Obsessive-Compulsive Disorder (OCD)
Someone with OCD might worry constantly about germs (that’s the obsession), and to ease that anxiety, they might wash their hands many times a day—even if they know it’s not necessary (that’s the compulsion).
Even though people with OCD usually know their thoughts or behaviors don’t make a lot of sense, it can be really hard to stop them.
What is OCD?
Types of OCD
The first step in the treatment of OCD is conducting a thorough assessment. Your child’s clinician will ask them questions about the intrusive thoughts they experience and the behaviors they use to try to get rid of them. Here are a few examples of types of OCD we commonly treat:
What it is: This type involves a strong fear of getting sick, dirty, or “contaminated” by germs, chemicals, or even certain people or environments that feel “unclean.”
Obsessions (the thoughts): “What if I catch a deadly disease?” or “That surface is dirty—what if I spread germs to my family?”
Compulsions (the behaviors): Repeatedly washing hands, showering, changing clothes, avoiding public spaces, or refusing to touch certain things or people.
How it feels: The anxiety doesn’t go away until the person has cleaned or avoided the “contaminated” thing—but even then, the relief might be short-lived.
CONTAMINATION OCD
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CHECKING OCD
What it is: This type is driven by fear that something terrible will happen because of a mistake or oversight.
Obsessions: “What if I left the stove on and the house burns down?” or “What if I didn’t lock the door and someone breaks in?”
Compulsions: Checking appliances, locks, lights, or emails/texts over and over. Some people may ask for repeated reassurance from others too.
How it feels: The person may know they already checked, but doubt creeps in, making them feel like they have to check “just one more time” to be sure.
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What it is: People with this type feel intense discomfort when things aren’t arranged in a certain way or don’t feel “even” or “balanced.”
Obsessions: “That picture is crooked—it’s driving me crazy,” or “I need to tap both sides of the table equally or something bad might happen.”
Compulsions: Arranging, reordering, or repeating actions until things feel “right.” This can include touching, tapping, counting, or doing things in a specific sequence.
How it feels: The goal isn’t always to prevent something bad from happening—it’s often about calming a powerful sense of internal discomfort.
What it is: This involves unwanted, upsetting thoughts that go against a person’s values or character. These thoughts are not something the person wants to act on—they’re distressing and feel wrong.
Obsessions: “What if I accidentally hurt my baby?” “What if I shouted something offensive in public?” or “Am I a bad person for having that thought?”
Compulsions: Avoiding certain situations, mentally reviewing past actions, seeking reassurance, or trying to “cancel out” the thought with a different one.
How it feels: These thoughts are scary and confusing, often leaving the person feeling ashamed or worried that they might be dangerous—even though they aren’t.
SYMMETRY & ORDERING OCD
INTRUSIVE THOUGHTS (Harm or Taboo Obsessions)
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Treating OCD with Exposure and Response Prevention
- After your child’s therapist has identified the specific intrusive thoughts and compulsive behaviors that need to be addressed, treatment can begin. The first step of treatment is psychoeducation, or learning about OCD. During the psychoeducation phase, your child will learn about the OCD cycle: Obsession → Anxiety → Compulsion → Short-term relief → Stronger obsession. Once people understand this pattern, they’re better prepared to break it.
- Another key part of psychoeducation is helping both the person with OCD—and their loved ones—feel empowered rather than helpless. Understanding that OCD is a treatable condition, not a personal flaw, can be a huge relief. When people learn what’s really happening in the brain and how OCD operates, they often feel more hopeful and more in control. They begin to see that change is possible with the right tools and support.
- Often, loved ones want to help but accidentally make the problem worse by participating in rituals or offering constant reassurance. Learning how to support someone with OCD in a healthy way—without feeding into the compulsions—can make a big difference. With this shared understanding, the whole family can become part of the recovery process, creating an environment that encourages progress and reduces shame.
Psychoeducation
Exposure and Response Prevention in Action
Exposure and Response Prevention (ERP) is a type of cognitive-behavioral therapy that helps people face their fears (exposure) without doing the usual rituals or behaviors to feel better (response prevention). Over time, this helps the brain learn that the feared outcome doesn’t happen—or that it can be tolerated without the compulsion.
Step 1: Create a Hierarchy
Example (for contamination OCD):
- Touching a doorknob → mildly anxious
- Shaking someone’s hand → moderate anxiety
- Using a public restroom without washing hands afterward → high anxiety
Step 2: Start with Mild Exposures
ERP begins with easier exposures from the bottom of the hierarchy. The person intentionally faces a trigger (exposure) without doing the compulsion (response prevention).
Example: Touching a doorknob and resisting the urge to wash hands.
At first, anxiety will go up—but with time, it naturally comes down. This teaches the brain: "I can handle this without doing the ritual."
Step 3: Practice and Repeat
Exposure is practiced again and again, until the trigger no longer causes overwhelming anxiety. Then the person moves up to more challenging exposures. The key is not doing the compulsion, even when it feels uncomfortable. Over time, the brain learns that the feared consequences don’t happen—or don’t need to be feared. Each success builds confidence and weakens OCD’s grip. One of the deeper goals of ERP is helping the person accept uncertainty instead of trying to feel 100% safe or “just right.” This is powerful, because OCD thrives on the promise of certainty.
Step 4: Keep Practicing and Prevent Relapse
Once progress is made, it’s important to keep practicing exposures and using the tools learned in therapy. OCD can sneak back in, especially during stress, so regular practice helps keep it in check.
