Obsessive-Compulsive Disorder (OCD) is a complex and often misunderstood condition that goes far beyond simple quirks or cleanliness preferences. OCD is a debilitating disorder, and many individuals avoid seeking treatment because of barriers such as cost and social stigma.
Nobody is ‘just a little OCD’!
Understanding OCD requires recognizing its close relationship with the anxiety disorders, as these conditions share important features like heightened responsibility, catastrophic beliefs, and safety-seeking behaviors. In fact, a strong case can be made for simply just labelling OCD as an anxiety disorder!
Example: In contamination-related OCD, avoiding public bathrooms for fear of becoming contaminated and spreading the contaminants to loved ones serves the same function as bringing a companion to feel reassured that a catastrophe will not take place or avoiding public transport out of fear that escape would be difficult (as is seen in Agoraphobia). Simply put, safety-seeking behaviors ensure that the patient never experiences the counterfactual of what would have happened had they not performed their safety behavior. More technically, diligent employment of safety-seeking behaviors provides temporary relief from fear and anxiety while inhibiting long-term fear extinction.
Understanding Behavior Through Function
When encountering a novel concept, I break it down into its fundamental components and build up from there. Yet when trying to understand OCD, I was puzzled by its relocation to a new chapter in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
My oversimplified model for the treatment of anxiety disorders is as follows: willingly expose yourself to whatever you are afraid of, and don’t do your safety behaviors.
While I recognize that there are nuances in treatment, to me this model served as a solid foundation to better grasp the various models that have been put forth for the anxiety disorders. I found this model to also be a good fit for understanding OCD. However, this presented a problem to me, as OCD was removed from the anxiety disorder chapter in DSM-5. To me, this did not compute. What followed was considerable time researching to find any gaps in my simplified anxiety model that might explain this change.
To make a long story short, I have not yet found compelling arguments against fitting OCD my simplified model for anxiety disorders.
Publication Alert!
As part of my PhD journey, I’ve had the incredible fortune to write a review paper about the classification of OCD together with my supervisors, Per Carlbring and Jan Bergström. Make no mistake about it: this paper would not have been possible without their unwavering support and openness to discussing an unconventional idea from a newly admitted PhD student.
Doing a PhD is scary. Taking a public stance and challenging the formal conceptualization of OCD is even more scary. And that’s exactly how I like it! For me, life wouldn’t be fun if it wasn’t sometimes a bit scary (see what I did there: willingly exposing myself to a feared situation!)
And in case it hasn’t become evident, our findings supported my simplified anxiety disorder model: OCD is best understood as an anxiety disorder. At least for now…
You can read our paper’s in press, journal pre-proof, version by clicking the link below!
Hlynsson, J. I., Bergström, J., & Carlbring, P. (in press). Seeing Beyond the Diagnostic and Statistical Manual: A Function-Centered Review of Obsessive-Compulsive Disorder and Anxiety Disorders. Journal of Obsessive-Compulsive and Related Disorders. https://doi.org/10.1016/j.jocrd.2025.100967
You can even listen to an AI-generated podcast that does a relatively good job summarizing some of the main arguments in our paper below.
