Expert Tips for Understanding OCD, and How to Treat It

By Ginny Graves 

Obsessive-compulsive disorder isn’t what most people imagine it to be. We asked experts to explain what’s really going on inside the brain—and how to find long-lasting relief

Many of us have made a casual comment about obsessive-compulsive disorder, as in “I’m so OCD about washing vegetables.” But for those who suffer from the disorder, obsessions (like a fear of germs) and compulsions (like disinfecting) can be debilitating. OCD may be especially challenging at a time like this, when public health messages intended to protect us from COVID-19 can reinforce germophobia—or amplify feelings of uncertainty, a component of the illness. “Studies are underway to determine how difficult the pandemic has been for those with OCD, but it’s safe to say that some people with the disorder are really struggling right now,” says Elna Yadin, PhD, an OCD specialist on the clinical faculty at the Perleman School of Medicine at the University of Pennsylvania.

Does that mean that if you’ve become fanatical about sanitizing you have OCD? No. “OCD is an anxiety disorder that causes intense distress,” Yadin explains. “Obsessions are intrusive, unwanted, relentless thoughts or urges that can cause fear, guilt, distress, or disgust. And in an effort to get rid of or neutralize those upsetting thoughts, a sufferer develops compulsive behaviors.”

RELATED: How to Deal With OCD—From 4 People With the Diagnosis

The disorder, which is estimated to affect one in every 100 adults in the U.S. (and equal numbers of men and women), can come on at any time, though it frequently occurs after a traumatic or stressful event and tends to hit in the preteen years or in early adulthood. A number of genes have been linked to the disorder, so you can inherit a predisposition for OCD. If a parent has it, there’s about a one in four chance her child will, too

Because doctors often don’t recognize the condition and sufferers tend to hide their symptoms, it typically takes 15 years or more for those in need to get help, which is a shame, since OCD can interfere with, or even debilitate, their ability to function. The good news: Treatment can ease the disorder’s grip and transform people’s lives.



RELATED: Aly Raisman Revealed That She Lives With OCD in a Candid Interview

On Repeat

When you think about OCD, you might imagine someone whose hands are raw from excessive washing. But the disorder isn’t about cleanliness. It’s about unwanted thoughts. And fear of germs is just one of hundreds of disruptive thoughts that torment sufferers, says Jonathan Grayson, PhD, director of the Grayson LA Treatment Center for Anxiety & OCD in Pasadena, California. “Obsessions include everything from worry that you left the stove on to fears that you might kill someone you love. They’re limited only by people’s imaginations, and people with OCD tend to be extremely creative and intelligent,” says Grayson.

Other common obsessions include perverse sexual thoughts, fear of blurting out an obscenity, concern with offending God, and superstitions about colors or numbers. “Many of us have passing scary thoughts, but we’re able to realize they’re irrational and let them go. People with OCD get stuck in a thought loop: ‘How do I know for sure I didn’t do something terrible or dangerous, or that I won’t do it soon?’ ” Grayson says. “These thoughts produce agonizing anxiety.”

That’s where the compulsions come in. They’re intended to counteract the obsessions and calm the distress, and they range from the rational, like cleaning to get rid of microbes or checking the stove to make sure it’s off, to the magical—such as counting while performing a task to end on a “good” number; repeating routine activities, like going in and out of doors; or repetitive body movements, like tapping or blinking. It isn’t always clear why people develop their unique compulsions, or why those particular actions supply relief. 

RELATED: New Study Suggests Brain Glitch May Cause OCD

You might suspect you’re “a little OCD” if you like to have your pencils arranged just so, or you triple-check your purse for your passport before you board an international flight. But having an obsessive trait or engaging in compulsive behavior doesn’t mean you have a personality disorder. “Obsessions and compulsions in OCD cause real impairment,” explains Jeff Szymanski, PhD, executive director of the International OCD Foundation in Boston. For instance, a fear of contamination may drive someone to spend hours cleaning her office every day. “If you have OCD, you don’t like the compulsions or want to do them. You have to do them [in order to] relieve your distress,” adds Szymanski.

