What is OCD? (It's probably not what you think it is!)

By Lyndsay Babcock - Clinicail Psychologist

Many people have heard of Obsessive Compulsive Disorder (OCD), but it remains one of the most misunderstood psychological conditions.

OCD is often portrayed as a preference for cleanliness, order, or routine. While these can sometimes be part of the picture, they are not what defines OCD.

At its core, OCD is a disorder of doubt.

It is a condition characterised by intrusive thoughts, images, urges, or sensations that trigger significant distress, and repetitive behaviours or mental acts performed in an attempt to reduce that distress.

For many people, OCD can be exhausting, confusing, and deeply isolating.

What does OCD feel like?

Most people experience unwanted thoughts from time to time.

You might briefly wonder whether you locked the door, have an inappropriate thought during a meeting, or imagine something bad happening to someone you love.

For most people, these thoughts come and go.

For someone with OCD, the experience is different.

The thought becomes "sticky".

The brain treats it as important, meaningful, or dangerous.

Questions begin to emerge:

"What if I left the stove on?"

"What if I accidentally harmed someone?"

"What if this thought means something about who I am?"

"What if I made a mistake?"

"What if I'm responsible for something terrible happening?"

The person then feels driven to do something to obtain certainty.

This may involve checking, seeking reassurance, reviewing memories, researching online, confessing, mentally analysing, or avoiding situations altogether.

The relief is usually temporary.

Before long, the doubt returns.

Why does OCD happen?

Modern research suggests that OCD develops through a combination of biological, psychological, and learning factors.

Neuroimaging studies consistently show differences in brain circuits involved in threat detection, error monitoring, and habit learning, particularly within the cortico-striato-thalamo-cortical network (Robbins et al., 2019).

Put simply, the OCD brain is often highly sensitive to uncertainty and potential mistakes.

It generates more "what if?" signals than it needs to.

At the same time, certain psychological factors appear to maintain OCD.

Research has identified several common thinking patterns:

• Inflated responsibility

• Intolerance of uncertainty

• Overestimation of threat

• Perfectionism

• Beliefs about the importance of thoughts

  
  

For example, someone without OCD might think:

"Maybe I forgot to lock the door."

Someone with OCD may think:

"What if I forgot to lock the door and someone breaks in? If I don't check, I'd be responsible."

The problem is not the thought itself.

The problem is the meaning attached to the thought.

One of the more confusing aspects of OCD is that the content of the intrusive thought is often the exact opposite of what the person values. A loving parent may experience intrusive thoughts about harm coming to their child. A deeply caring person may become preoccupied with the possibility of hurting someone. A conscientious employee may worry endlessly about making a mistake. In this sense, OCD often latches onto what matters most. It is as though the mind identifies something precious and then becomes hypervigilant about protecting it. Unfortunately, it does this in a very distressing way. Rather than highlighting our values directly, it generates endless "what if?" scenarios designed to eliminate risk and uncertainty. Understanding this can be an important shift for many people. The presence of an intrusive thought does not tell us what a person wants to do or who they are. More often, it tells us something about what they care deeply about, fear losing, or feel responsible for protecting.

Why compulsions keep OCD going

One of the most frustrating aspects of OCD is that the things people do to feel better often strengthen the condition.

Checking provides temporary relief.

Reassurance provides temporary relief.

Mental reviewing provides temporary relief.

But each time relief follows a compulsion, the brain learns:

"This must have been dangerous."

As a result, the obsession becomes more convincing next time.

This creates a self-reinforcing cycle

Research consistently demonstrates that avoidance and compulsive behaviours prevent the brain from learning that uncertainty can be tolerated and that feared outcomes often do not occur (Craske et al., 2022).

How therapy helps

The good news is that OCD is highly treatable.

The most effective psychological treatment is Exposure and Response Prevention (ERP), a specialised form of Cognitive Behavioural Therapy.

ERP helps people gradually face situations, thoughts, images, or feelings that trigger OCD while reducing the compulsive responses that normally follow.

Importantly, the goal is not to prove that fears are impossible.

The goal is to develop a different relationship with uncertainty.

Over time, the brain learns that distress rises and falls naturally, and that certainty is not required in order to feel safe.

Many therapists also integrate Acceptance and Commitment Therapy (ACT), which focuses on increasing psychological flexibility and reducing struggles with unwanted thoughts.

This approach helps people move away from asking:

"How do I get rid of this thought?"

And toward:

"How do I live my life even when uncertainty is present?"

A different way of understanding OCD

At The Self Centre, we often help people understand that OCD is not a reflection of who they are.

The content of the obsession is rarely the issue.

Whether the thought involves contamination, relationships, morality, health, sexuality, religion, or harm, the underlying process is often the same.

A brain that is desperately trying to obtain certainty.

The irony is that certainty is not something any of us can fully achieve.

Recovery often begins when people stop trying to eliminate uncertainty and start building confidence in their ability to tolerate it.

Because the goal is not to have perfect certainty.

The goal is to be able to live a meaningful life without needing it.

References

Robbins, T. W., Vaghi, M. M., & Banca, P. (2019). Obsessive-compulsive disorder: Puzzles and prospects. Neuron, 102(1), 27-47.

Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2022). Maximising exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 152.

Abramowitz, J. S., Taylor, S., & McKay, D. (2021). Obsessive-compulsive disorder. The Lancet, 398(10312), 1638-1650.

International OCD Foundation. Clinical practice resources and treatment guidelines.