compulsive behaviours impair one’s ability to function in aspects of day to day life and take up a minimum of an hour per day.

A case study published by the UK’s National Health Service describes how one mother of four, ‘Diana’, had intrusive thoughts related to harming her children, specifically strangling them with the cords of their dressing gowns. Her distress and terror were so great that she would compulsively take their dressing gown cords, tie them into multiple knots so they could not possibly be put around a child’s neck, and put them in a high cupboard.

So no, OCD is not a quirky part of your personality, nor is it the reason you like to colour-block your bookshelf, organise your pantry, or keep a tidy home.

In fact, research published in the Proceedings of the National Academy of Sciences shows that there are critical differences in the brains of OCD sufferers, compared to unaffected controls. Participants were shown two angry faces. One of those faces was presented with a mild electric shock. This taught participants that this face represented a threat, and there was an increase in sweat production in the moments between seeing the ‘threat’ face and experiencing the electric shock. When the electric shock was paired with the non-threat face, control participants were able to switch their response – so they responded with fear to the face now paired with the shock and had no reaction to the originally threatening face.

However, participants with OCD reacted to both as threatening. Their brains were unable to learn that one of the faces was safe, and this was represented by a lack of activity in the ventromedial prefrontal cortex, the part of the brain that signals safety.

Do throw-away phrases like “I’m a bit OCD” undermine the intense suffering of those actually affected by OCD? Do they contribute to misunderstandings about the neurological differences in those affected by the disorder?

In the best world, using such phrases would help to decrease the stigma related to this debilitating disorder. The first step is probably just understanding that being tidy, or particular, or well-organised is a world apart from living every day at the behest of intrusive thoughts and compulsive behaviours, a slave to another misunderstood mental illness.

Dr Jessica L Paterson, Senior Research Fellow, CQUniversity, Appleton Institute