The “many shades of OCD” myth

There are few aspects of Obsessive Compulsive Disorder more contentious than the misuse of the term “spectrum” to describe a broad range of severity of the condition. The phrase “I’m a little OCD” will generally enrage the average person with actual diagnosed OCD, because there is no such thing as “a little OCD”. 

Mental health professionals use the term “OCD spectrum disorder” specifically to mean a medical condition, such as body dysmorphic disorder (BDD) and trichotillomania, which can be related to OCD and which can be comorbidly present with OCD. They don’t use “spectrum” to mean a continuous range of severity of OCD from very mild to debilitating. To avoid any confusion, I will use the term “range of severity” in this post. 

But some experts in OCD are starting to seriously consider the possible existence of an OCD range of severity. To be clear, it is already generally accepted that there is a narrow variation, ranging from moderate to severe. 

In my personal experience I’ve only met or talked online with people with actual OCD which falls into this range. The severity of an individual sufferer’s OCD can vary. Sometimes it can be moderate. Other times it can be more severe. For some sufferers, the severity of their OCD can vary by time of day or time of year. When first learning about other people’s OCD, this was a revelation to me. My own OCD, prior to undergoing therapy, was unwaveringly severe every waking second, unless I retreated into nature, for a brief respite. I had thought that everybody’s OCD would be exactly like mine was. 100% on, full blast, all the time. 

So I admit that I have a history of having preconceptions about what is or isn’t OCD. I am therefore treading a little more carefully towards the subject of a broader range of diagnosed severity. My gut reaction is to shout, “NO YOU ARE NOT A LITTLE BIT OCD! THERE’S NO SUCH THING!” But… what if there is a broader range of OCD suffering?

The thing which makes OCD what it is isn’t the intrusive thoughts, everybody has intrusive thoughts. It’s how a person reacts to those intrusive thoughts. A “normal” person will just think “well of course I’m not going to push somebody in front of a train”, then they move on to thinking about what to cook for dinner. A person with OCD may hold onto the thought and start to obsess that they are a potential murderer. This horrifies them, so they avoid train stations for fear that the thought will come true. It won’t come true, but that’s not what the OCD constantly whispers. 

So there already exists a dividing line between what is considered “normal” and what is considered “disordered”. Some people are suggesting that we move that dividing line to the left a bit. The diagnosis is partially achieved and quantified by completion of a questionnaire. Depending upon how highly you score, you are rated “normal” to subclinical, not requiring treatment or moderate to severe, requiring treatment. 

So what’s wrong with potentially having a broader scale of diagnosable OCD severity? Essentially it’s the problems of popular cultural misconception and subjectivity, compared to medical reality. 

There are three bits to OCD, not two. What bits? What bits am I talking about?

I’m talking about the Obsessive bit, the Compulsive bit and the Disordered bit. This is the basic distinction that the media stubbornly refuse to understand. 

Put in very basic terms, you can experience the “O” bit and the “C” bit, but without the “D” bit, it’s simply not OCD. But how can that be? Surely if you are obsessed and compelled, it must be OCD?

Not necessarily. The crucial factor isn’t what is thought or what action is done, but how that thought is reacted to, why the action is done and how much the thoughts, reactions and actions interfere with living a normal life. How much suffering is there? 

Take, for example, the media’s favourite portrayal of OCD, the cleaning compulsion. The common misconception is, “I spent a whole hour tidying the house. I’m so OCD, but a tidy house satisfies me so much”. The person has thought, “My house is untidy and is annoying me. I need to tidy it” and they then tidy it. Their house becomes tidy, they are no longer annoyed and they feel positive for having completed a dull chore. They might be obsessive about tidiness. They might be compelled to keep their house tidy. But what about the “D” bit? 

A person with OCD would typically think, “My house is untidy. I am a bad person because my house is now a hazard to people’s health, harbouring germs and risking injury through accidents. Someone could die because of my untidy house. If someone dies because my house is untidy, it will be my fault. I will have caused that person’s unnecessary death. I must tidy my house completely right now, before someone dies”. And then they tidy the house. And again. And again. And again, because they fear that even the tiniest bit of overlooked untidiness could cause death”. 

This sounds incredibly extreme to a “normal” person. People normally react to such an example with, “Wow, that must be at the really severe end of the scale”, but sadly it’s not. That is an absolutely typical example of the intrusive thought – reaction – compulsion process for an average OCD sufferer. The main variations between moderate and severe OCD are the extent to which the condition consumes a sufferer’s time, energy and focus, resulting in suffering.  
This is the “D” bit. How disordered is your life as a result of having the condition? Is the condition all consuming, exhausting, terrifying, guilt inducing, shameful, soul destroying, debilitating? It’s not called a disorder for nothing. 

There is no grey area. There is no broad range of tones of severity. If OCD is a light, it’s either on or off; there’s no infinitely adjustable dimmer switch. It is a harsh and glaring spotlight. Either your mind is in turmoil because you have the disorder or it’s not, because you don’t. There is no “little bit OCD”. No subtle mood lighting for a satisfyingly tidied house. 

What happens if the normal/disordered cutoff gets moved to the left a bit? The fear of many OCD sufferers is that it will legitimise the “little bit OCD” myth, further underplaying the true severity of the condition for most sufferers. It is already viewed popularly as a joke condition. Not a proper mental illness, but just being a bit of a fruitcake like Monica out of Friends. 

If some people are diagnosed as sufferers of an apparently less severe form of OCD, will that trivialise the condition further? Will these people be given access to treatment – medication or therapy – that they are currently denied? Will more mental health resources be made available for OCD treatment or will an already threadbare single duvet have to stretch across a now double bed? I could have a pretty good guess at the answer to that last question. 

I would hope that any professional expansion of the concept of an OCD range of severity would be as a result of earlier diagnosis of the condition after onset, to take into account the smaller amount of time that a person has been thinking and acting in an abnormally conditioned manner. Earlier diagnosis is a fantastic thing. It reduces the amount of time that a person is alone in suffering & it reduces the extent of the mental scarring inflicted by OCD. 

If the earlier stages of the transition over the threshold into the “D” bit can be diagnosed and treated sooner for more people, then I am happy to see an expansion of the severity range concept. 

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