Obsessive Compulsive Disorder - TV Tropes

The four components that make up the OCD cycle.

Obsessive-compulsive disorder, commonly referred to as “OCD”, is frequently misrepresented in fiction. Most people are surprised to find that compulsive rituals are not the defining trait of OCD—in reality, it is an anxiety disorder that causes repeated, unwanted thoughts, which usually, but not always, lead to compulsive rituals. The rituals (which may or may not have anything to do with order) are simply attempts to quell the anxiety from the intrusive thoughts. Fiction so exaggerates the "ordering rituals" part in OCD, depicting people who are tormented by books in their shelf that aren't in the exact right position while remarking that they are “so OCD” (even though it’s not a verb) that people are downright dumbfounded to find out that the anxiety disorder behind the rituals actually exists.

Like other anxiety disorders, OCD exists on a spectrum and its presentation can vary greatly from person to person and from day to day (depending on how much stress the person is dealing with).

A few other subtypes of OCD tend to get undue attention in fictional presentations, such as an obsession with contamination, which manifests in lengthy cleaning rituals. This is probably because this can be so clearly presented onscreen, skipping over the thoughts that lead to the rituals in the first place. People with contamination OCD are shown repeatedly scrubbing their hands with soap after touching any door handle, for example. Most people believe that contamination OCD is the only kind of OCD, and are unaware of any other subtypes or straight up believe they don’t exist, leading to OCD becoming a very misunderstood disorder.

There are other subtypes (themes) of OCD as well, such as sexual OCD (e.g. a priest tormented by erotic fantasies), harm OCD (e.g. worrying that the iron or stove element was left on, or a babysitter struggling with visions of killing the children they care for), and moral OCD (e.g. worrying about being a “bad person”, or doing something morally incorrect). Most people with purely obsessional OCD also struggle with rumination, where they dwell on their worries to the point of it consuming their mind for hours and hours. This is only scratching the surface, and anything can become an OCD obsession. However, these different kinds of OCD themes are rarely, if ever, shown in fiction.

Obsessive-compulsive personality disorder (OCPD), on the other hand, really is all about order. Whereas OCD is an anxiety disorder, with compulsions and behaviors that alleviate anxiety from unwanted or intrusive thoughts, OCPD is a personality disorder. The person is globally meticulous and nitpicky, desiring order in every aspect of their life. Where someone with OCD is aware their behavior is irrational (which causes more anxiety, which needs to be relieved, which leads to more irrational behavior...), someone with OCPD doesn't suffer distress from their behavior and views it as The Best Way Of Doing Things; distress with OCPD comes from someone screwing with their system, not from their behavior itself. OCPD used to be called anal retentiveness (aka being anal), based on Sigmund Freud's belief such behavior stemmed from potty training issues in childhood, but was later officially named OCPD after that explanation was discounted as baseless in the psychiatric community (actual cause is overactive in the prefrontal cortex), though it's still informally by laypeople. In real life, OCPD is one of the most commonly diagnosed disorders.

There's nothing to prevent someone from having both OCD and OCPD at the same time, however this is quite rare.

Experts liken OCD to a hungry beast, which hungers for compulsions to be acted on. While acting on compulsions may provide temporary relief, in practice, doing so strengthens their grip, leading to a vicious cycle (as depicted in the above image). Because of this, individuals with OCD are treated various kinds of psychotherapy, such as exposure and response prevention (ERP) and inference-based cognitive-behavioral therapy (I-CBT). Medications, usually but not always a SSRI (selective serotonin reuptake inhibitor) are sometimes prescribed to aid the process. With treatment, obsessions and compulsions can become less prevalent, but many people struggle to find relief even with treatment.

Fiction can land all over the place on this one. Sometimes the person has one or two odd behaviors, sometimes the person is incredibly demanding and particular. Sometimes it's a crippling disorder that limits the character's ability to function, sometimes it's just a mild quirk. However, fiction usually lands on the “mild quirk” having to do with contamination and order, with a realistically crippling ritual being Played for Laughs with a character remarking on how they’re “so OCD”. To this day, OCD remains as one of the most inaccurately portrayed mental disorders in fiction.

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