What is OCD Really?
When people hear “OCD,” they often picture someone who likes things neat, washes their hands a lot, or double-checks the stove. While that is certainly how some people experience OCD, that description is entirely incomplete, and for many people, it hides the real problem.
The truth is, OCD is really a disorder of getting stuck.
Stuck in thoughts.
Stuck in doubt.
Stuck in loops that feel impossible to escape.
If you’ve ever felt like your mind won’t let go, no matter how much you try, this might finally explain why.
Why OCD Is So Often Misdiagnosed
OCD affects roughly 2–3% of adults, which translates to millions of people in the U.S. Yet many individuals don’t realize they have OCD, and many clinicians don’t recognize it right away either.
This can lead to:
People needlessly suffering for years before finding the proper diagnosis
Sufferers ending up in the wrong treatment, potentially making their OCD worse (or at best staying the same)
In the OCD field, research shows that it takes on average 10–17 years before receiving the correct diagnosis. Having worked in this field for over a decade, I can personally attest that the delay is not just a meaningless statistic; it’s something OCD specialists like myself hear all the time from clients and families who have been “through the ringer” trying to find the right provider.
Why the delay happens
There are several reasons why OCD is likely to slip through the cracks
1) Limited training in graduate school
Many clinicians receive minimal formal training in OCD, often times just a brief hour long lecture within a broader diagnostic class. Unless they pursue further training outside of graduate school, that may be all they receive.
2) Shame and stigma
Many people with OCD experience deeply distressing intrusive thoughts (sexual, violent, taboo, identity-related) and fear being judged, hospitalized, or reported. They may never disclose their symptoms fully.
3) Misleading media portrayals
Pop culture often portrays OCD as only handwashing, checking the stove, or counting. Those can be OCD, but as mentioned earlier, OCD extends far beyong that.
4) The “I’m so OCD” problem
OCD is frequently mistaken for a “preference” or “being organized.” In reality, OCD is a debilitating disorder involving intrusive thoughts and compulsive behaviors that can hijack a person’s life.
A Quote That Captures OCD Perfectly
Years ago, I ran OCD groups at a partial hospitalization (PHP) OCD program. One member’s words really struck a cord with me:
“OCD takes a finger, then an arm, then a leg—and before you know it, it’s taken everything.”
That’s OCD in a nutshell. A seemingly benign behavior that starts out as “small reassurance” can quickly evolve into a full-blown, tortuous OCD cycle, leading to intense anxiety, lost time, and a nervous system stuck in chronic dysregulated fight-or-flight mode
To make matters worse, OCD also has a way of targeting the things we value most, whether that's family, relationships, morality, health, identity, work, school, faith, or responsibility. So, not only do sufferers experience anxiety and the grief that comes with OCD taking up time, but a deep shame about having the things they care most about thrown into question.
What OCD Actually Is In Simple Terms
Clinically, OCD involves:
Obsessions: intrusive thoughts, images, urges, or sensations that feel unwanted and distressing
Compulsions: behaviors—physical or mental—done to reduce anxiety, gain certainty, or “neutralize” the obsession
One important nuance: Even though the DSM describes OCD as “obsessions or compulsions or both,” in real clinical practice, OCD always involves both. Compulsions, especially subtle mental compulsions, are what keep OCD alive. There is a term called “Pure O” OCD, which stands for “Purely-obsessional” form of OCD. However, this is a misnomer, and it actually refers to OCD manifestations where compulsions are mostly mental (e.g., rumination, counting, monitoring, overanalyzing, etc).
The OCD Cycle (The Most Important Concept)
If you want to understand OCD at the deepest level, the most important thing to understand is the OCD cycle.
Here’s a simplified version:
Trigger (a situation, image, memory, sensation, or “what if”)
Intrusive thought / obsession (“What if I…?”, “What if that means…?”, “What if something terrible happens?”)
Distress (anxiety, dread, guilt, shame, uncertainty)
Compulsion / safety behavior (physical or mental) to feel better or prevent harm
Short-term relief
Long-term worsening (the brain learns the obsession was a real threat)
Example: contamination fear
Someone touches a doorknob and has an intrusive thought:
“What if there’s blood I can’t see? What if it’s HIV? What if I spread it to people I love?”
They feel dread and urgency. So they:
wash hands for a long time
avoid doorknobs
sanitize repeatedly
mentally reassure themselves
seek reassurance from others
They may feel better in the moment.
But the brain never gets “disconfirming evidence” that the doorknob was safe. So next time, the threat alarm fires even louder, leading to more anxiety and stronger urges to wash, clean, or mentally reassure (e.g., engaging in compulsions)
In other words:
You can’t talk your way out of OCD. You have to show the brain by behavior.
That’s why OCD is best understood as a fear-learning and reinforcement problem—not a logic problem, and why Exposure and Response Prevention is considered the gold standard treatment.
Everyone Has Intrusive Thoughts—So What Makes It OCD?
