#HowOCDWorks: Typical Anxious Woman

“My wife’s got O.C.D and keeps asking me to help clean the house.
Her loss though – I refuse to do it until she asks me perfectly.”
Internet proverb (Sickipedia)

Let’s start with compulsions.
So imagine there’s a woman called Rose, who’s putting clothes into her washing machine. Halfway through, she gets worried: what if the cat manages to get into the washing machine before she closes it?
It is possible. Rose’s cat is not very bright.
Rose checks the washing machine. She checks it again, just to make sure. She goes back to getting clothes out the basket. But as soon as she looks away from the machine, she starts to worry the cat might jump in and hide in it while she’s not looking.
So she looks at the washing machine, puts her hand under the clothes; no cat. She knows it’s stupid, but somehow, she still thinks the cat might be in there. Her brain is telling her that her senses are wrong.
Rose is 30 years old. She takes all the clothes out and dumps them on the floor. She is still finding it hard to believe there is no cat in her empty washing machine.
This is me trying to illustrate what it’s like living with my form of OCD. You check and check, but your brain is still telling you “This isn’t right.”
A compulsion is a repetitive behaviour or mental act that people feel driven to perform as a result of anxiety, caused by their obsessions. For me, compulsions are often caused by a general anxious feeling; a sense that something is wrong, but if you check it might be OK.
Eventually, you reach a point where your thinking mind and your brain’s entrenched faulty mechanisms are battling each other. It’s like having a very concerned, persistent demon following you.
You: I’ve locked the door.
Demon: But is it locked? Check it.
You: I just locked it.
Demon: But is it actually locked?
So you go back. You check it. Just in case.

So, onto the joke I started with:
People find OCD compulsions funny. Why is that?
Here’s my take: in many people’s minds, OCD means compulsive tidying, cleaning, checking and worrying. And I don’t think it’s coincidental that this stereotype overlaps with ‘humorously’ sexist views of women. Google OCD jokes and you will see what I mean. Many of the traits we associate with OCD are also stereotypically feminine traits, which both men and women are mocked for displaying.
Why is the “cleaning the house” joke funny? Would it be as funny if it was about a man? Is it still funny to read about a woman who had to leave her family because of her compulsive cleaning*?
We’re starting to understand that people with extreme compulsions need help; but at the same time many women and girls with OCD are discouraged from getting help at all.
Why? Because they’re told in so many words that they’re “just an anxious woman”.
If they’re a mother, they are told it is natural to worry. If they’re a teenage girl, they’re told it’s school stress or hormones.
Society often associates OCD with checking up on people, being anxious, clean and tidy, overprotective of children and afraid of the outside world. People joke about tidy women being “so OCD”; or “my mother is so OCD, she’s always nagging.”
OCD is associated often with gender stereotypes like the female neat freak: the fussy, repressed, controlling woman, often a housewife, who’s “completely OCD” and would definitely check for cats in the washing machine. Bree from Desperate Housewives springs to mind:
Bree Van De Kamp is not impressed by your feeble attempt at humour.

Yeah, women like this exist. Maybe some of them have mental illnesses, others are simply tidy and fussy. But we’ll never get anywhere if we assume every woman is the same.
We need to accept that our stereotypes of people with OCD can intersect with stereotypes, often negative stereotypes, about women and girls.
The fact that real-life OCD is not always like the stereotype means that people of all genders might not even realise they have a mental illness. And conversely, many women and girls with OCD are still socialised to not realise their compulsive checking, worrying or other behaviours might be signs of a mental illness.
What we need to do is reevaluate our collective view of OCD, and look at how that view intersects with society’s view of women and girls. Because the picture is not pretty.
I am a 22-year old Woman Who Checks. I accept that I am an Anxious Woman, owing to a mental illness. But if I hadn’t been constantly told that worrying was normal and that I was just a sensitive anxious girl, I would have got help much sooner.

*The story is one of many cited in Jeff Schwartz’s Brain Lock. Highly recommend it.

