I often hear phrases like “I’m a bit OCD” used to describe liking things tidy, organised or arranged in a particular way. But Obsessive Compulsive Disorder (OCD) is very different.
OCD can be frightening, exhausting and incredibly time-consuming, because many compulsions aren’t visible to other people, someone may be struggling significantly without anybody around them realising. October being OCD Awareness Month provides an opportunity to talk more openly about what OCD can actually look like.
What Is OCD?
OCD usually involves obsessions and compulsions.
Obsessions are unwanted intrusive thoughts, images, doubts or urges that cause distress. These might involve fears about contamination, causing harm, making a terrible mistake, relationships, sexuality, religion or whether something “bad” could happen. However importantly intrusive thoughts often focus on the things that matter most to us.
Having an unwanted thought doesn’t mean you want it to happen. It doesn’t mean it says something important about who you are. Intrusive thoughts are part of being human.
When Intrusive Thoughts Become a Problem?
The difficulty often isn’t the thought itself, it’s what we do next. When a thought feels threatening or dangerous, we naturally want certainty or relief.
This might mean washing hands repeatedly, check doors, appliances or messages, ask other people for reassurance, avoid certain situations and people or repeatedly search online for answers.
But compulsions can also happen entirely inside our heads, such as replaying conversations, analysing memories, checking how you feel, mentally reviewing if you have done something wrong or repeatedly try to ‘work out’ what an intrusive thought means.
All of these strategies may provide temporary relief but that relief then re-enforces and teaches the brain;
‘That thought was dangerous and I needed to do something about it.’
So the OCD cycle continues.
CBT and OCD
CBT for OCD involves learning to understand this cycle and gradually changing the response to intrusive thoughts and uncertainty.
Rather than trying to achieve complete certainty, therapy helps people to learn that they can experience doubt or discomfort without responding with compulsions.
This can include Exposure and Response Prevention (ERP) which is an evidence-based treatment for OCD. The aim isn’t to deliberately make somebody distressed or simply tell them to ‘stop worrying’. It’s a gradual and collaborative process of helping the brain learn:
‘I don’t have to solve every doubt.’
OCD Can Get Better
Many people live with OCD for years before seeking support, particularly when their intrusive thoughts feel embarrassing, shameful or frightening. Sometimes people worry that even telling a therapist what they’re thinking will lead to judgement. However, understanding OCD changes that conversation.
A thought is not an action.
A thought is not an intention.
And having an intrusive thought doesn’t define you.
I’m Claire Calvert, an accredited CBT therapist based in Sunderland, and I work with young people and adults experiencing OCD and anxiety.
CBT including ERP can help people understand the OCD cycle, reduce compulsions and develop a different relationship with intrusive thoughts and uncertainty.