Intrusive thoughts are universal.
Many people without OCD have fleeting thoughts known as “the call of the void” that may sound like:
“What if I jumped?” while standing on a cliff
“What if I pushed that person?” on a train platform
The difference is what happens next.
In OCD, the brain interprets the thought as meaningful and dangerous:
“Why did I think that?”
“What does it mean about me?”
“What if I actually do it?”
“How do I make sure it never happens?”
That interpretation of the thought as a danger is the spark that fuels the cycle.
Common OCD Theme Clusters
OCD can be grouped (loosely) into several common theme clusters. These aren’t exhaustive, but they can be helpful ways to categorize and understand one’s lived experience with OCD. And as we know, we have to name it to tame it!
1) Contamination OCD
Not just handwashing—this can include fears about:
germs, viruses, COVID, HIV
toxins, asbestos, radiation
bodily fluids (blood, saliva, semen, feces)
It can also include emotional contamination, such as:
avoiding objects or images for fear they will “transfer” negative qualities
fearing that a negative thought will contaminate a positive memory
2) Responsibility for Harm or Mistakes
Often includes checking and reassurance behaviors:
stoves, locks, doors, windows
“hit-and-run” OCD (fearing you hit someone while driving and didn’t realize)
Repeated retracing, circling back, checking mirrors
3) Unacceptable Thoughts OCD
Intrusive thoughts that feel taboo or disturbing, including:
sexual intrusive thoughts
violent intrusive thoughts
blasphemous thoughts
suicide-themed intrusive thoughts
4) Symmetry / “Just Right” OCD
Driven less by fear of a catastrophe and more by a powerful internal sensation of “wrongness” or imbalance:
touching/bumping to “even it out”
arranging until it feels “just right”
sometimes overlaps with magical thinking (“If I don’t fix this feeling, something bad will happen.”)
Physical Compulsions vs. Mental Compulsions
Compulsions can be visible (i.e. physical behaviors) or invisible (i.e. mental compulsions)
Examples of physical compulsions
checking (locks, appliances, reassurance seeking)
cleaning, washing, sanitizing
repeating actions (redoing, re-entering rooms)
avoidance (subtle life restriction)
confessing, asking for reassurance
counting, ordering, symmetry rituals
Examples of mental compulsions
These are often missed in therapy and they’re a huge reason OCD is underdiagnosed. Even seasoned OCD specialists can miss mental compulsions without a careful assessment:
self-reassurance (“I’m fine, that won’t happen.”)
rumination and analysis (“Did I do that? What if I did?”)
mental review and retracing
scanning feelings, arousal, bodily sensations
“figuring it out” or trying to get certainty
thought suppression and blocking
mental neutralizing (prayers, replacing thoughts)
It can be especially tricky, as mental compulsions can look like “insight,” but they function like rituals, which will inevitably keep OCD running.
Remember: OCD Is Not a Thinking Disorder
One of the most important clinical reminders:
OCD is not a thinking disorder. It’s an emotional disorder.
Many people with OCD are highly intelligent. They often know their fears are irrational. But logic doesn’t solve the problem because the cycle is reinforced by anxiety relief, not by reasoning.
OCD also creates urgency. It rewards immediate action and punishes waiting.
OCD Often Wears Many Masks
Most people with OCD have more than one theme, and themes can shift over time. The content changes, but the process stays the same:
intrusive thought → distress → compulsion → relief → reinforcement
That’s why “subtypes” matter less than understanding the mechanism.
Why is it important to distinguish OCD from anxiety?
If OCD is present and you treat it like general anxiety, it often doesn’t improve—and can worsen.
OCD responds best to OCD-specific, evidence-based treatment, especially:
Often integrated with ACT (Acceptance and Commitment Therapy) principles
One example of this is mindfulness, an evidence-based skill that involves paying attention to the present moment in a non-judgmental, curious way. Mindfulness is backed by hundreds of studies and is often very helpful for folks with anxiety. When used wisely, it can also be useful for people with OCD. However, OCD can weaponize mindfulness to get people to use it as a subtle compulsion, thus fueling the OCD cycle. That’s why getting an accurate diagnosis and the right treatment is essential: improvement can be dramatic, even after years of suffering.
Next Steps
If you’re a clinician wondering whether a case is OCD or anxiety, start by asking:
What are the intrusive experiences (thoughts/images/urges/sensations)?
What is the client doing—physically or mentally—to reduce discomfort or gain certainty?
Do the “coping strategies” function as compulsions (short-term relief, long-term worsening)?
Is there a pattern of obsessional doubt and repeated mental checking?
If you’re a client or family member reading this and something “clicked,” that’s common. Many people experience a huge sense of relief when they finally have language for what they’ve been dealing with.
OCD is highly treatable, and you don’t have to keep fighting it alone. Visit our Contact page to schedule a free 15-minute phone consultation with one of our highly trained specialists to get started on your journey towards getting your life and peace of mind back.