Obsessive-compulsive disorder (OCD) is often misunderstood as being neat or particular. In reality, OCD involves obsessions — unwanted, intrusive thoughts, images, or urges that cause intense distress — and compulsions — things you do, physically or mentally, to relieve that distress or prevent something bad from happening. Compulsions bring short-term relief, but over time they teach the brain that the fear was real and the ritual was necessary, so the cycle grows stronger.

OCD can take many forms: fears of contamination, of causing harm, or of having done something wrong; a need for things to feel “just right”; checking, washing, counting, or seeking reassurance; and distressing thoughts about relationships, morality, religion, or identity. Many people with OCD keep their symptoms private for years because the thoughts feel shameful or frightening. They are not a reflection of who you are, and they respond well to treatment.

How it works

The most effective treatment for OCD is exposure and response prevention (ERP), a form of cognitive behavioral therapy. In ERP, we work together to gradually and deliberately approach the thoughts and situations that trigger obsessions, while practicing not doing the compulsion. Over time, this teaches your brain that you can tolerate uncertainty and discomfort, and that the feared outcome is less likely or less catastrophic than OCD insists.

ERP is collaborative and paced. We start by understanding your particular obsessions and compulsions, then build a plan of exposures that starts with manageable steps and works upward. You are always part of deciding what comes next. Treatment often also addresses the beliefs that keep OCD going, like an inflated sense of responsibility or the idea that having a thought makes it more likely to come true.

Who this is for

I work with adolescents and adults with OCD and related concerns, including:

Contamination, harm, checking, and “just right” OCD
Intrusive or taboo thoughts (sometimes called “Pure O”)
Excessive reassurance seeking
Health anxiety
Phobias and other fear-based anxiety

For younger children with anxiety or OCD, working with parents can be especially effective. See Parenting.

My background

Exposure-based treatments are a core part of my clinical training. I use exposure therapy across a range of conditions, including prolonged exposure (PE) for PTSD, and I have used ERP to help clients with OCD reduce their symptoms and reclaim time and energy that OCD had taken over.