Most of us have occasional anxious thoughts like “did I lock the door?”, leading us to doublecheck the door is locked. However, for some these intrusive thoughts are more frequent and distressing, and lead to unhelpful, repetitive behaviours that can be difficult to control.
Struggling with Intrusive Thoughts or Repetitive Behaviours?
Roughly nine out of ten people experience intrusive thoughts or images that are disturbing to them (e.g. “what if a loved one has a car accident?”). However, for most people the distress caused by these thoughts passes quickly and they can move on with their day.
For some though, moving on from the thought is not so easy. Their thoughts can feel intensely distressing or out of character (called ‘ego-dystonic’ thoughts), and may come with a strong sense of urgency to do something to make the feeling or thought go away.
They then discover that repeating a particular action or behaviour after they have the thought makes them feel less distressed, which can lead to repeating the behaviour over and over again. The combination of distressing, intrusive thoughts with repetitive behaviours is what makes up Obsessive-Compulsive Disorder.
What Is Obsessive-Compulsive Disorder (OCD)?
As the name suggestions, Obsessive-Compulsive Disorder (OCD) involves two key parts: obsessions and compulsions.
Obsessions are recurrent intrusive thoughts, images, or urges that feel unwanted and cause significant distress or anxiety.
Compulsions are the repetitive behaviours or mental acts that follow. They’re done to neutralise or get rid of the obsession, and/or reduce the distress associated. The compulsion may not be logically related to the obsession, for example the urge to tap a particular object a certain number of times to negate the fear that a family member will be harmed.
While compulsions can bring short-term relief, they reinforce the strength of the original obsession, forming a vicious cycle that makes the obsessions return more frequently and feel more intense.
Common Types of OCD
OCD can look different person to person, and not all experiences of OCD are obvious from the outside. Some common types of OCD obsessions include:
- Contamination: Fears of encountering something unclean or dirty
- Violence or harm-related: Fears regarding causing harm to yourself or others
- Responsibility: Fears of being responsible for something terrible happening
- Perfectionism, symmetry and ordering: Excessive concern about exactness, or fears regarding forgetting or losing important information, or making mistakes
- Sexual or taboo: Unwanted intrusive sexual or taboo thoughts, including fears of sexually harming others or behaving inappropriately towards family, friends, strangers or children
- Religious/moral: Also called ‘scrupulosity’. Fears of damnation, offending God, violating moral codes, or excessive concern about doing the right/wrong thing
Some people also experience obsessions around their behaviour in relationships, their identity, or existential themes such as death and meaning in life.
Common compulsions aimed at preventing the fear coming true include:
- Washing and cleaning rituals
- Checking things a certain number of times
- Seeking reassurance from others
- Needing things to be in their proper place, or ‘just so’
- Needing to do things a certain way, a certain number of times, or ‘perfectly’
- Mental rituals such as counting, repeating phrases, praying, or reviewing memories
- Needing to say particular things a certain way or number of times, or murmur them under your breath
Many people experience a mix of these, and symptoms often change over time.
How OCD Can Affect Daily Life
OCD can be exhausting, as the obsessions and compulsions interfere with daily activities, special events, and prevent the person from relaxing and enjoying themselves.
These are some common ways OCD can affect daily life:
- Simple tasks take much longer than they should, leaving less time for more meaningful activities
- You can feel constantly on edge, or that your mind is busy and unable to slow down
- It can be hard to feel genuinely present, as your mind is constantly elsewhere thinking about obsessions or compulsions
- Relationships can be negatively affected, as your repeated seeking of reassurance can be frustrating to others, or you might feel embarrassed about behaviours that are hard to control. Your avoidance of certain triggering situations might also lead to withdrawal and isolation from loved ones.
- Work or study can also be impacted. Compulsions can cause you to run late or affect your ability to stay focused, or your avoidance of triggers might prevent you from completing necessary tasks.
The intense distress associated with OCD also commonly results in mood and anxiety difficulties, or difficulties with substances as you might self-medicate as a way to escape distress.
How OCD Therapy Can Help
OCD is treatable. Often combined with medication, therapy can make a real difference in your symptoms and address the underlying drivers of OCD.
Treatment focusses on helping you change your relationship with intrusive thoughts and gradually reduce the need to respond to them with compulsions. Rather than aiming to ‘get rid of’ the thoughts altogether, therapy helps you respond to them in a way that reduces their impact over time.
Counterintuitively, as time passes this usually results in reduced intensity and frequency of the thoughts, as well as reductions in engaging in compulsive behaviours.
