Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Does OCD make people smart? An OCD therapist weighs in

By Elle Warren

Dec 29, 20237 min read minute read

Reviewed byApril Kilduff, MA, LCPC

There are a lot of stereotypes about obsessive-compulsive disorder (OCD)—like it makes you highly organized, an overachiever, responsible, reliable, and on top of it. You’re the honor-roll student, or the top-performing employee. 

This idea of OCD being connected to intelligence was popularized in the early 1900s by Sigmund Freud (referred to as “the father of psychology,” though many of his theories are now outdated). Recent studies and meta-analyses have debunked this idea, finding no correlation between OCD and an above average intelligence quotient (IQ), according to April Kilduff, LPCC, LCPC, LMHC, therapist and clinical trainer at NOCD. 

Let’s look at the reality of OCD, the dangers of attributing “positive” attributes to it, and what help is available.

What exactly is OCD?

Obsessive-compulsive disorder has three primary characteristics: repetitive, unwanted intrusive thoughts, images, urges, feelings and/or sensations (obsessions); extreme distress over those emotions; and mental or physical actions that are done to relieve that distress (compulsions). OCD is a highly debilitating cycle of doubt and discomfort. In fact, it’s been named by the World Health Organization (WHO) as one of the top 10 most disabling disorders

Cleanliness or organization are just a few possible manifestations of the disorder. Other themes include:

  • Relationship where you become concerned that you’re in the wrong relationship or that your relationship and/or partner isn’t “good enough.”
  • Harm OCD has to do with fears that you’re secretly a violent person and will one day “snap,” either on accident or on purpose. Conversely, you might worry about becoming the victim of harm.
  • Sexual orientation or gender identity is a type of OCD where you become fixated on finding certainty about their “one, true” sexual orientation or gender identity.
  • Pedophilia OCD revolves around a worry that you’re secretly a pedophile. Remember, OCD sufferers find intrusive thoughts like these incredibly disturbing.
  • Sensorimotor/somatic is where you fixate on autonomic processes such as breathing, blinking, or swallowing, concerned that it’s not “normal” or that you’ll never be able to stop noticing it.
  • Scrupulosity/religious OCD is a worry about breaking moral, ethical, or religious codes that are important to you. You might fear being a “bad” or “wrong” person.
  • Existential is a subtype of OCD where you can’t stop thinking about questions of life and death. You want certainty about things, like the meaning of life, knowing whether or not you’re “real,” and what your “purpose” is.

Those are just a few of the more common subtypes, but intrusive thoughts can latch onto anything that you value. Similarly, there are a litany of compulsions that are tied to obsessions. But anything done with the intention of relieving the distress brought on by intrusive thoughts can become compulsive. 

Here are some examples of physical (or outward) compulsions:

  • Checking. For example, making sure the stove is off or the door is locked.
  • Tapping or touching. You may need to pick up and put down the TV remote or tap your knee a certain number of times in order to feel OK. There isn’t necessarily a logical connection between the intrusive thought and the action, just the urge to neutralize the intrusive triggers and relieve distress. 
  • Redoing. This can look like closing your car door a second time because it didn’t feel “just right” the first time.
  • Reassurance-seeking from others. Repeatedly asking a loved one, “Did I seem aggressive while we were having that conversation earlier?” or “Are you sure I didn’t upset you?” can be a sign of compulsive reassurance-seeking.
  • Avoidance. This is when you avoid places, situations, or stimuli that may trigger your intrusive thoughts. For example, if you have existential OCD, you may avoid watching movies that involve death or the afterlife.
  • Washing or cleaning. This can manifest as excessive hand washing, showering, or disinfecting of surfaces.

And these are some common mental (internal) compulsions, which are often more difficult to recognize: 

  • Rumination. Put simply, this is severe overthinking—turning something over and over in your mind, often for hours a day. It comes from feelings of “needing to get to the bottom” or “think your way out” of intrusive thoughts and the feelings they bring.
  • Reassurance-seeking from yourself. For example, repeatedly thinking I know my partner is ‘the one’ or I know I pray enough or I would never hurt someone.
  • Thought replacing. This is the act of replacing a “bad” thought with a “good” one. For example, after thinking, What if I push someone in front of a train? you might immediately think That person has really lovely shoes.
  • Mental reviewing. This looks like examining prior experiences and situations to look for proof that intrusive thoughts are or aren’t true. For example, if you have pedophilia OCD, you might look back and ask yourself, When I go sit in the park to read, do I stare too long at the kids on the playground?
  • Distraction. This happens when you try to keep your mind occupied to distract from intrusive thoughts. For example, maybe you engage in “retail therapy” or watch television as a distraction.

It’s crucial to note that compulsions bring only temporary relief. If left untreated, they reinforce your brain’s belief that intrusive thoughts are a serious threat that must be “solved” immediately. They keep you stuck in the obsessive-compulsive cycle, which gets worse and worse over time.

Why is it dangerous to attribute “positive” attributes to OCD?

While OCD is nothing to be ashamed of—just like we’re not typically ashamed of physical ailments—it’s important to make the distinction that OCD is something you have, not who you are. Attributing things you like about yourself to OCD can keep you stuck in it if you believe that you need the disorder to have those attributes. 

It also discredits you—as if your intelligence, or any other positive characteristic, is not a result of your own personality or efforts. It’s crucial you know that seeking treatment for OCD will not take away things you like about yourself, but instead, will give you more time, energy, and mental space to dedicate to what you value.

“Giving OCD credit for positive attributes can also be a form of denial about the harsh reality of OCD,” notes Kilduff. “That’s understandable, but the good news is we have a great treatment approach for OCD.”

Should I get help for OCD?

Even if you perceive your OCD as “not that bad,” it’s still a good idea to get help. Therapy should not be reserved for crises, but can be better thought of as a preventative measure. When gone untreated, OCD has a pattern of worsening. Thus, the earlier the intervention, the less likely you are to reach a crisis point. 

If OCD is bringing you distress—fear, anxiety, panic, shame, embarrassment, guilt—and/or impairing any aspect of your life and functioning, you deserve to receive assistance in gaining back whatever parts of your life OCD is trying to tarnish.

What help is available for OCD?

No matter the theme of OCD, it’s best treated with exposure and response-prevention (ERP) therapy. This treatment modality works by helping you confront your triggers and obsessions, under the guidance of an ERP-trained therapist, and helping you resist compulsions that only make your symptoms worse. 

It’s a collaborative process, with therapist working with you to understand the nuances of your experience. What do your intrusive thoughts sound like? What triggers them? What compulsions do you perform? From there, the two of you can develop a treatment plan—you’ll start small and work your way up to the triggers that bring the most distress.

You will never be forced into anything you’re not ready for, but your therapist will encourage you to push the boundaries of your comfort zone, which is necessary for treatment to succeed. However, they’ll never pressure you into anything that feels too hard. Rather, together you will choose exercises that allow you to practice not engaging in compulsions. Over time, you learn that anxiety and distress won’t harm you, and your brain’s alarm bells will fall quieter and quieter. 

Remember, the point of OCD treatment is not to take anything away from you—it’s the opposite. It aims to give you back the parts of your life that OCD has stolen or negatively impacted. If you’re afraid that the disorder will make you less intelligent (or less of any other positive attribute) Kilduff urges you to ask: At what cost do these things come? And is OCD really giving them to you? And perhaps an even more important question: What are the possibilities of a life in which you get to show off your intelligence and not be ruled by OCD?

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