How to Tell If Your Character Has Obsessive-Compulsive Disorder

“Honestly, do you have to have everything organised?” Ben says, rolling his eyes.

His colleague straightens the last pen on her desk and shrugs. “I’m just really OCD about it.”

Okay, stop right there.

If you’ve ever offhandedly said something like this, there’s something important you need to understand. Mental illnesses are not adjectives. Please, please, please don’t use them as such. These are very real conditions that affect millions of people around the world, and using them to make flippant remarks like the one above trivialises the struggle these people face. Not only that, using mental illnesses as adjectives perpetuates stigma and misconceptions, like those we’re going to be busting today.

What am I trying to say? Most people use these figures of speech without even realising they’re doing it, without realising the harm it can cause, so please take a moment to think before you speak. Let’s work together to end stigma, not inadvertently spread it, okay?

So, now that that’s out of the way, are you ready to shed light on the realities of obsessive-compulsive disorder (OCD) and put to rest those myths?

Let’s get started!

To Keep in Mind:

The information in this post comes from the DSM-5 (see ‘Further Reading’). Please do not use it to diagnose yourself or others. It isn’t intended to be a substitute for professional advice so do consult a qualified clinical professional if you have any questions about the diagnosis criteria. Feel free to use this information to diagnose your characters, however.

There are many common misconceptions surrounding obsessive-compulsive disorder. Let’s clear up a few. OCD doesn’t mean you’re a neat freak or perfectionist. It’s not all about cleanliness or hand washing. Just because you like your desk to be meticulously organised does not mean you have OCD.

Obsessive-compulsive disorder is a serious anxiety-related mental health condition distinguished by frequent intrusive thoughts, images or urges (called “obsessions”) and the repetitive behaviours or mental acts that often follow (called “compulsions”).

In today’s post, we’re banishing the myths surrounding OCD, delving into its actual symptoms and differentiating it from other mental health disorders. In future posts, we’ll take a closer look at the specific content of the obsessions and compulsions someone (or a character) with OCD might experience, as well as the symptoms of OCD and how they can present themselves.

There’ll even be a downloadable workbook at the end, to help you create a profile for a character who’s a realistic representation of OCD, not the stereotyped image perpetuated by popular media. How does that sound, intrepid writers?

So let’s dive right in...

How is Obsessive-Compulsive Disorder Diagnosed?

To be diagnosed with OCD, your character must display the following characteristics:

Criterion A:

The presence of obsessions, compulsions, or both.

Obsessions are defined by the following:

• You experience recurring and persistent thoughts, urges or images at some point during the disturbance. They are intrusive and unwanted and, in most individuals, cause significant anxiety or distress.
• You try to ignore or suppress these thoughts, urges or images, or neutralise them with some other thought or action (e.g., by performing a compulsion).

Compulsions are defined by the following:

• Repetitive behaviours (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that you feel driven to perform in response to an obsession or according to rules that must be rigidly applied.
• The purpose of these behaviours or mental acts is to prevent or reduce anxiety or distress, or to prevent some dreaded event or situation. However, these behaviours or mental acts are clearly excessive or aren’t connected in a realistic way with what they’re supposed to neutralise or prevent. (Note: Young children might not be able to articulate the aims of their behaviours or mental acts.)

Criterion B:

The obsessions and compulsions are time-consuming (e.g., they take up more than one hour a day) or cause clinically significant distress or impairment in social, occupational or other important areas of functioning.

Criterion C:

The obsessive-compulsive symptoms aren’t caused by the physiological effects of a substance, like a drug being abused or by medication, or another medical condition.

Criterion D:

The disturbance isn’t better explained by another mental disorder, such as:

• Excessive worries, as in generalised anxiety disorder;
• Preoccupation with appearance, as in body dysmorphic disorder;
• Difficulty discarding or parting with possessions, as in hoarding disorder;
• Hair pulling, as in trichotillomania;
• Skin picking, as in excoriation disorder;
• Stereotypies, as in stereotypic movement disorder;
• Ritualised eating behaviour, as in eating disorders;
• Preoccupation with substances or gambling, as in substance-related or addictive disorders;
• Preoccupation with having an illness, as in illness anxiety disorder;
• Sexual urges or fantasises, as in paraphilic disorders;
• Impulses, as in disruptive, impulse-control and conduct disorders;
• Guilty ruminations, as in major depressive disorder;
• Thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or
• Repetitive patterns of behaviour, as in autism spectrum disorder.