OCD treatment aims for you to:
- Reduce the intensity and frequency of intrusive thoughts
- Feel less driven to engage in compulsions or rituals
- Build confidence in tolerating uncertainty and discomfort
- Respond to thoughts in a more flexible and less distressing way
- Re-engage in everyday activities without avoidance or delay
- Improve concentration, sleep, and overall wellbeing
- Strengthen your sense of control and trust in yourself
OCD therapy is collaborative and paced according to your needs. You are not forced to confront anything before you feel ready, and your psychologist will support you step-by-step.
Our Psychologist’s Approach to OCD Treatment
We take an individualised and collaborative approach to working with OCD, using modalities that have a published evidence base. These include:
- Cognitive Behavioural Therapy with Exposure and Response Prevention (ERP): ERP is the gold-standard treatment for OCD. It involves gradually facing feared thoughts or situations whilst reducing the urge to engage in compulsions, helping to break the cycle between obsessions and compulsions over time.
- Acceptance and Commitment Therapy (ACT): ACT supports people to relate differently to intrusive thoughts, learning to notice them without getting caught up in them, while focusing on actions that align with personal values.
There is also evidence that for some people, their experience of OCD is related to underlying difficulties, such as attachment disruption, trauma, or existential fears. Your psychologist will explore your unique experience and symptoms and formulate a treatment plan based on your needs.
What to Expect in OCD Therapy
OCD therapy is a structured, gradual process. Early sessions usually focus on building the relationship with your psychologist, and your shared understanding of your symptoms. This includes identifying patterns between thoughts, feelings and behaviours, including when symptoms started and what makes them better or worse.
From there, therapy typically involves working towards reducing compulsions and facing feared situations in a supported way. This can feel challenging, particularly when you start making changes. However, you’ll be supported at each step, and because therapy is collaborative, you have the final say in the pace throughout.
Over time, many people notice that the thoughts are less powerful, less frequent, and easier to let pass without needing to act on them.
Why Choose Our OCD Psychologists?
At Peaceful Mind Psychology, we have a number of psychologists with experience supporting people with OCD and related difficulties, and understand how complex and distressing it can feel.
We aim to provide a space that is non-judgemental, practical, and focused on helping you make meaningful changes. This includes working with thoughts that may feel difficult to talk about with others, at a pace that feels safe and respectful.
If OCD has been taking up more space in your life than you’d like, support is available. Reach out to our team to discuss how we can support you.
If you’d like to learn more about OCD, the International OCD Foundation is a great resource. They have a huge range of information available on origins, treatment, and research about OCD, as well as OCD as it relates to other mental health conditions.
- What causes OCD to get worse?
Because compulsions tend to give us a sense of relief, this means we are more likely to repeat the compulsion the next time we’re distressed. Unfortunately the relief we get from engaging in compulsions tends to be short-lived, and actually reinforces the idea that our intrusive thoughts are dangerous and should be avoided – thus leading to a vicious cycle of intrusive thoughts and compulsions. Compulsions also can tend to get stronger when we are under a lot of stress in our lives more broadly.
- Is OCD an anxiety disorder?
Historically in psychological communities, OCD has tended to be classified under the heading of anxiety disorders. However, in more recent years OCD has been separated out into its own category of obsessive compulsive and related disorders. Whilst this is a topic of ongoing debate, it is fair to say that OCD and Anxiety share many features, including the experience of persistent and distressing thoughts. However, OCD differs from anxiety in that it also involves persistent attempts to control or avoid these distressing thoughts with rituals or compulsions. A diagnosis of OCD does not require a diagnosis of Anxiety, and vice versa, but it is also possible to have both OCD and Anxiety at once.
- What is the root cause of OCD?
Although the exact cause of OCD is unknown, like other mental illnesses it is believed that OCD likely develops from a combination of factors. These include genetics (i.e. it can run in families), and differences in how brains process threatening thoughts (like feeling overly responsible for things, believing a thought to be dangerous in itself, or needing complete certainty in life). Stressful life events can sometimes trigger or worsen OCD, but they’re not usually the main cause.
Research has also found that certain areas of the brain function differently in people with OCD, compared to people without OCD, pointing to a neurological basis also. Fortunately, brain imaging studies have also shown that effective OCD treatment can actually change the way our brain works and make it easier for us to let go of intrusive thoughts, without having to avoid or neutralise them.
- How do I help someone with OCD?
Firstly, learn about OCD – a good place to start is the International OCD Foundation website, which has information about how OCD works and how to support people with OCD. If possible, support the person with OCD in accessing appropriate treatment, and ask them how you can help in the treatment process. Finally, be patient and understanding, and act normally around them! People with OCD are usually aware that their behaviours may not make sense, and might feel embarrassed about their rituals and compulsions. Do what you do best by being a good friend and offering support when and where you feel comfortable. And of course, when caring for others, make sure to look after your own mental health too.