Obsessive compulsive disorder - OCD treatment and therapy from NOCD

How do I know if I have OCD? What experts recommend 

By Elle Warren

Oct 31, 20239 min read minute read

Reviewed byApril Kilduff, MA, LCPC

Staying curious about your brain and your experiences is a brave act of self-awareness and self-compassion. There are plenty of reasons you may be asking yourself if you do or don’t have OCD. 

First of all, you might not know what OCD really is. It’s a highly misunderstood disorder—so much so that it takes sufferers up to 17 years on average to receive proper treatment. 

Undoubtedly you have heard someone say “I’m so OCD!” because they like to color-code their bookshelf or make sure everyone who comes into their house takes off their shoes. As I’ll explain below, that narrative of OCD couldn’t be further from the truth. 

Moreover, it’s common for people who do have OCD to continually ask themselves, “Is this really OCD?” After all, OCD is dubbed as the “doubting disorder.” It pushes you to doubt everything you think you know to be true. OCD is always looking for loopholes, evidence that your worst fears really are true—one of its most creative loopholes is to make people doubt if they even have OCD in the first place.

Keep reading for an accurate portrayal of OCD, examples of obsessions and compulsions, the difference between OCD and anxiety disorders, and how to get help for either, with advice from Dr. Nicholas Farrell, a clinical psychologist and Regional Clinical Officer at NOCD.

What is OCD?

OCD is a rather common and very serious—sometimes even debilitating—mental illness. It’s characterized by two main groups of symptoms: obsessions and compulsions.

Obsessions consist of repetitive intrusive thoughts, images, urges, sensations, or feelings—sometimes, obsessions are referred to simply as “intrusive thoughts,” but know that they encompass many different intrusive triggers. Obsessions are often taboo, inappropriate, and/or uncomfortable in nature. They cause feelings of distress, anxiety, guilt, shame, fear, and even panic.

Note that everyone has intrusive thoughts, with or without OCD, but people with OCD find them impossible to dismiss, and feel intensely bothered by them. Someone without OCD may think something like, What if I stabbed someone with this knife I’m cutting vegetables with?, acknowledge that it was strange and untrue to themselves, and move on with their day. Someone with OCD, on the other hand, may interpret this as something to take seriously, a threat to who they are. 

The second component of OCD is compulsions. Compulsions are any behavior or mental action that is done with the intention of relieving the distress brought on by obsessions, often involving a search for certainty or reassurance. Compulsions are often highly repetitive, only bring temporary relief, and can take up large chunks of time. 

What are the symptoms of OCD?

Intrusive thoughts, images, urges, sensations or feelings vary widely. Remember, they are unwanted and not enjoyed by the sufferer. They can latch onto anything that you value, but there are some common themes:

Again, if you’re experiencing OCD, your intrusive triggers will be recurring, feel out of your control, and seem out of character with your true self. They may subside for a limited amount of time because of the temporary relief brought by compulsions, but they will always return, tending to get more complex and time-consuming. You might experience just one theme, or you may experience multiple. 

Compulsions are just as varied as obsessions. They can take form as either an external action or a thought pattern. Here are some common physical compulsions:

  • Checking. For example, checking to make sure the stove is off, or the door is locked, or squeezing your hand to “check” that your body is real
  • Tapping/touching. For example, you may need to pick up and put down the T.V. remote or tap your knee a certain number of times in order to feel “okay.” With this compulsion, there is often no logical connection between the intrusive thought and the action; one just feels the need to do it in order to neutralize the intrusive thought and relieve distress. 
  • Reassurance-seeking from others. Asking a loved one, “Can you squeeze my hand?” or “Did you see me push anyone when we were walking down that busy street?”
  • Avoidance. This looks like refusing to go to places, be in situations, or take in stimuli that may trigger your intrusive thoughts. For example, if you have pedophilia OCD, you may avoid going to parks or other places where children commonly are.
  • Washing/cleaning. This can look like excessive hand washing, showering, or disinfecting of surfaces.

Common mental compulsions include: 

  • Rumination. Put simply, this is severe overthinking. It looks like turning something over and over in your mind, even for hours a day. It comes from feelings of “needing to get to the bottom” or “think your way out” of intrusive thoughts and the feelings they bring.
  • Reassurance-seeking from yourself. For example, repeatedly thinking I’m sure I haven’t contracted anything deadly or I would never do something bad like that.
  • Thought-replacing. This is the act of replacing a “bad” thought with a “good” one. For example, after thinking what if I leave my partner?, you might immediately think My partner is such a good person; I want to get married.
  • Mental review. This looks like going through prior experiences and situations with a fine-tooth comb to look for proof that intrusive thoughts are or are not true. For example, if you have harm OCD, you might look back and ask yourself, When I played tag with my friends as a kid, was I violent or aggressive? 

