Previous definitions of OCD included that some people might experience only obsessions or only compulsions. It is now better understood that all people living with OCD experience both, albeit in less obvious ways.
Someone might perform compulsions that are not directly triggered by intrusive thoughts or obsessions, but this is because of the cycle becoming more automatic in the brain. In these cases, the obsession is no longer a fear of harm, for example, but a fear of the harm-based intrusive thoughts in themselves (obsessing about obsessing). The goal of the compulsions in this case is not to relieve anxiety, but to avoid it coming up at all.
Even though OCD ranges from mild to extreme, each person’s distress is very real. Everyone experiences obsessions and compulsions on occasion, but for the experience to be labelled disorder they must cause distress and impact noticeably on the person’s quality of life.
When someone lives with OCD, they do not experience their worries and rituals as quirks or annoyances, as they might look from the outside. The intensity of the anxiety and doubt that is felt on the inside is debilitating, exhausting, and chronic. The irrationality of the cycle gets confusing and horrifying. Furthermore, it can bring to feeling ashamed and isolated, or like you are losing touch with reality.
People living with OCD tend to hide symptoms because of the embarrassment someone feels about their irrational worries and behaviors, but also because of a fear that their intrusive thoughts might be misunderstood. Being aware of what is rational and what is not does not help reduce the anxiety of the OCD cycle, but it allows to choose what they show to others.
You might stick to invisible compulsions when around other people as much as possible, or have an easier time holding back while you are out, and then get overwhelmed by anxiety and the need for compulsions when you get home. OCD is often referred to as the ‘hidden’ or ‘secret’ condition, and people who struggle with it might wait even decades, before seeking any support. Victims are told there is no help available or that they just need to learn to live with it.
Some disorders related to obsessive–compulsive disorder like body dysmorphic disorder, hoarding disorder, excoriation disorder, or trichotillomania are considered separate disorders that require different and specific treatment.