Understanding Obsessive-Compulsive Disorder (OCD)
What Is Obsessive-Compulsive Disorder (OCD)?
The specific DSM category is Obsessive-Compulsive and Related Disorders. The related disorders include Body Dysmorphic Disorder, Hoarding Disorder, Trichotillomania (Hair-Pulling) Disorder, and Excoriation (Skin-Picking) Disorder. Obsessive-Compulsive Disorder (OCD) used to be categorized in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as an anxiety disorder. In the release of the DSM-5 in 2013, due to OCD’s unique features, the DSM committee created an entirely new DSM category. Despite having its own category, I still treat OCD as an anxiety disorder in my practice.
The formal definition of OCD is a mental health condition characterized by unwanted, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that an individual feels compelled to perform. These obsessions and compulsions can significantly interfere with daily activities and cause distress.
My less formal definition is a container to house one’s fears, usually developed in childhood, to keep one emotionally safe. OCD usually develops into a formal set of personal rules that requires strict allegiance. Despite one following the rules, it rarely feels enough to keep guilt and shame at bay.
Common Symptoms of OCD
- Obsessions: Technically, an obsession could be anything – an intrusive thought, image, sensation, etc. Think of obsessions as simply FEARS.
- Compulsions: What do we do when we are afraid? We try to fix our fears. Compulsions are the accumulation of ways we have tried to feel safe from our fears. Yes, we all know there are the checking, cleaning, and organizing compulsions, but there are zillions of ways we mentally or sneakily try to feel safer. Seeking reassurances, avoiding, strict adherence to praying a certain way, replacing bad thoughts with good thoughts, oversharing, overthinking, and the mother of all compulsions – ruminating – are all compulsions.
The very acts and rituals that have kept you safe in the past are now the problem.
Diagnosis
OCD is typically diagnosed by a mental health professional through a detailed interview and assessment of symptoms. The diagnosis is based on specific criteria outlined in the DSM-5TR.
Most people who come to my practice for assessment are shocked to learn the extent OCD symptoms have invaded their life. For example, many think their contamination fears are the only obsessions they have. In the assessment, a therapist will ask, “How do you handle making a mistake?” Usually, the response is, “What? I absolutely hate making any mistakes. Oh the shame. Wait, what? That is OCD?”
Despite having had OCD from an early age, I was shocked to realize how many aspects of myself were related to OCD symptoms. Once I started training to become an OCD specialist, I knew there was more work for me to remove compulsions that were keeping me stuck.
EVEN IF you are not formally diagnosed with OCD, does that mean you can’t benefit from treatment and healing? Not meeting formal DSM-5TR criteria means your health insurance will not provide coverage, but OCD treatment in my private practice means you don’t have to meet formal criteria to heal. By not accepting insurance, I am able to incorporate many psychological interventions to supplement the gold standard of treatment. See below on treatment options. (I also have a contract with NOCD where I provide insurance treatment for those who formally meet OCD diagnostic criteria.) I additionally love to provide counseling for family members of those with OCD. How to best help those with OCD is likely different than you are currently doing.
Subtypes of OCD
Social media sometimes focuses on subtypes of different mental health diagnoses. However, most DSM-5TR diagnoses do not differentiate in diagnosing subtypes. There are innumerable subtypes of OCD, but there is the one OCD diagnosis. Below is a list of different subtypes of OCD, but I consider all of them to be related to the core problem of responsibility.
- Contamination and Illness Fears – fears surrounding germs, getting sick, or making others sick
- Moral OCD – excessive guilt, fear of causing harm, and fear of being selfish or immoral (common compulsions can be over-apologizing, over-researching, ruminating, and always wondering if you’re a good person)
- Relationship OCD – constant doubt about your relationship and attraction as being enough
- Sexual OCD – unwanted sexual thoughts or images that feel very disturbing, wrong, or indicative of being a pedophile or sexual deviant
- Religious/Scrupulosity OCD – fear of offending God, sinning, or not being enough (also can include excessive and ritualistic praying, confessing, or seeking reassurances)
- Just-Right/Symmetry/Perfectionism – fear of anything not being just right or enough in order to move on (often repeating actions until they feel perfect or complete)
OCD therapists like to say that it is really tough to shock us. We’ve heard quite a lot!
General Treatment Options
OCD is treatable, and many people experience significant improvement with appropriate care. Common treatments include:
- Exposure and Response Prevention (ERP): Confronting obsessions without performing compulsions is necessary to remove the power of fears. ERP is the gold standard treatment for OCD and other diagnoses, like phobias.
- Medications: The use of mental health medications is a very personal issue. Medications though should not be a replacement for mental health treatment. If you want to pursue medications, seek professional help from psychiatrists who focus on OCD symptoms.
- Support Groups and Education: Joining support groups and learning more about OCD can help individuals and families cope.
Resources for More Information
- International OCD Foundation (IOCDF): The IOCDF is a major hub for OCD information, treatment guidelines, self-help resources, support groups, and downloadable brochures/fact sheets.
Link: International OCD Foundation | Educational Resources - Anxiety and Depression Association of America (ADAA): The ADAA is broader to include anxiety and depression, but there is dedicated content on OCD for treatment explanations, therapist directories, webinars, etc.
Link: Obsessive-Compulsive Disorder (OCD)
How I Treat OCD
- Psychoeducation
You will learn what OCD is, how the OCD cycle works, and why your brain is doing what it’s doing. Understanding the WHY reduces shame and helps you see your symptoms as patterns, not personal failures. - ERP
As the gold standard for treating OCD, ERP involves:- Exposure: Gradually facing the fears that trigger anxiety instead of retreating through compulsions
- Response Prevention: Resisting or reducing the compulsions that you commonly and probably automatically have learned to do
- CBT
In addition to providing ERP treatment, I provide Cognitive Behavioral Therapy (CBT) to work with the roots of your compulsions. I consider myself a mental health archeologist because I want to know the core limited beliefs that are keeping you stuck. In my experience, ERP is a wonderful therapy, and once the ERP tools are learned, it is a matter of applying them in daily life. However, as a responsibility disorder, OCD treatment needs to also work with limited core beliefs about oneself. - Addressing Inflated Responsibility
Most people with OCD feel responsible for everything and everybody. With that inflated responsibility, most people with OCD have limited their self-worth to what they do for others. Plus, I don’t know anyone with OCD who hasn’t felt used. The problem usually becomes when we use ourselves and limit our own abilities. Once the ERP tools are learned, treatment with me focuses on learning how to trust and accept yourself. Self-trust and self-acceptance are game changers in living a joyful life! - Support for Loved Ones
Loved ones can be a part of the healing process. In OCD treatment, the word accommodations is a bad word because family members have learned how to accommodate to OCD symptoms. That means OCD has all of the power. I provide support for all those affected by OCD!
What Working Together Looks Like
You don’t need to know if you or a loved one has OCD, I will help guide you.
In our work, you can expect:
- A nonjudgmental space – Intrusive thoughts can feel scary, taboo, or shameful. I understand that OCD attacks what you care about most.
- Collaborative planning – We create a clear plan together, including goals and the steps we’ll take.
- Practical skills – You will learn tools to handle intrusive thoughts and emotions, to reduce rituals, and to respond differently to anxiety.
- Respect for your values – Whether your values are spiritual, relational, ethical, or professional, we’ll align treatment together to what matters most to you.
Currently, I am seeing those over 18 years of age. I do not accept insurance in order for me to practice independent of insurance companies’ mandates and to incorporate additional psychological interventions. My 2026 psychotherapy rate is $200/session.