Rafa Nadal arranged his water bottles in a specific way during matches and repeated certain gestures before serving. These visible routines have raised a question: Could they be signs of obsessive-compulsive disorder (OCD)? It’s not possible to answer that by observing their gestures on a screen. Nadal himself has explained that these routines helped him focus on the competition. His case highlights an important distinction: repeating an action does not, in and of itself, mean you have OCD. Source regarding his statements and routines.
The difference is best understood when we consider how the person feels, what happens if they cannot repeat the action, and how much it affects their life. In OCD, there are obsessions, compulsions, or both, which can cause intense distress and take up a lot of time. An assessment should be conducted by a mental health professional.
Table of Contents
- What is obsessive-compulsive disorder?
- How can you tell the difference between a routine and a compulsion?
- Common Symptoms of OCD
- When is it a good idea to request an evaluation?
- Why does the obsession-compulsion cycle continue?
- OCD Treatment: Evidence-Based Options
- Understanding OCD Without Reducing It to a “Compulsion”
- Frequently Asked Questions About OCD
What is obsessive-compulsive disorder?
OCD is a mental health disorder characterized by obsessions, compulsions, or both. It does not simply mean being organized, demanding, or careful. It can present with a wide variety of symptoms and affect work, school, relationships, or sleep. In the ICD-11, it is classified under “Obsessive-Compulsive and Related Disorders,” a category of its own.
Obsessions: intrusive thoughts, images, or urges
Obsessions occur repeatedly and involuntarily. A person may experience a fear of contamination, doubts about whether they have locked a door, a need for things to be a certain way, or thoughts of harm that conflict with their values. Having an intrusive thought doesn’t mean you want to act on it.
Compulsions: actions intended to relieve distress
Compulsions are repetitive behaviors, such as washing, checking, or organizing, or mental acts, such as counting or silently repeating a phrase. There may also be a constant search for reassurance or certainty. They are usually performed to reduce distress or to try to prevent something feared. The relief may be short-lived, and the need to repeat the action returns. That is why OCD can go unnoticed: not all compulsions are visible.
How can you tell the difference between a routine and a compulsion?
A routine can help you prepare, focus, or give structure to your day. A compulsion is usually linked to a fear or a feeling that something bad will happen if it isn’t performed. But outward appearances alone aren’t enough to tell them apart.
| Helpful Question | Routine or habit | Possible signal to check |
|---|---|---|
| What happens if it isn’t done? | The person may feel uncomfortable but carry on anyway. | An intense discomfort or an urge that is difficult to resist arises. |
| Why is it repeated? | To get organized, prepare, or enjoy a tradition. | To dispel a doubt, reduce anxiety, or prevent a feared harm. |
| What effect does it have? | It does not significantly interfere with daily life. | It takes up time, causes suffering, or limits activities and relationships. |
This chart is meant as a guide, not a diagnosis. Nor is it necessary for someone to recognize their symptoms as “irrational”: awareness of what is happening varies from person to person. If thoughts or rituals begin to take over your day, it’s a good idea to seek an evaluation.
Common Symptoms of OCD
The content of obsessions varies greatly from person to person. Some common examples include:
- Contamination: a persistent fear of germs or substances, accompanied by excessive washing or avoidance behaviors.
- Verification: recurring questions about locks, devices, or possible errors, with frequent checks.
- Symmetry and order: a sense of unease when something doesn’t seem “right” or complete, accompanied by a need to rearrange or repeat it.
- Intrusive thoughts about harm, sex, or religion: unwanted thoughts that may be accompanied by mental rituals, avoidance, or a search for reassurance.
These are common themes, not specific types of people. Hoarding disorder has its own classification and should not simply be presented as a subtype of OCD.
When is it a good idea to request an evaluation?
If obsessions or compulsions take up a lot of time, cause distress, or interfere with daily life, it’s worth seeking help. Clinical criteria generally consider that they take up more than an hour a day or cause significant distress or interference; the one-hour mark is not an absolute requirement that must be met. The evaluation also helps distinguish OCD from other problems and choose the appropriate treatment.
