Imagine that you’re sitting at the dinner table with your family. Your parents have decided to make your favorite meal. You grin with anticipation as you pick up your steak knife, ready to cut into the perfectly cooked meat, when suddenly, a thought enters your mind:

“What if I murdered my whole family with this knife right now?”

You recoil with fear and set the knife down. Suddenly all you can see is yourself doing the horrible act. Anxiety and fear take hold of you as you excuse yourself from the table, trying to understand what the thought might mean.

You lock yourself in your room, terrified you might want to hurt the people you love, and you try with all of your might to push the thought away. You fall asleep and wake up the next morning, hoping the thought has passed, but alas, it hasn’t. You can’t get it out, and it’s all you think about for days. You begin to think you’re going crazy, or that you’re a murderer. You are consumed every day by horrible thoughts, guilt, and anxiety. You don’t know what’s happening to you, but you vow to keep these thoughts a secret, unable to tell anyone about the monster in your mind.

When people think of OCD, images of color-coding, cleaning, and extreme organization are usually the first things that come to mind. I'm sure we're all guilty of using the phrase “I'm so OCD.” We’ve all seen or taken that standard “How OCD Are You?” quiz where images of dirty dishes, out of place shelves, and crooked picture frames are presented on the screen. We take these quizzes, we see something out of place and it bothers us, or we hate being disorganized, so we consider ourselves to be “so OCD.”

When used in this way, the phrase makes it sound like OCD is something to be proud of, like a cute quirk or funny personality trait. But these things do not, in fact, make us “so OCD.” They make us normal human beings. Mental illness are not adjectives, and should not be used as such. There is a very real and detrimental stereotype about OCD, and many people assume that all OCD’ers are concerned with organization or cleanliness, but this is far so from the truth. Sure, there are some people with OCD who do experience contamination fears or symmetry OCD, but many, like myself, experience a dark and entirely different form of the disorder.

What if I told you there is a sub-type of OCD that can make you believe you are secretly a serial killer, ready to go on a murderous rampage? Because it exists, and it’s not as uncommon as you might think. The sub-type I’m referring to is called “Harm-OCD,” and it is a lesser known manifestation of what psychologists refer to as “Purely-Obsessional OCD.”

It is estimated that approximately 2.3% of Americans suffer from OCD, but the number could be much higher due to those that are misdiagnosed. Obsessive-Compulsive Disorder is characterized as an anxiety disorder where sufferers experience intrusive, unwanted thoughts which provoke certain compulsions. Most of these compulsions are observed to be outward, visible compulsions, but for those who suffer from “Pure-O,” compulsions can be covert, and entirely hidden.

Individuals who suffer from “Pure-O” are bombarded with horrible intrusive thoughts that they find repulsive, yet for some reason they cannot stop thinking about them. In the case of harm-OCD, an individual may have repetitive images of harming someone they love deeply, like their mother or father. They may worry about suddenly stabbing someone, or running someone over with their car. In turn, these individuals perform mental rituals to neutralize the anxiety on which they may spend days ruminating, trying to figure out if they are truly a bad person, or if they truly want to act on the thoughts. They may conjure up images of hurting someone, trying to determine if they could really do it. They might spend hours searching google for answers, taking “How Sociopathic Are You?” quizzes, or asking others for reassurance that they would never do what these thoughts are telling them. Even pushing away and resisting the thoughts are considered compulsions. These compulsions help to relieve the anxiety associated with the disorder, but the relief is only temporary and they end up feeding the OCD cycle.

Some people with the disorder have it so severely that they end up committing themselves, convinced they are serial killers. Many people with the disorder also experience impulses to act, and this can be extremely distressing. The truth is that these individuals do not want to have these thoughts, act on these impulses, or even associate with the ideas.

Individuals with the disorder experience extreme guilt over the thoughts, and they try in any way possible to rid themselves of them. OCD, also dubbed the “doubting disease,” can actually trick the sufferer into believing the thoughts, even though the thoughts are entirely against what the individual believes is moral. Moreover, individuals with this form of OCD never act on their thoughts, nor has there ever been a case where someone with OCD has ever acted on them.

Ironically, individuals with the biggest conscience are actually the most susceptible to the disorder. Scientists are still trying to figure out the confusing disease, and there are many more sub-types besides harm-OCD. Some individuals have relationship-OCD and worry about cheating on their partners even though they don’t want to. Some sufferers worry that they might be schizophrenic, secretly homosexual, attracted to family members, or even pedophiles. The list goes on. Sufferers understand that the thoughts may be ridiculous or irrational, but for some reason they still can't let go of them

When I was diagnosed with "Pure-O" last year, I decided I wanted to try and help others like me dealing with this disorder. I’ve opened up to much of my family and good friends about my experiences, yet so many others I’ve talked to have never heard of this type of OCD.

So why is this the case? Well, “Pure-O” isn’t exactly a friendly conversation starter, nor is it a very comfortable thing to talk about. “Hello, my name is Lisa, and I’m scared I’m a serial-killer! Nice to meet you!” Having the thoughts associated with this disorder is not only terrifying, but also extremely embarrassing. How do you tell your mother that you’re scared you might try and stab her in her sleep? Or that you’re worried you want to worship the devil? How do you tell your boyfriend you’re scared you might like the same sex, even though you don’t want to? How can you look your best friends in the eyes when you tell them these scary, and horrible, embarrassing thoughts?

You can because the thoughts are ridiculous, they are untrue, and in a way they are almost humorous. With the right therapy and support system, the disorder can be overcome. Exposure Response Prevention Therapy, a form of Cognitive Behavioral Therapy, is the leading therapy used in treating “Pure-O,” and it involves exposing sufferers to their biggest fears. A person with harm-OCD might be asked to look at knives, while resisting the urge to perform any mental or outward compulsions. Eventually, an individual may be asked to hold a knife to a loved one’s neck. Sounds scary? Imagine suffering from the disorder yourself.

Thanks to neuroplasticity, ERP is able to change the brain structure of those with OCD, helping them gain relief from the constant anxiety. But even with therapy, those suffering from OCD can never be cured fully and may continue to struggle with the disorder throughout their lives. The real problem is the lack of awareness of “Pure-O.” There may be many sufferers who like their peers, have no idea what "Pure-O" is, so they don’t even consider themselves to have a mental illness, they just believe themselves to be horrible people. I hope that one day, with enough information and advocacy, we can help get rid of the OCD stigma and spread awareness about these lesser mentioned sub-types of the disorder.

Occasionally, when I tell someone I have OCD, they smile and say “Me too!,” and I listen to them as they ramble about how they really hate even numbers, and how they like to color code everything. I smile and nod, wishing that I too was only worried about even numbers, and color coding my clothing. Unfortunately, the OCD stereotype will only continue unless we are able to create more awareness for the interesting, confusing, and majestic “Pure-O.”

So the next time you hear someone use the phrase "...so OCD," to describe something not so OCD at all, remember what it really means to have the disorder, and you too can help end the stigma.