In TV shows and movies, Obsessive-Compulsive Disorder (OCD) is often played broadly for laughs. Emma Pillsbury, the prim guidance counselor in Glee, wears disposable plastic gloves to eat, polishes her fruit, and cleans her pencil sharpener for an hour because she “doesn’t like things messy.” The curmudgeonly writer played by Jack Nicholson in As Good As It Gets stockpiles bars of soap for his hand-washing rituals.  Monk, Tony Shaloub’s detective on the TV show of the same name,  struggles with a whole compendium of other anxiety disorders along with OCD. He gets panic attacks in closed spaces, lines up identical shirts and pants in his closet and avoids cracks in the sidewalk.

Compulsions—repetitive behaviors performed to reduce the intense anxiety brought on by a feared object or mental image (i.e., obsession)—can seem senseless and even comical to an onlooker. In fact, OCD sufferers themselves often recognize the absurdity of their own rituals even though they’re powerless to stop them. But characterizations of the illness in the popular media, exaggerated for entertainment effect, contribute to several common misconceptions about it and intensify the shame people in the grips of OCD already feel.

Here are three common myths about OCD.

Myth #1:  “I don’t have OCD.  I’m a slob.”

OCD can take many forms. While some people with OCD, the stereotypical neat freaks, spend hours arranging and straightening, many others don’t care at all about maintaining order. They may fixate, instead, on cleaning and washing to keep contamination at bay; counting and repeating to ward off harm from bad thoughts; or checking locks, stoves, and faucets to prevent break-ins, fires, and floods. The variations in people’s fears and the rituals they engage in to ease them are endless, although obsessions do seem to cluster in several typical categories:  aggression, contamination, sex, religion, symmetry and exactness, and body-focused concerns about health or appearance.

Myth #2:  “I don’t have OCD. I don’t do any rituals.”

Compulsions can be subtle, even invisible. Patients often tell me they’ve been diagnosed with “pure O” OCD, but the concept of obsessional OCD without accompanying rituals hasn’t held up under scientific scrutiny. More likely, if you think you’re engaging in pure, mental obsessions, you’re probably carrying out rituals in your head. Common mental compulsions include reviewing facts, scanning your body or environment for information to make you feel safer, and reassuring yourself in a variety of other ways. You also might be doing some things you don’t consider rituals, such as researching facts on the Internet, asking other people for reassurance to calm you down, or avoiding your OCD triggers altogether.

So how do you know if you’re performing a compulsion? It’s complicated and sometimes hard to sort out.  Short answer: a compulsion is anything you feel driven to do to relieve the intense anxiety brought on by an obsession.

Myth #3:  “OCD is caused by childhood trauma. You have to uncover its roots to treat it.”

Popular culture, literature, and even many therapists rooted in the psychoanalytic tradition really go to town on this one. And it makes me angry because so many people with OCD have endured bad treatment as a result.

While stress or acute trauma can certainly activate or intensify OCD—or any other psychological condition, for that matter—the root “cause” is brain chemistry and misfiring neural circuits. Or possibly a strep infection, as in the case of sudden onset OCD in childhood (PANDAs). It can be tempting to blame your aversion to germs on your mother’s fastidious attention to your toilet training or figure out why you might want to harm old ladies when an image of running over one in your car pops into your head. But such intellectual exercises are red herrings. They distract you from the real business of dealing with OCD: confronting your fears through systematically exposing yourself to them and eliminating rituals.

E/RP (Exposure/Response Prevention) treatment really helps, as hundreds of research studies have shown.  It usually reduces anxiety over the long run, which is the outcome most people desperately seek. But an even more important consequence of exposure exercises, in my opinion and that of most other OCD specialists, is learning to tolerate the core fear underlying all obsessions and compulsions: the fear of uncertainty.

Movies and TV shows depict people with OCD as weird, ill tempered, endearingly quirky, or even crazy.  In real life, they usually don’t stand out at all. OCD is more often a hidden illness with rituals carried out in secret. Most of the patients I see lead productive, successful lives and suffer in silence. No one would suspect the depths of their inner turmoil. Even friends or family members in whom they’ve confided can’t really understand how painful OCD is, often trivializing it, albeit unintentionally, with comments like:  “I’m so OCD about that” and “Do you polish your grapes like Emma on Glee?”  But you can’t really blame them for their ignorance about OCD, when the media keep getting it so wrong.

That’s why I’m trying to set the record straight.