Obsessive Compulsive Disorder- Symptoms and Treatment for OCD

What is OCD?

Obsessive Compulsive Disorder (OCD) is a mental health disorder that involves obsessive thoughts, feelings, sensations, urges, and compulsive behaviors.
An obsession involves intrusive and unwanted thoughts that create significant anxiety, uncertainty, and discomfort. Most people with OCD will report that their obsessions greatly impact their quality of life and make it hard to cope with daily life.

A compulsion is an overt or covert repetitive behavior done in an attempt to reduce the anxiety and uncertainty created by intrusive thoughts. These compulsions are very time-consuming and only reinforce the obsession.

OCD

Symptoms of OCD

Obsessive Compulsive Disorder (OCD) involves obsessions AND compulsions. Common symptoms involve:

  • Severe degrees of anxiety, panic, worries, and fear.
  • High levels of uncertainty, anticipatory anxiety, and dread.
  • Feeling “stuck” in their thoughts, feelings, and behaviors.
  • Feeling like their “brain broke” and that something is wrong with them
  • Lack of motivation to engage in daily activities
  • Struggles to stop compulsive behaviors and feel bad about themselves for this.
  • Questions their diagnosis of OCD and worries “What if my thoughts are true?”
  • Many people with OCD also suffer from depression, hopelessness, low self-worth, and significant self-criticism.

Types of Obsessive-Compulsive Disorder (OCD)

Contamination OCD

  • Obsession: Intrusive thoughts and fears surrounding germs, chemicals, and contaminants.
    • E.g. “What if I get sick” or “What if I get dirty?”
  • Common Compulsions: Hand washing
    • Use of cleaning products
    • Avoidance of feared substances, chemicals and, household products.
    • Mental rumination about contamination.

Symmetry OCD

  • Obsession: Fear or discomfort about objects that do not line up correctly, symmetrically, or in a preferred pattern.
    • E.g. “What if things are not even and something bad happens?”
  • Common Compulsions: Moving or re-aligning objects or avoiding using objects in fear that they will get stuck having to be re-aligned again.
    • Asking family members to move or align objects to satisfy one’s obsession.

Sexual Orientation OCD, also known as HOCD

  • Obsession: Fear of being of a different sexual orientation. This obsession was once known as HOCD (fear and uncertainty of being or becoming a homosexual) but now applies to people of all sexual orientations.
    • E.g. “What if I am gay?” or “What if I am bisexual?” or “What if I am straight?”
  • Common Compulsions: Avoidance of anything that represents their fears’ sexual orientation
    • Mental rumination, in an attempt to figure out what sexuality best describes them or if they are in “denial”,
    • Online reassurance-seeking, or repetitively questioning if they actually have OCD.

“Just Right” OCD

  • Obsession: Fear of the “not right” feeling
    • E.g. “What if it doesn’t feel just right and something bad happens?”
  • Common Compulsions:  doing behavior (checking, walking through doors, cleaning items) until experiencing the “just right” feeling.
    • Mental rumination, in an attempt to figure out what sexuality best describes them or if they are in “denial”,
    • Avoiding events, numbers, colors, or words that result in the “not right” feeling.

Harm OCD

  • Obsession: Fears of violently hurting others.
    • E.g. “What if I harm myself or others?”
  • Common Compulsions: Avoidance of loved ones
    • Avoidance of potential harming objects (knives, cars, sharp objects, etc)
    • Asking for reassurance that they will not or did not hurt another.
    • Mental rumination to find certainty about the intentions of these thoughts or repetitive questioning if they actually have OCD.

Pedophile OCD

  • Obsession: Fear of being attracted to a minor, fear of performing a sexual behavior with a minor.
    • E.g. “What if I am attracted to a child? Or “What if I sexually assaulted a minor?”
  • Common Compulsions: Avoidance of areas where children gather (schools, daycare centers)
    • Mental rumination, in hope to find certainty about the intentions behind these thoughts
    • Mentally checking for arousal, seeking reassurance from loved ones or the internet
    • Repetitive questioning if they have OCD.

Post-Partum and Perinatal OCD

  • Obsession: Fear of harming one’s baby and/or child.
    • “What if I harm my baby?” or “What if I miss something and my baby is hurt?”
  • Common Compulsions: Avoidance babies and/or children,
    • Reassurance seeking from loved ones and the internet
    • Mental rumination, in the hope to find certainty about the intentions of these thoughts
    • Repetitive questioning if they actually have OCD.

