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The term "OCD" often gets thrown around lightly by people describing their affinity for neatness, but actual obsessive-compulsive disorder is a serious condition that goes well beyond just cleaning and counting.

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Sources:
http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.162.2.228
https://www.nature.com/mp/journal/v15/n1/abs/mp200894a.html
https://www.researchgate.net/publication/225845035_Obsessive-Compulsive_Disorder
https://www.nhs.uk/conditions/obsessive-compulsive-disorder-ocd/treatment/
http://www.sciencedirect.com/science/article/pii/S0022395612002531
http://onlinelibrary.wiley.com/doi/10.1002/da.22232/full
http://www.mdedge.com/clinicalpsychiatrynews/article/126694/anxiety-disorders/whats-next-deep-brain-stimulation-ocd
https://academic.oup.com/brain/article/132/4/853/284625
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[INTRO ♪].

Have you ever been around someone who claims to be “a bit OCD” about cleaning? But really they’re just, like, keeping a tidy kitchen or making sure their books end up on a shelf.

Thanks to stereotypes or a lack of information, some people think that obsessive-compulsive disorder is all about cleaning and counting. Which — to be totally clear — it isn’t. These ideas sort of touch on OCD symptoms, but they don’t paint an accurate picture.

So let’s dispel some of those misconceptions. The DSM-V, a constantly-evolving manual that clinical psychologists and other professionals use to diagnose disorders, describes OCD as consisting of — you guessed it — obsessions and compulsions. Obsessions are defined as persistent thoughts, images, or impulses that can’t be ignored or suppressed.

They’re more than just intense worries. Compulsions are defined as actions, such as hand washing, sorting objects, or ritualistic checking, that a person feels driven to perform because of an obsession — like to soothe a fear. They can either take the form of extreme responses, like scrubbing your bathroom for 6 hours a day because you think it won’t be clean otherwise.

Or they might be things that aren’t connected to realistic outcomes. Think… flicking the lights on and off eight times to make sure your cat doesn’t get sick. So one big misconception is that “all people with OCD have a need to clean everything.” In reality, there are a lot of different symptoms, which vary from person to person.

Many studies have suggested there are basically four kinds of OCD symptoms. One is, in fact, extreme levels of cleaning. Another is hoarding, or keeping everything from bus tickets to food packaging, because they’re loosely tied to a memory or may come in handy someday.

A third is obsession with symmetry and order, and possibly becoming very anxious in disorganized environments, like messy workspaces. And the fourth category is checking behaviors. Some OCD sufferers may keep checking that they’ve done things like turn off the stove, for fear of a fire breaking out, even when they’ve already checked 10 or more times.

Some of these symptoms may sound like things that everyone does like collecting things, or making sure your door is locked. But this brings us to a second misconception: that “everyone’s a little OCD.” The truth is, they’re not. Many psychological disorders are extreme manifestations of behaviors or beliefs that most people might experience once in a while.

But professionals may diagnose someone with a disorder when these symptoms affect their ability to function in everyday life, are particularly distressing to the patient, or make them a danger to themselves. So your friend who claims to be “a bit OCD” for rearranging their books is… not correct, or funny. Studies looking at the structure and function of the brain have found differences between those with OCD and the typical population.

And right now, research is trying to nail down which differences cause which symptoms. Scientists have found that many OCD patients seem to have a problem with a system of brain regions that helps regulate some of the urges we have, from aggression to needing to go to the bathroom. When this circuit is active, those urges come to your attention.

And the idea is that with OCD, your brain doesn’t get the message that you’ve sated that urge. Like, if you went to the bathroom and washed your hands, it’s basically like, “Have you really washed your hands? They can’t be clean.

Do it again.” ...and so on. So with a lot of mental illness, there also tends to be the feeling that someone with these conditions is alone. And that’s a third misconception: that “OCD is rare.” In 2010, researchers looked at data collected in the National Comorbidity Survey Replication, a nationally representative survey of US adults, to better understand how prevalent OCD could be.

From the 2073 responses in a subsample they checked, they found that around 2.3% of them met the DSM-IV criteria for lifetime OCD, and another 1.2% of people in the data set met the criteria for OCD lasting 12 months. And these researchers found that more than a quarter of individuals in this subsample didn’t meet the threshold for clinical OCD, but had subclinical obsessions or compulsions at some point in their lives. Now, people who suffer from disorders like OCD are able to manage their symptoms and live normal lives.

And that’s the last misconception we’ll talk about: that “there’s no treatment.“ Therapies that focus on changing behavior, such as Cognitive Behavioral Therapy, can be an effective approach to treating OCD. In these sessions, therapists work with the patient to figure out what fears and anxieties might be feeding compulsions, and help them work through these fears. Together, they may eventually work up to not performing rituals, like reinforcing that nothing’s going to happen to their cat if they don’t flick the light switch.

In many cases, behavioral therapies are combined with serotonin reuptake inhibitors, which increase the amount of the neurotransmitter serotonin that’s available in the brain. Research suggests that this can help regulate the dysfunctional impulse system, and reduce the severity of obsessions and compulsions. This has been shown to be the most effective overall approach, but of course, some treatments may not work for some people.

More recently, scientists have been looking into a potential treatment called deep brain stimulation, particularly for people that don’t see improvements from therapy or medication. This technique uses electrical pulses, delivered through a surgically placed probe, to better regulate areas of the brain that aren’t behaving typically. Kind of like a pacemaker, but for the brain.

Deep brain stimulation has been shown to be useful in other diseases, such as Parkinson’s, but it’s still in experimental stages for OCD — very few patients have received it so far, and scientists are still trying to figure out which areas can be stimulated to help. So, mental illness is really complicated, and there’s a lot of confusion about disorders like OCD. But next time someone jokes that they’re “a little OCD,” maybe you can set them straight.

Thanks for watching this episode of SciShow Psych, which wouldn’t exist without support from our patrons on Patreon. If you’d like to and are able to help out, you can go to patreon.com/scishow. And, as always, don’t forget to go to youtube.com/scishowpsych and subscribe. [OUTRO ♪].