Frequently Asked Questions

Before I share what OCD is, I’d like to remind you that you’re not alone. OCD is an experience that impacts many people’s lives.

Research suggests that anywhere between 2-3 million people experience OCD in the United States. One in 40 people will experience OCD in their lifetime!

For some people, receiving a diagnosis of OCD from a licensed provider can be a source of relief and understanding. For others, a mental health diagnosis might feel like an unwanted label or a box that feels constraining, scary, and limiting.

Everyone is different and I find it’s often helpful to explore with my clients ways we can talk about their experience that feels empowering and supportive.

OCD is made up of two general components: obsessions and compulsions. 

Obsessions can be described as thoughts, images, or impulses that can feel intrusive, disturbing, and/or unwanted. The presence of obsessions can create uncertainty, anxiety, and a lot of discomfort. In order to reduce that discomfort or unknown, it is natural to try to find a way to soothe the nervous system. 

Engaging in a behavior (a.k.a. a compulsion) can temporarily provide this soothing relief from immense discomfort. A compulsion can be physical or internal/mental. For example, a compulsion can be checking a door knob (external) or mentally counting up to a certain number (internal). The function of compulsions is to decrease the anxiety that obsessions create. 

Those who experience OCD know that after doing a compulsion, soon enough another obsession emerges. The desire to know, with 100% certainty, is never satisfied no matter how much someone engages in rituals. More questions around unknowns and uncertainty continue to rise leading to more compulsions as an attempt to experience relief. This is the cycle of OCD.

OCD (and anxiety in general) is a cycle with a rhythm that creates momentum through repetition. Over time, the cycle of OCD can begin to feel more familiar and habitual. At the same time, it can take over someone’s life, leaving them feeling smaller and smaller. 

When you begin therapy, you’ll learn more about how OCD, anxiety, and fear operates in your life. You’ll also learn how to shift the rhythm and momentum of anxiety into a direction that is more constructive, helpful, and liberating. 

This is a question I receive often. The experience of shame, guilt, and embarrassment related to the content of thoughts is shared by so many people. Remember, you are not alone.

First of all, I believe that the kind of thoughts someone experiences does not define who they are as a person. 

It can feel paralyzing when we feel like thoughts are fact. If someone has an intrusive, unwanted thought of harming someone else, it may feel like they actually want it to happen. This is where OCD can feel sticky and cloudy. People can question who they actually are, what their values are, and how they want to live their life. 

When your life becomes dominated by fears around uncertainty and your time spent worrying, avoiding, or doing outwardly “weird” or “strange” behaviors to reduce the intensity of fear, it’s natural to feel ashamed, especially when fear is connected to something that is personally and socially unacceptable. 

In many cases, the thoughts we deem as most disturbing and unwanted are reflective of what we value the most. For example, if I experience intrusive thoughts about harming others and I label the thought as “bad”, “wrong”, or a direct response to what I could be capable of, there is an immediate resistance to experiencing those thoughts. Behind the desire to not experience those thoughts is my value of ensuring those I love and care about are safe and free from harm. 

To trust another person enough to share the content of thoughts that you’ve worked hard to resist and eliminate can feel near impossible. I encourage you to remember this is a process. It can take time to get to know your therapist and build up enough warmth and confidence to feel safe enough to share your authentic experience.

  As an OCD therapist, I often share with my clients that I’ve heard all types of disturbing, intrusive thoughts. Although it may feel like you are the only one with a particular “flavor” of obsessions, it is likely the case that your theme is shared by many other people. Below are some examples of general obsessional themes:

- Aggressive (hurting someone else or myself)

- Sexual (inappropriate behavior, incest)

- Religious (morality)

- Superstitious (certain numbers, colors, etc… mean something special)

- Health/Body-Focused/Physical Sensations 

- Perfectionistic

In Western society and in social media, the experience of OCD is usually portrayed as a “classic” fear of germs, handwashing, and contamination.

This is the truth: OCD can show up in many different ways. The theme or content of intrusive thoughts can vary from person to person, however, the core of OCD is the same: fear of uncertainty or not knowing if something will happen or happened in the past. 

Sometimes people experience compulsions (another word for behavior) as external. For example, they may physically check to see if a bad thing happened. Other times, people describe internal or “mental” checking, reviewing, and avoiding in order to reduce the discomfort of disturbing thought content, fears of something bad happening, and even unwanted physiological sensations. Just because you may not be engaging in compulsions physically or externally doesn’t mean that your experience is not valid or is not reflective of OCD. 

It’s very common for people to have difficulty describing their fears, thoughts, and behaviors, especially because most people also feel embarrassed or ashamed of their experience. This is why working with a specialist in OCD can be very helpful! 

Typically in ERP, you and your therapist will begin therapy by talking about particular intrusive thoughts and the content of thoughts that feel most debilitating to you. 

You and your therapist will also talk about behaviors you engage in to help neutralize or eliminate the fear that these thoughts bring up for you. Your therapist will help you determine whether you meet the qualifications of an OCD diagnosis or another anxiety disorder and then discuss treatment options with you. 

This question is very common and can feel really scary. OCD might feel so unmanageable, overwhelming, and all-consuming that it is difficult to even imagine a life where you experience more space and time that is OCD-free.  When people desire to live a “normal” life in the context of OCD or anxiety, oftentimes what they are wanting is to live a life where the choices they are making in life are based on what they value, what brings them energy, and what allows them to feel more rooted and authentic in the present moment. It can be easy to internalize the impact of OCD and see yourself as inherently “bad” or “wrong” because you experience OCD. So, questioning how OCD might impact you in the future makes sense.

Typically, the trajectory of OCD is variable across someone’s life. Sometimes when people go through a stressful event (even something exciting like getting a new job, moving to a new place, or getting married), intrusive thoughts and fears may become more present as a response to increased life stress or change. 

The benefit of ERP is learning tools to help you manage OCD symptoms for the rest of your life throughout the ups and downs. It may be the case where follow-up or “booster” visits with your therapist are helpful if you notice OCD symptoms re-emerging with more intensity or frequency.