Abbie has a messy house. She also has OCD – why is that so surprising?

Abbie Williams is used to raising eyebrows when she tells people she has obsessive compulsive disorder (OCD). “People often look puzzled because I have a messy house and don’t care about things being ‘in order’,” says the 28-year-old, noting this confusion stems from the false belief that OCD always manifests in a physical compulsion, such as hand-washing or repeatedly checking a door is locked.

But the compulsions of OCD can be invisible to others, explains clinical psychologist Corrie Ackland, director of Sydney Phobia Clinic. She says the disorder is marked by both obsessions and compulsions: “Obsessions are these thoughts that are experienced as intrusive, unwanted and preoccupying, and that cause some level of distress.”

Because of the distress caused by those thoughts, people then engage in compulsions, which are “generally time-consuming, often quite ritualised or rigid behaviours that an individual feels compelled to do”. Compulsions are done in an effort to “neutralise the distress” caused by an obsession. So, if someone with OCD has an obsessive fear of germs, they may feel compelled to excessively wash their hands.

The compulsions of OCD can also be solely mental acts, says Ackland, such as counting, silently repeating words, or over-analysing thoughts.

Williams says intrusive and obsessive thoughts can be triggered by anything. For example, if she sees a distressing news story on TV, she may replay the disturbing images in her mind. “I then start questioning, ‘What does this thought popping into my head mean about me? Am I a violent person?’ ”

She then feels compelled to keep mentally replaying the image “until I am at peace that I’m not a bad person, or until I find meaning”. Alternatively, her compulsion may lie in telling others about her thoughts and seeking reassurance “that I am not a bad person”.

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These issues used to dominate her life, yet as she didn’t realise OCD could manifest without external compulsions, she had no idea she had the disorder.

Sadly, Williams is far from alone. Ackland says that increasing awareness about OCD has led to a rise in reported prevalence, with 3 per cent of the population having the disorder. But that figure could be higher as people like Williams, who don’t fit the stereotypes, fly under the radar.