The Truth About OCD (and Why It’s More Treatable Than You Think)

Obsessive-Compulsive Disorder (OCD) is widely considered one of the most misunderstood mental health disorders. From people casually saying, “I’m so OCD about this,” to others describing it as one of the hardest disorders to treat, the mixed messages about OCD can make it hard to separate fact from fiction.

Add to that the reality that many people have sought treatment for OCD and not experienced relief- often due to ineffective or mismatched interventions, and it makes sense why OCD continues to be seen as confusing, frustrating, and even hopeless. 

But, here’s the truth: we actually DO know a lot about OCD and what works in treating it!

OCD is highly treatable when you work with a therapist who has been trained in Exposure and Response Prevention (ERP), an evidence-based approach specifically designed for OCD. 

So, what exactly is OCD?

To start, OCD is made up of two core components:

• Obsessions- intrusive thoughts, urges, or images that significantly negatively impact someone’s life

• Compulsions- repetitive behaviors or mental acts in response to obsessions that are designed to help relieve the distress of the obsession

Some common obsession types are: 

• Harm- the fear of hurting someone or having hurt someone 

• Sexuality related- like orientation, identity, or taboo thoughts or behaviors

• Religious- sometimes including intrusive thoughts around sin, blasphemy, doubt, and/or divine punishment

• Contamination- the fear of becoming contaminated, germs and illness, environmental/household toxin exposure, the fear of exposure to bodily fluids or human waste, among others

• Hoarding- reticence to discard items due to fear of losing important information or wasting resources

• Somatic- feeling unable to stop hyperfixating on things like breathing, blinking, swallowing, etc.

• False memory- having vivid, fabricated memories that cause intense guilt; for example, having accidentally hit someone with your car when you were driving and not knowing/noticing/stopping

• Relationship- questioning one’s attraction to one’s partner or worrying about one’s partner being “the one” 

• And more- any repeated, persistent, intrusive, and unwanted thoughts that cause significant anxiety or distress

Similarly, some common compulsions include:

• Checking

• Washing

• Repeating

• Counting

• Ordering

• Arranging

• Hoarding

• Reassurance-seeking

• Ruminating

• Mental reviewing

Having OCD is often misinterpreted as having an “obsession” with things being “clean” or “organized.” In reality, many people with OCD have no contamination or symmetry concerns at all. 

For example, for some people, their compulsions are entirely mental, and nobody would ever know they are struggling. Others may feel constantly observed or judged because their compulsions are more visible. 

With OCD, there is no real “win” either way- whether others know what is happening or not. 

The intrusive thoughts and behaviors caused by OCD can be very overwhelming and make it difficult for people to be present in their lives and function the way they would like to.  

What’s important to know is that there is an effective treatment for OCD that shows a 65-80% reduction in symptoms for many within 8 to 16 weeks of treatment- Exposure and Response Prevention.

Exposure and Response Prevention (ERP) is a two-step process:

• Exposure- gradually being exposed to feared thoughts or situations

• Response prevention- practicing refraining from performing typical compulsive rituals or avoidance behaviors during the exposure process

As a result, this breaks the OCD cycle, and clients experience reduced distress and long-term symptom relief. 

Clients often express some fear or even hesitation when I first explain ERP. Those feelings are valid! When we first start, it can feel overwhelming to think about engaging in exposures and refraining from the compulsions that you’ve been used to for years. 

I like to remind clients that ERP is designed to be a gradual and collaborative process between you and your therapist. Your therapist is there to support you and meet you where you’re at. 

I have seen the same clients who express fear in the beginning become the ones who say, "I wish I did this sooner," "This has changed my life," and "I wish more people with OCD knew about this," as they finish ERP. 

If you are someone who is struggling with OCD, I highly encourage you to reach out to learn more; you deserve to take the power back from OCD and regain control over your life.