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OCD and Intrusive Thoughts
OCD has an incredible talent for finding the thing you care about most
- Florida LCSW, license SW27230
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- In network through Headway
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OCD is not just being organized
It is not liking your desk a particular way.
And it is definitely not a cute personality quirk because somebody color-coded their refrigerator.
Obsessive Compulsive Disorder can involve intrusive thoughts, images, sensations, urges, or doubts that become difficult to let go of.
People may then feel driven to do something to make the distress disappear or to make absolutely certain that everything is okay.
Those responses are called compulsions.
Sometimes they are visible.
Sometimes nobody else knows they are happening.
What it can look like
What OCD can look like
OCD can involve themes related to
- Harm
- Contamination
- Relationships
- Sexual intrusive thoughts
- Religion or morality
- Health
- Mistakes and responsibility
- Identity
- “Just right” sensations
- Fear of losing control
- Fear that a thought says something terrible about who you are
Compulsions can include
- Checking
- Washing
- Repeating
- Asking for reassurance
- Confessing
- Reviewing memories
- Googling
- Comparing feelings
- Avoiding triggers
- Repeating phrases mentally
- Trying to replace a “bad” thought with a “good” one
- Trying to prove to yourself with complete certainty that the fear is not true
A compulsion does not need to make sense to anyone else.
It only needs to provide enough temporary relief for OCD to convince you to do it again.
Why it sticks around
An intrusive thought is not the same thing as an intention
Brains generate strange material.
Having an unwanted thought does not automatically mean you agree with it, want it, or plan to act on it.
With OCD, however, the existence of the thought itself can begin to feel important.
- Why did I think that?
- What if it means something?
- What if I secretly wanted it?
- How can I know for certain?
Then the investigation begins.
Unfortunately, trying to achieve complete certainty can keep the thought important.
The goal of therapy is generally not to prove the thought false every time it appears.
That can become another reassurance cycle.
Instead, we work on changing the relationship you have with the thought and with uncertainty.
How I approach it
ERP-informed work
Exposure and Response Prevention, commonly called ERP, is an evidence-based treatment for OCD.
The “exposure” part means gradually coming into contact with thoughts, situations, feelings, or uncertainty that OCD has taught you to fear or avoid.
The “response prevention” part is equally important.
Instead of automatically completing the compulsion that normally brings temporary relief, we practice responding differently.
This is not about throwing you into the deep end and seeing whether you survive.
Effective exposure work should be thoughtful, collaborative, purposeful, and connected to your actual goals.
My practice incorporates ERP-informed strategies where they fit within my training and the needs of the client.
If you need a more specialized or intensive OCD treatment program, I will be straightforward about that too.
OCD and anxiety can overlap, but the treatment strategies differ. If worry, panic, or avoidance sounds more like you, the anxiety therapy page covers that side.
Reassurance is tricky
Someone saying “you are definitely fine” may make you feel better.
For five minutes.
Then OCD comes back with a follow-up question.
“But how do they KNOW?”
This is why treating OCD sometimes feels different from treating ordinary worry.
The therapeutic goal cannot always be making the anxiety disappear immediately.
Sometimes we are building your ability to notice the question without putting your entire day on trial trying to answer it.
Before you book
Common questions
A few things people often ask. There are more answers on the FAQ page.
Therapy is not a courtroom where we prove every intrusive thought innocent.
We can absolutely examine what is happening, but repeatedly providing certainty can sometimes reinforce an OCD cycle.
Intrusive thoughts are common, and experiencing an unwanted thought by itself is different from having an intention or plan.
Part of treatment is carefully understanding what the thought represents and whether compulsive responses are maintaining distress.
You will have a hard time shocking a therapist who has worked in community mental health, outpatient psychiatry, hospitals, substance use treatment, and serious mental illness.
OCD often attacks topics people find deeply personal or upsetting.
You are allowed to talk about them.
No.
ERP is structured therapeutic work involving exposure to feared triggers or uncertainty while changing the compulsive response.
Ready when you are
You can book a time on my Headway profile, where you can also check your insurance coverage. Questions first? Call 754.400.0824 or send me a message. The Insurance page has the plans I accept.
Want to nerd out on the research?
You absolutely do not need to read research papers to come to therapy. But if you are the kind of person who wants to know where this stuff comes from, here are a few good places to start.
- Obsessive-Compulsive Disorder National Institute of Mental Health
- Exposure and Response Prevention (ERP) International OCD Foundation
- What Is Cognitive Behavioral Therapy? American Psychological Association
This website is not for emergencies. If you are in crisis, call or text 988, or call 911.