What is OCD?

"Oh, she is so OCD!"

Is that a phrase you've heard before? Usually it follows someone scrubbing that one crumb left on the counter or straightening a picture frame that's just a little crooked.

In our day-to-day lives, we often hear the term OCD used to describe someone who likes things clean, organized, or "just right." While OCD can sometimes look like that, the reality is much more complex. In fact, many people with OCD have little or no concern about cleanliness or organization at all.

So then...what is OCD really?

Let’s first talk about what OCD is not.

• OCD is not just liking things neat or organized.

• OCD is not enjoying cleaning.

• OCD is not simply being a perfectionist.

• OCD is not a personality trait.

• OCD is a treatable mental health condition that can affect many different areas of life.

OCD stands for Obsessive-Compulsive Disorder, a mental health disorder characterized by the presence of obsessions and compulsions.

Obsessions are unwanted, intrusive thoughts, images, urges, or doubts that cause significant distress and are difficult to ignore or dismiss. These thoughts are not a reflection of who someone is or what they want. Instead, they often feel upsetting because they go against a person's values, beliefs, or sense of safety. Obsessions typically lead to feelings of anxiety, fear, guilt, or uncertainty.

That distress often leads to a compulsion, which is an attempt to reduce the anxiety or prevent some feared outcome from happening.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) defines compulsions as:

"Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly."

Compulsions don't always seem logically connected to the obsession.

For example, someone may have the intrusive thought:

"I have a headache. What if I'm dying?"

One person might repeatedly search their symptoms online for reassurance.

Another person might feel compelled to hop on one foot ten times because their brain tells them that doing so will somehow prevent something terrible from happening.

Someone else may repeatedly pray, feeling that unless they say the prayer exactly right, it won't count.

No matter what the compulsion looks like, the result is usually the same: a temporary decrease in anxiety. Unfortunately, that relief doesn't last.

Instead, it reinforces the OCD cycle.

You experience an obsession, which creates anxiety. To reduce that anxiety, you perform a compulsion. The anxiety temporarily decreases, but your brain learns that the compulsion "worked," making it even more likely you'll feel the need to perform it again the next time an obsession appears.

Over time, the cycle grows stronger.

Compulsions can be both physical and mental. Mental compulsions are often invisible to other people but can be just as exhausting.

Examples of physical compulsions

• Checking that doors are locked or appliances are turned off

• Repeatedly checking emails or text messages for mistakes

• Excessive handwashing or showering

• Cleaning the home more than necessary

• Arranging or lining things up until they feel "just right"

• Performing behaviors a certain number of times

• Avoiding specific numbers considered "bad" or "unlucky"

Examples of mental compulsions

• Repeating prayers until they feel "right"

• Searching the internet for reassurance

• Frequently asking others for reassurance

• Mentally reviewing past conversations to make sure you didn't say or do something wrong

• Repeating words, phrases, or numbers silently

• Trying to "cancel out" a bad thought with a good one

What is Scrupulosity?

One type of OCD that comes up fairly often is called scrupulosity.

With scrupulosity, obsessions and compulsions center around religion or morality.

This might include:

• Fears of committing sin without realizing it

• Intrusive blasphemous thoughts

• Doubting whether you are truly saved

• Fears of disappointing God

• Feeling the need to pray perfectly

• Feeling responsible for being morally "perfect"

Compulsions may include:

• Repeatedly confessing the same sins

• Constantly seeking reassurance from pastors, friends, or family

• Repeating prayers until they feel perfect

• Reading Scripture repeatedly to relieve anxiety

• Mentally reviewing actions to determine whether something was sinful

It's important to know that healthy faith and OCD are not the same thing. Treatment isn't about taking away someone's faith. Instead, it's about helping people recognize when anxiety
(not their faith) is driving their behaviors.

When does it become OCD?

Almost everyone experiences intrusive thoughts from time to time, and most people occasionally double-check a lock or seek reassurance.

These behaviors become concerning when they consume significant amounts of time, create intense distress, or interfere with daily life, relationships, work, or school.

How do we treat OCD?

The gold-standard treatment for OCD is a specialized form of Cognitive Behavioral Therapy (CBT) called Exposure and Response Prevention (ERP).

During ERP, you'll gradually face situations that trigger anxiety while learning to resist the urge to perform compulsions. The goal isn't to eliminate anxiety completely. Instead, it's to teach your brain that anxiety is temporary, manageable, and doesn't have to control your actions.

Over time, the obsessions lose their power, the urge to perform compulsions decreases, and life begins to feel less controlled by OCD.

Research has consistently shown ERP to be one of the most effective treatments available for OCD, with many people experiencing significant improvement in their symptoms (Foa et al., 2015).

Does any of this sound familiar?

Living with OCD can feel overwhelming, confusing, and incredibly isolating. The good news is that you don't have to navigate it alone.

Whether you're confident you have OCD or you're simply wondering if what you're experiencing is "normal," I'd be honored to help you sort through it. Together, we can better understand your symptoms, develop healthy ways to respond to anxiety, and help you move toward lasting change and greater joy.

If you're ready to take the next step, I'd love to walk alongside you.

Sources

• American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR).

• International OCD Foundation. What Is OCD? and Scrupulosity. Available at the IOCDF website.

• Association for Behavioral and Cognitive Therapies. Obsessive-Compulsive Disorder.

• Foa, E. B., Kozak, M. J., Goodman, W. K., et al. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder.