Signs That You or Someone You Know May Have OCD and Not Realize It

OCD & Co.

Apr 17

Written By Turning Point Psychological Services

People tend to think about OCD as a washing, organizing, and checking disorder, the reason being is that OCD is presented this way in the media. But there are numerous other manifestations of OCD that are very common but may not be immediately visible to others.

Some Less-Known, but Very Common, OCD Fears

Fear of Offending God, Doing Religious Rituals in a Wrong Way, or Being a Bad, Immoral, or Unethical Person (Scrupulosity)

This usually looks like the OCD sufferer is just a devoted, spiritual, or highly conscientious person. But it has more to do with OCD than religion or morality.

This type of OCD may lead to numerous, extremely rigid religious rules that greatly exceed what the person’s religion prescribes.

A person may question himself whether he is really concentrating during a prayer, if his faith in God is strong enough, or whether he accidentally mixed up the words of a prayer. This leads to repeating the prayer over and over again - sometimes for hours at a time.

Sometimes a person may start avoiding the place of worship as he feel unworthy of being there, or because his intrusive thoughts may increase when he attends the service.

Moral scrupulosity includes worrying about being a bad person, being a racist or an anti-Semitic, inadvertently telling a lie or keeping a secret, acting unethically or selfishly.

Rituals may include excessive confessing, self-reassurance, performing altruistic acts with the goal of proving that he is a good person, and mentally reviewing his behavior – trying to figure out if he has accidentally sinned or behaved immorally.

Unfortunately, very few religious leaders are aware of OCD. When a scrupulosity OCD sufferer comes to them for advice, they often encourage him or her to pray or confess more (that is, further reinforcing the compulsive behavior).

Excessive Worrying About Health (Illness Anxiety, Health Anxiety, Hypochondria)

This is an obsessive preoccupation with having a serious physical or mental disorder in spite of normal medical exams, test results, and reassurance by doctors. In addition to worrying about having an illness, the sufferers often worry about being responsible for missing the early signs of the disease and living with the consequences of not having done enough to obtain the correct diagnosis and treatment.

This fear leads to constant checking of the perceived symptoms, visiting medical professionals, repetitively seeking reassurance, asking family members to have a look at any visible symptoms, obsessively Googling, and requesting unnecessary tests.

Of course, just like with any other OCD, no amount of reassurance or negative test results provides long-lasting relief. The person suffering from this type of OCD feels better for a little while after being reassured by a medical specialist, but then starts worrying that the doctor or the lab may have missed an important sign of the illness or mixed up the results -- and the anxiety starts again.

Scary Intrusive Thoughts About Causing Harm to Oneself or Others

These include fear of physically attacking another person, hurting or molesting a child, shouting a racial slur in public, swerving the car into traffic or off a ramp, pushing a person under an approaching subway train, stepping in front of oncoming traffic, harming a baby, etc. The fears can also be related to the person not being sure if he or she had already committed some horrible act or crime, which leads to excessive physical and mental checking.

Sometimes, the sufferer may be afraid that he or she may cause harm to others just by thinking certain thoughts, having certain images, or performing (or failing to perform) certain action.

Understandably, having these unwanted thoughts causes a great deal of shame and embarrassment. It also leads to numerous compulsions, such as mentally reviewing past thoughts and behaviours, confessing, trying to “neutralize” or disprove disturbing thoughts, and avoiding people, objects, and situations that are related to these thoughts.

Fear of Having Caused a Hit-and-Run Accident

This relates to the previous category of fear of causing harm, but it’s so prevalent that it deserves a separate category. A person with OCD may question herself wondering if maybe she was too distracted and accidentally harmed a pedestrian when driving. Any bump on the road or a noise in the car is interpreted as hitting a pedestrian.

It is not unusual for a person with this type of OCD to consistently make U-turns to go back to check the driving route or listen to the radio and check the news to make sure there was no hit-and-run accident on their route. This checking is a compulsion that is aimed to relieve the anxiety caused by the thought of potentially having caused a car accident.

Fear of Being Gay (HOCD, Homosexual OCD, Sexual Orientation OCD)

HOCD is a fear of being gay (or, if the sufferer is gay, then sexual orientation OCD is the fear of being straight). This includes worries about being a fraud, a liar, the fear of never being able to have a healthy relationship, or of living in denial of who the person really is.

Common compulsions include trying to figure out their sexual orientation once and for all with 100% certainty. The sufferer may look at pictures of same-sex people while trying to make sure that he or she isn’t attracted to them, ruminate about past experiences trying to figure out if he or she ever had romantic feelings for a same-sex friend, check for a groinal response, try to neutralize the thoughts, and ask for reassurance about being straight.

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Emotional Contamination Fear (Mental Contamination)

Like being afraid of becoming contaminated by germs in the most well-known OCD type, here a person is afraid of being “morally contaminated” by coming into contact with a “bad” person or a specific item (say, touching am image of a pink ribbon may contaminate them with cancer; encountering a homeless person or a person with piercings or tattoos may contaminate them with “badness”). Similar to germ contamination, this type of mental contamination also seems to spread to other people, objects, thoughts, quotes, pictures and anything else that could be even very remotely associated with the original “mental contaminant.”

The main compulsion is usually to avoid all proximal and distal stimuli. Additionally, the person with OCD often develops numerous visible and mental rituals to try to prevent and “un-do” the contamination.

Responsibility OCD

This type of OCD is usually known as “checking OCD” and is related to the fear of being responsible for some calamity that may occur or already occurred.

