Hidden OCD: why obsessions are often kept secret
Research on OCD shows that many people living with OCD never seek treatment. Those who do receive treatment often wait a long time before asking for help. One review found delays ranging from just over three years to as long as 17 years. A recent meta-analysis found a similar pattern internationally: on average, people sought help around seven years after OCD began, and OCD remained untreated for about 6.7 years.
When OCD symptoms remain hidden and untreated for a long time, OCD can become more entrenched and harder to treat. So why is OCD so often kept secret, both from clinicians and from family?
OCD is characterised by recurring obsessions, compulsions or both. Obsessions are unwanted thoughts or mental images that feel intrusive and distressing. Their content is often frightening. This is one important reason why many people with OCD hide the disorder for years.
Symptoms target what we value
People with OCD often wonder why their symptoms take the particular form they do. Obsessions often centre on themes that matter deeply to the person, or to the people they care most about. A new parent, for example, may experience obsessions about harming their newborn child. The obsession is not only about something precious to the person with OCD; it also stands in direct conflict with the person’s attitudes, morals and feelings.
Clinically, obsessions often cluster around the areas that matter most to the person:
- A careful and conscientious person may become caught in obsessions about being responsible for mistakes.
- Someone who values cleanliness, or worries about health, may become preoccupied with dirt, germs or contamination.
- Aggressive obsessions often trouble people who are sensitive, caring and kind.
- Religious or sexual obsessions often appear in people with strong moral standards and a high sense of responsibility towards others.
To understand the apparent contradiction, consider this: would a person who actually wanted to act aggressively be tormented by these thoughts? Shame, disgust, distress and anxiety arise precisely because the thoughts conflict with the person’s values.
Many people with OCD do not immediately recognise that the obsessions they experience are symptoms of a disorder. Instead, they may fear that the thoughts reveal something bad about who they are. Seen in that light, it is not hard to understand why the content of the obsessions can become a source of shame. Afraid of being rejected by family and friends, being seen as “mad”, or being admitted to a psychiatric ward, many hold back from talking about their symptoms. Some never tell anyone.
“They would not love me if they knew my private thoughts” is a fear many people can recognise.
You are not alone with unwanted thoughts
It is common to believe that you are alone in having involuntary thoughts, and that others would distance themselves from you if they knew about them. In reality, many of the thoughts that people with OCD struggle with are also familiar to people who do not have OCD.
Research on intrusive thoughts in non-clinical groups shows that many people experience thoughts with content that can resemble OCD themes. These may include:
- thoughts about harming others or deliberately doing something dangerous
- thoughts about contamination, illness or pollution
- thoughts about jumping from a high place
- sexual thoughts that conflict with the person’s wishes or values
- thoughts about having left the stove, lights or other things on, even when the person knows this is probably not the case
For someone with OCD, it can be a great relief to hear that they are not alone in having this type of thought. That does not make the thoughts OCD in themselves. Intrusive thoughts are a common human phenomenon; what matters is the meaning attached to the thought, how much distress it causes, and what the person does afterwards.
For someone struggling with OCD, it is important to distinguish between ordinary intrusive thoughts, OCD-like patterns and OCD. We discuss that distinction in the encyclopedia entry on intrusive thoughts. The international Radomsky study, which we have covered in the research news article on intrusive thoughts, shows the same basic pattern: unwanted thoughts, images and impulses are far from rare.
In other words, there is not necessarily a difference in the number of involuntary, spontaneous thoughts people experience. Nor is there necessarily a difference in their content. But for people with OCD, the thoughts become linked to strong distress and anxiety. Why does that happen? Clinically, we talk about the thoughts being given particular meaning and significance.
When obsessions are given meaning
Some people with OCD experience what are sometimes called magical compulsions. Here, a person may feel that a specific action is needed to prevent something terrible from happening, even though the action has no real connection with what it is meant to prevent.
One example might be a man with symmetry obsessions. If the tins in the cupboard are not lined up perfectly, it can feel as though his neighbour and the neighbour’s whole family might be in a car accident the next day.
Others are troubled by thoughts and mental images of inappropriate behaviour and fear that the obsessions could actually lead to action. The thoughts might involve a fear of being a paedophile, stabbing a best friend with a knife, or something else entirely. Many people with OCD may become convinced that simply having the thoughts is as bad as carrying out the actions, or that the thoughts mean they want to carry them out. When the thoughts keep returning, that too can be interpreted as a sign that they are true.
The thoughts are no longer experienced as random mental events. They are given particular weight.
It is this meaning, attached to the thoughts, that triggers shame, disgust and anxiety in the person with OCD. Shame in particular plays a major role in the delay we often see between the onset of symptoms and the point at which the person seeks treatment. That delay can also influence how long treatment takes.
There is, however, no reason to feel ashamed. Many people in the general population experience the same type of thoughts. The difference is that the thoughts are not given the same meaning, and therefore often pass without becoming stuck.
When OCD no longer has to stay hidden
When OCD stays hidden, the person is often left alone with a very distressing interpretation of their own thoughts. Once obsessions are understood as symptoms, not as signs of who the person is, it becomes easier to speak about them, seek help and begin working with OCD.