OCD Basics
A person says, "I know it doesn't make sense, but I still feel like I have to do it." What characteristic of OCD does this illustrate?
What is insight?
A person with contamination fears touches a doorknob and immediately washes their hands for 10 minutes until they feel "clean enough." What is the compulsion?
Excessive washing/cleaning
True or False: OCD is just being neat or organized.
What is false?
These medications, also used for depression, are often prescribed for OCD.
What are SSRIs?
A person repeatedly washes their hands after touching doorknobs because they fear spreading deadly germs.
Contamination OCD
A client reports intrusive thoughts that are disturbing but never performs any visible rituals. Does this rule out OCD?
No. OCD can involve mental compulsions
A person repeatedly asks their partner, "Are you sure you’re not mad at me?" even after their partner says everything is okay. What is the compulsion?
What is mental reviewing/reassurance seeking
This personality disorder is often confused with OCD but is actually very different.
What is OCPD?
During ERP, should anxiety disappear before ending an exposure?
No. The goal is willingness to experience uncertainty, not achieving a specific anxiety level.
A college student spends hours rereading assignments because they don't feel "just right."
Symmetry/"Just Right" OCD
Why does performing a compulsion make OCD stronger over time, even though it reduces anxiety in the moment?
It negatively reinforces the behavior by teaching the brain that the compulsion prevented danger, making future obsessions more likely to trigger compulsions.
After having the thought, "What if I don't actually love my family?" a person spends hours analyzing their feelings and searching their memories for proof that they do love them. What is the compulsion?
Mental reviewing/rumination
A person says, "I have OCD because I'm really picky." What's missing from this statement?
OCD requires distressing obsessions and/or compulsions that cause significant impairment, not simply preferences or perfectionism.
A client says, "I touched the doorknob, but I kept telling myself it was probably clean." Why wasn't this a complete ERP exercise?
They used cognitive reassurance as a compulsion.
A father avoids holding his newborn because he has unwanted thoughts about accidentally hurting the baby.
Harm OCD.
If compulsions actually worked the way OCD expects they do, what would you expect to happen over time?
The obsessions and anxiety would decrease permanently. Instead, OCD typically becomes more demanding, requiring more frequent or more elaborate compulsions.
A person has the thought, "What if I accidentally hurt someone?" They replay the event over and over in their mind to determine whether they are a good person. What is the compulsion?
Mental checking/reviewing.
True or False: Intrusive thoughts reflect a person’s true desires.
What is false?
Patients gradually face feared situations using this type of ladder-like plan.
What is an exposure hierarchy?
A woman repeatedly asks her partner if he truly loves her and constantly questions whether they're "meant to be."
Relationship OCD.
A therapist asks, "What is OCD actually demanding from you every time you perform a compulsion?"
What is certainty? OCD continually demands complete certainty about feared outcomes, even when that certainty is impossible to achieve.
A person has an intrusive thought that feels scary. They immediately think of a positive image or repeat a phrase in their mind to "cancel out" the thought. What is the compulsion?
Mental neutralizing
Many people with OCD fear they are dangerous because of intrusive thoughts. What does research actually suggest about the likelihood they'll act on those thoughts?
They're no more likely than the general population because the thoughts are ego-dystonic and highly distressing.
What is the biggest difference between exposure and flooding?
ERP exposures are planned, collaborative, and repeated with response prevention, whereas flooding involves overwhelming exposure without gradual planning.
A person repeatedly worries that they have committed a moral or religious wrongdoing. They spend hours reviewing their actions and seeking reassurance that they are still a good person.