What is Obsessive-Compulsive Disorder (OCD)?

What is Obsessive-Compulsive Disorder (OCD)?

“Did I forget to lock the door?” You leave the house, step into the lift, but the same question keeps running through your mind: “What if the stove is still on?” “What if I forgot to lock the door?” You go back to check—maybe several times. To reassure yourself, you even take a photo of the unplugged appliance on your phone. Yet that inner voice won’t quieten, and you find yourself checking the photo repeatedly, just to be certain.

Everyone experiences thoughts like these from time to time. However, if these thoughts take over your mind, disrupt your day, and compel you to repeat actions over and over, this may indicate Obsessive-Compulsive Disorder (OCD).

If that inner voice still won’t quieten and you find yourself checking the photo hourly “just to be sure,” this may indicate Obsessive-Compulsive Disorder (OCD).

What Are Obsessions and Compulsions?

Obsessive-Compulsive Disorder (OCD) is characterised by involuntary, distressing, and repetitive thoughts (obsessions) along with repetitive behaviours (compulsions) performed to reduce the anxiety these thoughts cause.

For example, someone might wash their hands repeatedly due to a fear of germs or feel compelled to clean a surface over and over because they don’t feel at ease after touching it. Most of the time, the person is aware that these behaviours are irrational, but coping with the inner unrest experienced when not performing them can be very difficult. This stems from a lack of trust in oneself and one’s thoughts. Even if they are certain the door is locked, they do not trust that certainty and repeatedly return to check.

When OCD is mentioned, many think of cleanliness obsessions, but it can manifest in many different ways. For instance, a person might fear harming loved ones, feel shame about sinful thoughts, be unable to tolerate asymmetry, or feel an internal pressure for everything to “feel right.” These obsessions cycle continuously in the mind; as the person struggles to break free, their anxiety increases, and they attempt relief through compulsive behaviours. Although this relief is temporary, it soothes the person for a while. However, in the long term, OCD can significantly impact quality of life.

Can Compulsions Occur Without Obsessions, or Obsessions Without Compulsions?

Typically, when we think of Obsessive-Compulsive Disorder (OCD), we consider the combination of “intrusive thoughts + repetitive behaviours.”

That is, an unwanted, distressing thought (obsession) arises, and the individual develops a behaviour (compulsion) to reduce the anxiety caused by that thought. However, this pairing is not always so clear-cut.

No, while compulsions may appear to occur without obsessions, there is always an underlying obsession. Some individuals may intensely repeat behaviours such as hand washing or checking without consciously recognising the mental obsession. In such cases, the thought may not be at the conscious level but working “silently” beneath awareness. The person may feel compelled to repeat actions “without fully knowing why.”

Here, compulsions may seem to exist without obsessions because the individual either does not recognise or cannot verbalise their intrusive thoughts. Yet, beneath the surface, there is an internal trigger attempting to suppress anxiety. Therefore, these compulsions can feel like “automatic behaviours,” but they usually stem from suppressed or unconscious obsessions.

Conversely, obsessions can occur without compulsions. A person may be preoccupied with distressing thoughts but not exhibit any visible behaviours to alleviate them. In this case, obsessions (intrusive thoughts) exist without compulsions (repetitive actions). The individual attempts to push away or fight these thoughts mentally, without physical manifestations.

This type of OCD is often called “pure-O,” where the cycle happens purely on a mental level. This form of OCD can be particularly challenging as nothing outwardly visible occurs, making it harder for others to understand the person’s struggle.

In summary, not every obsession is accompanied by a visible compulsion, and not every compulsion has an obvious obsession. Recognising these differences is crucial for better self-understanding and tailoring the appropriate therapeutic approach.

The person may feel compelled to repeat actions without fully understanding why.

What is the Treatment for OCD?

OCD treatment typically involves a combination of cognitive-behavioural therapy (CBT) and medication, if necessary. The focus is often on Exposure and Response Prevention (ERP), a technique aimed at overcoming obsessive thoughts and repetitive behaviours. In this therapy, the individual is gradually exposed to their obsessive thoughts while learning to resist the compulsive behaviours they usually perform in response. Although challenging, this process helps reduce anxiety over time.

Medications that primarily affect the serotonin system are commonly prescribed under the guidance of a psychiatrist. Medication is not mandatory but may be used depending on the severity of OCD symptoms. These drugs help regulate chemical imbalances in the brain and reduce anxiety, thereby creating a supportive foundation for therapy. It is usually recommended that treatment continues concurrently with both a psychologist and psychiatrist.

Lifestyle changes can also play an important role in the recovery process. Healthy habits—such as regular sleep, exercise, meditation, and using coping strategies—can aid in managing OCD symptoms. Additionally, learning stress management techniques can have a positive impact on treatment outcomes.

The duration of therapy varies from person to person but typically ranges between 10 and 20 sessions.

OCD is a treatable condition with appropriate intervention and is commonly encountered in therapy settings.