As football fans don their unwashed jerseys, sit in their favorite couch seats or line up their remote controls like Robert De Niro's character in "Silver Linings Playbook," many might wonder whether their Super Bowl superstitions might be crossing over into something more serious -- such as obsessive compulsive disorder.
People with obsessive compulsive disorder, or OCD, often associate certain colors and numbers with bad luck, just like people who don't have OCD, but there are a few critical differences: When OCD patients see these colors or numbers -- or have other intrusive thoughts -- they feel they must perform rituals to avoid catastrophic outcomes, said Jeff Szymanski, clinical psychologist and executive director of the International OCD Foundation.
"OCD gets in your head and says, 'Look, this is going to happen if you don't act,'" said Shannon Shy, who lived with severe OCD for years until he found a way to manage it. "It's as real to you as the sun rising."
Shy, who is on the International OCD Foundation's board, remembers how he would have to drive past the same log in the road 20 or 30 times to be sure it wasn't a dead body. That was at the height of his disorder, when he hid the problem from the world and contemplated suicide.
"You decide, 'How do I want to spend my day?' but someone with OCD and superstitions doesn't do that," Szymanski said. "It's distressing. It's a have to, not an I prefer to."
People with OCD -- more than 2 million adults nationwide -- experience intrusive thoughts -- obsessions -- which can include fear of harm, contamination or losing control. To get rid of these thoughts, they perform rituals -- compulsions -- such as checking their stoves or washing their hands. Even praying can be a compulsion.
In "Silver Linings Playbook," the filmmakers showed De Niro's character positioning remote controls just so and asking his son Pat (played by Bradley Cooper) to sit in a specific spot on the couch during Eagles games for good luck. Neither of these behaviors necessarily signaled OCD, Szymanski said. But the anxiety De Niro's character displayed when he argued with his son for not sitting in the seat sounded to Szymanski like OCD.
OCD differs from putting on socks in a particular order to win a game, said Dr. Todd Peters, a psychiatrist at Vanderbilt Psychiatric Hospital in Tennessee
"That's not really going to get in the way of life," Peters said, adding that, in contrast, the person who anxiously has to repeat everything he did the day his team won probably has a problem. "Because life is ever-changing, they can't expect other people to buy into their ritual or compulsion. ... People get so stuck in their minds that they can't get off that topic."
Peters said people with OCD get "stuck" trying to rid themselves of anxious feelings through certain behaviors. Some of the behaviors are fairly logical, such as compulsive hand-washing to avoid germ contamination, but others are bizarre, such as needing to see a certain animal run to the right to keep a family member from dying. He's seen patients exhibit both.
Peters said it's important that people with OCD know that a combination of drugs and exposure therapy can help them manage their symptoms. About a third of the people who have OCD find a resolution, another third will have episodes that come and go, and a final third will struggle with moderate to severe symptoms throughout their lives.
Shy was lucky. Shortly after his diagnosis, he was plagued with the need to walk around his child's soccer field over and over again to check for rocks and glass because he was sure that the children would get hurt if he didn't -- and it would be his fault. He did the same for his front door, and said he was constantly washing his hands.
But after years of therapy and coming up with his own plan to keep the obsessions and compulsions at bay, Shy found a way to deal with his symptoms. Now he says he doesn't need medication.
"OCD can be defeated, and I'm living proof of that," he said. "But getting help is key. Don't be ashamed to get help. Don't try to go it alone."
To raise public awareness about obsessive compulsive disorder, Dr. Richard Besser, ABC News' chief health and medical correspondent, will host a one-hour "tweet chat" on Twitter today from 1-2 p.m. ET. To participate, sign into Twitter and click here for the hashtag. Follow the conversation or jump in with comments and questions of your own.
Medical experts from the National Institutes of Health, the Mayo Clinic, American Psychological Association and the International OCD Foundation will join Besser on the chat to answer your questions and offer advice.