Observations on OCD and a pathway through it

A substantial part of my counselling work involves supporting people living with anxiety conditions. Within this, a significant number of clients present with obsessive-compulsive disorder (OCD). My reflections here are drawn from working with hundreds of individuals who experience OCD in many different forms. 

The aim of this article is to help those living with OCD better understand what they may be experiencing and to reduce the sense of isolation, confusion, and self-blame that so often accompany the condition.

Understanding a condition is often one of the first meaningful steps toward self-compassion and recovery. Psychoeducation does not “cure” OCD, but it helps people contextualise their experiences, reduce shame, and recognise that what they are facing is a well-researched psychological condition rather than a personal failing.

Family influences, learning, and the development of anxiety

One observation that arises repeatedly in clinical work is the presence of early family environments characterised by heightened fear, vigilance, or over-protection. Many clients describe caregivers or relatives who were understandably anxious themselves — individuals who frequently warned of danger, emphasised risk, or communicated a strong sense that the world was unsafe.

Research supports this observation. While genetics play a role in vulnerability to anxiety and OCD, they are not determinative. Twin and family studies consistently show that environmental learning, modelling, and early relational experiences significantly influence whether anxiety conditions emerge and how they are maintained (Rachman, 1997; Pauls et al., 2014). Children learn not only through instruction, but through emotional atmosphere — what is feared, what is avoided, and how uncertainty is handled.

Over time, these learned patterns can shape core beliefs such as “I must prevent harm at all costs”, “I am responsible for keeping others safe”, or “Uncertainty is dangerous.” These beliefs later become fertile ground for obsessive fears and compulsive attempts to neutralise them.

Trauma, loss of control, and emotional dysregulation

A second consistent theme is the role of trauma — not always dramatic or singular, but often cumulative. Many individuals with OCD report past experiences that involved emotional overwhelm, helplessness, confusion, or a profound loss of control. These experiences may include childhood adversity, bullying, sudden loss, medical trauma, or prolonged emotional invalidation.

Trauma disrupts emotional regulation systems and heightens sensitivity to threat (van der Kolk, 2014). For someone vulnerable to OCD, this can manifest as a persistent internal alarm state. Thoughts that might pass fleetingly for others instead become “sticky,” fused with bodily sensations such as anxiety, dread, nausea, or tension.

Importantly, OCD fears are often not random. They tend to cluster around themes that deeply matter to the individual: harm, contamination, morality, responsibility, sexuality, religion, or safety. Whether the fear is of being harmed or of inadvertently harming others, the underlying experience is often the same — a profound sense of danger combined with a feeling of insufficient control.

What OCD feels like from the inside

OCD is frequently misunderstood as simply “liking things tidy” or being overly organised. In reality, the internal experience is far more distressing and exhausting.

For many people, OCD feels like:

• Persistent doubt: a relentless inability to feel certain, even when logic suggests safety.
• Mental captivity: a sense of being hijacked by thoughts that intrude without consent.
• Hyper-responsibility: an overwhelming belief that one must prevent harm at all costs.
• Mental rumination: replaying scenarios, analysing intent, checking memories, or rehearsing outcomes.
• Somatic distress: anxiety experienced physically through tightness, nausea, shaking, or breathlessness.

Crucially, people with OCD are often acutely aware that their fears may be exaggerated or unlikely — yet this insight does not bring relief. The problem is not a lack of intelligence or awareness, but a malfunctioning threat-detection system. Neurobiological research points to altered functioning in cortico-striatal circuits involved in error detection and threat monitoring (Pauls et al., 2014; DSM-5-TR, 2022).

The individual feels compelled to do something — to neutralise, check, avoid, reassure, or mentally review — because the emotional signal of danger feels real and urgent.

Over-estimating risk and under-estimating coping ability

A foundational principle underpinning anxiety disorders, and OCD in particular, is the tendency to over-estimate risk while under-estimating one’s ability to cope. This cognitive bias has been extensively documented in clinical psychology literature (Salkovskis, 1985).

Clients often describe believing that harm is not just possible, but probable or that they would be unable to cope if the feared event occurred. They may believe that responsibility for preventing harm rests entirely on them.

This belief system traps individuals in cycles of compulsive behaviour.

Ironically, the very strategies used to reduce anxiety — checking, avoidance, reassurance seeking — strengthen the disorder over time by reinforcing the belief that danger was averted because of the compulsion.

Untangling trauma, sensation, and thought

Therapeutic work often involves helping individuals gently disentangle triggering thoughts from trauma-linked bodily sensations. When fear is experienced viscerally, the mind understandably concludes that the thought must be important or true.

By learning to remain present with bodily sensations — rather than urgently escaping them — individuals begin to experience that anxiety, while uncomfortable, is survivable. This is not about forcing exposure, but about restoring a sense of agency and choice.

Relaxation techniques, grounding, and mindful awareness help individuals recognise that sensations rise and fall. Over time, this weakens the fusion between “I feel anxious” and “therefore something is wrong.”

How therapy can help with OCD

The evidence base for OCD treatment is strong. Cognitive behavioural therapy (CBT), particularly exposure and response prevention (ERP), is widely recognised as a first-line intervention (NICE, 2005; APA, 2020). ERP works by helping individuals face feared thoughts or situations while refraining from compulsive responses, allowing the nervous system to recalibrate.

Other approaches also play an important role. Acceptance and commitment therapy (ACT) helps clients relate differently to intrusive thoughts, focusing on values-based living rather than symptom elimination. Mindfulness-based approaches cultivate a non-judgemental awareness of internal experience. Compassion-focused therapy addresses shame and self-criticism, which are highly prevalent in OCD.

Importantly, therapy is not about eradicating thoughts — everyone has intrusive thoughts. Instead, it is about changing the relationship to them. Many people learn to live rich, meaningful lives alongside OCD, guided by values rather than fear.

Living a meaningful life with OCD

It is vital to emphasise that people with OCD regularly go on to live fulfilling, productive, and deeply meaningful lives. Recovery does not always mean the complete absence of anxiety, but the presence of freedom, self-trust, and purpose.

As is often said in trauma-informed work, it is not simply what affects us, but what we have been through. With understanding, support, and appropriate therapy, individuals can move through OCD rather than remaining trapped within it.

References

• American Psychiatric Association (2022). DSM-5-TR: Diagnostic and Statistical Manual of Mental Disorders.
• National Institute for Health and Care Excellence (NICE) (2005). Obsessive-compulsive disorder and body dysmorphic disorder (CG31).
• Pauls, D. L., Abramovitch, A., Rauch, S. L., & Geller, D. A. (2014). Obsessive-compulsive disorder: An integrative genetic and neurobiological perspective.
• Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy.
• Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy.
• van der Kolk, B. (2014). The Body Keeps the Score.