Elizabeth McIngvale, PhD, LCSW, director of the McLean OCD Institute in Houston, who has struggled with OCD herself, explains it this way: “You know the compulsions are irrational, and the relief you’ll get is only short-term—maybe 5 or 10 minutes, or an hour—but the urge to do them and the anxiety they’re coupled with are so intense you don’t feel like you have a choice. When that’s the only coping mechanism you have, you use it.”

Because compulsions offer temporary relief, they reinforce and strengthen OCD. As a result, when left untreated, the disorder usually gets worse. 

RELATED: 7 Things Everyone Gets Wrong About OCD, According to a Woman Who’s Had the Disorder All Her Life

The Role of Uncertainty

Just as your genes can make you vulnerable to OCD, so can your brain structure. “A complex brain circuit, which pays attention and responds to danger signals and involves high-level thinking, emotional processing, and behavior, is hyperactive in people with OCD,” says Szymanski. “They’re constantly trying to seek certainty—to be sure they washed the germs off their hands, or that their spouse is still alive.” But of course, it’s impossible to be 100 percent certain of anything. 

One thorough handwashing is enough to satisfy most of us. People with OCD are bombarded by niggling doubts. “What if all the germs aren’t gone?”

That’s not the only neurological difference found in OCD sufferers: While the fear-scanning circuit of the brain is hypervigilant, the regions that provide a sense of satisfaction after a task is finished are tamped down. As a result, people with OCD don’t experience a sense of completion when they wash their hands or check to make sure the stove is off, so they feel the need to keep repeating their compulsions again and again. “Some people take 10-hour showers, or can’t leave the house, while others appear to be high-functioning but spend hours a day battling intrusive thoughts or images,” says Szymanski.

RELATED: How Can I Tell If I Have OCD?

Facing Fears

The first step to overcoming OCD is finding a specialist who knows how to treat it. “Fifty percent of medical professionals and one-third of mental health professionals misdiagnose OCD as depression or anxiety or bipolar disorder,” says Szymanski. Most aren’t trained to treat it, either.

The most effective treatment for the disorder is exposure and response prevention therapy, or ERP; it’s a specific type of cognitive behavior therapy that requires a fair amount of effort on the part of both the therapist and the patient. You can search for therapists via the International OCD Foundation’s directory (, and be sure to ask prospective counselors if they have ERP training, says Grayson.

In ERP, a therapist helps you expose yourself to the situations, thoughts, or images that make you anxious—without performing your usual compulsions afterward. If you’re worried about germs, for example, the therapist might go with you to the animal shelter, where you can pet a dog and then resist the impulse to sanitize your hands. If your obsession is a fear that your spouse will die, you consciously have that thought over and over during a therapy session, but you don’t act on the urge to call and check on him or her. 

RELATED: The 2 Major Types of OCD—and How to Recognize Them

“Compulsions tell your brain that your fear is real. When you stop performing them and nothing bad happens, you begin to break the link so you can see your fears more realistically,” Szymanski explains. It’s not easy, but over time, ERP actually trains your brain to tolerate uncertainty.

The treatment is effective for about two-thirds of people. Most sufferers experience a significant reduction in their symptoms after 12 to 16 sessions. But it takes steady effort. Szymanski compares ERP to seeing a personal trainer. “If you go once a week and don’t do any exercise till the next session, you’re not going to see much improvement in your fitness,” he says. “But if you work out on your own between sessions, you’ll get stronger and lose weight fairly quickly.”

Some people also benefit from pairing ERP with selective serotonin reuptake inhibitors (SSRIs), a class of medication that is often prescribed for depression and anxiety. “The drugs seem to change the trigger point for uncertainty by making serotonin more available in the spaces in the brain where nerve impulses are transmitted,” says Grayson.

