She told me she’d spent three hours the night before replaying a conversation with a coworker, searching her memory for proof she hadn’t said something cruel. She hadn’t. She knew she hadn’t. And still, the question kept coming back: What if I did, and I just don’t remember?
She wasn’t washing her hands or lining up pencils. From the outside, nothing looked wrong. Inside, she was exhausted.
(Details changed to protect privacy.)
This is what OCD often looks like. It’s quieter, more private, and more painful than the stereotype suggests.
What OCD Actually Is
Obsessive-compulsive disorder (OCD) has two parts:
Obsessions: unwanted thoughts, images, or urges that feel distressing and hard to dismiss
Compulsions: things you do, in your body or in your mind, to get relief, feel certain, or prevent something terrible from happening
The relief never lasts. That’s the cycle. The more you try to get certain, the louder the doubt becomes.
OCD is also more common than most people realize. In a nationally representative U.S. survey, about 2.3% of adults met criteria for OCD at some point in their lives, and many more had symptoms below the diagnostic threshold (Ruscio et al., 2010).
Almost Everyone Has Intrusive Thoughts
If you’ve ever had a thought that made you think, Where did that come from? What does that say about me?, you’re in good company.
In a study of 777 university students across 13 countries and six continents, nearly 94% reported at least one unwanted intrusive thought in the previous three months. Doubting thoughts were the most common (Radomsky et al., 2014).
The thought itself isn’t the problem. What we do with the thought is where OCD takes hold.
Researchers have found that what separates everyday intrusive thoughts from OCD is mostly how much meaning we give them and how hard we try to control them (Radomsky et al., 2014). OCD tends to latch onto what matters most to you: your loved ones, your values, your faith, your sense of being a good person.
Signs of OCD You Might Not Recognize
OCD can show up in many ways beyond cleaning and checking:
Mental review: replaying conversations or memories to confirm you didn’t do something wrong
Reassurance seeking: asking others (or Google) again and again, “Are you sure?”
Relationship doubt: constantly questioning whether you love your partner or whether they’re “the one”
Fear of harming others: unwanted, horrifying thoughts that feel completely at odds with who you are
Moral or religious doubt: fear of sinning, being unforgivable, or being a bad person (often called scrupulosity)
Avoidance: steering clear of people, places, or situations that trigger the doubt
Checking and contamination fears: the more familiar patterns, which are very real too
If you grew up in a high-control religious environment, it can be especially hard to tell where spiritual conviction ends and OCD begins. Religious themes can become the language OCD speaks (Greenberg & Huppert, 2010). Untangling the two takes care and time.
Why OCD Is So Convincing
OCD sells itself as protection. Its message is: If you just think it through one more time, check one more time, make yourself certain, you’ll be safe.
I often think of compulsions as a part of you that learned only one move. It’s trying to keep you and the people you love safe, and it doesn’t realize the strategy is costing you your peace. That part deserves compassion, not shame. It also deserves a new way to do its job.
Living well with OCD usually isn’t about eliminating uncertainty. It’s about building a different relationship with it.
OCD vs. General Anxiety
The two overlap, but they aren’t the same. Anxiety tends to be about real-life worries (money, health, the future) and often feels like “too much.” OCD tends to involve thoughts that feel intrusive and out of character, paired with rituals or mental acts meant to neutralize them. That difference matters, because the treatments differ.
What Helps: Exposure and Response Prevention (ERP)
Cognitive behavioral therapy that includes exposure and response prevention (ERP) is widely recognized as the psychological treatment of choice for OCD. A large meta-analysis of randomized controlled trials found a large effect for ERP, though the researchers also noted that results varied depending on the comparison used and that the research has methodological limits (Reid et al., 2021).
In plain language, ERP means:
Gradually and collaboratively facing the thoughts, situations, or feelings you’ve been avoiding
Practicing not doing the compulsion, whether that’s checking, reassurance seeking, or mental review
Learning, through experience, that you can tolerate uncertainty and that the anxiety rises and falls on its own
It isn’t about forcing yourself through the worst of it. Good ERP is paced with you, and the relationship matters as much as the technique. I bring warmth, body awareness, and a parts-informed lens to this work, because OCD isn’t only a thinking problem. It lives in the body and in the story you’ve been told about what your thoughts mean.
Reid and colleagues also note that OCD is often detected late (Reid et al., 2021). If this post sounds like you, you don’t have to wait until it gets worse.
OCD Therapy in San Clemente (and Online)
I offer exposure-based therapy for OCD at The Bloom Room in San Clemente and online across California. If you’ve been white-knuckling your way through intrusive thoughts, I’d be glad to talk with you about what support could look like. Click below to book a free consult with me:
References:
Greenberg, D., & Huppert, J. D. (2010). Scrupulosity: A unique subtype of obsessive-compulsive disorder. Current Psychiatry Reports, 12(4), 282–289.
Radomsky, A. S., Alcolado, G. M., Abramowitz, J. S., Alonso, P., Belloch, A., Bouvard, M., Clark, D. A., Coles, M. E., Doron, G., Fernández-Álvarez, H., Garcia-Soriano, G., Ghisi, M., Gomez, B., Inozu, M., Moulding, R., Shams, G., Sica, C., Simos, G., & Wong, W. (2014). Part 1—You can run but you can’t hide: Intrusive thoughts on six continents. Journal of Obsessive-Compulsive and Related Disorders, 3(3), 269–279.
Reid, J. E., Laws, K. R., Drummond, L., Vismara, M., Grancini, B., Mpavaenda, D., & Fineberg, N. A. (2021). Cognitive behavioural therapy with exposure and response prevention in the treatment of obsessive-compulsive disorder: A systematic review and meta-analysis of randomised controlled trials. Comprehensive Psychiatry, 106, Article 152223. https://doi.org/10.1016/j.comppsych.2021.152223
Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2010). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry, 15(1), 53–63. https://doi.org/10.1038/mp.2008.94