It often manifests as checking if the door is locked or if the electric appliances are turned off. Other manifestations include checking food and beverage containers for possible damage, checking emails and tests repeatedly before (and after) sending them, mentally reviewing all the previous checking, and, of course, seeking reassurance.

Interestingly, it is not necessarily the disaster itself that some sufferers fear the most. Sometimes, it takes a person hours to leave the house as she keeps re-checking everything. But she is perfectly fine when her husband is the last one to leave the house even though she knows that he will not do the checking.

Or, a mom would spend hours checking and decontaminating the food before cooking for her kids but will let the kids eat the non-decontaminated food that their dad cooked as long as the mom wasn’t present during that cooking time. This is why I’m referring to this OCD type as responsibility-related. These individuals can’t tolerate the thought of being responsible for causing a disaster.

Relationship OCD (ROCD)

Relationship OCD involves difficulty tolerating uncertainty about the person’s romantic relationship. The person with OCD keeps wondering it her partner is the right one, or whether she has made the right choice, or if she loves her partner enough. It is difficult for a person with this OCD type to tolerate even the slightest doubt about her choice of partner.

Common compulsions here are monitoring the feelings and trying to figure out if these feelings are real, comparing her partner unfavorably to other people, mentally reviewing everything about the relationship, and repeatedly asking friends and family what they think (seeking reassurance).

Existential or Philosophical OCD

Existential OCD includes endless, intrusive, repetitive, and very disturbing thoughts about the meaning and reality of life. These questions have no true answer. Typical obsessions include questions such as:

What is the meaning of life?
What is life is just meaningless?
Why am I here?
What is the point of it all as we will all die in the end?
How can I continue living if I am unable to find the real meaning of life?
Is the world around me real?
What if everything is staged, like in the Truman Show?
Am I real or is somebody manipulating my brain?

The main compulsion is usually trying to figure it all out. Other compulsions include trying to disprove the thought, engaging in philosophical discussions, reading philosophical literature trying to find answers, seeking reassurance, researching the meaning of life, trying to distract oneself, or trying to stop the thoughts. As with the other OCD types, most compulsions are aimed at finding clarity and certainty.

Hyperawareness (Sensorimotor) OCD

This type of OCD is not well-known and is usually missed or misdiagnosed.

This is an obsession with not being able to stop thinking about a body part or a body function such as blinking, swallowing, breathing, or even thinking. The sufferer concentrates on these body parts or automatic processes and worries that he or she will not stop thinking about them, will go crazy, will never be able to live a normal life, etc.

This leads to compulsions of monitoring, reviewing, or checking the thinking about breathing, blinking, or another body process, body part, or a body part’s position. Other compulsions include trying to figure it out, trying to distract oneself from thinking, trying to stop the thinking, avoidance of any triggering situations or words, and seeking reassurance.

Patterns Common to All OCD Sufferers

As you can see, there is much more to OCD than organization and fearing germs. The possibilities of OCD obsessions are endless. It is not the obsession content that determines whether or not a person has OCD -- it’s the process of how the person relates to his or her intrusive thoughts.

When a person with OCD has an obsession, he or she feels compelled to do something to decrease the discomfort caused by the thought. This is driven by the mistaken belief that it is possible to somehow control the internal experiences (emotions, thoughts, images, urges, or memories). This includes asking for reassurance, checking, trying to figure things out, seeking absolute certainty, attempting to get rid of the thoughts or feelings (the internal triggers) or to neutralize them, avoiding specific situations and people (the external triggers), and seeking distractions from distressing thoughts, feelings, or images.

This usually brings some temporary relief, but OCD always comes back for more and the cycle of obsessions and compulsions continues and becomes stronger and more time-consuming.

OCD usually attacks things that matter the most to the person; therefore, the obsessions cause a great deal of distress.

In addition to the process of becoming hooked by intrusive thoughts people with OCD usually have the following characteristics:

1. Most OCD sufferers have an overwhelming need to be certain and feel that they are unable to function until they reach that point of 100 percent certainty. But, of course, this is impossible in our unpredictable life and, therefore, the endless “What if?” questions continue. OCD is sometimes called a doubting disorder and it’s a pretty accurate description.

The endless quest for certainty leads to constant “problem-solving” that gets in the way of the person’s ability to just live their life.

You can read more about the need for certainty here.

2. Another common characteristic of people with OCD is feeling unable to tolerate the possibility of being responsible for a potentially wrong or harmful action.

OCD Treatment

The approach to the treatment of OCD seems counterintuitive at first glance. Instead of trying to get rid of the obsessions (which, of course, would be highly desirable, but unfortunately, is impossible), the treatment includes stopping the rituals. This is called Exposure with Response Prevention (ERP, ExRP) and involves giving the person tools to not let OCD push them around. ERP is a very specific component of Cognitive Behavioural Therapy (CBT).

ERP is a very active therapeutic approach that allows people to practice voluntarily putting themselves in a situation that triggers compulsions and still not compulse. Gradually, this becomes easier to do.

The treatment is especially effective when combined with Acceptance and Commitment Therapy (ACT).

If the treatment is successful, the person may still have some obsessions, but does not engage with them and is able to just carry on with what he or she was doing.

Think you or someone you know may have OCD? Leave a comments below and share with us!

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Anna Prudovski is a Psychologist and the Clinical Director of Turning Point Psychological Services. She has a special interest in treating anxiety disorders and OCD, as well as working with parents.

Anna lives with her husband and children in Vaughan, Ontario. When she is not treating patients, supervising clinicians, teaching CBT, and attending professional workshops, Anna enjoys practicing yoga, going on hikes with her family, traveling, studying Ayurveda, and spending time with friends. Her favorite pastime is reading.

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