Obsessive-Compulsive Disorder, or OCD, has gotten a lot of attention over the last decade or two, but because there are so many manifestations of the disorder, many symptoms have gone unnoticed or underreported.
Authors and the media tend to center on “checkers,” “counters” and “washers.” These are among the more well-known types of OCD, the easiest to see, and the bizarre resulting behavior adds to the sensational elements most attractive to the media and public. But there are a number of other types of this disorder which aren’t as well known, yet the affect many OCD sufferers just as much as the more familiar types. These sufferers don’t get as much public attention perhaps because many of them experience their disorder in silence and unnoticed. There is nothing they do to outwardly call attention to themselves or warrant media attention.
With OCD, the sufferer experiences an obsession (the out-of-place thought) and reacts with a compulsion (acting on the obsession). A “checker” fears he hasn’t locked a door and must check it repeatedly; a “washer” fears germs and is continually trying to get rid of them. At the root of these compulsions is the feeling that “something bad will happen” if they don’t complete them.
The “checker” starts off with a reasonable concern: she didn’t turn off the iron before leaving the house. She goes back and checks to make sure it’s off so that it doesn’t start a house fire. But that’s where the OCD sufferer (the “O/C”) departs from the normal person. The O/C will keep checking the iron, fearing that they missed something before, or they might have accidentally turned it back on. Even though reasonable thought tells them they have turned it off, they just aren’t comfortable and can’t accept that everything is really okay. And yes, O/C sufferers are usually painfully aware that they have the disorder and what it does, but it doesn’t stop them – or they wouldn’t have OCD.
There is one type of OCD that is particularly frustrating for both the sufferer and anyone trying to help them. It is sometimes referred to as “Pure-O.” In this manifestation the entire obsessive-compulsive process takes place in the sufferer’s head with little or no outward evidence. The obsessive thought is followed by another thought or unrelated action to reduce the anxiety caused by the obsession. For example, when approaching a traffic light, an O/C might realize it will turn yellow any second, and if they can get through the light before that happens “everything will be okay.” The “everything” in this case might be a person, themselves, or a certain situation.
One way to think of this type of mental gymnastics is pure superstition. “If I do/don’t do X, then Y will happen.” In fact, O/Cs may actually have what some people might consider superstitious thoughts, for example, a preference for the number seven, even numbers, or an avoidance of an unlucky number like thirteen. They may prefer to use a certain door to enter a building because they think using it is better in their O/C world. Or they may have to leave work on an even-numbered minute according to their watch.
As you can see, these things can all go on inside a person’s head without being noticed. Even the compulsive act (choosing what door to use) is there, but known only to the O/C. in sufferers of Pure-O
The causes and treatments for Pure-O are similar to those for other types of OCD. The problem with Pure-O is that it may go undiagnosed for longer. It may not be recognized in a child because there is nothing overt, like checking or counting, to see. The child probably won’t know how to verbalize what is bothering him or her, and if they try, it may be misunderstood as childish fears. Adults who suffer from Pure-O may realize there’s something wrong with their thinking and may even realize it’s OCD, but because it may not affect anyone but themselves, they might be less likely to get treatment. They may even think it doesn’t really affect their lives, when in fact it affects almost every minute of their lives and they have just learned to live with it. Unlike the sometimes debilitating effects of someone who never leaves home for fear of germs, the Pure-O may be able to live a very normal-looking life while suffering inside.
This article isn’t about going into the causes and treatments for OCD, as these are covered extensively elsewhere. Primarily it is to bring to people’s attention to the fact that OCD goes much deeper than what gets attention in the media, and it can manifest itself in many ways that aren’t easily diagnosed, even by a mental health professional. The public, the media, and particularly health professionals need to be aware of this type of OCD in order to recognize it in patients and to make the public is aware that some people may have OCD even though it doesn’t seem to match what they know about it from previous media stories.