What it is
OCD involves:
- Obsessions: unwanted, intrusive thoughts, images, or urges that cause anxiety (e.g., contamination, harm, doubts, “just-right” feelings, taboo or religious themes).
- Compulsions: repetitive behaviors or mental rituals done to reduce anxiety or prevent something bad (washing, checking, arranging, repeating, seeking reassurance, mental reviewing/praying).
People with OCD usually know the thoughts are excessive, but the anxiety feels compelling. OCD is treatable.
Common signs and symptoms
- Intrusive thoughts/images/urges that feel “not me”
- Repetitive behaviors or mental rituals that are hard to resist
- Excessive reassurance-seeking (asking others, googling)
- Avoidance of triggers (knives, bathrooms, certain words/numbers)
- Time cost and distress leading to school/work or relationship strain
OCD is different from perfectionism or liking things neat—distress and time loss are key.
Why it happens
- Brain circuits for threat and habit get stuck in a loop: “danger → ritual → brief relief → stronger loop”
- Intolerance of uncertainty and over-responsibility (“If I don’t check, it’s my fault”)
- Stress, sleep loss, and certain life transitions can exacerbate symptoms
What helps
- Gold-standard therapy: Exposure and Response Prevention (ERP)
- Gradually face triggers (exposure) while resisting rituals (response prevention)
- Learn that anxiety peaks and falls without rituals, breaking the loop
- Cognitive strategies:
- Re-label intrusive thoughts as “OCD thoughts,” not facts or intentions
- Practice “maybe, maybe not” to build tolerance for uncertainty
- Medications:
- SSRIs at therapeutic doses for OCD (often higher than for depression)
- Clomipramine is another option; augmentation strategies for tough cases
- Lifestyle supports:
- Sleep, stress reduction, and reducing reassurance cycles with loved ones
When to seek help now
- Rituals take over an hour a day or significantly impair life
- Avoidance limits routine activities
- Thoughts of self-harm or not wanting to live (seek urgent help)
How to talk to a clinician
- “I have intrusive [contamination/harm/‘just-right’] thoughts and spend about [X] hours doing rituals or mental checking. I’d like ERP therapy and to discuss OCD-targeted medication.”
Outlook
With ERP and, if needed, medication, many people see strong, lasting improvement and regain time and freedom.
Resources for readers in the USA
- Immediate help: 988 Suicide & Crisis Lifeline (call/text 988); Crisis Text Line (text HOME to 741741)
- Find care: Psychology Today directory (filter for ERP/OCD); FindTreatment.gov; NAMI HelpLine (nami.org/help)
- OCD-specific: International OCD Foundation (IOCDF): iocdf.org (therapist directory and education)
- Low-cost/community: Open Path Collective; Community Health Centers (findahealthcenter.hrsa.gov); 211
- Insurance tips: Ask about in-network mental health benefits, telehealth coverage, deductible, copay/coinsurance, prior authorization, out-of-network reimbursement, out-of-pocket max; record rep name/date/reference number
- Work/school supports: FMLA, ADA accommodations (e.g., flexible scheduling); EAP; campus counseling
- Urgent options besides ER: Mobile Crisis via 988 (where available), behavioral urgent care
Disclaimer: Educational information, not a diagnosis. If in crisis, use the resources above.