Obsessive-compulsive disorder may not be what you think

“Hug my parents for 11 seconds or they will die. Pray to God and then kiss your fingers or you’ll get cancer… I once didn’t have a period for a year and then I thought I was like the Virgin Mary… and then I prayed to God every night to be the new Jesus Christ take away who was born in me.

This is the singer Camila Cabello, who recently opened up about her experiences with obsessive-compulsive disorder (OCD) in a conversation with Dax Shepard. Her story encapsulates how OCD stalks sufferers with an endless litany of doubts and protective countermeasures to fend it off, and sheds light on a disorder that afflicts one to two percent of the American population and takes an average of 14 to 17 to cure Treatment takes years and there are currently few proven interventions (the two best known are medication and exposure-response prevention therapy, or ERP).

In this week dedicated to OCD awareness, you’ll likely hear experts say that OCD represents neither a Martha Stewart-meets-Marie Kondo devotion to beauty or joy, nor the inherent potential for violence an M. Night Shyamalan- Movie about a serial killer with obsessive compulsive disorder and mother issues. They will probably tell you that it is a troublesome but treatable condition that can be resolved with evidence-based care that teaches you to “stick with the idiot” and “live by your values” by following your stare at your worst fears without batting an eyelid. This means that if you are being treated for OCD, you may be asked to touch a stranger’s doorknob without washing your hands, or to dwell on your frightening, violent thoughts without asking for reassurance. Over time, they explain, you will learn to live better with uncertainty.

However, what you may not hear is that between a quarter and half of people with OCD reject exposure and reaction prevention, citing difficulty digesting. You may also not know that even experts aren’t yet sure how exactly OCD is influenced by nature (genes, brain circuits, or autoimmune reactions) or by nurture, i.e. defense mechanisms gone wrong due to trauma.

A 2023 analysis found that untreated OCD resulted in an annual loss of over $8.4 billion in the United States alone, primarily due to lost work time, reduced productivity, and medical costs. Given these major implications, shouldn’t we have more and better options for OCD?

A different perspective on OCD

Researchers and doctors tend to focus primarily on relieving symptoms. But OCD isn’t just a relentless thief of time and minds; it is part of one’s personality.

It can be jarring to be so attuned to anxiety, but with OCD you may also find that you are aware of many other interesting things. You may also have an extremely imaginative and creative mind and a deeply open and generous heart. You may be more aware of death and all of its many possible incarnations, but you see clearly what makes life worth living.

Research shows that people with OCD tend to have higher levels of empathy than healthy controls. And like author John Green, who suffers from OCD, they often find it harder to simply ignore the fragility of the people and world they love.

I believe that people with OCD need more attention to what it’s like to live with this wide range of feelings and how difficult it is to be aware of them without punishing yourself for not doing more. They need support in taking up their own space without becoming – their worst fear – a narcissistic asshole.

Like the well-known OCD sufferers Charles Darwin or the musician Jack Antonoff, OCD patients constantly create what-if scenarios. They go down rabbit holes and get lost in thought spirals – but the same struggles with a huge amount of uncertainty can sometimes lead to innovation and opportunity.

I have found that many OCD sufferers are not trained to tame this wandering mind and capitalize on its many gifts. As author Elizabeth Gilbert notes, “After all, having a creative mind is like having a pet border collie: it needs work or it will cause you an outrageous amount of trouble.”

I argue that we need more clinicians and researchers who know how to realize this potential – who recognize the path to the “madness” of OCD. Imagine how much faster and better we could treat OCD with these answers.

I see my own unconventional view of OCD as comparable to Elaine Aron’s views on highly sensitive people or Susan Cain’s blockbuster revision of our understanding of introverts. OCD results from a misunderstanding of how to harness the fire of deep emotional imagination. Without that connection, I feel like you’re lost in pointless rituals that never fully satisfy, but don’t answer the underlying question: Why am I so driven anyway?

If you have OCD, I believe you are driven because you are likely acutely aware of and steeped in a Shakespearean scale of feelings and thoughts that few have grasped. You may feel it in those who have the same gift – but perhaps, like many other people with OCD, you have been told so often that what you notice doesn’t really matter that you have stopped noticing it .

In a world obsessed with a dystopian future or impending greatness, it is easy to be seduced into a mindset that favors simplification rather than nuance. But in my experience, people with OCD think and feel deeply about this nuance, realizing how strongly we can both love and hate those closest to us, how fragile and powerful we all are, and how easily the world gets out of control could run control or back into alignment.

Mastering this skill is not only the most humane of tasks before us; I submit that we need it now more than ever. We owe it to us to shine a light on the true gifts of those with OCD, because they might, most clearly of all of us, see our next steps forward.