Understanding OCD: The Basics
Living with Obsessive-Compulsive Disorder (OCD) is often misunderstood, extending far beyond common portrayals of cleanliness or organization. Many people carry misconceptions, believing everyone is "a bit OCD" or that compulsions are always visible, like handwashing. These pervasive myths not only contribute to negative stigma but also minimize the profound daily challenges faced by individuals genuinely struggling with OCD. The reality is that OCD can be a severely crippling condition, frequently going undiagnosed for years and often persisting into adulthood before proper recognition.
What is Obsessive Compulsive Disorder?
There are certain criteria that clinicians screen for when considering a diagnosis for OCD. This means that the following basic components need to be present, then it can branch into subtypes of obsessions or compulsions.
Obsessions: Recurrent, persistent, unwanted, and intrusive thoughts, urges, or images that cause marked anxiety or distress.
Compulsions: Repetitive behaviors (i.e. handwashing, checking) or mental acts (i.e. counting, reviewing) driven by an obsession or rigid rule for self.
Obsessions and compulsions are time-consuming in that people may spend at least one hour per day stuck in obsessive doubt or compulsive behaviors. There is also a level of significant distress or impairment in social, occupational, or other functional areas in a person’s life. This impairment may emerge in a variety of ways such as avoidance. You may avoid anything that would trigger obsessional doubt–going to work, social gatherings, eating certain foods, etc.--which makes life feel very boring.
The final piece of criteria for someone meeting an OCD diagnosis would be to rule out any substance use issues or other medical conditions.
Common Obsessions
Think of a minor, everyday worry—like wondering if you bumped something while driving. For most, that thought is fleeting. But for those with OCD, it transforms into an unshakable obsession. It creates a 'doubting disease' where you lose trust in your own memory. Even if you saw nothing in the road, the intrusive thought—'What if I hit a person'—feels more 'real' than the evidence of your own eyes.
Some common obsessions may include:
Fear of coming into contact with perceived contamination (e.g. bodily fluids, germs, household cleaners, etc.)
Fear of acting on an impulse to harm others, or self
Fear of being responsible for something bad happening, or not being careful enough
Fear of making mistakes, or doing things perfectly
Excessive worry about right/wrong
Fear of acting on sex-related impulse
Common Compulsions
When obsessional doubt builds, it is usually followed by compulsions designed to ease the distress. These behaviors are often driven by the need to prove that a 'feared self'—like someone who could be negligent—isn't true. Whether these compulsions are outward physical acts or internal mental rituals, their goal is to provide a temporary sense of safety and control.
Below are some common compulsions:
Washing hands or showering repeatedly, or in a certain way
Checking that you did/did not do something, checking that you did not make a mistake, etc.
Repeating routine activities, body movements, activities in multiples, etc.
Seeking reassurance, or confessing to a safe person
Mental reviewing of events
Praying to prevent harm, or cancel out bad thoughts
Common Subtypes
The obsessions and compulsions we’ve discussed are just the starting point. In reality, OCD often shows up as specific themes. If you’re struggling, you might notice your focus shifting from one theme to another, or you might even deal with several at once—this is incredibly common. I want to highlight the subtypes I see most often in my work to help normalize these experiences and show you that you aren't alone.
Pure “O” OCD: This theme shows up as mostly mental compulsions (i.e. mental reviewing, seeking reassurance, rumination). This subtype gets most often misdiagnosed as general anxiety since there typically isn’t physical compulsions attached to it.
Pedopheila OCD: This is a subtype that involves intrusive and unwanted sexual thoughts about children. These thoughts tend to evoke extreme shame and distress that don’t align with a person’s true self.
“Just right” OCD: This theme involves a person having to engage in mental or physical compulsions in just the “right” way, often to avoid a sense of discomfort.
Existential OCD: This theme involves intrusive thoughts about life’s big questions that may trigger obsessive rumination. Common existential thoughts may focus on free will, reality, or death.
Relationship OCD: This subtype will show up even in healthy and committed relationships. It involves an overwhelming sense of doubt or shame-based questioning about themselves in a relationship, or characteristics of their partner.
Contamination OCD: This theme involves fear of being harmed or harming others by some form of contamination in the environment, food, or even moral contamination from others.
Treating OCD
Recovering from OCD isn’t about achieving a life completely free of intrusive thoughts; it’s about changing your relationship with them. Intrusive thoughts are normal within the brain’s functioning, but the time we spend on them varies depending on a person’s anxiety. Remember that you have options to how you address your OCD symptoms.
The first step in your healing process is to begin working with a qualified psychotherapist, like myself, to properly assess for OCD. With a therapist you can begin to integrate proven approaches like Exposure Response Prevention (ERP) to face your fears or Inferential- Cognitive Behavioral Therapy (I-CBT) to dismantle the obsessional stories that OCD is telling you.
Even if you start doing the work independently, you are starting on a brave journey to deconstruct a complex disorder, and bridge the gap between fear and reality. Ultimately, the goal is to shift your reliance away from compulsions and back toward a fundamental trust in yourself and your senses. You are more capable than your doubt suggests, and with the right tools, you can reclaim your life from the cycle of OCD.
Reach out today and book a free consultation with an OCD therapist!
References:
International OCD Foundation. 2026. https://iocdf.org/about-ocd/
Patrick McGrath, PhD. NOCD, Inc, 2026. https://www.treatmyocd.com/blog/a-quick-guide-to-some-common-ocd-subtypes
Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.13, DSM-IV to DSM-5 Obsessive-Compulsive Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t13/
