What OCD Really Is – And Why Popular Culture Often Gets It Wrong

Obsessive-Compulsive Disorder (OCD) is one of the most misunderstood mental health conditions. While it’s often referenced in a throwaway line — “I’m so OCD about my desk” — the reality for those who live with OCD is far more complex, painful, and debilitating than a preference for tidiness. These casual comments, though often harmless in intent, perpetuate myths that can make it harder for people with OCD to be taken seriously and access the support they need.

In this post, we’ll unpack what OCD really is, how it shows up in people’s lives, the ways pop culture has distorted our understanding of it, and how therapy can offer meaningful help and hope.

Understanding OCD: Beyond Cleanliness and Quirks

OCD is a chronic mental health condition characterised by two key components: obsessions and compulsions.

• Obsessions are intrusive, unwanted thoughts, images, or urges that cause distress or anxiety. These are not just worries — they are persistent, disturbing, and feel alien to the person experiencing them.

• Compulsions are repetitive behaviours or mental acts a person feels driven to perform in response to an obsession, often to reduce anxiety or prevent a feared event — even if the connection between the compulsion and outcome is irrational (American Psychiatric Association, 2013).

It’s important to emphasise that people with OCD do not want these thoughts. The intrusive thoughts are not pleasurable or voluntary, and the compulsions are not enjoyable rituals — they are attempts to cope, rooted in fear and distress.

Common OCD Themes

OCD can present in many ways, and not all of them involve cleanliness or order. Common themes include:

• Contamination (e.g., fear of germs, chemicals, illness)

• Checking (e.g., doors, appliances, or that harm hasn’t come to others)

• Harm OCD (e.g., fear of accidentally or deliberately hurting someone)

• Sexual or violent intrusive thoughts (e.g., distressing images or urges)

• Religious or moral scrupulosity (e.g., fear of sinning or being immoral)

• Symmetry and order (e.g., needing things to feel ‘just right’)

A person might, for example, feel compelled to repeat a phrase in their head 12 times to prevent a loved one from dying — knowing intellectually that the link isn’t real, but feeling unable to risk it.

These aren’t personality quirks. OCD can cause immense suffering, disrupt relationships, affect work and education, and isolate people from the things they care about (Abramowitz et al., 2009).

OCD can present in many ways, and not all of them involve cleanliness or order.

Pop Culture and the Stereotyping of OCD

In recent years, OCD has become a kind of cultural shorthand for perfectionism, fussiness, or a strong preference for cleanliness. It’s referenced casually in TV shows, memes, and everyday conversation.

We’ve seen characters like Monica in Friends, who’s portrayed as “OCD” because she likes things tidy and organised, or Sheldon in The Big Bang Theory, whose rigidity and routines are played for laughs. While these portrayals may seem light-hearted, they flatten OCD into a caricature of neatness and control, which does a disservice to those who live with the real thing.

Why It Matters

When OCD is trivialised, several things happen:

1. Misunderstanding deepens: People may not recognise their own symptoms because they don’t fit the stereotype.

2. Stigma increases: Individuals with taboo intrusive thoughts (like sexual or violent content) may feel shame, fearing judgment or misunderstanding.

3. Access to treatment is delayed: People might not seek help, or may even be misdiagnosed, if professionals focus only on stereotypical presentations.

It’s also worth noting that OCD is often misrepresented as being part of someone’s personality — “she’s just a bit OCD” — rather than as a mental health disorder. This leads to a harmful conflation of preference with pathology.

The Emotional Cost of Living with OCD

For many people with OCD, the internal experience is one of guilt, shame, and fear. The intrusive thoughts can feel threatening to one’s sense of self, especially when they contradict core values — for instance, a kind and gentle person having graphic images of violence toward loved ones.

Because the thoughts are ego-dystonic (meaning they conflict with a person’s self-image), they can cause deep distress and confusion. A common fear among OCD sufferers is that having a thought must mean you want it — a misconception that fuels shame and secrecy (Rachman, 2003).

This is where reassurance-seeking becomes a hallmark compulsion: asking loved ones “do you think I’d ever hurt someone?” or googling obsessively to “prove” they’re not a danger. But while these compulsions may offer temporary relief, they ultimately reinforce the cycle.

