OCD is a disorder characterized by obsessions and compulsions. This means that people with OCD experience severe recurring intrusive thoughts (obsessions), which cause them to perform an action to temporarily ease the distress (compulsions).
OCD can also come in a variation called "pure O", which is when the compulsions are mental only.
The intrusive thoughts in the obsessions are egodystonic. This means that they go against your values and beliefs. For example, if you care a lot about not being racist, you may have intrusive thoughts that you are racist. These intrusive thoughts are not things that you "secretly want/like" and are not indicative of your moral character.
Intrusive thoughts can come in the form of words, images, sounds, or "urges". They can even provoke a groinal response, where you may experience a physical response of arousal; this does not indicate that you're actually aroused, and don't represent your true sexual or emotional desires.
OCD often causes anxiety and frustration, potentially as well as shame, embarrassment, and self-hatred.
OCD comes in quite a few different themes:
Common themes
Harming others, violently and/or sexually
Contamination
Existential questions
False memory or real events (doubts about whether you did something wrong in the past)
"Just right" or perfectionism (excessively redoing or adjusting things until they are "just right")
Pedophilia (distressing thoughts that you are a pedophile and/or thoughts about children)
Relationship (uncertainty about relationships)
Moral/scrupulosity (excessive concern with moral purity)
Religious (similar to morality, but from a religious frame)
Orientation (questioning your sexual orientation or gender)
Common underlying mental themes
Intense disgust sensitivity and low tolerance for disgust
Uncertainty intolerance
Magical thinking
Common compulsions
Reassurance seeking
Checking
Avoidance
Rumination
Treatment
OCD is often treated via cognitive behavioral therapy (CBT) to treat the cognitive aspect, or exposure and response prevention (ERP) to teach uncertainty tolerance.
Further reading:
The OCD checklist
Free OCD CBT worksheets
Overcoming your OCD workbook free PDF
OCD ERP worksheets and info sheets
Sources:
Mayo Clinic. (2023). Obsessive-Compulsive disorder (OCD). In Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/syc-20354432
Dimino, T. (2024, March 8). Groinal Response & OCD: Understanding the Connection. ChoosingTherapy.Com. https://www.choosingtherapy.com/groinal-response/
McGrath, P. (2024). 7 Different Types of OCD & Intrusive Thoughts | OCD Subtypes. In www.treatmyocd.com. https://www.treatmyocd.com/education/different-types-of-ocd
Pinciotti, C. M., Riemann, B. C., & Abramowitz, J. S. (2021). Intolerance of uncertainty and obsessive-compulsive disorder dimensions. Journal of Anxiety Disorders, 81, 102417. https://doi.org/10.1016/j.janxdis.2021.102417 (PDF)
Bhikram, T., Abi-Jaoude, E., & Sandor, P. (2017). OCD: obsessive–compulsive . . . disgust? The role of disgust in obsessive–compulsive disorder. Journal of Psychiatry and Neuroscience, 42(5), 300–306. https://doi.org/10.1503/jpn.160079
Einstein, D. A., & Menzies, R. G. (2003). The presence of magical thinking in obsessive compulsive disorder. Behaviour Research and Therapy, 42(5), 539–549. https://doi.org/10.1016/s0005-7967(03)00160-8
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Compulsive behavior as a direct result of these obsessions
Compulsions often get in the way of the rest of their life
Symptoms are distressing and unwanted
Symptoms may be egodystonic (go against their beliefs and values)
Specific themes or behaviors fluctuate and change over time
OCPD
Personality disorder (affects entire personality)
Strong desire to be in control
Strong value of perfectionism
Inflexible and rigid
Dedicated to work over relationships
Less likely to seek professional help
Difficulty delegating tasks to others
Extreme conscientiousness
Symptoms more consistent over time
Symptoms may be egosyntonic (align with their beliefs and values)
May not feel like anything about their behavior is wrong or inappropriate; may feel that they are simply being reasonable
Both
Perfectionism behavior (possibly)
Obsessive behavior
Inflexible and rigid ideas/beliefs/ethics
Fear of losing control
Scrupulosity (possibly)
Look similar on the outside, but feel different on the inside
Sources
Kelly, O. (2019). OCD vs. Obsessive Compulsive Personality Disorder. In Verywell Mind. https://www.verywellmind.com/ocd-vs-obsessive-compulsive-personality-disorder-2510584
What is the difference between OCD and OCPD (compulsive personality)? (2023). The International OCPD Foundation. In The International OCPD Foundation. https://www.ocpd.org/articles/what-is-the-difference-between-ocd-and-ocpd-compulsive-personality
OCD vs. OCPD: Differences in Symptoms, Treatment, and More. (2022). In Psych Central. https://psychcentral.com/disorders/whats-the-difference-between-obsessive-compulsive-disorder-and-obsessive-compulsive-personality-disorder
What is ERP? : The gold standard treatment for OCD is ERP, which is a version of cognitive behavioral therapy. During this therapy, the patient systematically faces their fears, working from the least to the most scary. During the course of the session, the patient resists performing their compulsions. This teaches uncertainty and distress tolerance.
