Signs Of OCD You May Not Be Aware Of

Obsessive compulsive disorder (OCD) is a complex mental health condition (via Biological Psychiatry). No one knows exactly what causes and drives the illness, though researchers have continued to investigate its origins.

People with OCD can spend hours each day performing repetitive compulsive behaviors, according to Biological Psychiatry. These rituals are described as being avoidant rather than habit-driven: Patients do them to keep themselves safe and avoid danger. Without these compulsions, they fear that something dreadful will happen. People with OCD are not delusional — they recognize that their thoughts and behaviors are irrational, yet, they continue to rely on their rituals to quell their anxiety.

When people think of OCD, there are many popularized narratives that may come to mind: The germaphobe, the hand-washer, the person with a meticulous cleaning ritual. But the symptoms of OCD are far more diverse than you may realize (via the Child Mind Institute). Not everyone struggling with the disorder will experience the same symptoms. Some behaviors are obvious, whereas others are subtle and can go unnoticed for quite some time. Here are some signs of OCD that you might not know about.

Hyper-responsibility, also known as "inflated responsibility," is the belief that we have the power to both produce and prevent negative outcomes (via Cognitive Behaviour Therapy). This is an important concept that's central to the psychopathology of OCD. It's one of the many cognitive distortions that tend to affect people with the disorder.

It's common for people with OCD to have an increased sense of responsibility for others, and they generally overestimate their role in different situations (via Psychiatry Research). They may think it's up to them to protect the safety of their friends, loved ones, and even strangers. Some people believe that not preventing a bad event from happening is equivalent to actually causing it, notes a study published in Clinical Practice and Epidemiology in Mental Health. This can lead to hypervigilant and controlling behaviors in an attempt to ward off danger.

People with OCD recognize the irrationality behind their beliefs (via Biological Psychiatry). However, a person with inflated responsibility may fixate on the idea that they're able to cause things that are outside of their control, like natural disasters and accidents (via Psychiatry Research). They then experience tremendous guilt and blame themselves when bad things happen.

Intolerance of uncertainty has been linked to a number of psychological conditions, including anxiety, posttraumatic stress disorder (PTSD), and OCD (via the Journal of Anxiety Disorders). It's common for people to feel uncomfortable with uncertainty to some degree. But some individuals find the unknown particularly hard to face or wrap their head around, and a select few find it unacceptable and even debilitating.

Your intolerance of uncertainty could be clinical if uncertain situations feel dangerous, stressful, and upsetting, explains the Journal of Anxiety Disorders. Some people believe that a lack of certainty will compromise their ability to function. You may experience an overwhelming need to avoid uncertain situations or to do things that create a sense of security, such as acting out a ritual that provides an anchor of reassurance. People who have a hard time with uncertainty also struggle to tolerate the emotions and physical sensations that uncertainty evokes in them (via Journal of Anxiety Disorders).

"Figuring it out" is a common mental compulsion that's intended to provide relief, per the International OCD Foundation. The point is to analyze and think about a situation so meticulously that you remove any semblance of doubt. But like most mental rituals, this behavior doesn't give the person with OCD the answer they're looking for. Instead, it feeds their anxiety even more. Overcoming the intolerance of uncertainty involves recognizing and accepting that the search for complete certainty is futile.

Another common cognitive distortion among people with OCD is the overestimation of threats (via Frontiers in Psychology). Patients often view certain situations and events as posing a far greater danger than they actually do. They're more likely to detect a threat where there isn't one or magnify an existing problem. They exaggerate the consequences of making a mistake or doing something imperfectly (via Clinical Neuropsychiatry). And they tend to go with worst-case outcomes as their default setting (via Proceedings of the National Academy of Sciences of the United States of America).

Due to these unhelpful patterns of thinking, the person develops compulsions like excessive checking to help them cope (via PNAS). They revisit and redeliberate decisions about specific things, such as whether they turned off the stove or locked the door. These repetitive actions are geared toward providing a sense of reassurance, but tend to exacerbate their anxiety instead. People with OCD often lack trust in their ability to cope if unwanted scenarios were to unfold.

"Overestimating the occurrence of threatening events has been highlighted as a central cognitive factor in the maintenance of obsessive-compulsive disorder" (via Behavior Therapy). An important step toward recovery is challenging and reappraising the actual danger associated with a feared outcome, notes a study published in the Journal of Obsessive-Compulsive and Related Disorders. This entails learning how to differentiate between rational and obsessional doubts: For example, washing one's hands after grocery shopping is reasonable in the context of a pandemic, whereas repetitive washing is a compulsive behavior that usually makes things worse. The patient can gradually learn to tease these apart.

Hoarding behavior is common in people with OCD (via Psychiatry Research). Hoarding was once deemed a sub-type of OCD, but it's now also treated as its own unique condition known as hoarding disorder. The main difference between hoarding disorder and hoarding OCD is that people with hoarding disorder accumulate stuff because they consider them to be valuable (via OCD-UK). People with OCD, on the other hand, acquire items due to obsessive thoughts and urges. For instance, they may fear that something bad or catastrophic will happen if they don't have a particular item at home or if they get rid of it.

Hoarding associated with OCD generally doesn't bring a person any pleasure but rather tends to cause them a significant amount of distress and anxiety (via OCD-UK). People may have seemingly practical or purely superstitious reasons for collecting things. But it's not uncommon for people to justify holding on to things that have little use or value.

Unsurprisingly, OCD-driven hoarding and panic shopping increased in the wake of COVID-19, reports a 2020 study published in Psychiatry Research. People began stockpiling supplies like soaps, sanitizers, masks, medications, and disinfectants. However, it's not entirely clear how much of these behaviors were healthy responses to a global pandemic or subclinical and clinical symptoms of OCD, according to a 2021 study from the Journal of Psychiatric Research.

Perfectionism is a common personality trait that exists on a spectrum (via BMC Psychology). It doesn't necessarily cause significant emotional distress and impairment for everyone who experiences it. Perfectionism, on the more severe end of the spectrum, however — also known as "maladaptive perfectionism" — can interfere with day-to-day functioning. This manifests as the need to meet unrealistic expectations and standards, and has been found to cause depression, hopelessness, neuroticism, and suicidal thoughts.

Maladaptive perfectionism can often show up in those struggling with OCD (via Frontiers in Psychiatry). Individuals may become overly preoccupied with setting goals, doing things in a very specific way, and preventing and avoiding errors. The idea of making a mistake or doing something imperfectly can feel unacceptable, if not deeply anxiety-inducing. Perfectionism can often underlie checking compulsions that are driven by the inkling of things "not being right." It can also lead to other OCD symptoms, such as repeating simple tasks over and over again (via Journal of Affective Disorders).

A person with OCD who fears that they might be "bad" or dangerous often experiences profound guilt and shame (via Cognitive Therapy and Research). As a result, they may mentally punish themselves in various ways. This is perpetuated by the erroneous idea that we should be able to control our thoughts at all times, and that "wrong" thoughts are as bad as wrong actions.

Self-punishment can include telling yourself how "bad" you are, regularly and repeatedly (via OCD Specialists). Some people emotionally abuse themselves, either internally or out loud, in order to feel a sense of justice. This may stem from a desire for retribution, namely not wanting to let themselves "get away" with their unethical thoughts.

Self-punishment can serve as a thought control strategy and a form of self-motivation for a person with OCD, notes Cognitive Therapy and Research. They may think that by punishing themselves, they're deterring themselves from wanting to engage with these thoughts and obsessions in the future. But this behavior simply continues to act as a compulsion.