What is OCD and what does it look like?

What is OCD?

As the name implies, Obsessive Compulsive Disorder (OCD) is characterized by obsessive thoughts and compulsive behaviors. Obsessions are intrusive, distressing thoughts or images that are pervasive and persistent. Due to the distressing nature of the obsessive thoughts, individuals with OCD attempt to suppress or neutralize the thoughts by completing an action called a compulsion. Performing compulsive behaviors provides temporary relief from intrusive thoughts but ultimately, reinforces the obsessions. A key feature of OCD is that the compulsive behaviors are not realistically connected to alleviating intrusive thoughts in a functional way. For example, someone with OCD may check their locks multiple times a day to ensure safety when checking their locks once would have realistically been sufficient. 

OCD Presentations

OCD is a unique mental health concern because there are many diverse presentations of OCD. For some, compulsive behaviors are readily obvious (e.g., repetitive hand washing, flipping a light switch) while others experience more subtle compulsions (e.g., checking social media, asking for reassurance). Furthermore, while some compulsions appear to be directly related to obsessive thoughts, other compulsive behaviors are not clearly linked to ruminative thoughts. For example, the relationship between handwashing and fear of germs is readily obvious. In contrast, a compulsion of counting to a specific number repeatedly is not directly related to preventing bodily harm. Despite the stark difference between these two examples, the obsessive thoughts and repetitive behaviors are equally distressing and limiting for someone suffering from OCD. 

Common OCD Presentations

The list below encompasses common symptom presentations of OCD. However, the list is not exhaustive and OCD symptoms can be similar to symptoms of other disorders (e.g., generalized anxiety disorder, obsessive-compulsive personality disorder, body dysmorphia, hair-pulling disorder, illness anxiety disorder etc.). Therefore, evaluation and diagnosis by a mental health professional is key in seeking help for symptoms like the ones listed below. 

Obsessions/ Intrusive Thoughts	Compulsions/ Neutralizing Behaviors
Fear of Harm
Unknowingly hitting someone with a vehicle  Accidentally starting a fire Fear of being harmed or killed Fear of home intrusion Ruminative anxiety over a loved one being harmed	Checking bumps in the road to ensure a pedestrian/ animal was not hit Excessively checking locks Excessively checking that home appliances are turned off, returning home to check multiple times Time-consuming research on safety threats and protective equipment Rituals intended to prevent harm (e.g., counting, praying, saying a specific phrase) Texting family members to make sure they are okay
Fear of Contamination
Fear of being infected with a disease/germ/parasite Fear of contracting an illness Fear of spreading an illness	Excessive handwashing/ cleaning/ sterilizing Repeatedly checking for symptoms of illness Excessive research on illnesses and symptoms Repeatedly asking if something is contaminated
Religious Obsessions
Fear of going to hell Fear of being punished by a higher power Preoccupation with following religious “rules”	Repeatedly praying/ asking a higher power for forgiveness Repeatedly making the sign of the cross or engaging in other religious actions
Superstitions
Preoccupation with “lucky” or “unlucky” numbers, omens, phrases etc.	Repeating phrases, counting to lucky numbers, grouping objects in certain numbers, etc. to avoid negative consequences
Sexual Orientation Uncertainty
Fear of belonging to a sexual minority group (despite consistently engaging in heterosexual relationships) This does not include sexual fantasies or pleasurable thoughts ***It is important to note that sexual orientation uncertainty related to OCD is different from sexual identity exploration and questioning sexuality	Repeatedly checking body sensations or checking for sexual arousal Viewing sexual content to check for arousal rather than for pleasure Mentally reviewing evidence that one does not experience undesired sexual identity Ruminating on the meaning of intrusive thoughts
Relationship Uncertainty
Fear of infidelity (despite lacking evidence) Preoccupation with ex partners or current partner’s ex partners Ruminating on partner’s perceived flaws Comparison to others’ relationships ***This does not include rumination about leaving an abusive partner	Repeatedly seeking reassurance from partner Checking partner’s social media, personal belongings, electronic devices for evidence of infidelity Frequent comparison to current partner’s ex partners Repeatedly checking ex partner’s social media Excessively reviewing pros and cons of relationship
Intrusive Violent Thoughts
Fear of acting on unwanted impulses Fear of impulsively poisoning/stabbing/ choking another person or animal Often accompanied by shame over these thoughts Fear of losing control and harming others	Removing access to dangerous objects, avoiding certain people/ situations Attempting to suppress or neutralize the thoughts with other behaviors (e.g., prayer, repeating phrases)   Ruminating on the meaning of the thoughts
Intrusive Sexual Thoughts
Fear of engaging in pedophilia Intrusive and distressing “taboo” sexual thoughts This does not include sexual fantasies or pleasurable thoughts Thoughts often cause shame	Repeatedly checking body sensations or checking for sexual arousal Mentally reviewing evidence that one will not engage in unwanted sexual behaviors Attempting to suppress or neutralize the thoughts with other behaviors (e.g., prayer, repeating phrases)   Ruminating on the meaning of intrusive thoughts
Need for “Perfection”/ “Exactness”
Preoccupation with order/ completeness Need for symmetry Feelings of distress in environments that lack exactness or symmetry	Reordering and rearranging objects to make them “just right,” complete, or symmetrical

