Obsessive Compulsive Disorder (OCD) is not a personality quirk or desire for cleanliness or order, but a serious mental health disorder that affects millions of individuals each year. OCD is characterized by the presence of obsessions and/or compulsions. Obsessions are unwanted (or intrusive) and persistent thoughts, urges, or images that cause distress (anxiety, fear, discomfort, even shame), whereas compulsions are repetitive behaviors or mental acts that an individual feels they must perform in response to an obsession or according to a very strict, rigid set of rules to prevent or neutralize their own distress. Often, compulsions (or rituals) seem unrelated to the person’s obsession(s), or otherwise irrational.

Part of what makes OCD so complex is that obsessions and compulsions can vary greatly among individuals with OCD given the numerous themes of obsessions as well as the human imagination’s attempts to reduce distress or discomfort caused by one’s obsessive thoughts, urges, or images. Common examples of obsessions include concerns about contamination, violence, responsibility, perfectionism, sexual behavior, religiosity/moral scrupulosity, identity, and existentialism, among others. Common compulsions include washing/cleaning, mental compulsions (praying, excessive reviewing, counting, etc.), checking, repeating actions, seeking reassurance, avoidance of situations, and doing something until it “feels right.”

Proper treatment for OCD is crucial, as more than 2/3 of the general population can’t correctly identify or understand OCD; this is even a problem in the mental health community. A common misunderstanding is that compulsions are not merely visible behaviors such as disinfecting a surface or handwashing, but also mentally revisiting a thought or image and intentional avoidance of situations where one might be exposed to their obsessions. While avoidance can, and often does, reduce the distress one experiences in the short term, as a coping strategy it can actually worsen one’s OCD symptoms through operant conditioning. What happens when we avoid situations that evoke anxiety or discomfort is that we subconsciously tell our brain that in order to feel safe and comfortable, we must avoid the trigger. This makes sense, in that we will naturally do things that make us feel better in the moment. However, through repetition, we teach our brain that we can’t handle the experience of anxiety or discomfort, and the pattern of engaging in compulsions becomes automatic. It takes an extended period and repeatedly confronting our triggers without engaging in our anxiety-relieving compulsions/avoidance to begin to un-do this pattern of behavior that has become automatic over time. This is the goal of Exposure with Response Prevention (ERP), which is a therapy modality that is supported by decades of research as one of the most effective treatments for OCD. ERP can also help treat panic disorder, social anxiety disorder, and specific phobias.

If you recognize any of these patterns in yourself or someone you care about, know that OCD is a highly treatable condition with the right support. Consider reaching out to a licensed mental health professional trained in Exposure and Response Prevention (ERP) to explore next steps.

Christian Paulisich is a licensed counselor in Maryland who specializes in working with individuals of all ages who struggle with anxiety, OCD, and other related disorders. If you need help and would like to schedule a consultation, call Christian directly at (443)507-8187.