Clinical OCD is a complex, debilitating mental health condition that overwhelms the lives of sufferers, affecting their work, relationships and overall well-being. People with the disorder have frequent intrusive thoughts and repeated actions to bring relief from those thoughts.

“In our treatment center, less than 5% are about being neat and tidy,” said Paul Peterson, CEO and founder of OCD Anxiety Centers in Utah. “Most people think they know what OCD is. They are incorrect. … OCD is a biologically based brain disorder. The brain is malfunctioning. It is typically genetic.”

This week is National OCD Awareness Week, which is part of National OCD Awareness Month. This year’s theme is “OCD Truths.” During the second week in October, organizations, patients and social workers focus on the condition while educating the public and helping people find the treatment they so desperately need.

OCD affects approximately 200 million people worldwide and 8.2 million in the United States, according to the International Obsessive Compulsive Disorder Foundation. That’s about 1 in 40 adults and 1 in 100 children. The condition is often overlooked and belittled as a personality quirk or choice, according to the foundation. However, it’s a real disorder that doesn’t discriminate.

OCD occurs when a person gets “stuck” in an unrelenting cycle of obsessions and compulsions The obsessions can include intrusive and disturbing thoughts and urges. Compulsions are the act of carrying out a ritual that will bring relief, but the relief is always fleeting.

Peterson said OCD comes in many different forms and attacks anything a person cares about. Some examples include intrusive or unwanted thoughts; checking things over and over; fear of germs and contamination; counting; fear of harming another person; distress related to faith, spirituality and religion; perfection; the need for constant reassurance; and many more.

People with the condition perform repetitive actions in an effort to bring calm, reassurance and comfort. For example, a person might think they are constantly being exposed to dangerous germs, so they compulsively wash their hands over and over again. Another person may feel the urge to repeatedly drive their car back to their original destination to make sure they didn’t run over someone. “OCD is known as the doubter’s disease,” Peterson said. “It makes them doubt what they should know. If I had a 10 out of 10 of distress, it would become incredibly important to me. In fact, everything else disappears.”

Peterson said OCD is about terror or fear. However, what a person fears is not their problem. Their problem is their brain misfiring and sending the wrong message. He said OCD is different from an anxiety disorder. In fact, the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, puts OCD in its own category.

“OCD is not an anxiety disorder. Anxiety is about worry and concern,” he said. “I am worried I am being judged, I am worried about real-life issues. It can get high in intensity, but it isn’t causing them to be terrorized.”

Peterson said every time a person obeys a fear, they neutralize — meaning, they perform a compulsion to get relief. That sends a message to your brain that it was good that it protected you in that way.

“Most people with these disorders can relate that they have seen through their lives, their disorder’s ebb and flow, but with a slight up,” he said. “They get worse over time. If I am socially afraid and don’t say anything, the next time I need to go somewhere, I know exactly how I will respond. But that is not where it ends. The brain is smart. It will try to protect you. Maybe the next time, I won’t go out at all. Now I don’t go to other things, and now I don’t leave my house.”

Peterson said although OCD doesn’t have a cure, a high level of exposure and response prevention, or ERP, with medication is shown through evidence to be the best option for treatment. ERP is a program through which patients are gradually exposed to situations that trigger their obsessions while teaching them to resist the urge to perform compulsions.

At the OCD Anxiety Centers in Utah, patients are enrolled either in person or via telehealth for three hours a day, five days a week. Peterson said the therapy is intense and patients need to practice their skills and exposures outside of therapy. However, he said people who aren’t willing to continuously practice ERP will likely fail, because repetitive practice is what rewires the brain.

“Also, the world downplays this disorder. It is in the top five most debilitating disorders, according to the World Health Organization,” he said. “We willingly go to the cancer unit for weeks at a time and then come home to go back and do it again for years, but somehow three hours a day with this thing that is so debilitating is a burden. We have to change how society sees this.”

Peterson said the bottom line is the fact that OCD is real and debilitating, and it’s nothing to make light of.

“OCD is not funny. You would never make fun of someone with Down syndrome. We should never do the same with OCD,” he said. “They are suffering. They put their smiling faces on and let the world believe one thing. But in general, they are not OK.”

Peterson said treatment with an OCD-trained therapist is crucial.

“The time it takes to do treatment is nothing compared to the years and years ahead of them if they don’t,” he said. “Stop saying you are OK when you are not OK. Most people are not OK, or at some point in their life, they will not be OK. Be honest and we can open our mouths to the world one person, one group at a time.”