What is OCD?

OCD stands for Obsessive-Compulsive Disorder and is a mental health condition characterized by unwanted, intrusive thoughts, urges, or feelings—called obsessions—that cause significant distress. This distress then drives the urge to perform compulsions, which are behaviors or mental acts done to neutralize, avoid, prevent, disconfirm, seek reassurance about, or disprove the core fears or doubts attached to these intrusions. Put more simply, OCD is a condition where your mind gets stuck on thoughts and feelings that feel important or dangerous, and you feel driven to do things to get relief or feel certain again.

Obsessive-Compulsive Disorder affects about 1 in 100 people in the general population (roughly 1–2.3% depending on the sample and method of measurement) and is associated with one of the longest durations of untreated illness among mental health conditions, often averaging around 7 years before adequate treatment begins, according to the National Institute of Mental Health (NIMH).

For more information about common symptoms and effective treatments, please read below.

Common Symptoms of Obsessive Compulsive Disorder

OCD is not about being “neat” or “type A.” It is a mental health condition characterized by intrusive thoughts and repetitive behaviors or mental acts that are performed to reduce distress. The Yale-Brown Obsessive Compulsive Scale II (YBOCS II) is the gold standard assessment tool used to diagnose and assess OCD symptoms. The symptoms described below are taken from the YBOCS II and are summarized with the help of ChatGPT for clarity and conciseness. These descriptions are for educational purposes only and are not meant or intended for diagnosis or assessment. Please seek the help of a qualified OCD professional for diagnosis and assessment.

Obsessions (Intrusive Thoughts, Images, or Urges)

Obsessions are distressing mental experiences that are unwanted, distressing, and ego-dystonic (they go against a person’s values).

  • Fear of harming oneself or others (even though there is no desire to do so)

  • Intrusive sexual thoughts or images that feel disturbing or taboo

  • Fear of contamination (germs, illness, bodily fluids, chemicals)

  • Excessive doubt or fear of making mistakes

  • Fear of causing accidents, disasters, or irreversible harm

  • Religious or moral fears (fear of sinning, offending God, or being immoral)

  • Need for things to feel “just right” or complete

  • Disturbing violent or graphic images

  • Fear of losing control or acting impulsively

Compulsions (Behaviors or Mental Acts)

Compulsions are attempts to reduce anxiety, neutralize thoughts, or prevent feared outcomes. They can either take the form of behaviors or mental actions.

  • Excessive handwashing, cleaning, or disinfecting

  • Repeated checking (locks, appliances, doors, messages)

  • Mental reviewing or replaying past events

  • Seeking reassurance from others

  • Repeating actions until they feel “right”

  • Counting, tapping, or repeating words silently

  • Avoidance of people, places, or objects that trigger distress

  • Confessing thoughts or seeking certainty about intentions

  • Excessive researching or “googling” for reassurance

Common Avoidance Behaviors in OCD

Avoidance is a common and central feature of OCD. While not always obvious, avoidance can significantly reinforce symptoms and reduce quality of life. Avoidance occurs when a person changes their behavior, routines, or environment to prevent triggering intrusive thoughts or distress.

  • Avoiding people, places, or situations that trigger intrusive thoughts

  • Avoiding objects associated with feared harm or contamination

  • Delaying or refusing tasks due to fear of making mistakes

  • Avoiding driving, cooking, or being alone due to harm-related fears

  • Avoiding news, media, or conversations that might trigger thoughts

  • Avoiding relationships or intimacy due to intrusive sexual or moral thoughts

  • Avoiding decision-making to prevent doubt or regret

How Is OCD Treated?

OCD is highly treatable. The most effective, evidence-based treatment is a form of cognitive-behavioral therapy called Exposure and Response Prevention (ERP). Many people also benefit from medication, particularly certain antidepressants, alongside therapy.

What Is Exposure and Response Prevention (ERP)?

