OCD: Just Can’t Get Those Thoughts Out of Your Mind?


By Ashwini Anand (Ash), Clinical Psychologist, Chethana Psychology, Melbourne

Introduction

Living with OCD often means years spent trying to control your experiences, seeking relief from overwhelming fear. You are not alone. Cycles of hope, disappointment, and self-blame are deeply human.

What Is OCD?

Obsessive-Compulsive Disorder (OCD) is an anxiety disorder with unwanted, repetitive thoughts (obsessions) and rituals (compulsions) that relieve distress. OCD is more than neatness or organisation; it involves a range of thoughts and behaviours. No two people experience it identically (American Psychiatric Association, 2013).

Compulsions in OCD can be physical or mental, making the disorder harder to recognise. Mental compulsions like praying, counting, replaying events, or seeking reassurance are not visible and may be seen as 'just anxiety.' Physical compulsions include checking, cleaning, or repeating actions. Both are distressing and time-consuming, and symptoms may shift between mental and physical forms over time (Abramowitz et al., 2019; Lochner et al., 2014).

Obsessions in OCD are not like everyday worries. They are persistent, distressing thoughts or images that intrude even when you try to dismiss them. Such obsessions often feel alien and distressing because they conflict with your values or intentions (American Psychiatric Association, 2013).

Stereotypes and Misconceptions About OCD

Stereotype: OCD is all about tidiness and routines.
Fact: It can involve intrusive thoughts about harm, sex, religion, contamination, or relationships. Intrusive thoughts are central to OCD and do not reflect your character. Many feel shame, but having these thoughts does not make you bad or dangerous. You are not alone (Williams et al., 2021).

Stereotype: People with OCD could simply stop worrying if they tried hard enough.
Fact: Attempting to control or avoid unwanted thoughts usually makes obsessions stronger. People with OCD have unique experiences with their illness, which may not match common assumptions (Salkovskis et al., 2017; Gillan et al., 2014).

Stereotype: If your rituals are not visible, you cannot have OCD.
Fact: Many people with OCD have rituals that are not obvious. Compulsions can be mental or unseen. Mental compulsions such as silent counting, seeking inner reassurance, or covert checking are important but may be missed. These can lead to under-recognition and more distress. Support and understanding are essential with hidden symptoms (Crino, 2014).

Overlap and Comorbidity

  • OCD and Eating Disorders: OCD often appears with eating disorders or body dysmorphic disorder, which all involve attempts to control certain aspects through repetitive behaviour. Overlap can complicate diagnosis and treatment, and people may experience more than one at the same time (Mitchison et al., 2013; Phillips et al., 2017; Kaye et al., 2019).

  • OCD and other Anxiety Disorders: Obsessive–compulsive disorder (OCD) is characterised by recurrent and intrusive thoughts, images or impulses (obsessions), and/or repetitive behaviours or mental acts (compulsions) (American Psychiatric Association, 2013). Other anxiety disorders, like generalised or social anxiety, focus on real situations and typically do not include compulsive rituals.

  • OCD and Autism: OCD and autism can both involve routines, but for different reasons: comfort in autism, anxiety avoidance in OCD. Although certain behaviours may appear similar, their underlying motivations can vary, making it challenging to distinguish between them when they co-occur (Russell et al., 2005; Van Steensel et al., 2011).

  • OCD and Trauma: OCD often coexists with trauma, which may contribute to symptoms. Complex trauma, such as prolonged emotional abuse, can make OCD harder to recognise and increase feelings of isolation. Overlap leads to misunderstandings and complicates access to help (Krause et al., 2022).

Living with OCD

OCD symptoms can evolve, with new obsessions or compulsions emerging as others fade (Abramowitz et al., 2019; Starcevic et al., 2012). Suppressing worries often intensifies anxiety and reinforces fear, leading to greater alienation and misunderstanding (Salkovskis et al., 2017).

Treatment and Getting Support

It may be time to seek professional help if these thoughts or behaviours interfere with daily life, cause significant distress, take up a lot of time, or hinder functioning at work, school, or in a relationship. If you feel unable to control these compulsions or are increasingly overwhelmed, reaching out to a mental health professional can be an important first step.

OCD is treatable, though progress can take time. Many hesitate to seek help after criticism or misunderstanding. You are not alone, and your journey is valid. Reaching out to a mental health professional, such as your GP, for a referral can help. Involve supportive loved ones if possible. Struggling does not diminish your worth. Seeking help is self-compassion, and support is available.

References

Abramowitz, J. S., Taylor, S., & McKay, D. (2019). Obsessive-compulsive disorder. In D. H. Barlow (Ed.), Clinical handbook of psychological disorders (6th ed., pp. 239–272). The Guilford Press.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Author.

Crino, R. D. (2014). Obsessive-compulsive disorder: Diagnosis and management. Australian Family Physician, 43(11), 774-779.

Gillan, C. M., Fineberg, N. A., & Robbins, T. W. (2014). A trans-diagnostic perspective on obsessive-compulsive disorder. Psychological Medicine, 44(3), 631-638.

Kaye, W. H., Wierenga, C. E., Bailer, U. F., Simmons, A. N., & Bischoff-Grethe, A. (2019). Nothing tastes as good as skinny feels: The neurobiology of anorexia nervosa. Trends in Neurosciences, 42(1), 14-22.

Krause, A. J., Bikson, M., & Rahman, A. (2022). ASD and trauma: Overlapping symptoms and diagnostic challenges. Current Psychiatry Reports, 24(4), 171–180.

Lochner, C., Stein, D. J., & van Balkom, A. J. L. M. (2014). Comorbidity in obsessive-compulsive disorder (OCD): A review. Australian & New Zealand Journal of Psychiatry, 48(8), 1513-1519.

Mitchison, D., Rieger, E., & Mond, J. (2013). The relationship between obsessive-compulsive symptoms and eating disorder features: A systematic review and meta-analysis. Eating Behaviors, 14(2), 163-171.

Phillips, K. A., Menard, W., & Fay, C. (2017). Gender similarities and differences in 1,000 individuals with body dysmorphic disorder. Comprehensive Psychiatry, 74, 30-37.

Russell, A. J., Mataix-Cols, D., Anson, M., & Murphy, D. G. (2005). Obsessions and compulsions in autism: A symptom or a co-morbid disorder? Journal of Autism and Developmental Disorders, 35(3), 395-406.

Salkovskis, P. M., Millar, J. F. A., Gregory, J. D., & Wahl, K. (2017). The cognitive approach to obsessive-compulsive disorder: Progress and future directions. Current Opinion in Psychology, 21, 40-45.

Starcevic, V., Brakoulias, V., & Viswasam, K. (2012). The nosological status of hypochondriasis: Towards a reconceptualization. Current Psychiatry Reports, 14(6), 560-567.

Van Steensel, F. J., Bögels, S. M., & de Bruin, E. I. (2011). Psychiatric comorbidity in children with autism spectrum disorders: A comparison with children with ADHD. Journal of Child and Family Studies, 20(6), 855-861.

Williams, M. T., Farris, S. G., & Turkheimer, E. (2021). Shame and stigma in obsessive-compulsive disorder. Current Psychiatry Reports, 23(7), 45-52.

Disclaimer: This blog post is provided for general information and psychoeducation purposes only. It is not intended as a substitute for professional advice, diagnosis, or treatment. If you are seeking mental health support or assessment, please consult a qualified health professional.