Understanding Obsessive-Compulsive Disorder: myths, realities, and treatment

June 26, 2024

Written by Kevin Marra, MD Director of Medical Services 

In my experience as a psychiatrist, I've frequently noticed that conversations surrounding Obsessive-Compulsive Disorder (OCD) tend to stir up a mix of misconceptions and uncertainties. In this article, we'll delve into what OCD truly is, dispel common myths, explore its prevalence, and discuss effective treatment options. 

What is OCD?

OCD is more than just a penchant for neatness or a desire for orderliness; it's a complex anxiety disorder characterized by recurrent obsessions and compulsions. Obsessions are intrusive, unwanted thoughts or images that repeatedly plague the individual's mind. These can range from fears of contamination to worries about harming oneself or others. Compulsions, on the other hand, are repetitive behaviors or mental acts performed in response to the obsessions, aimed at reducing distress or preventing a feared event.¹ Typically, individuals with OCD recognize that their thoughts and/or behaviors are irrational but are unable to effectively manage the obsessions and/or compulsions from interfering with their daily lives. Different from other anxiety disorders, OCD is usually circumscribed to one specific worry rather than general everyday concerns.

Misconceptions About OCD

Contrary to popular belief and what is typically portrayed in movies and on TV, OCD extends far beyond outward behaviors like excessive handwashing or checking locks repeatedly. It encompasses a spectrum of symptoms, including intrusive thoughts, doubts, and rituals aimed at alleviating anxiety. It's crucial to recognize that someone isn't simply "OCD" because they exhibit traits of orderliness or rigidity; true OCD involves distressing obsessions and compulsions that significantly interfere with daily life and last for an extended amount of time.

Diagnosis & Prevalence

I have found that OCD often goes undiagnosed even though the individual has struggled for years. This can be due to the individual knowing that their fears are irrational and may involve taboo subjects, and are embarrassed to disclose them. When evaluating a patient, I listen for phrases like, “I have to do XYZ”, which implies that they see no other option than engaging in compulsive behaviors. In fact, my follow-up question is, “What happens if you don’t do XYZ?” and typically, the response is, “I do not know because I’ve always done it”. To comfort the patient and remove embarrassment, I try to normalize their fears and symptoms so I can dig deeper to get an accurate diagnosis.

OCD affects approximately 2-5% of the population and is typically diagnosed by age 19, with boys often diagnosed earlier than girls. While genetics play a role, environmental stressors can exacerbate symptoms of OCD.²

Treatment Options

Fortunately, OCD is treatable, and individuals with OCD are usually highly motivated even though it is difficult to imagine not engaging in compulsive behaviors. While a combination of medication and psychotherapy is usually the gold standard of treatment for moderate to severe anxiety disorders, in OCD medication plays an even more vital role when developing a treatment plan. Selective serotonin reuptake inhibitors (SSRIs) are often prescribed to alleviate symptoms, while Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) are highly effective forms of psychotherapy.

ERP, generally considered the gold standard psychotherapy, involves gradually exposing individuals to their feared situations or thoughts while refraining from performing compulsive behaviors. This gradual exposure helps desensitize them to their fears and teaches them healthier ways to manage anxiety. By challenging the urge to engage in compulsions, individuals with OCD can regain control over their lives and reduce the distress caused by their obsessions.

Living Beyond OCD

Obsessive-Compulsive Disorder is a debilitating condition that affects millions worldwide, yet it's often misunderstood. By shedding light on the realities of OCD—its symptoms, prevalence, and treatment options—we can foster greater understanding and support for those living with this disorder. With the right interventions and support systems in place, individuals with OCD can lead fulfilling lives, free from the shackles of their obsessions and compulsions.

About the Author 

Kevin Marra, MD has served as the Director of Medical Services since HopeWay opened in 2016. He has been instrumental in leading and growing the medical team as HopeWay has expanded its services. Dr. Marra is a proud native of West Virginia, and attended West Virginia University where he earned a BA in Biology. He went on to earn his Medical Degree from the West Virginia University School of Medicine. Dr. Marra completed his General Psychiatric Residency Training at the University of North Carolina where he served as Chief resident in his final year. He went on to complete a Forensic Psychiatry Fellowship at UNC the following year. In medical school, Dr. Marra was inducted in to the Alpha Omega Alpha National Medical Honor Society. He is also a member of the American Psychiatric Association and the American Academy of Psychiatry and the Law where he was selected as a Rappeport Fellow in 2011.