Beyond the Stereotypes: Understanding Obsessive-Compulsive Disorder (OCD)

Hi all! It’s good to see you again and I hope you’re getting out to enjoy the fall colors. This month’s blog post focuses on Obsessive-Compulsive Disorder (OCD). OCD is a mental health condition often misunderstood and trivialized in popular culture. It’s frequently reduced to jokes about being “neat” or “organized,” but for the millions of people worldwide who live with it, OCD is a serious, often debilitating disorder characterized by a cycle of distressing intrusive thoughts and repetitive, ritualistic behaviors. 

To help me out with this post, I tapped into my good friend, Jayme Kolbo, MA, LPCC. Jayme is a therapist based out of St. Paul, MN who specializes in treating chronic anxiety, self-doubt, shame, and repetitive behaviors. She is the owner of OCD & Anxiety Wellness Collective. You should check out her website! It is chocked full of resources, which is linked here. 

Jayme wrote the rest of this post! Have fun reading through the rest of it or listening to my voice read it to you. I hope this finds you well!  Know that I see you and I’m rooting for you. Take care of yourself and others. 

What is OCD?

OCD used to be described as the doubting disease. It is defined in the Diagnostic and Statistical Manual (DSM-5 TR) by the presence of two core components: obsessions and compulsions.

Obsessions

Obsessions are persistent, unwanted, and intrusive thoughts, images, or urges that cause significant anxiety, distress, and dread. They are not enjoyable or desired thoughts; rather, they feel ego-dystonic—meaning they are inconsistent with the person’s core beliefs and values.

Obsessive thoughts can center around almost anything, but some common themes for obsessions include:

• Contamination: Fear of germs, dirt, or illness (for example: what if this thing I touched is contaminated, what if I get sick or spread illness to loved ones, what if I get rabies, what if there is asbestos in my home, what if I’m a disgusting person)
• Harm/Responsibility: Fear of causing harm to oneself or others (for example: what if I hit someone with my car, what if I left my coffee maker plugged in and it causes a fire, what if I poisoned/undercooked their food, what if I snap and lose control, what if I experience psychosis, what if I’m a narcissist, what if I’m depressed and suicidal, what if I harm myself or loved ones even though I have no desire or intention to do so)
• Symmetry/Order: A need for things to be “just right” or perfectly balanced (for example: something bad could happen if I don’t feel just right when I leave my house, what if I don’t sleep if I don’t follow my bedtime routine perfectly, what if everything spirals out of control if things are not in their place)
• Unwanted Religious, Sexual, or Immoral Thoughts: Intrusive thoughts that conflict with moral/ethical beliefs or sexual desires (for example: what if I offended my higher power, what if I completed a religious practice wrong, what if I’m attracted to children, what if I’m a different sexual orientation than I think I am, what if I’m a bad person, what if I did something bad in the past and I just don’t remember)

Context matters in determining what is an obsessive thought. Obsessive thoughts are out of context, meaning they are scary possibilities that are not connected to reality in the here and now. For example, someone with OCD who experiences intrusive, obsessive thoughts about killing their loved ones does not want to think about or actually kill their loved ones. This is important. These thoughts feel scary and are unwanted, meaning they don’t fit with the individuals’ true desires, intentions, or self. The thoughts are out of context and do not equate to a real threat. Yet people with OCD get stuck on their scary thoughts being possible, even when they recognize it’s unlikely or irrelevant given evidence in the here and now. Because individuals with OCD get stuck on these scary possibilities, they feel compelled to take actions to be sure they do everything they can to prevent the scary possibilities from happening, which is where compulsions come in.

Compulsions

Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rigid rules. The goal of a compulsion is to reduce the anxiety caused by the obsession or to prevent a dreaded situation from happening. However, the relief is only temporary and compulsions reinforce obsessive thoughts, causing a never ending cycle.

Examples of compulsions include:

• Checking: Repeatedly checking locks, stoves, light switches, feelings, the news, etc
• Washing/Cleaning: Excessive hand washing, bathing, or meticulous and unnecessary cleaning routines
• Repeating: Redoing tasks or activities until they feel “just right” (turning on/off light switches, getting in/out of the car, locking/relocking the door, putting on clothes, praying, re-reading, re-writing, etc)
• Reassurance-seeking: asking loved ones for reassurance repeatedly, using AI chatbots for reassurance, going to excessive doctor’s appointments for reassurance, repeating reassurance to self mentally, researching content of obsessions for reassurance, comparing self to others for reassurance
• Mental Rituals: Repeatedly replaying events in mind, counting, praying, replacing a “bad” thought with a “good” thought to “neutralize” a thought, ruminating or trying to figure out an imaginary problem that is not happening right now

It is crucial to understand that while people with OCD often recognize that their obsessions are irrational and their compulsions are excessive, they feel they must perform these behaviors to manage the intense distress that comes from obsessive thoughts and to prevent a feared catastrophe from happening. Unfortunately, the OCD brain learns very quickly that obsessions cause distress (bad) and compulsions provide temporary relief (good), which reinforces the fear of obsessive thoughts and the desire to perform compulsive behaviors. The problem is that obsessions are out of context and compulsions are never enough to completely eliminate the possibility of a feared catastrophe from happening, which is why obsessive thoughts then continue even after compulsive behaviors are performed. When we try to apply real solutions (compulsions) to imagined problems (obsessions), the OCD brain comes up with new, creative possible ways the imagined problem could still happen and demands more solutions (compulsions) to be certain it doesn’t.