How Therapy Can Help with OCD

The good news is that OCD is highly treatable. With the right support, people can reclaim their lives from the grip of obsessions and compulsions.

1. Cognitive Behavioural Therapy (CBT) with Exposure and Response Prevention (ERP)

The gold-standard treatment for OCD is a specialised form of CBT called Exposure and Response Prevention (ERP). ERP involves gradually exposing a person to their feared thought, image, or situation — without allowing the usual compulsion to follow.

For example, someone who fears contamination may be encouraged to touch a doorknob and then resist the urge to wash their hands. Over time, this reduces the anxiety attached to the stimulus and weakens the compulsion’s power (Foa et al., 2005).

While ERP can be challenging, it is evidence-based and shown to reduce symptoms significantly. A therapist trained in OCD treatment will work collaboratively, pacing exposure in a safe and supportive way.

2. Addressing Shame and Self-Compassion

Because OCD often involves themes that feel taboo or “unacceptable,” therapy must also create space for emotional healing — including naming and processing shame. Clients often need to hear, sometimes for the first time, that having a thought is not the same as acting on it. This distinction can be life changing.

Therapists may incorporate elements of Compassion-Focused Therapy (CFT) or Acceptance and Commitment Therapy (ACT) to help clients build a kinder relationship with their minds, rather than trying to control or suppress every thought (Twohig et al., 2010).

3. Psychoeducation and Validation

Learning about OCD — how it works, why compulsions backfire, and how the brain gets ‘stuck’ in certain loops — can be hugely relieving. Therapy provides a space to understand that you’re not “going crazy,” and you’re not alone.

Therapists often share metaphors or analogies to support understanding. One popular analogy is to think of OCD as a brain smoke alarm that goes off even when there’s no fire — the response feels urgent, but it’s false danger.

4. Medication (When needed)

In some cases, medication can help, particularly if symptoms are severe. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed and have been shown to reduce OCD symptoms in many people (Pittenger & Bloch, 2014). Therapy and medication together can be especially effective.

It’s important that any medication decision is made in collaboration with a GP or psychiatrist who understands OCD. For many, therapy alone is enough — but for others, medication can be a helpful addition.

With the right support, people can reclaim their lives from the grip of obsessions and compulsions.

A Message to Those Living With OCD

If you’re reading this and seeing yourself in some of these descriptions — perhaps in the intrusive thoughts you’ve never dared to voice — please know this: You are not your thoughts. You are not broken or dangerous. You are someone who is struggling with a treatable condition that affects millions of people across the world.

OCD doesn’t define you. And you don’t have to go through it alone.

Whether you’ve been diagnosed, suspect you might have OCD, or are supporting someone who does, know that therapy can offer hope. It won’t make your brain perfect (because no brain is), but it can free you from the prison of compulsions and help you live more fully, with greater self-trust and peace of mind.

Let’s Talk About OCD More Honestly

The next time someone says “I’m so OCD,” consider pausing. Ask what they really mean. Are they saying they like things neat? Or are they trying to describe a need for control, or anxiety about something going wrong?

Let’s use those moments to open up real conversations — ones that invite understanding instead of reinforcing stereotypes.

The more accurately we talk about OCD, the more likely it is that those who are suffering will feel seen, understood, and empowered to seek help.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Abramowitz, J. S., Taylor, S., & McKay, D. (2009). Obsessive-compulsive disorder. The Lancet, 374(9688), 491–499. https://doi.org/10.1016/S0140-6736(09)60240-3

Foa, E. B., Yadin, E., & Lichner, T. K. (2005). Exposure and Response (Ritual) Prevention for Obsessive-Compulsive Disorder: Therapist Guide. Oxford University Press.

Pittenger, C., & Bloch, M. H. (2014). Pharmacological treatment of obsessive-compulsive disorder. Psychiatric Clinics, 37(3), 375–391. https://doi.org/10.1016/j.psc.2014.05.006

Rachman, S. (2003). The treatment of obsessions. Oxford University Press.

Twohig, M. P., Hayes, S. C., & Masuda, A. (2010). Increasing willingness to experience obsessions: Acceptance and commitment therapy as a treatment for obsessive-compulsive disorder. Behavior Therapy, 41(3), 365–380. https://doi.org/10.1016/j.beth.2009.09.005