Obsessive Compulsive Disorder (OCD)

In-person and telehealth treatment for OCD in Massachusetts and Virginia by trained exposure and response prevention (ERP) therapists.

Understanding OCD

Living with OCD can feel like being stuck in a loop you didn’t choose. You may know your thoughts aren’t entirely logical — but that doesn’t make them any less loud, convincing, or distressing.

OCD is made up of two parts:

  • Obsessions: unwanted, intrusive thoughts, images, or urges that bring distress.

  • Compulsions: repetitive actions or mental rituals that you feel driven to do in order to relieve the anxiety or “make something bad not happen.”

Many individuals with OCD do not immediately recognize their experiences as part of the disorder. Because intrusive thoughts can feel private, shameful, or “just part of who they are,” they may not identify them as obsessions. Similarly, subtle or internal compulsions — like mental checking, repeating phrases silently, or seeking reassurance in indirect ways — may not be recognized as compulsions at all.

As a result, people often minimize or rationalize these experiences, assuming they are simply anxious, overly cautious, or “just quirky.”

Contamination

Intense fear, anxiety, and a heightened sense of danger when faced with perceived germs, contamination, or illness risks.

  • Contamination

    If I sit near that person, their bad energy or illness might transfer to me.

    If I take this medicine, it might actually harm me, rather than help me.

    What if I go near my friends, and I give them an illness and they die?

  • These intrusive thoughts are typically accompanied by intense anxiety or disgust — and are often followed by compulsions such as excessive handwashing, cleaning, avoiding certain places, or seeking reassurance.

Pedophelia (POCD)

Thoughts that are wanted, distressing, and inconsistent with the individual’s values or desires

  • What if the fact that I noticed a child means that I’m secretly a pedophile?

    What if this unwanted thought about a child means I could harm them?

  • Common compulsions may include avoiding being around children entirely, mentally “checking” feelings during interactions, replaying moments to ensure nothing inappropriate happened, researching sexual orientation or legal definitions, and seeking reassurance that they are “not a bad person.”

  • POCD is not the same as pedophilic disorder. People with POCD are distressed precisely because these thoughts and images are unwanted and misaligned with their identity or values.

What OCD Really Looks Like

For many people, the term OCD brings to mind a very narrow image — someone who is “overly clean,” organized, or particular about details. This stereotype is often reinforced by television and movies, where OCD is portrayed as quirky, obvious, or even humorous.

While some individuals with OCD do experience contamination fears or ordering rituals, this is only a small part of the full picture. In real life, OCD can look very different — and often, it’s not visible to anyone else.

Let’s explore some of the real ways OCD manifests in daily life:

Perfectionism

Involves anxiety, distress, and a sense of threat when things feel “not right” or incomplete

  • If I don’t get every detail just right, something bad will happen.

    If I make even one mistake, it will ruin everything, and everyone will see I’m a fraud.

  • Common compulsions tied to perfectionism OCD can include rereading or redoing work repeatedly, rewriting or rephrasing until it feels “exactly right,” over-preparing, avoiding tasks unless they can be done perfectly, or seeking reassurance that something is “good enough.

Magical Thinking

Believing that thoughts, numbers, or small actions can directly influence unrelated events

  • If I think about my partner getting into an accident, it might actually happen.

    If I don’t knock on wood after a bad thought, something awful will happen.

    If I don’t touch the doorknob four times, someone will die.

  • Common compulsions may include repeating specific actions (e.g., tapping, counting, avoiding certain numbers), neutralizing “bad” thoughts with “good” ones, or avoiding triggering situations altogether.

Harm

Overwhelming fear of causing harm, losing control, or being responsible for danger, despite having no intent to act.

  • What if I were to jump in front of that car, even though I don’t want to die?

    I keep thinking about stabbing my partner with my fork, even though I’m not upset with them

  • Common compulsions may include hiding or avoiding sharp objects, mentally reviewing or “proving” that they would never hurt anyone, seeking reassurance from others, avoiding driving or high places, or replaying scenarios to ensure nothing dangerous happened.

Religion or Spirituality

Centers on moral perfectionism, fear of sin, or doubts about one’s beliefs.

  • What if I didn’t pray the right way, and now I’ve upset my God without meaning to?

    What if this thought proves I’m not really faithful, and I end up going to hell?

    What if I accidentally say or do something wrong, and I can never be forgiven?

  • Common compulsions may include excessive praying or repeating prayers until they feel “just right,” seeking reassurance from religious leaders or loved ones, avoiding spiritual spaces to prevent “wrong” thoughts, or confessing perceived sins repeatedly.

Existential

Persistent anxiety and fear when facing unanswerable questions about reality, meaning, or existence.

  • What if nothing around me is real, and I can never prove that none of this exists?

    What if I suddenly forget my identity completely, and there’s nothing I can do to prevent it?

  • Common compulsions may include mental rumination, reassurance seeking, researching philosophical or religious answers for hours, or avoidance of triggering topics or media.

Sensorimotor

Obsessive attention to automatic bodily sensations that most people tune out

  • I can’t stop noticing my breath, no matter what I’m doing.

    What if I lose my ability to swallow normally because I think about it too much?

  • Common compulsions may include trying to distract oneself from the sensation, testing or controlling the bodily process (e.g., forcing or monitoring breaths), mentally checking to see if the sensation is still noticeable, or avoiding quiet environments where awareness is heightened.