You might also experience physical symptoms of stress and anxiety. These can include a tight chest, gastrointestinal issues, clenching your jaw, dizziness, headaches, and much more. Dr. Farrell says this physical experience of OCD is “one of the most underappreciated aspects of OCD.” 

It’s not talked about as often as the core symptoms of obsessions and compulsions, but it’s still highly common. “It’s a very anxiety-and-fear-based condition, and those emotions, especially when we experience them at more intense levels, take a physical toll on us,” Dr. Farrell says. 

How is OCD different from anxiety disorders? 

Dr. Farrell explains that both OCD and anxiety disorders are driven by “anxiety and apprehension about future things that could go wrong or that the person views as likely to go wrong,” and that both drive the sufferer to make “desperate efforts to try to detect and neutralize perceived threats.”

Thus, OCD and anxiety disorders, which include generalized anxiety disorder, social anxiety, panic disorder, and specific phobias, do share similarities. They are still two distinct conditions. 

Anxiety disorders are characterized by feelings of restlessness, being “on edge,” an inability to control feelings of worry, becoming easily fatigued, trouble concentrating, physical symptoms like headaches, stomachaches, or muscle tension, problems with sleep, and/or difficulty concentrating.

To put the difference between OCD and anxiety disorders simply, those with an anxiety disorder don’t experience obsessions and compulsions. Someone with an anxiety disorder does experience “persistent, worrisome thoughts,” Dr. Farrell says, but they’re much less likely to violate the sufferer’s values or beliefs.

“The hallmark of OCD,” Dr. Farrell explains, “is the experience of intrusive mental content and misinterpretation of that mental content as a threat to themselves, the people around them, or what they believe about the world.” That experience is not a hallmark of anxiety disorders. 

Moreover, while those with anxiety disorders may engage in “safety behaviors”—actions taken to feel more comfortable and prevent worries from coming true—they are much less repetitive and complex in nature than compulsions. 

Most often, Dr. Farrell explains, safety behaviors within anxiety disorders take shape as “passive avoidance.” For example, someone with social anxiety avoiding social situations. 

It’s not uncommon for those with OCD to also have an anxiety disorder, so if you think you may be experiencing both, an OCD specialist will be able to help you understand the characteristics of each condition and how to treat both—often, they can be treated effectively at the same time. 

What should I do if I think I might have OCD?

First of all, your own experience of your symptoms is entirely valid. The fact that you have awareness of your thought patterns, state of mind, and actions is so important in moving forward. 

However, a diagnosis from a trained professional can point you in the direction of proper, evidence-based treatment, answer any questions you might have about medication (which is a useful recovery tool for some), and notably, some insurance companies actually require an official diagnosis before they’ll cover therapy costs.

If you think you may have OCD, you should seek a diagnosis and treatment from a therapist who has specialized training and experience in treating OCD with exposure and response prevention therapy (ERP), the evidence-based gold standard of OCD treatment. ERP consists of two essential components: gradually facing the things you fear, and resisting the urge to engage in compulsions.

You and your therapist will work together to identify all your obsessions and their triggers. Then, you’ll come up with exposure exercises designed to confront these triggers in a gradual, intentional manner.

Your therapist will give you tools to resist compulsions before, during, and after the exposures. Recovery doesn’t happen overnight, but it does happen over time. You will become less and less bothered by your intrusive thoughts. 

The goal of ERP isn’t to never have intrusive thoughts again—remember, everyone has them, and we can’t stop, control, or prevent our thoughts. The goal is to stop sounding the alarm when they pop up, and learning that you can tolerate the discomfort and uncertainty that they bring.

Where to take the next step toward recovery

Just by reading this article, you’re taking a huge step toward taking your life back from OCD. If you feel hesitant to reach out for help, Dr. Farrell encourages people to ask themselves: “What kinds of things is this problem starting to take away from me?” And to use that as motivation to seek treatment.

If you think you may be suffering from OCD and/or an anxiety disorder, I encourage you to read more about NOCD’s evidence-based approach to treating both conditions. You deserve to live the life you want to live, not the life OCD and anxiety want you to live.

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