For many, the phrase “obsessive-compulsive disorder” (OCD) conjures up images of endless hand-washing, relentless checking of locked doors, or carefully lining up items in perfect order. But fresh research and expert voices now highlight unexpected symptoms often overlooked—not just by the public, but even by those who struggle with the disorder themselves. As understanding of OCD advances, mental health professionals urge a shift away from stereotypes, offering new hope for more accurate diagnosis and effective support, especially for Thai people whose experiences may take unique cultural forms (NYT).
For decades, OCD’s common image in popular media has been shaped by portrayals of visible rituals around cleanliness or order. Yet, as detailed in recent reports and echoed by experts such as faculty psychiatrists at leading US and Thai institutions, OCD can manifest in diverse and sometimes invisible ways. Sufferers might be tormented by persistent, unwanted thoughts about harming loved ones, doubts about the truth of their relationships, extreme fears about making mistakes, or intrusive worries about taboo subjects. Dr. Carolyn Rodriguez, an OCD specialist from Stanford Medicine, notes that many feel compelled to keep their struggles secret out of fear that their obsessions reveal something “dangerous” about themselves, when in fact these thoughts are classic but misunderstood symptoms of the disorder.
According to the International OCD Foundation and recent academic reviews, these lesser-known subtypes—such as “relationship OCD,” “sexual orientation OCD,” or “emotional contamination OCD”—are not separate diagnoses, but represent unique expressions of the same underlying mental illness. Online communities and clinical practice have given rise to informal labels for these patterns, helping sufferers recognize and normalize their experiences. As Dr. Rodriguez explained: “Creating names for different expressions of OCD may help sufferers feel less alone.” She emphasized that “understanding these distinctions can help clinicians tailor a precise treatment plan… otherwise, people who experience the disorder might not even recognize they have it.”
Standard clinical definitions describe OCD as a pattern of intrusive obsessions and compulsions that cause marked distress and take up at least an hour per day, often severely affecting quality of life (Wikipedia). An “obsession” is a recurring unwanted thought, image, or urge that generates anxiety, disgust, or discomfort, while a “compulsion” is the repetitive act—be it physical or mental—performed to ease that distress. These compulsions might be apparent (washing, checking, counting) or entirely internal (praying, seeking mental reassurance, or replaying conversations). In Thailand, mental health specialists from major hospitals note that some forms—such as repeated reassurance-seeking, compulsive “luck” rituals, or overwhelming doubt—may be deeply entwined with cultural beliefs and social structures (Nation Thailand).
Interestingly, the content of obsessions and compulsions can change over time for the same individual, and many people experience more than one theme simultaneously. Among Thai patients, concerns about contamination are prevalent, but cases of excessive collecting, fear of causing harm, or fixation on personal “bad omens” have also been reported. As described by a Thai paediatric psychiatrist, common manifestations in children may include compulsive cleaning to avoid imagined germs, persistent anxiety over order or good luck symbols, or refusing food out of fear it is “unclean.” Importantly, what distinguishes OCD from personality quirks is the degree to which these thoughts and actions consume time, cause suffering, or interfere with daily life.
Globally, it’s estimated that about 2.3% of adults will experience OCD at some point, with women somewhat more likely than men to be diagnosed (NIMH). However, data from a Thai survey of medical students suggest the prevalence of obsessive-compulsive symptoms may be even higher in some groups. A 2021 cross-sectional study among over 690 students at a Bangkok medical faculty found that 26.7% reported significant obsessive-compulsive symptoms, especially among second-year students (JPAT/Mahidol). The most common obsession was fear of losing something valuable (75%), while the most frequent compulsion was repeatedly asking for reassurance (61%).
The Thai study is particularly notable because these symptoms were significantly linked with educational, social, and psychological challenges, including depression and interpersonal conflicts. Individuals with higher levels of obsessive-compulsive symptoms were more likely to report friendship problems, academic stress, and emotional distress—mirroring trends observed in international research.
Experts caution, however, that OCD is more than just “having quirks” or being “overly tidy.” Many Asians—Thais included—may dismiss or hide symptoms, attributing them to family strictness, superstition, or normal anxiety (Nation Thailand). Yet, when intrusive thoughts and repetitive actions dominate one’s ability to function, or are accompanied by feelings of shame, confusion, or isolation, professional evaluation is vital.
The causes of OCD are complex, involving both genetic and environmental factors. If one parent has OCD, their children are at increased risk; stressful environments, strict upbringing around cleanliness or moral values, and even certain brain infections can make symptoms worse. Neurobiological models implicate regions like the orbitofrontal cortex and amygdala, while recent studies have begun tracking biomarkers and neural activity patterns that may shape future treatments (Texas Children’s Hospital).
Current treatment recommendations usually combine medication—especially selective serotonin reuptake inhibitors (SSRIs) at higher doses than for depression—and specialized therapy called exposure and response prevention (ERP). ERP involves gradually confronting one’s most distressing thoughts or situations, with the guidance of a therapist, while resisting the urge to perform rituals. Thai psychiatric specialists underscore the need for tailored interventions, involving family and even school communities for child and teenager cases. When standard treatments fail, experts increasingly turn to emerging approaches, including deep brain stimulation and repetitive transcranial magnetic stimulation, with promising results for treatment-resistant cases (PubMed).
Societal misunderstanding remains a significant barrier. Widespread use of “OCD” as slang for perfectionism or neatness trivializes the real suffering many endure, and can keep Thais from seeking help or identifying symptoms in loved ones. As one Thai child psychiatry expert explained, “If you keep doing these things repeatedly for hours or for days, then it’s OCD, since you would not be able to do things properly… In children, there are also cases of OCD caused by anxiety.” This distinction is crucial: while double-checking a locked door or worrying about a test is normal, becoming unable to move forward in life signals a need for intervention.
Culturally, Thailand’s emphasis on social harmony and avoidance of “loss of face” can amplify stigma, making families reluctant to discuss mental health issues. In some households, excessive rituals may blend with spiritual practice or merit-making, creating challenges for diagnosis. Nonetheless, increased public education, improved access to mental health resources, and open dialogue are key to changing perceptions.
Looking ahead, mental health authorities predict rising awareness as more Thais turn to online resources, social media forums, and national health campaigns for information. Ongoing research is likely to uncover new forms and triggers for OCD, especially as digital lifestyles, social pressures, and expectations evolve. For Thailand, continued investment in training clinicians, destigmatizing mental health, and broadening school-based mental wellness screening will be essential.
For Thai readers, the most practical step is to consider not just visible behaviors, but the hidden, painful thoughts and rituals that may point to OCD. If you, your child, or someone you care about struggles with obsessive worries or repetitive habits that interfere with life, seek assessment at a mental health clinic. Destigmatizing these symptoms and talking openly—at home, in schools, and with medical professionals—can make all the difference in finding relief and support.
References:
- The Unexpected Symptoms of O.C.D. – The New York Times
- Obsessive–compulsive disorder – Wikipedia
- Obsessive Compulsive Disorder (OCD) – Nation Thailand
- A Screening of Obsessive-Compulsive Disorder in Medical Students – JPAT/Mahidol University
- Researchers discover a new neural biomarker for OCD – Texas Children’s Hospital