OCD is often misunderstood as just being “neat” or “organized,” but it’s a complex anxiety disorder marked by intrusive thoughts and compulsive behaviors. Learn how OCD really works, what it looks like beyond stereotypes, and how therapy can help.

When most people hear “OCD,” they think of contamination fears or the compulsion to wash hands or clean excessively. Because this presentation is the most familiar to the general public, it’s common to hear someone say, “I’m so OCD!” when they feel mildly stressed by a mess or simply prefer a tidy space.

However, this misunderstanding can be harmful. Many people who actually struggle with OCD don’t recognize it in themselves because their symptoms look very different—and are often invisible to others. In fact, it can take years before someone with OCD seeks help, often because of shame or fear about what their thoughts might mean about them. Increasing awareness of the full spectrum of OCD can help prevent years of silent suffering.

What Is OCD?

OCD (Obsessive-Compulsive Disorder) is defined by the presence of obsessions and/or compulsions, which often reinforce one another in a distressing cycle.

• Obsessions are intrusive, unwanted thoughts, urges, or images that cause anxiety or distress. They are misaligned with a person’s values or desires.

• Compulsions are repetitive behaviors or mental rituals performed in response to obsessions in an effort to reduce anxiety or gain control over them.

While compulsions might bring short-term relief, they ultimately make OCD stronger—like trying to put out a fire with air. Over time, the cycle becomes more intense and difficult to break.

For example, someone without OCD might have an odd intrusive thought and shrug it off. Someone with OCD, however, feels intense anxiety and uncertainty about what that thought means about them, finding it almost impossible to let it go.

Understanding Obsessions

Obsessions can focus on many different themes, ranging from contamination or orderliness to taboo or moral fears involving sexuality, religion, or harm.

These thoughts are ego-dystonic, meaning they conflict with a person’s true beliefs and values.

For instance, someone with religious obsessions may have intrusive thoughts about cursing at God or burning down their church—not because they want to, but precisely because their faith matters deeply to them. People with OCD are among the least likely to act on these intrusive thoughts because they find them deeply distressing.

Understanding Compulsions

Compulsions can be physical (like washing, checking, or organizing) or mental (like counting, praying, reviewing, or seeking reassurance).

A person with contamination fears might wash their hands repeatedly, while a new parent with intrusive thoughts about harming their baby might mentally “wash away” those thoughts by repeating phrases of reassurance or performing loving rituals.

Examples of the OCD Cycle

Example 1

• Intrusive Thought: “You didn’t clean your hands well enough.”

• Compulsion: Wash hands again.

• (The anxiety decreases temporarily, but the thought soon returns.)

Example 2

• Intrusive Thought: “What if I hurt someone?”

• Compulsion: Avoid others, pray, or visualize kindness.

• (The anxiety decreases momentarily, but the thought resurfaces.)

How Do I Know If It’s OCD?

For an OCD diagnosis, obsessions and compulsions must:

• Take up at least one hour per day, and

• Cause clinically significant distress or impairment in daily life.

People with OCD may struggle to focus at work, withdraw socially, or feel mentally preoccupied most of the day—even if outwardly they seem “fine.”

In contrast, someone who simply enjoys cleaning feels satisfied after doing so and doesn’t experience distressing intrusive thoughts about it.

“What If It Isn’t Really OCD?”

Many people with OCD—especially those with taboo or moral obsessions—question whether they really have OCD or if they’re “in denial.” This uncertainty is, in fact, part of the disorder.

A helpful distinction is desire versus distress:

• Someone with OCD experiences distress because their intrusive thoughts go against their values or desires.

• Someone who is genuinely exploring their sexuality or identity may feel anxiety about others’ reactions, but not because their thoughts feel inherently wrong or unwanted.

Support and Treatment for OCD

If you suspect you might have OCD, reaching out to a therapist is a powerful first step. A trained clinician can assess your symptoms, help clarify what’s happening, and support you in finding evidence-based treatment.

OCD is highly treatable. With therapy—especially approaches like Exposure and Response Prevention (ERP)—many people regain control over their lives and reconnect with their values, goals, and relationships.

If you’re looking for a therapist in Seattle to help you navigate and manage OCD, reach out to schedule a consultation with a member of our team at Constellation Therapy. You don’t have to face this alone.