Moral or Religious OCD

  • Obsession: Fear of offending God or fear of not having salvation.
    • Fear of doing a behavior that doesn’t line up with their morals/religion.
    • E.g. “What if I offended God and never go to heaven?”
    • E.g. “What if I do something that goes against my morals?”
  • Common Compulsions: Praying over and over.
    • Praying or behaving “perfectly”
    • Saying religious words or phrases over and over.
    • Avoidance of blasphemous or “immoral” thoughts.
    • Mental review of behaviors to resolve if they were “good” or “bad”

Relationship OCD or ROCD

  • Obsession: Fear and uncertainty about whether their partner is “the one”.
    • E.g. “What if I don’t actually love my partner?” or “What if I cheat on my partner?”
  • Common Compulsions: Mentally reviewing their partner’s behaviors.
    • Mentally scrutinizing their feelings and emotions towards their partner.
    • Checking and comparing one’s feelings for their partner

Emotional Contamination OCD

  • Obsession: Fear that contact with a person will alter them or endanger them.
  • Common Compulsions: Avoidance of feared person
    • Mental review of the proximity of feared person during recent exposure
    • Handwashing, cleaning, and other physical compulsions in the hope to neutralize their recent exposure to the feared person.

Existential OCD

  • Obsession: Repetitive questioning about the purpose of one’s life.
    • E.g. “What if I never know the reason for life?”
  • Common Compulsions: Mental rumination about the purpose of life
    • Excessive research or inquiry about the meaning of life.

Obsessing about Obsessing

  • Obsession: Fear that one will never be able to stop obsessing or having intrusive thoughts.
    • E.g. “What if I never get better?” or “What if I never stop obsessing?”
  • Common Compulsions: Mental avoidance of feared thoughts
    • Avoidance of events that may trigger obsessions.
    • Tries to engage in treatment perfectly or using therapy skills as a way to avoid fear.

Hyper-Awareness OCD

  • Obsession: Fear that one will never stop noticing a sensation or feeling (breath, hands tingling, a specific side of their body or body part, itches).
    • E.g. “What if I never stop noticing my breath?”
  • Compulsions: Mental rumination over the sensation or how to get rid of the sensation
    • Avoidance of behaviors that increase the awareness of uncomfortable sensations.

Perfectionism Obsessions

  • Obsession: Fear of not being perfect or being perceived as not perfect in one or more areas of life
    • E.g. “What if I make a mistake?” or “What if I fail?”
  • Common Compulsions: Attempting to be “perfect” (high grades, hobbies, social skills, friendships, not hurting people’s feelings, not being vulnerable).
    • Highly self-critical of self
    • Redoing actions and projects to assure perfection.

Hyper-responsibility Obsessions

  • Obsession: Fear of being responsible for a tragic event.
    • E.g. “What if I am responsible for an accident?”
  • Common Compulsions: Checking (stoves are off, doors are locked, matches are out, no one was hurt, etc)
    • Mentally reviewing or asking for reassurance to be sure no one was physically hurt or no one’s feelings were hurt.

Testing for OCD

The diagnostic criteria for OCD are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM).  All of our clinicians are trained to be able to diagnose OCD and OCD-related disorders, such as Health Anxiety, Panic Disorder, Generalized Anxiety Disorder, Compulsive Skin Picking, and Hair Pulling.

During treatment, we use a common OCD test called the Yale-Brown Obsessive-Compulsive Scale (YBOCS) to identify each symptom of OCD and create an appropriate plan for treating OCD and get you back to your normal level of functioning.  In addition to administering this test for OCD, our clinicians will also assess for other disorders, to make sure you are being treated with the highest quality care.

Treatment for OCD

Fortunately, there are several evidence-based treatment options available for individuals struggling with Obsessive-Compulsive Disorder (OCD). These treatments have been extensively studied and have been shown to be effective in managing the symptoms of OCD and improving the overall quality of life for those affected by this condition.

The two primary evidence-based treatments for OCD are:

  1. Cognitive Behavioral Therapy (CBT): CBT is a highly effective psychological treatment that focuses on helping individuals identify and modify the negative thought patterns and behaviors that contribute to their OCD symptoms.
  1. Medication: Certain medications, particularly selective serotonin reuptake inhibitors (SSRIs), have been found to be effective in reducing the symptoms of OCD and improving overall functioning.

In addition to these primary treatments, there are also some alternative and complementary therapies that may be beneficial for individuals with OCD, such as mindfulness-based interventions, exposure therapy, and transcranial magnetic stimulation (TMS).

