OCD 101: What Is It And How Do You Treat It?

What is OCD? Very few people understand what it is or how it impacts someone struggling with it. Obsessive Compulsive Disorder (OCD) is characterized by scary thoughts that won’t go away unless you perform a ritual.  These thoughts can make people feel crazy and damaged.  However, there’s hope for a better life.

What Causes OCD?

We’re not sure what causes OCD.  Research shows it’s due to some combination of three key factors:

  • psychological:  how we think and respond
  • biological:  genetics and how our brains are wired
  • environmental:  life events and what matters to us


How OCD Starts and Why it Gets Worse

OCD usually starts out as a way to cope with anxiety.  Rituals are a quick and basic way to make anxiety go away.

At first, doing rituals gives you a sense of control and peace which further reinforces doing the ritual again.  Initially, it doesn’t take much time to do a ritual.  It’s not a big deal to wash your hands again or say a quick prayer.  No one seeks therapy for a behavior that makes them feel better and only takes an extra couple of minutes.

The more comfort you feel after a ritual, the more you buy into the idea of doing whatever it takes to make the fear go away.

You realize your thoughts are irrational.  However, the fear and anxiety they cause feel so real, that you’re willing to do anything for a moment of peace.  This includes researching, asking for reassurance, checking, and repeating any behaviors that make you feel calmer and like you’ve answered any doubts your brain has.

Eventually, the thoughts become so large and threatening that it takes significant effort to calm the anxiety they cause.  Rituals become complicated and take up a lot of time.  They may even stop working regardless of how often you do them.

This is how people wind up showering for 8 hours, making sure the door is locked 20-30 times every time they leave the house, asking for reassurance from family for days, or rewriting one sentence repeatedly for an hour.


The 2 Parts of OCD

OCD is made up of two key parts.  They depend on each other to make you anxious, perform rituals, and keep you afraid.

Obsessions – Persistent ideas, images, or thoughts that intrude into a person’s thinking and cause significant worry and anxiety.

  • Common obsessions:  Contamination, losing control, perfectionism, harm, religion, and health.

Compulsions – Behaviors and/or mental acts that are performed repeatedly in response to an obsession to get rid of or prevent anxiety.

  • Compulsions can be obvious behaviors like checking, washing, cleaning, and putting things in a specific order.
  • They can also be “behaviors” no one can see like counting, repeating words and thoughts, researching answers, praying, replacing a “bad” thought with a “good” one, or playing a mental scenario over and over again to analyze different parts of it.


Can I Only Have Obsessions But No Compulsions?  

A lesser known form of OCD is called Pure Obsessional OCD, often referred to as “Pure O.”  People report obsessions but do not have observable compulsions.

These obsessions often take the form of intrusive thoughts or mental images of committing an act they consider amoral, dangerous, or inappropriate.

After further assessment, these people report that they actually do engage in reassurance-seeking, avoidance behavior, or mental compulsions.

Common examples of mental rituals include:

  • Constantly thinking about an obsession to prove to themselves they have not actually done anything.
  • Silently praying or repeating thoughts.
  • Using words or thoughts to undo an obsession.


CBT:  The Best Way to Treat OCD

Compared to traditional talk therapy, research-based Cognitive Behavioral Therapy (CBT) is significantly more effective for treating OCD.

The approach is based on giving you the information and strategies you need to manage the threatening thoughts instead of giving in to them.

We constantly work together on how to challenge thoughts and introduce new behaviors.  This helps you learn to manage OCD symptoms.

Although OCD results in anxiety, it is unique and requires a specific approach.  You can’t use logic to work through OCD the way you would with other anxiety disorders.

Treating OCD like other anxiety disorders can actually make it worse. 

Using logic, reasoning, and proof only makes the obsessions worse. 

They provide short term relief, but it’s only a matter of time before the obsession pops up again looking for more proof.

ERP:  Gold Standard CBT Treatment for OCD

Exposure Response Prevention (ERP) is a form of Cognitive Behavioral Therapy specifically for OCD.

We begin by developing a detailed understanding of your triggers, thoughts, and responses.

This leaves us with a map or blueprint of your specific OCD.  As a result, we can focus all of our efforts where it counts the most.

Effective treatment for OCD is made up of two core pieces:

  • Exposure Response Prevention (also called ERP or exposure therapy):

    • We create a list of fears and anxiety-provoking situations.
    • You will experiment during sessions with exposure exercises aimed at helping you confront these OCD fears in a new way.
    • The work is gradual, starting small and working toward the most anxiety provoking thought.
      • We work at the pace you can handle.
      • Starting with a big fear to get immediate relief usually backfires.
    • You are given homework assignments so that you can continue to challenge the OCD between sessions.
      • Homework is an essential part of treatment. It allows you to practice new OCD and anxiety coping skills in the “real world.”
        • Think of it as 6 days and 23 hours worth of free therapy.
    • Following a structured protocol, you gradually challenge more OCD symptoms and learn better methods for coping with obsessions and anxiety.

The goal is for you to become desensitized to thoughts and fears that previously bothered you.

Obsessions that terrorized you now can actually become boring.

Once your brain isn’t scared, you don’t have to do rituals to get reassurance or relief.


  • Mindfulness-Based Techniques:

    • Everyone has weird thoughts.  Someone without OCD can eventually shake off a disturbing thought or feeling.
    • Most of the distress people experience related to OCD has to do with how they respond to the scary or strange thought.  Someone with OCD can’t just let it go.  The thought and resulting anxiety stick with them.
    • We will work on helping you learn how to live with unpleasant thoughts and feelings rather than constantly trying to control or avoid them.
      • It sounds weird and impossible.  We know.

OCD really can be managed.

These techniques will make you an expert on your OCD and support your happiness and well-being for years to come.


Your Next Step In Living With OCD

You’re likely going to spend a lot of time looking for information on line and asking others for reassurance to make sure you’re not going crazy.  At some point, you’ll realize that you may have OCD.


Contact us when you’re ready to have an OCD treatment expert help you figure out your situation.

A life without constant fear is possible.


Stay strong,

Dr. Levy

Clinical Director

Bucks County Anxiety Center



Dr. Ronit Levy is a clinical psychologist and director of Bucks County Anxiety Center in Newtown, PA. She specializes in treating teens and adults struggling with anxiety due to Anxiety Disorders, OCD, chronic illness, and life events. Dr. Levy trains and supervises other therapists and presents on mental health in the community.

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