Last week, Grammy-winning singer and songwriter Noah Kahan revealed that in 2025, while on a trip to Joshua Tree, he was diagnosed with obsessive compulsive disorder at age 28. This debilitating condition affects an estimated 10 million people in the U.S. and 240 million globally, causing unwanted intrusive thoughts and repetitive behaviors. Although the disorder is common, it is severely underdiagnosed.
“I started putting all these pieces together from my childhood, and these different rituals I’ve had my whole life. It wasn’t just anxiety or being stressed,” Kahan told Rolling Stone. “I didn’t realize how much of it has nothing to do with physical touch. A lot of it’s a mental obsession.”
Kahan explained his thoughts made him think he was in danger, even if it wasn’t real. He said, “I could convince myself that I ran somebody over, knowing for a fact that I didn’t see another person on the road.” He described feelings of shame and fear after telling people about his “insidious” thoughts, worried he’d be judged.
I’ve also experienced the disturbing effects of this condition since childhood, but I didn’t know it was OCD until I was diagnosed at 33. My intrusive thoughts often came late at night or while driving alone, leaving me spiraling over worst-case scenarios. During some episodes, I pictured myself flipping my car off a highway or bleeding out during childbirth.
I didn’t talk about these thoughts with anyone early on, out of embarrassment, and worried my thoughts would become real. This led to years of panic attacks, leaving me wondering if I should just give up.
Shame and missed or overlooked symptoms like Kahan’s and mine are associated with delayed diagnosis of OCD. Not only can this worsen symptoms, but it can also be life-threatening.
A systematic review from the Journal of Affective Disorders found patients with the disorder are a higher risk of suicide and suicidal ideation. Another report from the International OCD Foundation also showed that people with the condition are five times more likely to die by suicide than someone without OCD.
“People feel shame for experiencing intrusive thoughts. They think they must be a monster or they’re going crazy. But they’re not,” explained Michelle Stiles, a licensed mental health therapist specializing in panic and anxiety disorders.
The first time I experienced suicidal ideation, I had intrusive thoughts about going to the woods late at night, falling into the creek and accidentally harming myself. Then, I considered doing it on purpose, thinking my family would be better off without me. At the time, I had no idea my symptoms were more than just anxiety.
Within the field of psychology, this condition is often misinterpreted, explained Alegra Kasten, a licensed therapist and founder of the Center for OCD, Anxiety and Eating Disorders, a practice based in L.A. “Many clinicians don’t understand the wide-ranging presentation of symptoms, including rumination and mental checking,” Kasten said. “If a clinician doesn’t know how to assess for ‘invisible symptoms,’ they might miss the diagnosis of OCD entirely.”
Recognizing the condition is just a start. According to the International OCD Foundation, 95% of patients diagnosed with the condition in the U.S. are not getting the most effective treatment and 75% of cases are being misdiagnosed or missed.
In my mid-twenties, I met with multiple therapists, before I knew I had OCD. I went through talk therapy and it temporarily relieved my symptoms. But I still woke in the middle of the night panting with racing thoughts. These panic attacks continued for years, until I learned I’d been misdiagnosed with generalized anxiety disorder.
Kasten says people don’t know OCD requires specialized treatment, or that regular talk therapy, like psychodynamic methods, can make their symptoms worse.
Kahan has been vulnerable about his mental health, often using his songwriting as a way to express emotions. Despite being a highly acclaimed musician, Kahan was still diagnosed with OCD later in life. This led to worsening symptoms, just as it did for me. On his most recent album, “The Great Divide,” recorded around the time of his diagnosis, Kahan sings the words “I prepared for the warfare, with the voice in my head” in a song called “Paid Time Off.”
A study in the Journal of Obsessive and Compulsive-Related Disorders found there is often a significant delay in identifying the disorder, sometimes almost a decade from the onset of symptoms to diagnosis.
Although there are a number of factors that contribute to delayed diagnosis of OCD, there is effective treatment available. The “gold standard” method recognized by medical providers is a combination of cognitive behavioral therapy and exposure response prevention. Other methods include acceptance and commitment therapy, mindfulness-based stress reduction and prescription medications like SSRIs. A large systematic review from Psychiatry Research showed exposure therapy is highly effective for patients with OCD and showed a decrease in anxiety and depression.
“Although exposure therapy doesn’t help 100% of people with OCD,” Kasten said, “I’ve seen it improve the lives of many people.”
When I was finally referred to a specialist, the psychiatrist who specialized in anxiety related disorders, quickly diagnosed me with OCD. He began treating me with cognitive behavioral therapy and exposure response prevention therapy, which helps you to face your fears and change your response to triggers like intrusive thoughts. I’m now in remission from the disorder.
Kahan shared that weekly Zoom therapy and taking Lexapro has helped him significantly improve his health and his creativity.
Despite the disorder being prevalent in the U.S., the International OCD Foundation found that diagnosis rates are still low, at around 3%. That’s why identifying OCD later in life is problematic. It needs to be addressed earlier or it could lead to harmful effects.
The first step is to create awareness on the signs of the condition and the best methods to treat it, so people can recognize when they need help. Next, medical providers need to be trained properly to conduct assessments, diagnosis and treatment of OCD. This will help prevent patients from being overlooked and misdiagnosed in the future, while reducing the risk of suicide among people struggling with the disorder.
Most importantly, it’s critical to normalize the conversation around OCD. Kahan’s willingness to share his experience should be a reminder to all of us that diagnosis of this debilitating condition needs to be destigmatized. Without proper identification and effective treatment, it can be deadly.
The more transparent patients are about intrusive thoughts, the less shame other people with OCD will feel when they are diagnosed. This will help people struggling with the disorder to get the help they need sooner and improve their symptoms faster, offering them a chance to lead a longer, healthier life.
Lisa McCarty is a Washington, D.C.-based freelance writer and journalist who is working on a reported nonfiction book.
Suicide prevention and crisis counseling resources
If you or someone you know is struggling with suicidal thoughts, seek help from a professional and call 9-8-8. The United States’ first nationwide three-digit mental health crisis hotline 988 will connect callers with trained mental health counselors. Text “HOME” to 741741 in the U.S. and Canada to reach the Crisis Text Line.
