Here's a fun reminder that OCD is not (1) a quirk to describe people who have specific preferences, (2) a disorder to describe anyone who washes their hands a lot, or (3) the reason you like your desk to be organized.

The thing is, obsessive-compulsive disorder is so misunderstood! OCD describes a mechanism. It's not just a set list of certain behaviors, like a checklist, as so many people assume!

Everyone has compulsions to some extent. It's the degree to which they interfere with your life that defines OCD. You might, for example, knock on wood as not to "jinx" something. But if it's not distressing and you quickly move on, that's within the acceptable range of behavior.

Knocking on wood was one of my compulsions, actually! The difference is that what started off as a typical, unnoticeable thing quickly got out of hand.

For one, it had to be in multiples of three. At one point, I was knocking on wood 27 times whenever I talked about something I didn't want to have happen. That mechanism in the brain that says, "Okay, I'm satisfied!" goes haywire. It fails to self-soothe and it snowballs.

In that way, OCD isn't really about what the compulsions are. It's about the mechanism behind them. The brain is fearful or anxious, we engage in some kind of behavior to self-soothe. Except the compulsion leads to a spiral, in which we have to engage more & more to find relief.

Obsessions just describe the fears or anxieties that that we're trying to find relief from. For people with OCD, obsessions are usually fueled by uncertainty (which is why many people call OCD the "doubting disease").

So if you're afraid of becoming ill, and you wash your hands to resolve that, that's not OCD. But if you become consumed by thoughts around that fear, and wash your hands repeatedly to try to self-soothe, only to find the thoughts & behavior escalating... THAT is OCD.

Why does this happen? There are a bunch of theories that I won't get into on Twitter. But uncertainty is a big part of what drives obsessive-compulsive disorder. I'll give you an example...

I don't know that my mom is alive right now. I mean, I ASSUME she is, because everything in my experience has told me that the odds are very, very high that she is living right now. But I can't actually see her — she's not in the room with me.

The part of our brain in which something "feels" true and the part of our brain that tells us something is logically true? Are two different parts of the brain. In people with OCD, the "feeling true" threshold is super wonky sometimes.

I FEEL it's true that my mom is alive. That is an emotional response that my brain conjures up based on my experiences. Logically, I can also deduce that there's a pretty good chance she's fine. So I'm not anxious about that right now.

In someone with OCD who is afraid of burning their house down, for example, they might check the stove to make sure they didn't leave a burner on. They walk away, and they feel better at first, knowing that they've checked the stove, and everything is just fine.

A non-OCD brain just needs to check the stove once, and the logical "I know this is true" and the feeling "this feels true" both kick in. But in an OCD brain, it might not. They know they just checked, and yet the feeling of certainty and satisfaction? Doesn't kick in.

So they check the stove again. That's the compulsion! That's why someone with OCD can check the stove like, a hundred times, and even though they know they just did, they compulsively do it again — they're trying to self-soothe, but the "feels true" mechanism is failing.

OCD is, in essence, the brain's struggle to self-soothe around particular, fear-based uncertainties, and the compulsive rituals that develop in an effort to self-soothe.

It's like the brain really, really wants that "this feels just right" kind of feeling! But it's not producing it when it usually would, or when it does, it takes a lot more the next time to get the same feeling.

Sometimes the compulsions are obvious, like hand-washing and stove-checking. But sometimes, they're entirely mental! They're things that people can't actually see, and people with OCD might not even realize they're doing.

I had a particular obsession around my cat dying due to my negligence. Any time he'd fall asleep, I'd check his breathing to make sure he didn't die. Sounds totally fine — until you start checking his breathing over, and over, and over.

The lousy thing is, the more you give into compulsions? The more you obsess and the more frequently you feel the need to perform those compulsions/rituals. That's the mechanism! That's why it's kind of the worst.

Imagine being on fire and you see a giant bucket labelled "WATER." And you're like, oh, awesome! I should pour that on myself! You do, and everything is fine. Except the next time you're on fire? It's the same bucket, but it's gasoline inside.

That's kind of OCD in a nutshell. The compulsion works at first, but then suddenly it... well, doesn't. It fuels the fire. Your brain keeps insisting you're on fire and it sees a bucket labelled water. But the water stops putting out the fire.

So it's not really about the actions themselves. You can have as many kinds of compulsions as you have people with OCD! The obsessions and corresponding rituals vary from person to person — which is why only 50% of us are correctly diagnosed.

The brain is doing its very best job to offer people relief from anxiety and fear! It's just that the wires are a little crossed, and the usual mechanisms that keep us from engaging in compulsions too much and ruminating too often aren't working as effectively.

I talk about this a bit in this blog entry, if this topic is interesting to you: https://letsqueerthingsup.com/2018/05/12/i-didnt-know-i-had-ocd-heres-why-the-stereotypes-are-so-harmful/

And I highly, highly recommend checking out the OCD Center of Los Angeles: https://ocdla.com/  (They have tons of resources, screening tools, and a long list of all the different obsessions and compulsions they often see in folks with OCD!)

It's so important to not reinforce stereotypes about OCD! I had no idea I had it, bc hand-washing was never my thing & I'm not a very organized person. When we give people a false idea of what a disorder looks like, people with it don't realize they have it and that there's help!

I've had obsessions around a ridiculous number of things, but seldom did they ever fit the stereotype. I was lucky to learn that there are many, many types of obsessions and compulsions — and no two people with OCD will manifest in the exact same way.

So please, cut the OCD jokes! All it's doing is making it super hard for people with the disorder to get help, and making it hard for us to be taken seriously when we ask for it.

Thanks for coming to my TED Talk, hahaha.