So it's time to do another #psychwords, where I explain the psychiatric/psychological meaning of a word to help #EndTheStigma .

Today: "OCD / Obsessive-Compulsive" /1

I'm [carbon] dating myself here, but thanks to Netflix maybe some will get this - many people think that "OCD" is someone who needs things in a particular way, and is rigid - like say Monica Gellar (Courtney Cox) from "Friends."

"I'm such a Monica, I'm so OCD!" /2

People will often say they're "OCD" or "obsessive" about things - they like tidiness, or they like things to be in order.

"I know I'm a bit OCD but I really do prefer things to be stapled on the left side."

"She's obsessive about cleaning her room." /3

This is an insidious form of stigma called "illness/disability borrowing," and it's as cruel as implying that sitting in a chair for a while is akin to having paralysis, or needing reading glasses and joking that you're "going blind." /4

The disability community deals with this a lot, and they rightly call out how cruel, demeaning, and insensitive it is.

It is VERY COMMON for patients with OCD to complain to me how they feel nobody understands their challenges because of how OCD is perceived. /5

So what is OCD actually? Most people know that "OCD" refers to "Obsessive Compulsive Disorder". Each word is critical to OCD. And I promise you, these definitions really matter if you don't want to use language that harms others. /6

In OCD,

"Obsessions" are:

recurrent (keep coming over and over)
unwanted (not compatible or helpful)
and hard-to-suppress/control thoughts that attack people. /7

"Someone will break into my home." (safety)
"My mom is dead." (health/loss)
"My hands are filthy." (hygeine)
"You'll intentionally kill someone." (taboo)
"I hate God." (blasphemous)

Because they are recurrent, unwanted, and hard-to-control, they are TORTUROUS. /8

"Compulsions" are behaviours that are:

Recurrent
Compelled (MUST or feel the need to do)

Note: recurrent means do OVER and OVER, NOT just "every day" - ad nauseum or hours upon hours, a truly debilitating amount of time or frequency) /9

In OCD, compulsions are often related to the underlying obsession, but not always. Almost always, the goal of the compulsion is to reduce the distress of the obsession.

But let me tell you, this is a DISTRESSING condition. /10

This is not "normal" pickiness or "normal" habits. This is handwashing until bleeding. This is spending hours organizing before leaving for work. This is ritualistic behaviour designed to prevent death or disease that can go for hours and interrupt every daily activity. /11

That goes to the last part of "OCD" - Disorder.

This isn't "I like to be neat" or "I prefer smooth textures" or "I brush my teeth for exactly 2 minutes!".

This is SIGNIFICANT impact to relationships, occupation, education, family, or health. /12

It is SO TRIVIALIZING AND CRUEL to call your habit your "OCD" or your preferences your "OCD." Children, teens, adults alike have all told me how frustrating it is.

Why? Because if you think that's OCD, what solutions will you offer? /13

"You should just leave it, it'll be there tomorrow."
"Sometimes when I get stuck I go for a jog."

... to which the OCD sufferer instantly recognizes that the person they're talking to doesn't understand, and will almost always smile and nod and leave feeling more alone. /14

OCD is a debilitating disorder which REQUIRES TREATMENT.

* psychotherapies are gold standard and a variety of therapies can be helpful

* medications are often lifesaving in OCD and necessary especially when the problems is so entrenched that they prevent therapy /15

The seeds of OCD can also be a result of a trauma or loss. I have worked with many people who have their OCD starting with a real event of the obsession (fire alarm leading to safety obsessions, a family death leading to OCD). /16

OCD can happen at all ages of life: in 1-3% of people. In about 40-50%, the disorder is severe, enduring and not time-limited (without treatment). I have seen severe cases in children as young as 6 but typically OCD develops in late adolescence or early adulthood. /17

So, no, no matter how particular Monica got on 'Friends," she was NOT OCD. She loved her life, she had a job and friends and didn't spend hours on hours stuck, near suicide, wishing escape from the tormenting obsessions that repeatedly attacked her. /18

So please, let's spread the #psychwords :) lets stamp out this awful overuse of a disorder. /19

A special note on "obsessions":

Yes, one can be "obsessed" with people (stalkers, for example, will have severe attachments to their victims), this form of obsession in psychiatry is called "fixation", "erotomanic delusion," or "obsessive love." NOT OCD obsessions. /20

A special note on "compulsions":

Recurrent behaviours can be called:
* habits
* stereotypy (automatic movements, such as seen in autism's "hand flapping")
* mannerisms (purposeful repetitive movements)
* tics (involuntary repetitive simple muscle movements) /21

Compulsions by themselves can be "overdoing something" - as in compulsive video gaming, jogging, tanning, or cleaning.

I think being broad with "compulsion" is OK, as long as we are using *involuntary* or *poorly controlled* behaviours, not behaviours of preference. /22

In other words, there is a big difference between regularly or often checking your email and compulsively checking your email. /23