While treatment doesn’t cure OCD, it can help sufferers learn to cope with the disorder so it has less impact on their lives. “When the pandemic first began, we were concerned that people in treatment for OCD would backslide—and many of them did,” says Szymanski. “But in talking with many therapists around the world who treat the disorder, we realized that a significant percentage of patients actually handled the pandemic better than people without OCD, because they’d learned to embrace uncertainty. They had developed the skills to face the fear, and function normally.” 

This article originally appeared in the  March 2021 issue of Health Magazine. Click here to subscribe today!

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IOCDF Town Halls

I highly recommend everyone to check out all the amazing work the IOCDF has been doing with providing resources to the public. From their Town Halls to their virtual support groups. Simply search IOCDF on youtube. A very common but lesser known form of OCD is moral scrupulosity watch below to learn more about the symptoms, treatments and how to recover!

Lean Into The Fear

Intrusive thoughts feel so real and intense that it creates an automatic urge to want to get rid of them. The internal dialogue quickly turns to STOP! I can’t handle it, I hate these thoughts, what does this mean etc?! Practicing bringing the thought in and showing you aren’t afraid will make the brain move on and not get “stuck”. An example is you have a thought of something horrible instead of trying to run away from it ask for more, say I want these thoughts and the thought loses its power because you are no longer afraid of it. Aaron Harvey an OCD advocate gives a great example of this when talking about passing a ladder on the street and right away having the thought that something bad will happen now if I go near that ladder, someone will get hurt or I might push someone into it. Instead of being afraid and scared he goes directly to the ladder stands under it allows all the horrible and horrifying thoughts to enter and moves on, and the more you practice this throughout the day leaning into the thoughts and fears the more your brain realizes it can no longer trap you. This is very hard to do but even trying a little bit everyday will significantly decrease the grip OCD has.

I Was Terrified I Was a Sociopath. I Actually Had OCD.

Great Article by Jordan Taylor

“I routinely sobbed in my husband’s arms, knowing I loved him so deeply, but convinced my deviant thoughts meant we’d have to get a divorce.”

BY JORDYN TAYLOR AUG 24, 2020stressed woman has too many thoughtsSIPHOTOGRAPHYGETTY IMAGES

I wanted to be happy on my honeymoon. Instead, as my husband and I clinked our glass mugs of mulled wine at a holiday market in Berlin, I was tormented by thoughts of all the ways I could ruin his life.

The mental anguish began a few months before we got married. Whenever we did something wedding-related—engagement photos in the park, tastings at the caterers’—I’d get this weird feeling of disassociation, like there was a thick glass wall between me and the rest of the world. I was supposed to be enjoying this. What did it mean that I felt nothing? The question was terrifying. I knew I loved my husband more than anything else in this galaxy and beyond. But what if some secret part of me didn’t want to marry him?

I was so sad and confused that for the first time in my then-twenty-five years, I got professional help. My therapist chalked up my symptoms to my discomfort with the wedding industrial complex, and assured me I’d feel better as soon as the nuptials were over.

But I didn’t. I couldn’t shake the idea that since I didn’t feel pure, unbridled joy throughout the wedding-planning process, it must mean I secretly didn’t love my husband. On our honeymoon, and for the next six months, my thoughts spiraled. I worried I was a sociopath who’d faked every emotion in her life, and I needed to find the answer for certain. Whenever I smiled or laughed around my husband, I mentally calculated how “real” it felt. Whenever I looked at him or touched him, I tried to measure my attraction to him. Whenever I doubted the sincerity of an interaction, I frantically searched my brain for a good memory to cancel out the bad.

Sometimes these mental rituals brought relief; other times they heightened my panic. They occupied my every waking hour, exhausting me. I routinely sobbed in my husband’s arms, knowing I loved him so deeply, but convinced my deviant thoughts meant we’d have to get a divorce. (Somehow, my wonderful husband never once considered divorcing me throughout this ordeal.)

