When you have obsessive-compulsive disorder (OCD), you may have unwanted thoughts, urges, or images that keep popping into your mind. You may try to fight with them or get rid of them. You know they don’t make sense but they bother you anyway. And they keep coming back. These are known as the obsessions in obsessive-compulsive disorder.
You may also have things that you feel you have to do. You may have to repeat them over and over until you feel you’ve done them enough, or just right. You might feel that if you don’t do these things, something awful might happen, or that if you don’t do these things, you will not be able to relax or feel OK. These actions are known as the compulsions in obsessive-compulsive disorder.
These obsessions and compulsions give rise to what is called the OCD cycle:
- A disturbing thought, image, or urge comes up in your mind, which leads to:
- Unpleasant feelings such as anxiety, disgust, doubt, or discomfort, which lead to:
- Doing something that makes the unpleasant feelings go away or get less intense, which leads to:
- Relief, which unfortunately is always temporary, until the cycle starts again.
If you’re experiencing OCD, you’re likely familiar with this cycle and the way you feel trapped. You probably spend a lot of time and energy either doing compulsions or avoiding situations that cause obsessions to arise in the first place.
In popular culture, OCD is often portrayed as someone who is scared of germs, or someone who is very neat and orderly, with everything in just the right place. In fact, OCD can take many forms, and in my clinical experience, many people experiencing OCD have some mix of different kinds. Regardless of what kind of OCD you are experiencing, the underlying principles are the same.
Here are some examples of common types of OCD, and the obsessions and compulsions that might go along with each. This does not cover every possibility, but represents some of the most common ways that OCD shows up.
| Type | Obsessions | Compulsions |
| Contamination | Worry about germs, either contact with yourself or contaminating others, concerned about cleanliness | Hand washing, cleaning, avoiding touching certain things, avoiding certain areas, keeping clean and dirty things separated. |
| Harm | Worries about harming others, worries about having harmed others in the past, violent or aggressive mental images, sexual thoughts or images that feel inappropriate | Avoiding others, seeking reassurance that you aren’t capable or harm, researching, checking to make sure you haven’t harmed anyone, repeating memories to check that you didn’t harm anyone |
| Just Right | Feeling like things need to be done a certain way, symmetry concerns – wanting things to be the same on both sides, worries that “something bad” might happen if things are not done the right way | Repeating things until it feels “just right,” moving your body in a certain way, making sure objects are arranged a certain way, repeating mental actions or images |
| Sexuality | Worries and doubts about your sexuality (e.g. Am I actually gay? Am I actually straight?) Note: this is different than normal sexual identity exploration – this is persistent doubt and questioning despite all experience and evidence. | Checking to see if you are attracted to certain people, avoiding situations that lead to obsessions, asking other people what they think you “are,” constantly researching to try and “figure out” your sexuality |
| Relationship | Doubting your intimate relationships | Questioning if you are with the right person, testing yourself to see if you are really attracted to or love your partner, comparing your relationship to others |
| Religious / Scrupulosity | Worries that you have violated religious rules, worries that you are damned, worries that you have not acted the right way according to your religion, morals, or ethics | Doing things to “un-do” sinful actions, excessive prayer or seeking forgiveness, rigid rule following, repeating prayers or other religious actions until they feel “just right” or “enough,” avoiding saying, doing, or seeing things that feel wrong |
| Magical Thinking | Feeling that certain numbers, words, colors, etc. are “bad,” worries that certain thoughts will cause bad things to happen | Avoiding looking at, hearing, being around, or using “bad” numbers, words, colors, etc. Doing things to “un-do” bad thoughts or actions, counting or talking in specific ways to protect yourself |
| Pure O | Some people talk about “Pure O,” OCD meaning there are obsessions but no compulsions. | Many researchers, and my own clinical experience, suggest that there is not really a Pure O type. This perspective suggests that what is actually happening is that the compulsions are mental actions, there is no outward physical compulsion. |
If you or someone you care about is experiencing symptoms of obsessive-compulsive disorder, it is important to get help. Most people suffering with OCD wait years before getting treatment, and even then they often get ineffective treatment.
The front-line treatment for OCD is exposure therapy, or, exposure with response prevention (ERP). This is the best researched, most effective therapy for OCD. Traditional talk therapy is effective for many mental health concerns, but is typically ineffective for OCD. That is why it is important to seek out a specialist who has the advanced training required to deliver exposure therapy to reliably address OCD.
Briefly, exposure therapy involves helping people to gradually, but systematically, face the situations, thoughts, places, people, or objects that lead to obsessions, while at the same time not engaging in the compulsions. For example, a person experiencing contamination OCD might work on touching a doorknob or a lightswitch and then not washing their hands. At first, this will feel very challenging. Over time the anxiety naturally lessens and the obsessions and compulsions are reduced and go away.
If you are ready to begin breaking free from OCD, contact me to get started. I provide exposure and response prevention therapy (ERP) online via telehealth to people throughout Colorado. I have been practicing therapy since 2010 and have received advanced training and experience in exposure and response prevention since 2015.
Get started by setting up a free 20 minute consultation. I will find out more about your problems and explain how I would approach treatment and what exposure therapy would look like for you. Call or email me, I look forward to speaking with you!
-Aaron Hudyma, Ph.D.
telephone: 303.834.7405
email: contact@hudymapsychology.com