Specifiers

Many people with OCD have dysfunctional beliefs, such as an inflated sense of responsibility, a tendency to overestimate threats, perfectionism, an intolerance of uncertainty, an over-importance of thoughts and the need to control thoughts.

You may also vary in the degree of insight you have about the accuracy of your obsessive-compulsive beliefs. For example, you could have:

Good or Fair Insight

This means that you recognise that your obsessive-compulsive disorder beliefs are definitely or probably not true, or that they may or may not be true. For example, you believe that the house definitely won’t, probably won’t, or may or may not burn down if the stove isn’t checked 30 times.

Poor Insight

This means that you think your obsessive-compulsive beliefs are probably true. For example, you believe that loved ones will probably become ill if the kitchen isn’t cleaned multiple times a day.

Absent Insight/Delusional Beliefs

This means that you are completely convinced that your obsessive-compulsive disorder beliefs are true. For example, you are certain that imagining a car crash will increase the likelihood of it happening. This is the most rare of all, with only 4% or less of cases featuring this level of insight (which busts the myth that people with OCD don’t realise their beliefs are irrational).

It should also be specified whether the individual has a current or past history of a tic disorder. Up to 30% of people with OCD have a lifetime tic disorder, and there’s a tendency for these individuals to have different themes in their OCD symptoms and other factors to individuals without a history of tic disorders.

Don’t worry if any of this seems confusing—we’ll explore all of these criteria in detail in the next couple of posts (starting here) so if you don’t quite understand what they mean, all should be explained there.

OCD and Other Disorders

What differentiates OCD from other disorders? Let’s take a brief look at the parallels and differences between several similar mental health disorders so that it’s clear in your mind what is and what isn’t a feature of OCD.

OCD and Obsessive-Compulsive Personality Disorder

Maybe you read my post on obsessive-compulsive personality disorder (OCPD)? If so, you’ll know that OCD and OCPD are not the same thing (though they can both be diagnosed in a person, if their symptoms are present).

OCD is characterised by intrusive thoughts, images or urges (obsessions), or by repetitive behaviours that are performed in response to these intrusions (compulsions). OCPD lacks these obsessions and compulsions and is instead characterised by a pattern of excessive perfectionism and rigid control that reaches all areas of the individual’s life and causes significant impairment.

OCD and Anxiety Disorders

The recurrent thoughts, avoidant behaviours and repetitive requests for reassurance that can feature in OCD can also occur in anxiety disorders. They differ, however, in several ways.

The recurrent thoughts—in this case, worries—found in generalised anxiety disorder (GAD) typically involve real-life concerns, while the obsessions of OCD typically don’t. OCD obsessions can also include odd, irrational or seemingly magical content.

Some individuals with OCD have a fear reaction to certain objects or situations, just like people with specific phobias. However, in those with specific phobias, the feared object tends to be much more circumscribed, and the rituals of OCD aren’t present. The feared objects or situations in social anxiety disorder (a.k.a., social phobia) are limited to social interactions, and the aim of the individual’s avoidance and reassurance-seeking behaviour is to reduce this social fear.

OCD and Major Depressive Disorder

Both OCD and major depressive disorder can feature rumination. However, the rumination that features in major depressive disorder is typically consistent with the individual’s mood and isn’t necessarily experienced as intrusive or distressing. These ruminations also aren’t linked to compulsions, as they tend to be in OCD.

OCD and Psychotic Disorders

Remember from the ‘specifiers’ section that some individuals with OCD have poor insight or delusional OCD beliefs? These can also feature in psychotic disorders. Where they differ, however, is in OCD’s obsessions and compulsions, which distinguish it from delusional disorder, and in the absence of other features of schizophrenia or schizoaffective disorder (e.g., hallucinations or formal thought disorder).

OCD and Other Obsessive-Compulsive (and Related) Disorders

There are other obsessive-compulsive disorders besides OCD and it’s important to note where they’re different.

Body dysmorphic disorder also features obsessions and compulsions, but these are limited to concerns about physical appearance. Trichotillomania has no obsessions and the compulsive behaviour is limited to pulling out one’s own hair.

The symptoms of hoarding disorder focus exclusively on the persistent difficulty in parting with possessions, the distress that comes from discarding items, and the excessive accumulation of objects. However, if obsessions typical of OCD are present, and these obsessions lead to compulsive hoarding behaviour, then a diagnosis of OCD would be given instead.

Phew. That’s a lot of information! If you’re ready for more, head over to Write It Right: The Subtypes of Obsessive-Compulsive Disorder and dig into the content of the obsessions and compulsions your characters might be experiencing.