OCD Support & Treatment

Many people with OCD experience shame surrounding persistent, intrusive thoughts and neutralizing behaviors. Those with OCD, especially children may have difficulty identifying the condition as a mental health concern. Children and adults with OCD may struggle to share the extent of their concerns with loved ones and mental healthcare providers. Therefore, supporting a child or loved one with OCD can be difficult. Parents, caregivers, and loved ones can help by doing the following:

1. Providing mental health resources and encouraging the person to seek professional help. Symptoms of OCD are often addressed through Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP). CBT helps the individual build awareness of intrusive thoughts, reframe these thoughts in a balanced and realistic way, and replace compulsive behaviors with positive behaviors. In ERP therapy, individuals learn to tolerate and reevaluate distressing thoughts without reinforcing them through compulsive behaviors. 

2. Externalizing symptoms of OCD by naming them and expressing the concept that OCD is separate from the person’s identity and does not define them. When a child or loved one expresses an obsessive thought or engages in a compulsive behavior, parents and caregivers can help to create awareness by identifying the thoughts and behaviors as symptoms of OCD. 
   

3. Being careful not to reinforce obsessions by providing excessive reassurance or supporting compulsive behaviors. Although it is appropriate to provide reassurance to children and loved ones in most contexts, reassuring someone with OCD in the context of obsessive thoughts may reinforce these thoughts and perpetuate compulsive behaviors.

If you, your child, or a loved one is experiencing symptoms of OCD, talking to a therapist is a great place to start!

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At Balanced Minds Psychology & Wellness we specialize in assisting teens and children with navigating life’s challenges. To learn more about me and the services I provide, checkout my profile. If you are ready to start the therapy process, contact us today to schedule a free consultation, either over telehealth or in person!

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Resources

For more information on OCD, visit the following:

• Obsessive-Compulsive Disorder (OCD) in Children - Stanford Medicine Children's Health (stanfordchildrens.org)

• Helping a child with obsessive-compulsive disorder - Harvard Health

• Obsessive-Compulsive Disorder (OCD) in Children: A Quick Guide (childmind.org)

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References

Cleveland Clinic. (2024, April 30). Signs of relationship OCD and how to Cope.

https://health.clevelandclinic.org/relationship-ocd

Ecker, W., & Gönner, S. (2008). Incompleteness and harm avoidance in OCD symptom

dimensions. Behaviour Research and Therapy, 46(8), 895–904.

https://doi.org/10.1016/j.brat.2008.04.002

International OCD Foundation . (2010). Contamination fact sheet. Obsessive Compulsive

Contamination Fears. https://iocdf.org/wp

content/uploads/2014/10/Contamination-Fact-Sheet.pdf

Williams, M. T., & Wetterneck, C. T. (2019). Understanding sexual obsessions. Sexual

Obsessions in Obsessive-Compulsive Disorder, 7–38. https://doi.org/10.1093/med-

psych/9780190624798.003.0002