Eventually my therapist saw my constant self-doubt for what it really was: obsessive-compulsive disorder, or OCD. Over the course of a year or two, I learned to manage it with cognitive behavioral therapy, or CBT. But when she first diagnosed me, I was confused. I always thought people with OCD engaged in physical compulsions like organizing and hand-washing to battle their intrusive thoughts, or “obsessions.” I’d never seen a mainstream depiction of my brand of OCD: where the compulsions took place entirely inside a person’s head.

The condition is known as “pure O,” short for “purely obsessional,” and it’s the subject of a new series called Pure on HBO Max (inspired by a book of the same name). When I saw the trailer the other day, saw the main character, Marnie, in mental agony trying to make sense of her intrusive thoughts, I teared up. I was seeing myself. And finally, other people would see me, too.

OCD Virtual Conference!

The first event of its kind, this virtual event has programming for everyone in the OCD community: individuals with lived experience, their family members and supporters, and the professionals who treat them. Running from Friday, July 31 through Sunday, August 2nd, this virtual event will feature 70 talks, 36 discussion groups, and 160 presenters!

I encourage anyone who is suffering with OCD or has a loved one suffering with OCD to attend this years conference!

To register simply go to the link and click the register button in the top right corner!


Relationship OCD is a very common and confusing form of OCD. COVID-19 has really impacted the way we live with more people working from home and layoffs on the rise. ROCD can really take advantage of these situations being around your partner 24/7 is not easy to begin with and this is a perfect catalyst for ROCD to be triggered.

Dr. Stephen Phillipson describes ROCD as:

“It’s a subset of OCD where a person is preoccupied with establishing whether their feelings for their partner are sufficient to maintain the relationship or be in the relationship.

People with ROCD have a tsunami of emotional distress over often more meaningless aspects of their partner, in terms of whether they would be a suitable partner, and so there is a tremendous amount of endless navigation or rumination about the qualities of what they think are correct or justified to continue in the relationship with.There is just an endless preoccupation, there is an endless answer seeking, sometimes even reassurance seeking from one’s partner.

Common symptoms of ROCD involve endless answer seeking and endless rumination about their partner’s qualities, and whether their internal feelings justify being in the relationship. They become very focused on their level of arousal as a proof that the person that they are with is justified to remain with. The probably is, the more that we focus on and put pressure on ourselves to have a very passionate response, the less likely we are to have that response. So it’s common that there is a tremendous amount of sexual malfunctioning or sexual apathy, because of that inverse relationship between the pressure to be sexually aroused, and then the way the brain responds to that pressure to be sexual, it’s very paradoxical.

There can be a focus on a partner’s appearance there can be a focus on a person’s character. I’ve had patients have associations about loved one’s own dating history, in terms of how long did their partner wait before they engaged in certain sexual acts as if that would provide them with reassuring evidence, or uncomfortable evidence about their partner’s character.”

A common thought process for people with ROCD is to check if their significant other has good character or if they are attracted to them. They tend to have intrusive thoughts that try to paint a horrible picture of your partner. This can be very distressing on a relationship, your partner becomes the target of the intrusive thoughts which can lead to a lot turbulence in the relationship. ROCD in specific is very difficult to deal with as relationships by nature are difficult and complex knowing when you have legitimate concerns vrs OCD is sometime hard to navigate. I encourage anyone who is going through ROCD to speak with a trained OCD therapist to help them navigate this subset.

What is OCD?

Picture a scene from a horror film playing over and over again in your mind, but this horror film is not any horror film it is about yourself, your loved ones and innocent people. The horror film is vivid with images and words popping up. You are left feeling helpless and terrified and doubting who you are as a person. How could I think these things? Do I want this? Who am I? Will I snap?

OCD wants you to be afraid of the horror film and always be enslaved to its storyline. But just like a horror film the audience knows it is not real, without the suspenseful music, special effects and graphic images it wouldn’t impact the viewer. OCD feels real because of the graphic images, thoughts and things the person cares about. If the sufferer can be an audience member and realize it is not real, sit back be uncomfortable but know that nothing is actually happening OCD will loosen its grip.

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