Addendum

Misdiagnosis in general
NAMI:
“OCD is often misdiagnosed, and it is often underdiagnosed. Many people have dual disorders of OCD and schizophrenia, or OCD and bipolar disorder, but the OCD part of their illness is not diagnosed or treated. In children, parents (and teachers and doctors) often are aware of some anxiety or depression but not of the underlying OCD.”

Misdiagnosis in women for OCD
BJGP: “A hidden problem: consequences of the misdiagnosis of perinatal obsessive-compulsive disorder”.
”Detection and help-seeking for all perinatal problems is low relative to the prevalence and this is particularly true of anxiety,4 although little evidence exists regarding OCD. In perinatal OCD, the shame of disclosing difficulties is often compounded by fears of being misunderstood by professionals and being judged a potentially harmful parent. Parents themselves may not make sense of their experiences as OCD, particularly if they have no previous history. This may be particularly true of those experiencing thoughts of deliberate harm who often fear they are ‘going mad’.”
More on OCD in parents – “It may be particularly difficult for mums first to recognise their experiences as OCD and second to seek help due to the shame and secrecy associated with the illness, especially at a time when they themselves and those around them expect them to feel happy. As there is often a lack of awareness of OCD during pregnancy and postnatally, people are rarely asked about these experiences by professionals. Despite recent breakthroughs in awareness, understanding and treatment of OCD, many GPs and mental health professionals may still not recognise the symptoms of OCD or even know how to correctly treat the disorder.”
Myths about OCD: includes the myth that OCD is a “women’s disease” which shows how feminised the OCD stereotype is. This is despite the fact that OCD affects people of all social groups and genders at the same rate.

… and for other illnesses
Essay on trauma, mental illness and misdiagnosis: “Pollett writes that individuals who have experienced violence, like others dealing with mental health problems, face mental health treatments that are primarily based on the biomedical model (focused on biological and genetic factors of mental health instead of social determinants such as poverty, housing, stigma and past experiences of violence). Women who require mental health services often receive inappropriate diagnoses and treatment or are denied services because their behaviour is misunderstood or stigmatized.”

In addition, the book Preventing Misdiagnosis of Women: A Guide to Physical Disorders that Have Psychiatric Symptoms, by Elizabeth A. Klonoff has an interesting discussion on theories about gender-specific stress being a contributing factor to anxiety disorders. (p. xxii)

Stereotyping
“Ho
w can I be just like Bree Hodge?”: (Answer: “develop an unhealthily extreme case of OCD”)
OCD jokes: Sickipedia
Woman explains her OCD:When I first went to my doctor and she gave me the diagnosis, I disregarded it: ‘I’m not washing my hands or constantly rearranging the spoons, so it can’t be OCD’.”

#HowOCDworks: Talking about OCD

Last Christmas I bought a graphic novel called The Nao of Brown. Huge, absorbing and intimate, it was the story of a young London woman of colour living with OCD. For the first time, I could see my own illness – flashes of intrusive thoughts, irrational fears, obsessions and compulsive habits – visualised in front of my eyes.
I thought about recommending the book to my family, but decided against it. One, the more you bang on about a book, the less people want to read it; two, did I really want them knowing what OCD was like?

Skip to now. I walk into the kitchen at home, and find my dad reading the book. I do a double take. Although he knows I have OCD, we’ve never spoken about it very much.
We discussed the book. Then this happened:
Him: “So is this what it’s like, having OCD?”
Me: [hesitates] “Yes, it is. But…”
Then we talked about it.
Nao of Brown is not a perfect book – it forces OCD into a cinematic narrative, along with other problems. But still! He had been given an insight, we’d had a conversation about it. I was amazed that a single book could do that.

