Understanding Obsessive Compulsive Disorder (OCD)

By Salina Grilli, LMSW

 “Oh that’s just my OCD.” – A friend commenting on how organized she is. 

Obsessive Compulsive Disorder (OCD) is one of the most commonly misunderstood mental illnesses. It is often associated with organization and cleanliness. However, OCD is a complex disorder that is more than just ‘cleaning’ and ‘organization.’

What is Obsessive Compulsive Disorder (OCD)?
OCD is a neurobiological disorder that is characterized by intrusive and recurring thoughts, feelings and/or sensations (obsessions), accompanied by behaviors that are used to minimize discomfort and ‘undo’ the obsessive thought (compulsions). 

What is it like to suffer from OCD?
Imagine this scenario: You’re home with your spouse cooking dinner one night. As you chop up the vegetables, you have an image pop into your head where you grab the steak knife from the counter and start stabbing your spouse. 

Individuals without OCD might say to themselves, “Weird, I must be watching too many true crime shows, maybe I should cut back,” and then return to cooking. 

For individuals with OCD, intrusive thoughts are much harder to let go of. You might think, “What if I’m actually a murderer? I might lose control one day and kill my spouse.” Since this is incongruent with your values, you feel anxious and panicked. To reduce your anxiety, you might engage in a compulsive behavior (for example, repeating the word ‘peace’ to yourself 10 times). This provides you with temporary relief. When the thought comes back, you feel more anxious and have to repeat the word ‘peace’ 10 times. As these intrusive thoughts reoccur you find yourself trapped in the OCD cycle:


So, how do I know if I have OCD?
Everyone experiences intrusive thoughts, but for individuals with OCD these intrusive thoughts are almost impossible to ‘let go,’ and their thoughts become debilitating.  In order to be diagnosed as having OCD, obsessions and compulsions must cause significant impairments in functioning and/or take up a substantial amount of time (at least one hour per day). If you find yourself fitting into one of those categories, it might be helpful to speak to a therapist to assess whether you have OCD. 

What are common obsessions?

  • Contamination
    • Examples: germs, bodily fluids/waste, toxins/chemicals
  • Fear of Losing Control
    • Example: Fear of harming your children. 
  • Responsibility for harm or mistakes
    • Example: Fear of being responsible for a fire or car accident.
  • Order/symmetry 
    • Example: Fixation with ending on even numbers.  
  • Obsessions concerning violence, sex, morality and religion
    • Example: Hurting a family member

What are common compulsions?

  • Checking
  • Decontamination
  • Ordering/arranging
  • Repeating actions
  • Reassurance seeking rituals

What are the best treatments for OCD?
The most effective treatment for OCD is a combination of Exposure and Response Prevention (ERP). Exposure and Response Prevention is a subset of Cognitive Behavioral Therapy (CBT) that exposes individuals with OCD to their intrusive thoughts, images, and sensations (obsessions) without using anxiety-reducing techniques (compulsions). 

The purpose of exposure therapy is to reduce the anxiety associated with the feared thought/image/sensation. This is accomplished through exposures that help an individual recognize that their thoughts are irrational. 

ERP is often paired with Cognitive Behavioral Therapy (CBT), which focuses on understanding and changing unhelpful thoughts, behaviors and emotions that reinforce the OCD cycle.

How effective is treatment for OCD?
According to Stanford Medicine's Department of Psychiatry approximately 65-75% of individuals who complete ERP therapy maintain improvements 6 months and 3 years after the intervention.

Abramowitz, Jonathan S. Getting over OCD a 10-Step Workbook for Taking Back Your Life. The Guilford Press, 2018.

Salina Grilli is a therapist at Cobb Psychotherapy. If you would like support in prioritizing and taking care of your mental health, contact Cobb Psychotherapy and see how therapy can help.