*A revised version of this article has appeared in the International OCD Foundation Spring 2020 newsletter
Obsessive Compulsive Disorder (OCD) encompasses unwanted intrusive thoughts, images, urges or sensations (obsessions) which increase anxiety as well as physical or mental behaviors intended to bring relief from anxiety (compulsions). Obsessive themes vary but generally coalesce around similar topics. Someone suffering with OCD often feels alone and that they are “the only one in the world like this.” Often, OCD will choose to torment the sufferer with intrusive thoughts related to what is most important or emotionally salient to them such as their sexuality, romantic relationship, health, or their kids. Other times OCD will appear to choose a theme at random. Despite this randomness, the torment is the same. The clinical observations outlined in this article will focus on topical OCD, a type of OCD with themes that appear to vary depending on what is topical and currently relevant in society or in the news.
One type of OCD that has gained popularity in the last few years is Transgender OCD (tOCD), a form of Sexual Orientation OCD (SO-OCD). In 2015, one of the biggest stories of the year was Bruce Jenner coming out as a transgender woman and transitioning to Caitlyn Jenner. This tabloid story marked a watershed moment for the transgender community. What resulted was a societal shift in the conversation surrounding transgender issues and transgender acceptance. Around the same time, bathroom bills in many states were garnering more attention on the news and on social media. These proposed laws either restricted or permitted which bathroom was allowed based on gender and led to fierce debate. Before this time, it was relatively infrequent if not completely nonexistent to hear about tOCD. Conurrent with the rise of the LGBTQ movement, individuals suffering with transgender OCD, began appearing at a higher frequency, with sufferers concerned with “how do I know if I’m transgender, or if I will become transgender?” Patients who never had OCD presented with tOCD. Patients who had previously been treated for other OCD themes began discussing fears related to gender. OCD latched on to the dramatic increase in attention that transgender concerns were receiving. One of the hallmark features of OCD, is that its sufferers have an intolerance of uncertainty. Since there is no accurate, objective test predicting sexuality and gender, OCD has a tendency to prey on this ambiguous gray zone.
Sexuality obsessions remain one of the more common Pure-O subtypes while the underlying feared consequence appears to have shifted. OCD sufferers appear to be less preoccupied with the fear of the “gay” stigma as the LGBTQ community has gained more acceptance. However, as gender and sexuality labels such as “pansexual” and “gender fluid” have entered the lexicon, the idea of not knowing which category one fits into has gained traction in those who experience topical OCD. As with all OCD, it is the intolerance of uncertainty that underlies these concerns.
Another topical OCD trend has been observed following the exposure of the widespread sexual abuse allegations against Harvey Weinstein in 2017. The #MeToo movement arose after a harrowing amount of women came forward and broke their silence on surviving sexual assault and harassment in the workplace. Since OCD is a disorder that often preys on the fear of having done something wrong in the past, many individuals with intrusive thoughts began to fear that they were also guilty of being horrific perpetrators outlined in a recent allegation. It is common for OCD sufferers to experience intrusive thoughts of murdering, molesting, raping, cheating or deceiving others. Individuals with this OCD theme started scanning their memories even more than usual to search for any evidence of past impropriety. These individuals began to be flooded with intrusive thoughts and became more convinced that they were bad people who had committed an appalling act because of what they were reading every day in the news. This particular topic caused many OCD sufferers to question, or doubt their memories, thus taking advantage of their emotional vulnerability.
OCD themes related to contamination or disease can also change based on health trends. For many years, one of the most common contamination fears revolved around contracting AIDS. As the treatment of AIDS has improved and management of the disease seems possible, anxiety provoked by the threat of AIDS has decreased. AIDS is not in the news with the same frequency and magnitude as it once was. Individuals living with contamination OCD may still notice a red mark on a wall and be inundated with intrusive thoughts that it is blood, but the threat of this leading to AIDS is not as potent as it once was. Conversely, fears of developing Amyotrophic lateral sclerosis (ALS) or Multiple sclerosis (MS), or the recent Coronavirus have increased dramatically. This can likely be attributed to enhanced messaging from the “ice bucket challenge,” from the news, and through other social media campaigns.
There are countless more examples of how the prevalence of OCD themes vary with what is societally relevant. Following the deaths of Robin Williams and Anthony Bourdain, many people who have OCD experienced an increase in suicidal obsessions, a form of harm OCD. Many OCD sufferers became plagued with questions such as, “What if I commit suicide,” or “what if I am capable of committing suicide,” or “how do I know if I will become suicidal in the future?” Harm obsessions centered on mass shootings and school shootings have risen as these horrific events have become more commonplace and are more easily remembered.
OCD can manifest in a multitude of ways. The examples outlined above are an example of how the intrusive thoughts associated with OCD can fluctuate depending on what is societally relevant. OCD may appear different because of the shifting themes, but it is the same disorder regardless of the presentation or presenting theme, or topic. Despite how challenging it may appear and feel, hope exists for OCD sufferers in the form of Cognitive-Behavioral Therapy and Exposure and Response Prevention.