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On r/OCD,animated sex with zombie videos a Reddit community dedicated to OCD-related support and discussion, countless threads touch upon the intersection of the mental health condition and friendship. "Does anyone have bad OCD about their friends?" one posits. Another asks, "What’s the best way to deal with the fear of your friends leaving you?"

These are the kind of questions that potentially permeate those who have obsessive compulsive disorder (OCD). The mental health condition causes people to have obsessive thoughts and engage in compulsive activity, according to the National Health Service. OCD presents itself in different ways to different people, and for many, it can apply to a person's close relationships. As Marianne Eloise, author of Obsessive Intrusive Magical Thinking, wrote in 2016, "My relationship is the best thing for my OCD, but OCD is the most damaging thing to my relationship."

When it comes to friendships, this statement holds as much weight. Those suffering from OCD may find that the condition has implications on friendship, both small and substantial.

In what ways can OCD affect friendships?

Like many mental health conditions, there are tangible social implications connected to OCD that can be difficult to pinpoint. This is also, in part, because OCD is often misconstrued by the media and popular culture, especially movies and TV, where the phrase has long been used out of context. Its misconceptions arguably make it all the harder to explain to friends and loved ones, as Nina White tells Mashable. The activist and forensic linguistics student says that she has pure OCD (also referred to as 'Purely obsessional' or 'Pure O'), a form of the condition that has the person engaging in hidden compulsions and repetitive behaviors or rituals.

"As my OCD doesn’t manifest itself in the stereotypical way, this makes it harder to explain the nature of my condition and some people have questioned whether I actually have it," says White. "I find that people’s knowledge surrounding OCD is fairly limited, so I need to educate them on what it actually is and the many ways it can manifest." She explains that this applies to friends, family, and partners, and that she previously struggled with having to "mask" her condition for fear of judgment or people avoiding her.

Many people say they never realized the influence that the mental health condition holds over friendship, and how pervasive this can be. On TikTok, people have given the example of compulsively seeking reassurance from those around them. As the condition is defined by having obsessive or intrusive thoughts and compulsive behaviors, seeking reassurance is a common way in which these compulsions manifest. TikTokker @healwithleila, for example, posted about asking for reassurance from friends who feel like they should refrain. "My OCD begs for reassurance constantly it’s exhausting," she wrote.

"People suffering from OCD may enlist their friends in compulsions, especially compulsively seeking reassurance about the friendship," says Ferdinando Palumbo, the director at BirchTree Psychology, a practice in New Jersey specializing in OCD.

Alongside reassurance, there are other compulsions that arise, as many on TikTok have explained. User @phebelou posted about oversharing as a compulsion; the account @treatmyOCD has acknowledged various OCD symptoms that can affect relationships, from people-pleasing tendencies to catastrophizing and jumping to conclusions.

These are just some ways in which OCD's impact on friendships can be traced. One particular form of OCD, known as Relationship OCD (ROCD), is centered around obsessions and compulsions typically related to one's partner; it can cast doubt over one's relationships, with a person questioning closeness and compatibility with a partner and seeking reassurance that they are with the "right" person. But while it has more to do with romantic relationships, ROCD can apply to friendships or familial relationships, too.

Palumbo explains that feelings of doubt sit at the crux of friendship-related OCD. These doubts are both time-consuming and can result in repetitive behaviors. Examples include compulsively re-reading texts, asking friends whether they're offended by certain comments, and asking for constant clarification. He says these behaviors can put a "strain" on friendships. Friends may become "embroiled" in one's rituals and compulsions, or even "trigger unwanted thoughts", according to the Anxiety and Depression Association of America.

Michael Moore, an associate professor at Adelphi University, adds that various forms of OCD have the potential to impact friendships. He says that the effects can be both indirect (for example, OCD sufferers can be late to appointments due to rituals) or direct (involving friends in compulsions or rituals).

"This puts the friend in the difficult position of trying to help, but perhaps not knowing how, and unintentionally doing more hard than good through encouraging bad habits," says Moore.

Addressing the issue – and lending support

For those suffering with OCD, communication has paved the road for better understanding and increased support.

White says that she recently became more comfortable opening up about her OCD: "At the end of the day, it is a part of who I am," she says. "In recent years, I’ve been involved in mental health activism where I’ve spread awareness about OCD and tried to counter the misconceptions surrounding it."

When a close friend is aware of OCD, they may be in a better position to provide adequate and reasonable support. Palumbo says he has asked some clients to create a couponing system with their friends, in order to tackle compulsive reassurance-seeking. The system has a select amount of coupons available, through which a person with OCD can ask their friends for reassurance. Each week, coupons are eliminated until there are none left.

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"Through treatment or guiding oneself through reducing the compulsions," says Palumbo, "there is good cause to believe that people can get better from OCD and have healthier friendships without the compulsions straining these relationships."

BeyondOCD.org, an organization dedicated to raising awareness, also suggests that friends take a step back from a friend's rituals and not over-engaging in providing constant reassurance of helping them to avoid triggers. The organization says that such actions "doesn’t help decrease the symptoms in the long term." Instead, as the mental health organization Mind UK also suggests, friends can support those with OCD by talking it through and keeping an open mind.

Dr. LeMeita Smith, director of clinical services at United Health Services, says that fear of being misunderstood or judged can cause individuals with OCD to "have a hard time getting close to others."

"Friendships can be difficult to manage as it can be overwhelming for someone with OCD to spend time with others while also feeling stuck in their own mind," says Smith. She says that OCD thoughts "go beyond regular anxieties", which sometimes makes it difficult to participate in "socializing, maintaining conversations, and simply enjoying time spent with others."

Combatting this fear of judgment can require explaining the condition and its subjective effects on an individual. White admits that that this can be "quite exhausting" but doing so can increase empathy and awareness. Educating others on OCD, she hopes, will help "OCD sufferers to feel a little more comfortable being themselves, and in understanding that having OCD isn’t something to be ashamed of."

Moore agrees that letting friends in the loop is vital — but keeping the line between friend and therapist is equally important. He added it may not be appropriate for all relationships.

"The way to navigate these challenges is to try, to the extent possible, to be open and communicative with your friends about your struggles with OCD," he says. "Let your friend know what you are struggling with and be clear about how they can help, and when they should sit it out and let you handle it."