For example, checking once to make sure the door is locked before leaving is common. But repeatedly going back to check, arriving late to work, and feeling that you can never be quite sure enough is a different experience altogether. This example doesn’t allow for a diagnosis, but it does show why the impact of the behavior matters—not just the gesture itself.
Why does the obsession-compulsion cycle persist?
Let’s imagine the doubt: “Did I lock the door?” A sense of unease sets in; the person checks it again and feels relieved. Later, the doubt returns. Checking the door can inadvertently teach the person that only by checking again is it possible to feel safe. This cycle helps explain why rituals can become increasingly difficult to break. It’s a useful psychological explanation, not a universal description of every case.
The research also examines the brain circuits involved in OCD, but reducing the disorder to a “malfunctioning brain alarm” oversimplifies a complex problem.
OCD Treatment: Evidence-Based Options
Treatment is tailored to the person’s symptoms, their severity, and the person’s preferences. Cognitive-behavioral therapy with exposure and response prevention (ERP) is one of the recommended psychological interventions. With professional support, patients work gradually and systematically to confront situations that trigger distress without automatically resorting to compulsive behaviors. It does not involve “strictly prohibiting” behaviors or forcing someone to endure unbearable anxiety: the individual participates in the plan and progresses at a suitable pace. The goal is to learn to respond differently to uncertainty and resume activities that OCD had limited.
In some cases, it is recommended to combine psychotherapy with medication. Selective serotonin reuptake inhibitors (SSRIs) are a pharmacological option that must be prescribed and monitored by a healthcare professional. It may take weeks to see results, and the treatment is adjusted based on its effectiveness and side effects.
When standard options are not sufficient, a specialized team can evaluate other approaches. Neuromodulation techniques are reserved for specific situations and are not the routine next step following an initial treatment.
If you’re interested in learning about other therapeutic approaches, you can read my article on EMDR. In this article, I do not present it as the first-line treatment for OCD: the specific recommendation with the strongest evidence in the guidelines I consulted is CBT with EPR.
Understanding OCD Without Reducing It to a “Compulsion”
Nadal’s routines show that repetitive behavior can make sense to the person performing it. But from the outside, we don’t know whether a gesture causes suffering, stems from an obsession, or limits that person’s life. Labeling someone based on what we see can misinform others and downplay the experiences of those living with OCD.
If you recognize yourself in these situations, asking for help doesn’t mean you have to wait until you’re “really struggling.” An evaluation can help clarify what’s going on and what kind of support would be best. You can learn more about how I work in individual therapy in Málaga or schedule an initial appointment.
Inmaculada Rodríguez Psychologist
Psychology by Inmaculada Rodríguez
Frequently Asked Questions About OCD
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No. El orden, por sí solo, no define un trastorno. Lo relevante es si hay obsesiones o compulsiones que causan malestar, ocupan mucho tiempo o interfieren en la vida diaria.
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No permiten llegar a esa conclusión. Sus rutinas eran visibles y él explicó su utilidad para concentrarse, pero un diagnóstico exige una evaluación clínica que no puede hacerse observando un partido.
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Sí. Hay obsesiones sobre distintas cuestiones y compulsiones que pueden ser mentales, como contar o repetir frases, además de conductas visibles como comprobar u ordenar.
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No siempre. El grado de conciencia varía. Tampoco hace falta que una persona considere “irracional” su miedo para que sus síntomas merezcan atención profesional.
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La terapia cognitivo-conductual con exposición y prevención de respuesta (EPR) es una intervención recomendada. Se planifica con un profesional, de forma gradual, y en algunos casos se combina con medicación.
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Cuando te producen sufrimiento, ocupan mucho tiempo o afectan al trabajo, los estudios, las relaciones o el descanso. Una evaluación puede ayudarte a entender lo que ocurre sin tener que autodiagnosticarte.
