OCD Is More Than a Fear of Germs

Often reduced to jokes about neatness and handwashing, obsessive-compulsive disorder is one of the most misunderstood mental health conditions. Beneath the stereotypes lies a complex disorder marked by intrusive thoughts, crippling anxiety, and repetitive behaviours that can consume everyday life. Experts explain why OCD is far more than a preference for cleanliness — and why recognising it matters.

Every Tuesday evening, 31-year-old Roopa leaves work early for therapy to get help in dealing with obsessive-compulsive disorder that has quietly shaped the rhythm of her life for more than ten years. Some mornings begin with anxiety before she has even stepped out of bed. At therapy, she is learning to resist the compulsions —  repeatedly checking whether doors are locked, not rechecking the stove, not seeking reassurance, not restarting rituals when panic sets in. “The hardest part,” she says, “is sitting with the fear and doing nothing about it.” Slowly, painfully, she is learning that recovery is not about eliminating thoughts, but reclaiming control from them. 

For years, obsessive-compulsive disorder has been flattened into a single cultural stereotype: the person obsessively washing their hands, arranging books symmetrically, or sanitising every surface in sight. The phrase “I’m so OCD” has casually entered everyday conversation, often used to describe neatness or perfectionism. But psychiatrists say the reality of OCD is far more complex, exhausting, and deeply misunderstood.

Take Anu, a mother of two. Every time a family member stepped into the house, she insisted they bathe immediately. If they refused, she spiralled into visible anxiety and panic. Eventually, her husband sought psychiatric help for her, and she was diagnosed with obsessive-compulsive disorder. Stories like hers are more common than people realise.

Mental health experts describe OCD as a condition driven by two interconnected experiences: obsessions and compulsions. Obsessions are intrusive, unwanted thoughts that create intense distress. Compulsions are repetitive actions or rituals performed to ease that anxiety, even temporarily.

“Obsessions are thoughts, images or impulses that repeatedly enter a person’s mind and cause distress, while compulsions are repetitive behaviours carried out to reduce that distress,” explained Dr R Sathianathan, former director of the Institute of Mental Health.

Sometimes these compulsions are visible: excessive cleaning, constant checking, repeated counting. But often, they are invisible. A person with OCD may repeatedly fear they have harmed someone, even when they have not. Another may be consumed by religious guilt, intrusive sexual thoughts, or irrational doubts that refuse to quieten. Some spend hours mentally replaying conversations, seeking reassurance, or trying to “neutralise” thoughts they know make little sense but cannot escape.

That is where public understanding often falls short. Because mainstream portrayals have long centered around cleanliness and orderliness, many people whose symptoms look different do not recognise that they may have OCD at all. Psychiatrists say patients frequently delay seeking help because they fear being judged.

“People with OCD are usually aware that their thoughts are irrational, but they are unable to control them,” said Dr Sathianathan. “That awareness itself causes tremendous anxiety.”

The disorder also tends to emerge early. Doctors note that OCD often begins during adolescence or young adulthood, gradually intensifying over time if left untreated. What begins as a repetitive habit can slowly evolve into rituals that consume hours of a person’s day and interfere with work, relationships, and everyday functioning.

Dr M Thambirajah, consultant psychiatrist, pointed out that OCD exists on a spectrum many people fail to recognise.“Everyone may have obsessive thoughts occasionally,” he explained. “But in OCD, these thoughts become persistent, distressing, and disabling. Compulsions are not habits people enjoy. They are driven by fear and anxiety.”

And despite how casually the term is used online, OCD is not rare. Studies estimate that between 2 and 4 per cent of people may experience it during their lifetime, making it one of the world’s more common mental health conditions.

The internet, interestingly, has become one of the few places where the complexity of OCD is openly discussed. Online support groups are filled with people describing compulsions that have nothing to do with handwashing at all. Some speak about intrusive thoughts they are terrified to admit publicly. Others talk about spending hours trapped in cycles of checking, reassurance-seeking, or mental rituals invisible to everyone around them.

The conversations reveal something important: OCD is not about liking things clean. It is about living with relentless anxiety that refuses to switch off. Treatment today usually combines medication with cognitive behavioural therapy, especially Exposure and Response Prevention (ERP), considered one of the most effective approaches for OCD. The therapy gradually helps patients confront anxiety without performing compulsions. For many, it can be life-changing.

“Patients improve significantly when they receive timely treatment,” said Dr Thambirajah. “But many people continue suffering silently because they are embarrassed or because families dismiss the symptoms as personality traits.”

In more severe or treatment-resistant cases, psychiatrists are also exploring advanced interventions such as Deep Brain Stimulation (DBS), where targeted electrical stimulation is used to regulate areas of the brain linked to obsessive thought patterns. But mental health professionals argue that awareness remains the biggest gap.

Popular culture still treats OCD as a personality trait. In reality, it can be debilitating, isolating, and emotionally draining. Beneath behaviours that may appear harmless or quirky from the outside is often a person battling intrusive fears for hours every single day.

And perhaps that is the conversation that needs to shift most urgently: OCD is not a preference for neatness. It is a serious mental health condition that deserves understanding, nuance, and empathy.

Always consult a qualified healthcare professional for mental health concerns.

• The Good City Crew