It’s important to recognize that compulsive behaviors are also out of context given that the obsessions that prompted these behaviors are out of context. For example, someone with contamination OCD might wash their arm in the shower (trigger) and then have the thought that they could have missed a spot on their arm (obsession that causes distress), so they re-wash their arm (compulsion that provides temporary relief). This is not necessary if the thought is out of context and they’ve already washed their arm in the shower. The OCD brain is dismissing or doubting that the arm is clean and instead attending to the possibility of being a disgusting person, which means they also could have missed other spots (more obsessions) and now showers take an hour (more compulsions). It does make sense to wash again if you actually missed a spot though. So while compulsions might be confusing or unnecessary to those without OCD, they are typically based in logic that is understandable if you know the obsessive thought and feared outcome someone is trying to prevent. The compulsive behavior itself is just not necessary because there was no problem to begin with (the arm was already washed).

The Impact and Reality of Living with OCD

The media often portrays OCD in a singular, restrictive way—usually focusing on cleaning or organizing. In reality, OCD manifests in countless ways. Some forms of OCD, often referred to as “Pure O,” are characterized primarily by obsessions and mental, or internal, compulsions, making them less obvious to an outside observer but equally distressing.

The constant battle against intrusive thoughts and the time consumed by compulsions can severely impact a person’s life, leading to:

• Significant time loss: Compulsions can take hours out of a day.
• Impaired functioning: Difficulty working, attending school, sleeping (OCD dreams are very common), taking care of basic needs, or maintaining relationships.
• Isolation: The need to hide rituals or avoid perceived triggers can lead to social withdrawal. The more compulsions people do, the smaller their world becomes.
• Mental exhaustion: The continuous fight against anxiety and distress is physically and emotionally draining.

It’s a misconception that someone with OCD just needs to “stop worrying” or “be less rigid.” OCD is rooted in biological factors which transact with lived experiences, and it requires professional, evidence-based treatment.

Hope and Treatment

The good news is that OCD is highly treatable. Effective interventions typically involve a combination of psychotherapy and medication.

1. Exposure and Response Prevention (ERP): This is the gold standard for OCD treatment. A type of Cognitive Behavioral Therapy (CBT), ERP gradually exposes the individual to triggers of their obsessional fears while reducing and eliminating compulsive rituals they would normally perform. With repeated practice over time, the individual with OCD learns that obsessive thoughts are meaningless, feared outcomes do not occur, anxiety decreases all on its own, and compulsions are not necessary, all of which contributes to breaking the obsessive-compulsive cycle.
2. Medication: Selective Serotonin Reuptake Inhibitors (SSRIs) or Clomipramine (a tricyclic antidepressant) are common first-line psychiatric medications prescribed to help reduce the intensity of obsessions and compulsions. Higher dosages of SSRIs are typically necessary for effectively treating OCD. More information on psychiatric medication for OCD can be found here: https://iocdf.org/about-ocd/ocd-treatment-guide/medication/
3. Inference-Based CBT (ICBT): ICBT is another type of CBT for individuals with OCD. ICBT is primarily a cognitive therapy that looks at obsessions as doubts that are created using a faulty reasoning process. This faulty reasoning process, also called obsessional reasoning, takes individuals with OCD out of reality in the here and now and into an imagined, scary possibility (called inferential confusion). ICBT teaches individuals to identify their obsessional doubts, understand how their obsessional doubts formed, and see how the reasoning process for their doubts is faulty and not how they normally reason in non-triggering situations. ICBT then teaches individuals with OCD how to apply normal reasoning to their obsessional doubt triggers to stay in reality in the here and now instead of getting lost in an imagined, irrelevant possibility. The goal in ICBT is to help clients learn to trust their senses and themselves instead of their obsessional doubts.

More information on best practices for OCD treatment can be found here: https://iocdf.org/about-ocd/ocd-treatment-guide/

If you or a loved one is struggling with the symptoms of OCD, seeking help from a mental health professional specializing in the disorder is an important first step towards recovery. 

Shining a Light: OCD Awareness Week

Every year, advocates, organizations, and individuals join forces to promote understanding and reduce the stigma surrounding Obsessive-Compulsive Disorder during OCD Awareness Week, held annually from October 12th to October 18th.

OCD Awareness Week is a vital initiative designed to:

• Educate the Public: Countering harmful stereotypes and spreading accurate information about the disorder’s true nature and impact.
• Reduce Stigma: Creating a safe space for people with OCD to talk openly about their experiences without fear of judgment or ridicule.
• Promote Early Intervention: Encouraging those who suspect they might have OCD to seek treatment promptly, as diagnosis can often be delayed by years due to misunderstanding.
• Support Research and Advocacy: Highlighting the need for continued funding for research into better treatments and raising the voices of the OCD community.

During this week, communities host events, share stories of hope and recovery, and provide resources for those seeking diagnosis and treatment. Recognizing OCD Awareness Week is a proactive step toward creating a more empathetic and informed society where people living with OCD can find the support they need to lead fulfilling lives, free from the constraints of their symptoms.

If you want to support the cause, check out the International OCD Foundation and take time during October 12-18 to educate yourself, listen to the experiences of those with OCD, and share accurate information. Understanding OCD beyond the stereotypes is the first step toward effective support and recovery.

IOCDF OCD Awareness Week:

https://iocdf.org/programs/ocdweek/

Jayme’s photo is courtesy of Jeff Schad Imagery.