Rasika Karkare 
Obsessive-Compulsive Disorder, or OCD, is one of the most commonly discussed and often misunderstood mental health conditions. Due to the fast spread of myths and misconceptions around OCD, people may even wonder or question if they can have OCD symptoms without being diagnosed with it. OCD affects almost 0.8% of people in India and almost 1% of the population around the globe. It is a complex condition that manifests in many forms, causing significant disruption in the daily lives of individuals. This article aims to explore the lesser-known aspects of OCD — whether one can have OCD symptoms without the disorder, the different forms OCD can take, and how it can affect one's sense of identity.
Understanding OCD
OCD is a mental health condition characterized by unwanted and often disturbing intrusive thoughts called 'obsessions' and repetitive patterns of behaviour called compulsions. An individual may experience only obsessions, only compulsions or both, depending on the severity of the condition.
People with OCD generally experience a pattern of sudden, unwanted thoughts or fears known as obsessions. The obsessions lead to emotions such as stress and anxiety. To ease or get rid of these obsessions, people often indulge in repetitive rituals or patterns of behaviour known as compulsions. Although indulging in compulsive behaviour provides a sense of relief, it lasts only for some time before the anxiety and obsessions return again. Thus, people with OCD often feel stuck in a cycle of obsessions and repetitive behaviours.
Common Symptoms of OCD
Obsessive Thoughts
Obsessions are persistent, unwanted thoughts, urges, or intrusive images that cause emotional distress. Attempts to ignore or resolve them often lead to repetitive behaviours, adding to the distress. These obsessions can cause significant disturbances in concentration. Some examples of common obsessions are:
- Fear of being contaminated
- An excessive need for symmetry or orderliness
- Fear of unintentionally harming yourself or others
- Unwanted thoughts or imaginations related to sex
Compulsive Behaviours
Compulsive behaviours are repetitive behaviours that people engage in, to get rid of distressing obsessions. It is important to note that, people with OCD find no pleasure in performing compulsive behaviours; rather, they feel compelled to engage in them to relieve themselves from anxiety. Despite providing temporary relief, compulsions fail to offer lasting solutions, as obsessions are likely to return. Thus, people often get stuck in a time-consuming cycle of obsessions and compulsions without any relief. Some common examples of compulsions are:
- Repeatedly washing hands or bathing in the fear of being contaminated
- Repeatedly seeking assurance from others
- Repeatedly checking doors, and stoves before leaving the house
Identifying OCD: Can You Have OCD Symptoms Without Having OCD?
It is important to note that many people experience intrusive thoughts, in fact, intrusive thoughts are common. The difference between common intrusive thoughts and OCD is that common intrusive thoughts are less harmful, and people are unlikely to act on them as well. Some of us may even have some repetitive behaviours that help us cope. But occasionally indulging in intrusive thoughts or repetitive behaviours does not mean that someone may have OCD.
The diagnosis of OCD depends on the severity of the symptoms and the extent to which they are causing a disturbance in someone's life. For someone to be diagnosed with OCD, they need to engage in compulsive behaviours for at least an hour per day.
Sometimes conditions, such as anxiety disorders, can lead to OCD-like symptoms. In fact, intrusive thoughts are common in anxiety disorders. The difference between anxiety and OCD is that people with anxiety are unlikely to indulge in any compulsive behaviours.
In rare cases, people may suffer from OCD symptoms such as intrusive thoughts or compulsive behaviours, but they may be less harmful or have no significant impact on an individual's daily functioning. Such a condition is called sub-clinical OCD. Thus, it is indeed possible to have OCD-like symptoms without actually getting diagnosed with OCD.
Can OCD Exist Without Intrusive Thoughts?
OCD typically involves a combination of obsessions and compulsions. However, it is possible to have only obsessions or only compulsion symptoms. The Diagnostic and Statistical Manual of Mental Disorders (DSM), a guidebook for the diagnosis of mental disorders, lists various subtypes of OCD, some of which can manifest without intrusive thoughts. They are:
Trichotillomania
Trichotillomania is characterised by an irresistible urge to pull out one's hair, whether from the scalp, eyebrows, eyelashes, or other body areas like armpits or the genital area. The primary method of hair pulling for most people with this condition involves using their fingers, although some may also use tweezers or other instruments.
Although trichotillomania is categorised as a subtype of OCD, it differs from OCD in many ways. While OCD is characterized by unwanted, intrusive thoughts leading to compulsions, trichotillomania involves repetitive behaviour (hair pulling) without any intrusive thought. Here, the repetitive behaviour is triggered by urges and other factors, such as stress and not by intrusive thoughts.
Skin Picking
Similar to trichotillomania in many ways, people suffering from skin picking or excoriation disorder experience compulsive urges and growing tension until they pick their skin. Skin picking may also sometimes be carried out in response to stress or uncomfortable emotions. Here, too, there are no underlying intrusive thoughts.
Can OCD Exist Without Compulsions?