The thing is, OCD is hard to talk about.
The problem with speaking about it in any way is that it is a very misunderstood illness, one that plays on our worst fears. For many people, it’s hard to speak about any of their OCD obsessions, fears or worries at all.
We’re developing the tools to talk about depression, self harm and eating disorders, and I’m forever thankful for it. But there’s work to be done.
It’s not always enough to hope a book ends up in the right hands; being able to talk about OCD gives you power. So does having your mental illness respected and validated.
These are some usual responses to disclosing that you have OCD:

  • “What’s OCD?”
  • “OCD? But you’re not neat”
  • “Oh, I saw a documentary about that!” [goes on to explain how OCD works]
  • “But OCD’s a SEVERE mental illness. People are COMMITTED because of OCD. You don’t have OCD. You’re just anxious. You’re an anxious person. You should try improving your diet.”
  • “Are you sure you have OCD?”
  • “So what’s it like having OCD?”
  • “I have OCD too! I’ve got these weird habits like only eating red smarties!”

I don’t blame anyone for saying things like this. It’s hard to know anything about OCD when it’s so misunderstood and there is so little information about it. It’s a vicious cycle: OCD is hard to talk about: we have very little cultural precedent for discussing OCD openly, which makes it harder to talk about. So we don’t talk about it.
But we can change that.
For people with OCD, it should be possible to verbalise the fact that you have OCD without necessarily having to:

  • explain your entire experience of living with a painful mental illness
  • talk about your actual intrusive thoughts and obsessions to a near-stranger, as though you’re speaking to a therapist
  • clarify that you’re not making it up
  • have your honesty and self-knowledge questioned
  • have your illness trivialised and compared to other people’s silly habits
  • having your life experience taken as being universal for everyone who has OCD

So for people who don’t have OCD, here are some ways you can help:

  • Don’t ask people with OCD to explain their lives to you, if they don’t want to!
    Everyone’s experiences are different. Mentally ill people are not robots who can explain their mental illness to you on command.
    You need permission, trust, and respect to have conversations like this.
    I am happy to talk about OCD if you have my permission and trust, and I know there is enough respect between us for you to take it seriously!
    Similarly, if you don’t know the person well don’t ask what kind of intrusive thoughts they have. This is an upsetting subject for the person with OCD, and it takes a lot of trust to discuss it.
  • Don’t assume people with OCD are all neat.
    Some of us are neat. Some of us are messy. Some of us have OCD rituals like cleaning, others just have intrusive thoughts. Some of us are shy, others are extroverted. Many of us have other mental illnesses, or mental or physical disabilities. Some of us have mild OCD, for other people it is so severe they have to be hospitalised.
    In short, just accept what the person is like. Accept their experiences are real. Don’t use their personal habits to question their OCD.
  • You are not an expert because you read one article or watched one documentary!
    Most documentaries and articles about OCD pick the most sensational cases. If you don’t have OCD, you are much better off assuming you don’t know much from the jump. And don’t hand out diet and lifestyle advice when it’s not asked for.
  • Don’t explain to people who have OCD what OCD is like.
    We know, dude.
  • Don’t assume the experiences of one person with OCD are universal.
    People have done this with me, which is why I try to clarify that my life experiences are not the norm. Nor am I an expert: I’m just a young white cartoonist, in South London.
    There is no such thing as a typical life experience, or a normal manifestation of OCD. Be open to the fact that people’s experiences are different.
  • Do not ask people if they’re “sure” they have OCD!
    If someone has diagnosed themselves, they are probably already questioning and feeling a huge amount of self doubt. If you’re not a doctor and don’t know much about OCD, there’s no reason for you to add to that load.
    If someone is officially diagnosed by a doctor, they’re probably already worried that no one takes their OCD seriously.
    If the person who has disclosed OCD to you is a friend or colleague, offer your support. If they’re not close, accept their word. It is OK to say you don’t understand and OK to ask questions, so long as you ask permission first.
  • Don’t trivialise. Don’t crack a joke.
    Disclosing a mental illness isn’t usually much fun: it takes trust. People disclosing will probably be nervous. It’s generally not the right time to try and lighten the mood, especially if you don’t know the person too well yet.
    Be sensitive to the tone and subject of the conversation.
    Yeah, some people cope with difficult situations with humour, and people with OCD might do that too. But there’s a time and a place for everything. The person disclosing will probably be a lot more nervous than you!

That goes for other mental illnesses, as well!