ERP is a subbranch of cognitive behavioral therapy that helps people learn that they can experience intrusive thoughts, uncertainty, and anxiety without needing to perform compulsions or avoid situations.

ERP is tailored to each individuals specific fears and concerns, and works by gently and gradually helping people:

  • Face feared thoughts, images, situations, or sensations (exposure)

  • Resist the urge to perform compulsions or avoidance behaviors (response prevention)

  • Learn, through experience, that anxiety rises and falls on its own

  • Discover that feared outcomes do not occur — or are tolerable even if uncertainty remains

Rather than trying to eliminate intrusive thoughts, ERP focuses on changing the relationship to them.

What ERP Is Not

ERP is often misunderstood. It is NOT:

  • Flooding or forcing people into overwhelming situations

  • about “getting rid of thoughts”

  • About proving thoughts are irrational

  • About white-knuckling anxiety alone

ERP is collaborative, paced, and tailored to the individual.

How ERP Helps Over Time

It is rather interesting, and albeit ironic, that the most effective behavioral treatments we have for Anxiety and OCD are facing fears (done in a controlled way). We don’t currently know and can say for certain as to how facing fears and resisting the urge to avoid those fears is helpful. Yet, there are a few popular theories that attempt to explain why. Among those are the ideas of Emotional Processing and Inhibitory Learning.

Emotional Processing Theory

Emotional Processing Theory is a fancy way to explain the idea that exposure first works by activating and introducing a “fear structure”—a supposed web of associations between different objects, situations, emotions, and behaviors that resides in memory— to incompatible information, thereby changing its structure. The implicit idea here is that this fear structure is a dynamic entity that has the ability to change and alter its structure. The indicator used to determine if this “fear structure” had been altered was habituation, the lessening of anxiety one feels in response to a trigger over time. It was thought that habituation was a consequence of information being altered or extinguished within the “fear structure”: “Well, if you are getting less anxious after facing the the same thing, something must be changing!”. There are a few gaps to this idea that don’t match up to later research:

  1. By using habituation (fear reduction) as a treatment metric, it implicitly stereotypes anxiety itself as “bad”, potentially encouraging a “fear of fear” mindset

  2. Long-term outcome studies have shown that people can experience positive outcomes without becoming less fearful.

This last point may sound interesting. How is that you can have long-term positive outcomes, without becoming less fearful?

Inhibitory Learning

So, how is it that people can have long-term positive outcomes without becoming less fearful? To explain this, the Inhibitory learning framework posits the existence of a “fear structure”—a web of fear based associations—and a “safety structure”—a web of safety based associations. Exposure, then, doesn’t work by altering the fear structure, but by rather strengthening the safety structure, so that when confronted with the scary situation, the safety web of associations “outcompetes” the fear-web of associations. Think Jarvis defeating Ultron in some alternate universe (excuse the nerdy marvel reference), or even how vaccines work. We didn’t get rid of or “destroy” smallpox. It still exists out in the world and attempts to infect us. Vaccination strengthened the body’s competing system — immunity — until the virus had nowhere to take hold. Inhibitory learning is in this same vain: fears the virus and exposure the “vaccination”. Exposure strengthens the minds safety system so that fears have nowhere to take hold.

The implication here is as a result of facing our fears, we become braver, more open and willing to face what is scary in service of some deeper value. And besides, what does “long-term positive outcome” actually mean? The answer probably looks akin to the answer to the question: “What encompasses a good life? One that is rewarding and meaningful?”. That is not an easy question to answer, but it likely involves some struggle and pain in service of something that makes that discomfort worthwhile: Living a fuller life even when anxiety shows up, rather than waiting for anxiety to disappear.

People with OCD often fear that having intrusive thoughts says something about who they are. Facing your fears and learning to resist running away from them helps demonstrate, again and again, that thoughts are not actions — and that anxiety does not need to be obeyed and that maybe, the monster doesn’t have any teeth.

Resources and Information

If you are someone you know is struggling with OCD or related symptoms, please refer to these resources for help and guidance.