Sometimes OCD can manifest without any overt compulsive behaviours. This condition is called Purely Obsessional OCD or Pure-O in short. In this condition, people experience distressing obsessive thoughts without engaging in visible external compulsions. However, the compulsions in this condition mainly exist in the form of mental rumination. A few examples of repetitive mental rituals are counting, checking, or seeking reassurance internally. Since compulsions in Pure-O are not externally visible, diagnosing the condition can be challenging.
Can We Have Intrusive Thoughts Without OCD?
Intrusive thoughts are completely normal. In fact, a 2014 study discovered that approximately 94% of participants reported experiencing at least one intrusive thought in the three months leading up to the study. Intrusive thoughts are usually harmless as long as one recognizes that they are just thoughts and does not try acting on them.
The difference between normal intrusive thoughts and OCD is that normal intrusive thoughts are occasional, fleeting, and cause minimal distress, while intrusive thoughts in OCD are persistent, distressing, and trigger compulsive behaviours, significantly impacting daily life.
Can OCD Make You Feel Like A Different Person?
Living with OCD can be overwhelming, as it can have a profound impact not only on one's daily life but sometimes it may lead people to question their own identity. In fact, OCD can radically influence how people see themselves.
OCD and Intrusive Thoughts
One of the most common symptoms of OCD is the presence of intrusive thoughts. Intrusive thoughts are unwanted thoughts and images that pop up in one's mind unexpectedly. These thoughts can be very distressing, and they can be about anything ranging from fears of contamination, harming oneself or others, or concerns about morality. A person with OCD often struggles with these thoughts consistently throughout the day. The persistent occurrence of intrusive thoughts may lead people to doubt their identity and beliefs because these thoughts often conflict with who they truly are and what they value.
The Ego Dystonic Nature Of Intrusive Thoughts
Most intrusive thoughts in OCD are ego-dystonic. This means that they are totally opposite to one's true nature, personality and values. For example – a person might be really scared that they might stab their spouse, even though they would never actually do it. Their mind might keep generating thoughts and images about the same, leading to feelings of disgust. Repeated exposure to these distressing, intrusive thoughts may create a sense of internal conflict where people start doubting their own intentions and actions.
OCD and Thought-Action Fusion
Thought-action fusion is the tendency to believe that merely thinking about an action is equal to committing the action. For example – if an unwanted thought pops up in your mind about harming a loved one like your brother, you might believe that it is equivalent to actually hurting them in real life.
Additionally, with thought-action fusion, people also believe that thinking about a negative event increases the likelihood of it happening in real life. For instance, people might believe that thinking about a loved one getting hurt in a car crash might make the accident more likely. This kind of thought-action fusion is common in OCD and makes people doubt themselves and their reality.
Feelings of Shame And Guilt
People with OCD often struggle with feelings of shame and guilt, even though they might not have done something wrong or bad. This is because they struggle to differentiate between intrusive thoughts and reality. Intrusive thoughts are often believed to be facts, leading to feelings of guilt and shame. Thus, constant feelings of guilt and shame can lead people to believe that they are 'bad' or 'wrong', harming their identity.
How To Overcome Identity Issues In OCD?
As mentioned earlier, OCD can harm one's self-esteem and perception of self. However, one can overcome identity issues in OCD by treating OCD symptoms. A few ways to treat OCD are:
Remember, Thoughts Do Not Equate To Actions
It is important to remember that intrusive thoughts do not reflect your true nature or your intentions, rather, they are just thoughts that occur as a part of OCD. Understanding that intrusive thoughts are different from your real self can help improve your self-image.
Cognitive Behaviour Therapy (CBT)
CBT is a form of psychotherapy that can help you challenge negative thoughts about yourself and replace them with more realistic thoughts.
Exposure and Response Prevention (ERP)
ERP is a form of therapy that focuses on helping you face intrusive thoughts and fears without indulging in compulsions. It can also help you learn effective ways of coping, leading to a reduction in OCD symptoms and improvement in self-image.
Conclusion
OCD is a complex condition that manifests in many forms. Intrusive thoughts, a common symptom of OCD, are experienced by many people. However, it does not mean that one is suffering from OCD. A diagnosis of OCD requires careful consideration of the severity of the time frame of symptoms. Occasionally, OCD-like symptoms can also be an indication of an underlying anxiety disorder due to the similarities between the two conditions. While OCD typically causes intrusive thoughts, it can sometimes occur without intrusive thoughts as well, and in some cases, without visible compulsions.
Additionally, OCD can indeed change one's perception of themselves and make them feel as if they are a different person due to the ego-dystonic nature of intrusive thoughts. Feelings of guilt and shame and the thought-action fusion in OCD can also contribute to negative self-perception. However, one can deal with these negative effects by remembering that intrusive thoughts don't define who they are. All forms of OCD can be treated with a combination of therapies such as Cognitive Behaviour Therapy (CBT) and Exposure and Response Prevention (ERP), and sometimes treatment might involve medications as well. Thus, it is important to consult a clinical psychologist or a psychiatrist to get an accurate assessment if you see yourself or a loved one experiencing symptoms of OCD.
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