Cognitive Behavioral Therapy (CBT) for OCD

Cognitive Behavioral Therapy (CBT) is widely recognized as the most effective psychological treatment for Obsessive-Compulsive Disorder (OCD). This evidence-based approach focuses on helping individuals identify and modify the negative thought patterns and behaviors that contribute to their OCD symptoms.

The core components of CBT for OCD include:

  1. Psychoeducation: The therapist will provide the individual with information about the nature of OCD, the underlying mechanisms that contribute to the condition, and the rationale for the CBT approach.
  1. Cognitive Restructuring: The therapist will work with the individual to identify distorted or irrational thoughts that fuel their obsessions and compulsions, and then work to change their reaction to these thoughts.
  1. Exposure and Response Prevention (ERP): This technique involves gradually exposing the individual to the situations or stimuli that trigger their obsessions, while preventing them from engaging in the compulsive behaviors they typically use to alleviate the anxiety and uncertainty. This helps the individual learn to tolerate the anxiety and reduce the power of their obsessions over time.
  1. Behavioral Experiments: The therapist may also guide the individual in conducting behavioral experiments to test the validity of their beliefs and challenge their compulsive behaviors.

By engaging in CBT, individuals with OCD can learn to manage their symptoms more effectively, reduce the impact of their obsessions and compulsions on their daily life, and develop more adaptive coping strategies. Research has consistently shown that CBT, particularly when combined with ERP, is the most effective psychological treatment for OCD, with long-lasting benefits for individuals who complete the therapy.

To read more about ERP, please read our extensive article HERE

Alternative and complementary treatments for OCD

While the primary evidence-based treatments for Obsessive-Compulsive Disorder (OCD) are Cognitive Behavioral Therapy (CBT) and medication, there are also several alternative and complementary therapies that may be beneficial for some individuals in managing their symptoms.

Some of the alternative and complementary treatments that have shown promise in the treatment of OCD include:

  1. Mindfulness-Based Interventions: Mindfulness-based therapies, such as mindfulness-based cognitive therapy (MBCT) and acceptance and commitment therapy (ACT), can help individuals with OCD learn to observe their thoughts and feelings without judgment, and develop greater acceptance and flexibility in the face of their obsessions and compulsions.
  2. Self-Compassion: A Powerful Ally in ERP and CBT: Self-compassion is often an overlooked but essential ingredient in effective OCD treatment. While ERP and CBT are the backbone of OCD recovery, integrating self-compassion into these therapies can help you navigate the challenges more smoothly and with greater resilience.

    How Self-Compassion Enhances ERP and CBT:

    • Reduces self-criticism: ERP can be tough, and it's common to feel frustrated or critical of yourself when facing difficult exposures or setbacks. Self-compassion allows you to approach your treatment with kindness, reducing the harsh self-judgment that can make the process feel even more overwhelming.
    • Supports emotional regulation: Self-compassion teaches you to soothe yourself when the anxiety feels intense. During ERP, the goal is to face anxiety head-on without resorting to compulsions, but this can be emotionally draining. By practicing self-compassion, you learn to provide yourself comfort during these tough moments, which can reduce the emotional intensity and help you stay committed to your treatment.
    • Encourages persistence: CBT and ERP require consistent practice and patience. When progress feels slow or setbacks occur, self-compassion helps you maintain motivation by reminding yourself that recovery is a journey, not a race. Instead of giving up when things get tough, self-compassion encourages you to acknowledge the effort you’re putting in and keep going, even when it’s hard.
    • Reduces avoidance: One of the biggest challenges in ERP is the natural desire to avoid anxiety-inducing situations. Self-compassion allows you to face these moments with a gentle mindset, acknowledging that it’s okay to feel discomfort and that you’re brave for showing up despite the fear. This reduces the resistance to exposures and makes it easier to engage in the process.

Medications for OCD

There are multiple medicines for OCD that can help throughout treatment. Research shows that 7 out of ten people with OCD benefit from using medicine for OCD. Serotonin Reuptake Inhibitor (also known as SSRI’s) are the most common medicine for OCD and can be administered by a psychiatrist or medical professional.  Click here to read about the most effective OCD meds.

If you are not interested in taking medications, click here to read out article on how to overcome OCD without medication.

Please note that we do not require our patients to take medication in order to receive treatment. Taking medication is a very personal decision and one you should make with your medical team.

If you have some or all of these OCD symptoms, we would love to help you. Use the form below to contact Kimberley Quinlan, LMFT, and find out about our treatment options.  We have 9 highly-trained, compassionate health care professionals who are all trained to provide high-quality OCD advice, diagnosis, or treatment.

Please note that this article should not be considered therapy, nor should it replace professional mental or medical advice, diagnosis, or treatment.