Obsessive-Compulsive Disorder (OCD) affects between 1-3% of the global population. While this may seem small at first glance, it amounts to 10 million people in the US alone. This means that just about every school and workplace will have some people with OCD.

Unfortunately, OCD is often misunderstood, stereotyped, and stigmatized in society and in the media. It’s often treated as a “personality quirk” or a preference for being clean and organized. The truth is this is not what OCD is about at all.

In reality OCD is characterized by obsessional worries that cause a lot of distress and anxiety, and compulsive behaviors and thinking styles that people use in an attempt to get those worries to go away. This may work in the very short term, but it ultimately worsens symptoms in the long run. The good news is, there is a way out.

• Obsessions are unwanted, upsetting thoughts that often go against a person’s value system and sense of self, which is what makes them so disturbing. The content of your intrusive thoughts does not mean anything particular about you. People with OCD have all sort of obsessional thoughts, including violent, sexual, or taboo thoughts. Any OCD specialist will see this as OCD, not as genuine thoughts that mean something about you, and will be entirely unphased.

• Compulsions are all the behaviors you do to try to get rid of your obsessions, push them away, neutralize them, debate them, or attempt to prove them wrong. Critically, this includes both physical or overt compulsions (checking, re-doing, washing, asking for reassurance, searching online, arranging things, etc) AND mental compulsions (mentally reviewing past events, compulsive rumination, trying to figure something out in your head, repeating words or phrases in your head, etc).

  • OCD treatment must address both mental and physical compulsions. Mental compulsions have been historically overlooked in OCD treatment. Our practice specializes in specifically addressing these, alongside overt, physical behaviors.

You may have read about OCD themes or subtypes on other websites, on social media, or on reddit.

OCD themes or subtypes refer to the category of obsessions that a particular person tends to worry about most often.

Critically, whether you worry about harm, whether you left the stove on, contamination, sexual themes, or anything else, OCD is OCD, and the treatment is the same. Different OCD themes are not different disorders but rather different manifestations of OCD. They may look different on the surface, but they all come down to the same mental process that drive anxiety and distress.

Common OCD subtypes include:

• Checking OCD

• Harm OCD (upsetting thoughts about harming others or oneself)

• Sexual Orientation OCD / Homosexual OCD (sometimes called SO-OCD and HOCD)

• Pedophilia OCD (POCD)

• Contamination OCD (Worrying that things might be contaminated, mentally tracking contamination from one thing to the next, washing, cleaning).

• Existential OCD (Compulsively thinking through existential questions with no real answers, trying to figure out if you are real, if the world is real, if others are real, etc)

• Sensorimotor OCD (Getting stuck on paying attention to a body part or bodily function, like breathing)

• False Memory OCD (Worrying that you may be responsible for something bad that you can’t quite remember)

• Real Event OCD (Replaying a past event over and over to try to figure something out about it, which typically leads to more confusion, not less)

• Relationship OCD (Compulsively wondering if you’re in the right relationship, if this person is really right for you, and other related questions)

This is not an exhaustive list of OCD themes. Just about any hypothetical question a person can worry about can be an OCD theme. Many people find they hop from one theme to another before they get appropriate treatment.

OCD is primarily treated through Exposure and Response Prevention, also called ERP. Traditional “talk therapy” does not help with OCD, and can often make things worse, as people spend hours analyzing their obsessions without finding any way out.

Fortunately, there is a well-established way forward.

For more on how I treat OCD using Exposure and Response Prevention, visit the OCD Therapy page.

ERP has been the gold-standard treatment for OCD for several decades.

Exposure means gradually confronting situations that make you anxious or that trigger OCD concerns.

Response prevention means learning to do this without doing rituals or compulsions.

By approaching these situations without doing compulsions, your mind and body have the opportunity to learn that anxiety will go down on its own, and that compulsions are not necessary to tolerate it.

Many people are nervous that this will be too difficult or too anxiety provoking. This is a common reaction, but it often based on an old-school understanding of ERP, in which people were thrown in to the deep end and asked to tolerate dramatic situations. This is not how I practice ERP, and this dramatic version is now rarely practiced in the OCD treatment community. In addition to lacking compassion, it is entirely unnecessary for success.

I design ERP to be as precise, effective, and straightforward as possible with 0 dramatic or super difficult exposures.

My ERP approach begins with teaching response prevention, and in particular how to stop ruminating, BEFORE exposures. In other words, how to drop mental compulsions. Most people find that once they disengage from rumination and compulsive thinking processes, their anxiety decreases, and exposures are easier. In this view, the purpose of all exposure isn’t to spike your anxiety for no reason, but to simply teach you that you can disengage from mental and physical compulsions in the presence of a trigger. And in fact, when you do this completely, you actually feel less anxious, not more.

As with adults, OCD in children is characterized by a cycle of obsessions (intrusive worries, upsetting questions) and compulsions (mental rituals and physical behaviors children do over and over to try to push the obsessions away).

Important considerations when working with kids with OCD include:

• Because of stigma and misunderstanding about OCD, children and their families may not understand that OCD is what they’re dealing with. They may be worried about developmental concerns, or alternatively downplay worries as “normal for kids.” Getting a correct, well-thought-out diagnosis is, therefore, critical.

• The content of OCD in children can vary enormously, as with adults. It is commonly said that the process is what matters in OCD, and the content is ultimately irrelevant. That said, there are some common themes:

  • excessive checking

  • excessive washing

  • repeatedly rearranging things

  • saying lucky words or numbers

  • repeatedly asking for reassurance (Am I going to be okay? How do I know you won’t die in the night? Did I just say something horrible? What if I did something bad and I forgot? etc).

OCD in children is different than a personality quirk, a preference, or getting really interested in a topic for a while. Notably, children (and adults, for that matter) do not enjoy performing compulsive rituals. Rather, they feel terrified and anxious. They feel they have no choice in whether or not to perform them.

Another key consideration when working with children with OCD is incorporating the family and support system into treatment. OCD affects family systems, and everyone has a role to play in helping the child untangle from their obsessions and compulsions. OCD therapy generally includes sessions to teach parents concrete skills to support their child while, at the same time, not accommodating the child’s anxiety.

To inquire about individual therapy for your child, complete the contact form.

To learn more about group therapy for parents of children with OCD and anxiety, visit the groups page.

Whether you are interested in individual therapy for yourself, for your child, or in therapy groups, the first step is a free, 20-minute consultation. This allows me to learn more about you and what you’re looking for and gives you a chance to learn about me and my approach. If we both feel it’s a good fit, we can move forward with scheduling the first session. Sign up here.