OCD can present very differently from one person to another. Some experiences may be readily visible, while others occur almost entirely internally.

Common patterns can include:

• Contamination concerns, such as fears involving germs, illness or becoming contaminated
• Checking, such as repeatedly checking locks, appliances, messages or completed work
• Fear of causing harm, including persistent doubts about accidentally or intentionally harming someone
• Need for symmetry or exactness, where things may feel incomplete or “not right”
• Intrusive sexual, violent or religious thoughts that are unwanted and distressing
• Relationship-related doubts, involving persistent uncertainty about one’s feelings, partner or relationship
• Moral concerns, including excessive fears of having behaved wrongly or being a bad person
• Reassurance seeking, such as repeatedly asking others whether something is safe, acceptable or certain
• Mental rituals, including reviewing memories, repeating phrases, counting or attempting to replace an unwanted thought with another thought
• Avoidance of people, places, objects or situations that trigger obsessive fears

Not everyone who experiences intrusive thoughts has OCD. Intrusive thoughts can occur in people without a psychological disorder. In OCD, however, the person can become caught in a cycle of interpreting these thoughts as particularly significant or threatening and attempting to obtain certainty or relief through compulsions and avoidance.

These strategies may provide temporary relief, but they can also reinforce the cycle and make the obsessions increasingly difficult to tolerate.

At People Psychological Solutions, our clinical psychologists work with individuals experiencing obsessive thoughts, compulsive behaviours, reassurance seeking, avoidance and related difficulties.

Assessment begins with understanding the person’s experiences rather than simply determining whether particular symptoms are present.

Depending on your individual circumstances, this may involve:

• Understanding the nature and frequency of intrusive thoughts, images, urges or doubts
• Identifying compulsive behaviours and mental rituals
• Exploring reassurance seeking and avoidance
• Understanding situations that trigger obsessive concerns
• Assessing how much time symptoms consume and how they affect everyday functioning
• Using standardised psychological measures where clinically appropriate
• Exploring when the difficulties began and how they have changed over time
• Considering other psychological conditions that may contribute to similar experiences
• Identifying other difficulties that may occur alongside OCD

A careful assessment is important because OCD can sometimes be mistaken for other difficulties.

For example, repetitive worry can occur in anxiety disorders, while intrusive thoughts may occur in several psychological conditions. Repetitive behaviours can also occur for reasons unrelated to OCD.

Understanding what function these thoughts and behaviours serve for the individual helps guide appropriate treatment.

OCD is treatable.

One of the most established psychological treatments for OCD is Cognitive Behavioural Therapy (CBT) incorporating Exposure and Response Prevention (ERP). ERP is recommended as a first-line psychological treatment for OCD in established clinical guidance.

At People Psychological Solutions, treatment is tailored to the person’s particular pattern of obsessions, compulsions and avoidance rather than simply addressing “anxiety” in general.

What Is Exposure and Response Prevention?

ERP involves gradually learning to face situations, thoughts, sensations or uncertainties that trigger obsessive fears while reducing the compulsions normally used to obtain relief or certainty.

For example, someone who repeatedly checks whether a door has been locked may gradually practise leaving after locking it once rather than returning repeatedly to check.

Someone experiencing intrusive thoughts may instead practise allowing the thoughts to occur without trying to suppress, analyse, neutralise or seek reassurance about them.

Exposure is planned collaboratively and carried out progressively. The purpose is not to force someone into their worst fear without preparation.

Instead, therapy helps the person develop a different relationship with uncertainty and distress and learn that compulsive rituals are not necessary for them to move forward.

Depending on the individual’s difficulties, psychological treatment may therefore involve:

• Understanding the person’s individual OCD cycle
• Identifying obsessions, compulsions and avoidance patterns
• Recognising less obvious compulsions such as reassurance seeking and mental rituals
• Developing an individualised exposure plan
• Gradually approaching previously avoided situations
• Reducing compulsive behaviours
• Learning to respond differently to intrusive thoughts
• Developing greater tolerance of uncertainty
• Addressing beliefs that maintain obsessive-compulsive patterns
• Reducing the impact of OCD on work, relationships and everyday activities
• Developing strategies for maintaining progress and managing future symptom recurrence

The aim of treatment is not necessarily to ensure that an unwanted thought never occurs again. Trying to completely eliminate intrusive thoughts can itself become part of the struggle with OCD.

Instead, treatment helps a person become less controlled by the thoughts and less dependent upon compulsions to feel safe or certain.

What About Medication for OCD?

Medication can also form part of evidence-based treatment for OCD. Selective serotonin reuptake inhibitors (SSRIs) are among the established medication treatments, and some individuals may receive psychological treatment and medication together.

Clinical psychologists do not prescribe medication. Where medication assessment may be appropriate, we may recommend consultation with a psychiatrist or another appropriately qualified medical practitioner.

Psychological treatment can take place alongside medical management where appropriate.

People experiencing OCD may also experience other psychological difficulties, including:

• Depression
• Other anxiety-related difficulties
• Trauma-related difficulties
• Difficulties within relationships
• Other obsessive-compulsive and related conditions
• Neurodevelopmental conditions

The presence of another condition does not necessarily mean that OCD treatment cannot proceed. However, understanding the broader clinical picture allows treatment to be planned according to the individual’s needs.

It is also important not to assume that every repetitive thought or behaviour is caused by OCD. Our psychologists therefore consider both the person’s symptoms and the psychological processes underlying them.