Previous definitions of obsessive-compulsive disorder 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 not directly triggered by intrusive thoughts or obsessions, but this is because the brain’s cycle is becoming more automatic. In these cases, the focus is no longer a fear of harm, for example, but a fear of the harm-based intrusive thoughts in themselves (obsessing about obsessing). In this case, the compulsions’ goal 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 genuine. Everyone experiences obsessions and compulsions occasionally, but for the experience to be labeled a disorder, it must cause pain and noticeably impact the person’s quality of life.
The irrationality of the cycle gets confusing and horrifying. When someone lives with OCD, they do not experience their worries and rituals as quirks or annoyances, as they might look outside. The intensity of the anxiety and doubt felt on the inside is debilitating, exhausting, and chronic. Furthermore, it can feel ashamed and isolated or like you are losing touch with reality.
People with OCD tend to hide symptoms because they are embarrassed about their irrational worries and behaviors and 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 them to choose what they show to others.
You might stick to invisible compulsions around other people as much as possible, 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 called the ‘hidden’ or ‘secret’ condition, and people who struggle with it might even wait decades before seeking any support. Victims are told there is no help available or just need to learn to live with it.
Some disorders related to an obsessive-compulsive disorder, like body dysmorphic disorder, hoarding disorder, social anxiety disorder, excoriation disorder, or trichotillomania, are considered separate disorders that require different and specific treatment.