Can you have OCD if you’re not a neat freak?
We expect OCD to look a certain way: constant hand-washing, hospital corners, perfectly-folded bath towels organized by color. But that’s just one way it can present. In reality, only a small fraction of people with OCD have cleanliness or contamination OCD, and not everyone with these types of OCD presents in this way. OCD takes many forms and has many themes, most of which have nothing to do with cleanliness.
What is an OCD theme?
An OCD theme is a topic of obsessive thoughts and compulsions. The cycle of involuntary intrusive thoughts and voluntary responses is the same regardless of the theme or themes. However, it can seem very different because the content of the thoughts and types of compulsions vary widely.
Common themes that do not include cleanliness or contamination include:
Sexuality and gender (Am I really straight, queer, trans, cis, etc.?)
Religion and morality (Am I going to hell? Are my thoughts morally wrong? Am I secretly a racist?)
Just rightness (Are my books even? Did I count the right number of steps just now?)
Emotional contamination (How do I get the “wrong” thought out of my head? Did the cemetery I just passed get “death” all over me?)
Health (Do I have cancer? Was that palpitation actually a heart attack?)
Harm (Did I run over someone and not realize it? Am I going to drop my baby?)
Emetophobia (Will I throw up everywhere if I leave the house without a plastic bag?)
Relationship (Do I really love my partner? Am I in the right relationship? Will my partner cheat?)
This, of course, isn’t a comprehensive list. If a theme isn’t here, that doesn’t mean it isn’t OCD.
How contamination themes develop
Contamination themes don’t necessarily arise in a single way. However, some experiences are common to many people with OCD. Developmental experiences—often involving a lack of control over one’s body or environment—can cause people to respond in exaggerated ways.
These experiences often involve intrusion and a lack of autonomy, like not having your own space or not being able to control your body. Contamination themes can be a response to childhood sexual or physical abuse. It can also look like having a high-need family member who is constantly the focus of attention. A sibling’s chronic illness, for example, can disrupt events that are supposed to be centered around someone else, like a hospital visit that interrupts a birthday party. Sometimes, families identify one person who can do no wrong and is allowed to be the center of the family’s emotional life. This family member is permitted to access everything, meaning there's no event where they can’t make themselves the center of attention, and no door you can lock that will keep them out.
In response to this lack of autonomy, your brain seeks a way to establish control, which can result in compulsions and rituals.
Why would someone with OCd be messy?
There are many possible reasons. One simple reason: If your OCD themes don’t line up with cleanliness and contamination, you might not feel compelled to have a tidy living space. There is also a big overlap of people with OCD and ADHD. Untreated ADHD can make it hard to focus on cleaning or to keep your stuff in order.
It’s also possible to have cleanliness or contamination themes and still have a dirty or hoarded home. Someone who is afraid of germs might not be bothered by messiness, in the same way that someone who is bothered by messiness might not care about germs. And OCD isn’t always logical. Someone with contamination OCD might be okay with a dirty floor or counter, but might worry about miasmas floating in the air from the bathroom.
You might also have perfectionism compulsions around cleaning, which, ironically, can mean you put off cleaning messes because you want to do it perfectly. If an object is dirty, you might want to scrub several times with just the right cleaning fluid. This can be time-consuming and cause a lot of anxiety, so the cleaning might not get done and messes might sit for a long time. You might even think that if you do it improperly, you'll touch the germy area and be contaminated. Or you might maintain “dirty” and “clean” areas in the home with different levels of cleanliness. In that case, you might feel like you can’t enter the “dirty” areas to clean up without being contaminated. Chemical contamination can also be an obsessive fear, so you might avoid using cleaning products like bleach in your home.
Getting help
Whether or not you believe you meet the criteria for OCD, you can still get help from an OCD-specialised therapist. Your condition doesn’t have to meet the full criteria, and you don’t have to know whether you meet the full criteria to seek help. In fact, even if you just have generalized anxiety, you can still get therapy: The treatments are the same.
How do you know if you need therapy? The short answer: when it starts to affect your life. But what does that mean? Everyone tends to think their life is normal and what they experience is standard. There are some obvious signs that your OCD is becoming unmanageable, like losing your job or isolating yourself. But this can also look like:
Not being able to sleep because of anxious thoughts racing through your head
Worrying your thoughts are going to make you do something bad or “go crazy”
Ruminating for hours about the same thing
Always feeling tense or never being able to relax
Not doing the things you enjoy because you’ll be anxious the whole time
When other people describe their worries, the fear doesn’t seem to be at the same intensity as yours, or they seem to move on faster
Constantly asking people for reassurance
Media avoidance (e.g., avoiding certain TV shows)
OCD therapy typically involves exposure and response prevention (ERP) and acceptance and commitment therapy (ACT). ERP involves gentle, self-directed exposure to fears so you can take part in activities you enjoy. Exposure doesn’t have to happen all at once, and it shouldn’t: It’s a process where your brain learns safety around feared situations. ACT involves learning techniques to accept intrusive thoughts without responding to them. In the long term, ACT techniques can make intrusive thoughts less intense and interrupt avoidant responses.
If you’re ready to start getting a handle on your OCD, get matched with a therapist.
