What OCD Actually Is (And Why “I’m So OCD” Hurts More Than You Know)

I was diagnosed with OCD at 28 years old.

Twenty-three years after my first symptom.

I was five years old the first time OCD showed up in my life, though I wouldn’t have the words for it for decades. Over the years, I collected diagnoses like puzzle pieces that never quite fit: PTSD, depression, generalized anxiety. And while there were threads of truth in all of them, none of them captured the extremity of what I was experiencing. None of them explained why my brain felt like a runaway train that I couldn’t slow down, no matter how hard I tried.

That’s because most of what I was experiencing was OCD. It had been OCD all along.

And here’s the part that still gets me: I was a nurse practitioner. I had medical training. I understood mental health diagnoses in a clinical context. And I still didn’t see it in myself, because OCD has been so thoroughly stigmatized and stereotyped by the media that even healthcare providers often have a distorted picture of what it actually looks like.

When most of us picture OCD, we picture handwashing. We picture someone standing at a sink, unable to stop. And while contamination OCD is real and valid, it is just one small slice of a much larger disorder. You do not have to have compulsive handwashing. You do not have to have any contamination fears at all to have OCD.

Because what OCD actually is, at its core, is an intolerance of uncertainty.

That’s it. That’s the engine. When someone with OCD washes their hands compulsively, it’s not really about germs. It’s because they cannot tolerate the uncertainty of what if. What if I am contaminated? What if I get sick? What if I make someone else sick? The compulsion is an attempt to neutralize that unbearable not-knowing. And for a little while, it works. Until it doesn’t. And the cycle begins again.

Once you understand OCD as an intolerance of uncertainty, you start to see it everywhere it hides.

The Moment Everything Finally Made Sense

My official diagnosis came after one of the hardest seasons of my life.

When I was pregnant with my daughter Meadow, my OCD was loud. Specifically, it was showing up as what’s called magical thinking OCD, the belief that if I did or didn’t do certain things, something terrible would happen. One of those thoughts was this: if you have a baby shower, something will happen to the baby.

I had the baby shower anyway.

Just a week later,  late in my third trimester, I found out unexpectedly that Meadow had a set of four congenital heart defects.

One in a million times, OCD gets it right. And my brain latched onto that with everything it had.

What followed was something that, even as a nurse practitioner who knew better, I could not logic my way out of. I compulsively apologized. Probably 300 times. Because in my OCD brain, her heart defect was my fault. I had the baby shower. I caused this.

Intellectually, I knew that a baby’s heart forms at six weeks. I knew my shower had nothing to do with her diagnosis. But you cannot reason with OCD. That’s not how it works. And that’s one of the most important things I want you to understand.

What OCD Is Not

When most people hear “OCD,” they picture someone arranging pencils by color or wiping down countertops three times. They think of the person who jokes, “I’m so OCD about my closet.”

I want to be gentle here, because I know people mean no harm when they say this. But I also need to be honest: when OCD gets reduced to a quirky personality trait, it makes it that much harder for people like me to be taken seriously. It took 23 years and a medical crisis for me to finally get the right diagnosis. That’s not uncommon.

OCD is not a preference for neatness. It is not being a little type A. It is not something you can just push through or think your way out of.

And it is absolutely not a sign that someone is dangerous or unstable. This is a stigma I want to dismantle entirely. People with OCD are not a threat. In fact, many of us are the most conscientious, self-aware, deeply feeling people you will ever meet, precisely because our brains are wired to be hypervigilant about harm.

What OCD Actually Is

OCD (Obsessive Compulsive Disorder) is an anxiety-based condition characterized by intrusive, unwanted thoughts (obsessions) and repetitive behaviors or mental acts performed to relieve the distress those thoughts cause (compulsions).

Here’s the part that most people miss: OCD is a shape-shifter. It likes to show up in different costumes, but underneath every costume, it’s the same disorder doing the same thing: generating distress and demanding relief.

For me, OCD shows up in a few different ways:

Magical thinking OCD is the belief that my actions (or inactions) have the power to cause or prevent harm. This is the one that convinced me a baby shower caused my daughter’s heart condition. It’s the one that told me publishing my children’s book about Meadow would invite something terrible to happen. I published the book anyway. That’s what showing up looks like with OCD.

Harm OCD involves intrusive thoughts about causing harm, which are deeply distressing precisely because they are ego-dystonic. They go against everything you value. They don’t mean you want to do harm. They mean your brain is generating worst-case scenarios on a loop.

And then there are the sneakier compulsions that don’t look like compulsions at all. Reassurance seeking (asking over and over if everything is okay, if you’re a good person, if something bad is going to happen) and avoidance (steering clear of people, places, or situations that trigger obsessions) are two big ones. These feel like coping. They’re actually feeding the cycle.

The Cost of Waiting 23 Years

I think about the little girl who was five years old and already fighting a war inside her head that no one could see. I think about all the years I was treated for the wrong things, not because my providers were bad, but because OCD is notoriously underdiagnosed and misdiagnosed, especially when it doesn’t look like the Hollywood version.

I think about how different things might have been if someone had seen it sooner.

I’m not sharing this to be heavy. I’m sharing it because there is someone reading this right now who has spent years collecting diagnoses that almost fit. Someone who has been told they’re anxious, or sensitive, or “a worrier.” Someone who has never heard their experience described accurately.

This is for you.

What you’re carrying might have a name. And having a name for it, even after all this time, can change everything.

Showing Up Anyway

I have severe OCD. I also run a business, host a podcast, write newsletters, raise a daughter with a complex heart condition, and show up for my life every single day.

OCD is part of my story. It is not the whole story.

The work isn’t about making OCD disappear. It’s about building the capacity to act in alignment with your values even when OCD is screaming at you not to. It’s about publishing the book even when your brain tells you something terrible will happen if you do. It’s about having the baby shower.

It’s about showing up anyway.

If you think you or someone you love might have OCD, please seek out a therapist who specializes in ERP (Exposure and Response Prevention), which is the gold standard treatment for OCD. The International OCD Foundation (iocdf.org) is a great place to start