Is ERP too much? : ERP is intentionally designed to not be too overwhelming. You don't move on to the next step until you're okay with your current level.
How helpful is ERP? : ERP is effective for around 60% of OCD patients. It's approximately as effective as other therapies. It's also effective when self-administered, and has also been found to reduce depression and anxiety symptoms. Longer treatment sessions are even more effective.
What is I-CBT? : I-CBT is a metacognitive treatment that focuses on the underlying thought processes that lead to obsessions. The idea is to teach patients to question the faulty reasoning behind them. This can be used as an alternative to ERP.
How helpful is I-CBT? : I-CBT has been shown in some studies to be approximately as effective as regular CBT for OCD. However, it's a new treatment, and more research is needed on how it works.
Cognitive therapy
What is cognitive therapy? : Additional cognitive therapies (including cognitive behavioral therapy (CBT)) are sometimes used alongside ERP. These therapies work with the goal of addressing underlying psychological mechanisms that drive OCD, such as putting excessive importance on thoughts, thought-action fusion, and overestimating threats.
How helpful is cognitive therapy? : Cognitive therapy alongside ERP has not been shown to be more effective than ERP alone. Despite this, it is still used in clinical practice. In contrast, cognitive behavioral therapy (CBT), is found to be generally effective for most people. However, this effectiveness is only moderate compared to placebo.
Acceptance and commitment therapy (ACT)
What is ACT? : ACT teaches patients to stop avoiding, denying, and struggling with emotions and accept them instead. This can involve changing self-talk and problem solving, as well as mindfulness, acceptance, following personal values, and taking action.
How is ACT used? : ACT can also be used alongside ERP to help with distress tolerance. ERP fundamentally involves experiencing scary and distressing situations, which can be difficult for a lot of people. ACT can teach some skills needed to manage these experiences. Some of these coping skills are mindfulness, grounding exercises, and more.
How helpful is ACT? : ACT is moderately effective at treating OCD symptoms. It's slightly less helpful than CBT or ERP on its own, but more effective when combined with medication.
Medication
OCD may be treated with selective serotonin reuptake inhibitors (SSRIs), typically in higher doses than when treating depression.
Around half of OCD patients find SSRIs helpful, and experience a 40-50% symptom decrease.
Medications are usually used alongside other therapies.
Sources:
Diagnosing and treating obsessive-compulsive disorder (2026). In Apa.org. https://www.apa.org/monitor/2026/04-05/obsessive-compulsive-disorder-diagnosis-treatment
Psychology Today. (2022). Acceptance and commitment therapy. In Psychology Today. https://www.psychologytoday.com/us/therapy-types/acceptance-and-commitment-therapy
Song, Y., Li, D., Zhang, S., Jin, Z., Zhen, Y., Su, Y., Zhang, M., Lu, L., Xue, X., Luo, J., Liang, M., & Li, X. (2022). The effect of exposure and response prevention therapy on obsessive-compulsive disorder: A systematic review and meta-analysis. Psychiatry Research, 317, 114861. https://doi.org/10.1016/j.psychres.2022.114861
Julien, D., O’Connor, K., & Aardema, F. (2016). The inference-based approach to obsessive-compulsive disorder: A comprehensive review of its etiological model, treatment efficacy, and model of change. Journal of Affective Disorders, 202, 187–196. https://doi.org/10.1016/j.jad.2016.05.060
Abramowitz, J. S., Taylor, S., & McKay, D. (2005). Potentials and Limitations of Cognitive Treatments for Obsessive‐Compulsive Disorder. Cognitive Behaviour Therapy, 34(3), 140–147. https://doi.org/10.1080/16506070510041202
Philip, J., & Cherian, V. (2020). Acceptance and commitment therapy in the treatment of Obsessive-Compulsive Disorder: A systematic review. Journal of Obsessive-Compulsive and Related Disorders, 28, 100603. https://doi.org/10.1016/j.jocrd.2020.100603
Olatunji, B. O., Davis, M. L., Powers, M. B., & Smits, J. A. J. (2013). Cognitive-behavioral therapy for obsessive-compulsive disorder: A meta-analysis of treatment outcome and moderators. Journal of Psychiatric Research, 47(1), 33–41. https://doi.org/10.1016/j.jpsychires.2012.08.020
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