What is OCD? Understanding Its Subtypes and Effective Therapy for Recovery
OCD is a mental health struggle that many people face, marked by intrusive thoughts and repetitive behaviors aimed at reducing anxiety. These patterns can be incredibly draining, leaving you trapped in cycles of doubt, fear, and constant mental checking. Whether it’s compulsively seeking reassurance or avoiding certain thoughts or situations, OCD often feels overwhelming and isolating.
As a therapist who supports individuals navigating OCD, I’ve seen how these symptoms take root in people’s lives and disrupt their sense of peace. In this post, I’ll explore the nature of OCD, its various forms, and touch on how Exposure & Response Prevention (ERP) therapy can help break the cycle, giving you tools to regain control and find relief from OCD.
OCD Defined:
According to the DSM-V, OCD is characterized by the following:
-Obsessions: thoughts, urges, or images, that are upsetting, intrusive, and unwanted and create high distress & anxiety. Efforts are made to suppress, ignore or neutralize the thoughts by engaging in compulsions.
-Compulsions: Outward or inward acts a person feels compelled to perform in attempts to prevent disaster, reduce the distress and anxiety around the obsessions and due to rigid rules. These compulsions are not realistically connected to the obsessions and are excessive. Compulsions can be physical acts (e.g. hand-washing, checking locks), or mental acts (e.g. internal self-checking, rationalizing).
-Impact: Time spent on obsessions/compulsions is significant and/or causes significant impairment in one or more areas of life (e.g. work, relationships); it is time-consuming and prevents people from engaging in activities that are important to them, and cause high levels of anxiety and fear.
About 1 in 40 adults have or will experience OCD in their lifetime; that’s about 2.3% of the U.S. population, or 8.2 million people. We don’t know exactly what causes OCD, but current research indicates there is likely nature (genetics, brain structure) and nurture (modeling, early life experiences, environment).
An Endless Loop: Getting Stuck in the OCD Cycle
Compulsions in OCD, like checking, counting, or avoiding certain situations, offer brief relief from the anxiety caused by obsessive thoughts. In the moment, these actions feel necessary to prevent a feared outcome or to ease distress. However, this relief is only temporary. Over time, the compulsions actually reinforce the OCD cycle by feeding the underlying fear and uncertainty, making the intrusive thoughts return more frequently. As a result, the person becomes more dependent on the compulsions, which maintains and often worsens the symptoms over time. OCD can take on many different forms. It’s not uncommon for someone to have multiple subtypes of OCD, or a more nuanced experience of OCD.
Examples of OCD Subtypes:
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Fear of germs, dirt, or illness
Common compulsions: excessive cleaning, handwashing, avoiding perceived contaminated places
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Fear of harm or danger (e.g., leaving the stove on or doors unlocked)
Common compulsions: repeatedly checking appliances, locks, or seeking reassurance from others
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Intrusive thoughts of causing harm to oneself or others
Common compulsions: mental rituals, avoiding objects or situations that trigger fear
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Obsessive doubts and fears about romantic relationships
Common compulsions: constantly analyzing the relationship, seeking reassurance, self-checking your attraction to your partner(s)
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Obsessive concerns about morality, religion, or being "good"
Common compulsions: excessive prayer, seeking reassurance, avoiding morally ambiguous situations, self-monitoring for any “bad,” thoughts
Many people experience how tiring and time-consuming these obsessions and compulsions are. You’ll notice from the above examples that some compulsions are more overt, like excessive hand-washing or having to check you turned off the stove multiple times. Other compulsions can be more covert, like avoidance, and what has been termed Compulsive Reasoning (CR), which involves constant mental reviewing to make sure you didn’t say anything “wrong,” rationalizing, and analyzing.
Regardless of how a person’s compulsions manifest, living with OCD is incredibly difficult, not only due to the tiring cyclical nature of obsessions and compulsions, but the secondary impact. The time-consuming rituals and emotional distress that come with OCD can create strain in your relationships, affect your ability to work, and make it hard to enjoy the things you love like traveling or spending time with friends. You may find yourself isolating out of fear of saying the “wrong thing,” or making someone feel uncomfortable, or avoiding eating at restaurants with loved ones, experiencing relationship challenges, etc.
Effective Treatment for OCD
The good news is that OCD is that there is research-backed support for OCD. Here, I’ll provide a brief description of ERP and how it can help with OCD. For a deep-dive into what it’s like to experience ERP, click here.
ERP involves two components, 1. Gradually facing the situations or thoughts that trigger anxiety (exposure) while 2. Resisting the urge to engage in compulsive responses (response prevention). This process helps your brain learn that anxiety will naturally decrease over time, even without performing the compulsion, and that feared outcomes rarely, if ever, come to pass.
If you have OCD, you may be thinking the idea of not engaging in your compulsion doesn’t even feel possible. If that’s where you’re at, that’s ok. Starting with fears that are less intense and building confidence through successful exposures is key to an effective treatment plan.
Through consistent exposure work, ERP reduces the power that obsessions and compulsions hold, allowing you to gradually experience relief and gain a new sense of control. And you’re never alone in the process; your therapist plays a key role, guiding you through safe, structured exposures and offering support as you confront intense emotions. My goal is to provide guidance to ensure that each step is challenging yet manageable, empowering you to face fears and make meaningful progress. To learn more about what an ERP therapy session could look like, check out this blog post.
Ready to find relief from OCD?
I invite you to reach out to me, and let’s work together!
Reach Out: Take the first step by contacting me here.
Let’s Chat: Schedule a consultation to discuss your experience with OCD and see if we’re a good fit.
Start Healing: Begin your personalized healing journey and break the cycle of OCD!
Helpful Resources for learning more about OCD:
Sources:
Levine , L. (2022, February 10). How do I stop thinking about this? what to do when you’re stuck playing Mental Ping Pong. International OCD Foundation. https://iocdf.org/expert-opinions/how-do-i-stop-thinking-about-this-what-to-do-when-youre-stuck-playing-mental-ping-pong/
The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association [APA], 2013)
International OCD Foundation. (n.d.). Who gets OCD? International OCD Foundation. Retrieved October 28, 2024, from https://iocdf.org/about-ocd/who-gets-ocd/