What Obsessive Compulsive Disorder Really is and What It is Not
Cali Werner, PhD, is a licensed clinical social worker, sport psychology consultant, and elite distance runner who specializes in OCD and anxiety treatment. She is the Director of Referral Relations at the OCD Institute of Texas and founder of Athlete Rising.
We often hear the term OCD thrown around in ways that are completely misaligned with what it actually is. Individuals will say things like, “I am so OCD,” or “If you walked into my room and saw how neat it was, you would understand I have OCD.” When described in this way, people think they are identifying characteristics of OCD when, in reality, they most likely are not.
Individuals with OCD struggle with intrusive thoughts or triggers (i.e., obsessions), followed by repetitive or ritualistic behaviors (i.e., compulsions) performed in an attempt to relieve the anxiety brought on by the intrusive and unwanted thoughts. The ritual may bring temporary relief, but it ultimately reinforces the obsession and keeps the anxiety cycle going.
When someone says, “I am so OCD because I like to keep things neat and tidy,” they are typically describing Type A personality characteristics or perfectionistic tendencies. The keyword here is like. When an individual likes a behavior, they are not describing OCD. They are describing ego-syntonic behaviors that align with their sense of self and do not feel distressing or unwanted. If perfectionistic tendencies significantly impact functioning and the individual does not see a need to change them, this may reflect something more consistent with Obsessive-Compulsive Personality Disorder (OCPD), rather than OCD.
It is important to note that individuals with OCD do not like engaging in their repetitive behaviors or experiencing their intrusive thoughts. They feel driven to perform rituals in order to prevent something bad from happening. OCD is an ego-dystonic disorder, meaning the behaviors feel unwanted and inconsistent with the person’s values.
For example, someone may feel they have to arrange everything in their backpack perfectly before a big presentation. If this is truly OCD, they are not organizing because it makes them feel productive or “on top of it.” In fact, they likely wish they did not have to complete the ritual at all. They feel compelled to do it in order to prevent the presentation from “going sideways.”
Most individuals with OCD have insight that their thoughts and rituals are unrealistic or irrational. However, the intensity of the anxiety can make it feel impossible not to engage in the compulsion. When left untreated, OCD often worsens over time and can lead to significant impairment.
The gold-standard treatment for OCD is a specialized form of Cognitive Behavioral Therapy (CBT) known as Exposure with Response Prevention (ERP). Many clinicians may say they treat OCD, but if they are not providing evidence-based ERP, they are likely not delivering the most effective treatment for this disorder.
A helpful resource is found on the Anxiety Society Podcast, episode “Good vs. Bad Therapy,” which explains how to determine whether you are working with a quality, evidence-based clinician. Research shows that individuals with OCD are often untreated or misdiagnosed for 12-17 years after symptom onset. This delay highlights the need to build awareness and challenge misinformation in the media.
Treatment for OCD is specific, and it works. Individuals with this diagnosis should not have to suffer when effective, evidence-based care is available.
Read more from Cali Werner
Cali Werner, Director of Business Development and Behavior Therapist
Cali Werner, PhD, LCSW-S, CMPC, is a clinician, sport psychology consultant, and elite distance runner whose work bridges high-performance athletics and mental health. As Director of Business Development at the OCD Institute of Texas, an intensive treatment facility that treats OCD, anxiety, and related disorders, and founder of Athlete Rising, she specializes in treating athletes struggling with OCD, anxiety, and perfectionism. Drawing on her experience as a Division I runner, where she won 9 conference championships, at Rice University, her participation in the 2020 U.S. Olympic Trials marathon, and her doctoral research on Olympian mental health, she integrates personal insight with evidence-based practice.
