Commonly asked questions in OCD therapy

These are questions which frequently crop up in therapy with OCD and which are extremely important for OCD sufferers to know the answers to. In particular, having a clear idea about what exactly constitutes OCD and what doesn't can make all the difference. 

An overriding fear in many sufferers is that their thoughts/images/feelings/sensations belong to them, rather than to the condition and that they make them a bad person. I hope that if you are an OCD sufferer, or suspect you have OCD, this article will encourage you to seek help. 

OCD - Commonly asked questions

Q. How do I know if it's OCD as opposed to me that my thoughts are coming from? What if they are real?

A. Any recurring thoughts/images/feelings/sensations you experience which create high anxiety or discomfort, where you then feel a need to engage with a repetitive ritual (in your head or physically) belong to OCD. It really doesn't matter what shape these take.

Q. What if my thoughts are related to a real-life event and therefore not imaginary?

A. OCD can attach itself to absolutely anything and sometimes this will be a real-life event. Although the event itself is real, and perhaps to a certain extent your concerns around it are rational, if OCD is involved there will be an irrational element to this. This is the part which we can work with to manage. 

I have yet to meet a client who has ever lost control in this way. People with OCD are extremely harm-averse and are therefore some of the least likely people on this planet to harm.

Q. I have started doing my ERPs (Exposure and Response Prevention) and now I feel more anxious. Is this normal?

A. Yes it is. When you first begin working with ERP tasks you are starting to change a long-standing pattern of behaviour. Your brain understands this as you being less safe than you were before, so it will turn up the alarm bells to prompt you to protect yourself more. This is why you feel more anxious. However, the reality is that you are perfectly safe to engage with these tasks. 

Q. I was doing really well and starting to feel my anxiety come down a bit and then suddenly a new thought appeared in my mind. Now I can't stop worrying about this one. 

A. When your OCD notices that you are beginning to take charge and are no longer paying so much attention to its demands, it's not happy. It wants complete control over your life and when you start to take some of that control from it, it has to create new ways to get back in. A good way to do this is to bring in a brand new thought (although an old one you haven't obsessed over for a while is also an option).

Q. I worry that despite my very strong feelings against it, I might one day lose control and do something inappropriate/horrific.

A. I have yet to meet a client who has ever lost control in this way. People with OCD are extremely harm-averse and are therefore some of the least likely people on this planet to harm. We are unfortunately also probably the most likely to worry about doing harm.

Q. How long does it take to be able to manage OCD?

A. This varies depending on how you are affected by it and also on how much you put into your ERP exercises. The more committed you are to your tasks, the faster you will begin to see results. Most commonly I see my clients for between 10 and 20 sessions.