What Is OCD, Really? It’s More Than You Think
You may already know the stereotypes.
People often picture OCD as excessive handwashing or needing everything arranged perfectly. But these images barely scratch the surface—and often do more harm than good by keeping people from recognising the real struggles of OCD.
So, what is OCD?
OCD, or Obsessive-Compulsive Disorder, is a serious mental health condition marked by:
Obsessions: unwanted thoughts, images, or urges that create intense distress or anxiety
Compulsions: mental or physical acts that a person feels driven to perform in order to reduce the distress or prevent something bad from happening
People with OCD don’t want to think or do these things. In fact, the content of obsessions often clashes with their values, making them feel even more ashamed or isolated.
How common is OCD?
About 1–3% of people experience OCD (Kessler et al., 2007; Adam et al., 2012). That means in Ireland alone, tens of thousands of people may be struggling with OCD right now—often in silence. It’s also a condition associated with substantial impacts on mental health, quality of life, and healthcare usage (Kochar et al., 2023; Eisen et al., 2013).
What does OCD look like?
OCD can take many forms—some more recognisable than others. Research shows OCD commonly appears across several symptom dimensions (Bloch et al., 2008):
Contamination: Fear of germs, illness, or bodily fluids. These fears are often linked not only to danger (e.g., getting sick or infecting others) but also to intense feelings of disgust—a visceral sense that something is "gross," "unclean," or "contaminated".
Symmetry and ordering: A need for things to feel “just right” or to follow specific arrangements or patterns.
Forbidden or taboo thoughts: Intrusive thoughts about violence, sex, religion, or morality—often deeply distressing and misaligned with the person’s values.
Responsibility and Harm Avoidance: A heightened fear of causing harm through inaction, forgetfulness, or negligence. This can lead to excessive mental reviewing, reassurance seeking, or even avoidance of certain situations altogether.
Checking: Repeated checking of locks, appliances, body symptoms, or memory. Often linked to fears of causing harm (e.g., “Did I leave the oven on?”), but can also stem from memory distrust or an intolerance of uncertainty.
But OCD doesn’t stay in one lane. For many people, the content of their obsessions shifts over time (Skoog & Skoog, 1999), which can make the condition harder to recognise without specialist understanding.
“But I don’t do rituals…”
Some people think: “I don’t have OCD because I’m not cleaning or checking all the time.”
But many compulsions happen in the mind.
Mental compulsions include:
Repeating phrases or prayers to “undo” a thought
Mentally reviewing events for reassurance
Trying to “figure out” if a thought means something
These are just as real—and just as exhausting—as visible rituals.
Why OCD Feels So Overwhelming
The OCD cycle feeds on doubt and fear.
Here’s how it works:
An unwanted thought shows up: “What if I accidentally harmed someone?”
It creates a spike of anxiety or shame.
The brain says: “Quick—fix it!” so you check, wash, confess, or mentally replay.
The anxiety drops (for now), but your brain learns that this compulsion helped—so it demands it again next time.
The more you try to get certainty, the more trapped you feel.
You’re Not “Crazy”—You Have OCD
One of the most painful parts of OCD is how isolating it can be.
You might wonder:
“Why am I having these thoughts?”
“What’s wrong with me?”
“What if I never feel okay again?”
The truth is: these thoughts aren’t your fault. OCD attaches to the things you care most about—your loved ones, your safety, your values—and weaponises them.
But with the right help, OCD can get better. It’s not about eliminating thoughts—it’s about changing your relationship with them.
What Comes Next
In future posts, I’ll be exploring:
Why OCD is so sticky—and how therapy can help
What Exposure and Response Prevention (ERP) looks like
Common myths about OCD treatment
What clients say helps most (and what makes them quit)
References
Adam, Y., Meinlschmidt, G., Gloster, A. T., & Lieb, R. (2012). Obsessive–compulsive disorder in the community: 12-month prevalence, comorbidity and impairment. Social Psychiatry and Psychiatric Epidemiology: The International Journal for Research in Social and Genetic Epidemiology and Mental Health Services, 47(3), 339–349. https://doi.org/10.1007/s00127-010-0337-5
Bloch, M. H., Landeros-Weisenberger, A., Rosario, M. C., Pittenger, C., & Leckman, J. F. (2008). Meta-analysis of the symptom structure of obsessive-compulsive disorder. The American journal of psychiatry, 165(12), 1532–1542. https://doi.org/10.1176/appi.ajp.2008.08020320
Eisen, J. L., Sibrava, N. J., Boisseau, C. L., Mancebo, M. C., Stout, R. L., Pinto, A., & Rasmussen, S. A. (2013). Five-year course of obsessive-compulsive disorder: predictors of remission and relapse. The Journal of clinical psychiatry, 74(3), 233–239. https://doi.org/10.4088/JCP.12m07657
Kessler, R. C., Angermeyer, M., Anthony, J. C., DE Graaf, R., Demyttenaere, K., Gasquet, I., DE Girolamo, G., Gluzman, S., Gureje, O., Haro, J. M., Kawakami, N., Karam, A., Levinson, D., Medina Mora, M. E., Oakley Browne, M. A., Posada-Villa, J., Stein, D. J., Adley Tsang, C. H., Aguilar-Gaxiola, S., Alonso, J., … Ustün, T. B. (2007). Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World psychiatry: Official Journal of the World Psychiatric Association (WPA), 6(3), 168–176.
Kochar, N., Ip, S., Vardanega, V., Sireau, N. T., & Fineberg, N. A. (2023). A cost-of-illness analysis of the economic burden of obsessive-compulsive disorder in the United Kingdom. Comprehensive psychiatry, 127, 152422. https://doi.org/10.1016/j.comppsych.2023.152422
Skoog, G., & Skoog, I. (1999). A 40-year follow-up of patients with obsessive-compulsive disorder [see comments]. Archives of general psychiatry, 56(2), 121–127. https://doi.org/10.1001/archpsyc.56.2.121
