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Obsessive Compulsive Disorder

Therapy for OCD in Pittsburgh.jpgOne of my primary specialties is working with people who are struggling with Obsessive-Compulsive Disorder (OCD). OCD is a common mental health disorder affecting over 3.3 million adults and over 1 million children in the U.S. It can take many forms, and can look very different from person to person. The common link between these varied presentations is that all people struggling with OCD experience 1) obsessions and 2) compulsions.



Obsessions are intrusive thoughts, images, or urges that can get stuck in one's head and that cause severe discomfort. You may notice that this is a very different definition from the word's everyday usage. Typically, being "obsessed" with something means that you really like thinking about it. An OCD obsession, on the other hand, is an unwanted thought; something you don't like worrying about, and are trying hard to get out of your head. Some common obsessions include:

  • Contamination Concerns: Intrusive thoughts that one is in danger due to coming into contact with germs or other contaminates, or that one is dirty and needing to be clean.

  • Perfectionism: Intrusive urges to have one's behavior and performance be "perfect." These urges sometimes result from an innate preference to have things be "perfect," but can also result from fears of bad consequences such as being judged by others or not getting into college.

  • Health Concerns: Intrusive thoughts/fears that one is experiencing, or will experience, serious health problems.

  • Just Right OCD: Intrusive urges or needs to have things, such as one's environment, one's school work, or even the behavior of others, be "just right."

  • Scrupulosity: Instrusive thoughts that one is going to hell and/or that God is disappointed/angry.

  • Bad Thoughts: Instrusive "bad thoughts" about oneself, others, and the world. These can lead to a pervasive belief that, deep down, one is a bad person.

  • Harm thoughts: Intrusive thoughts that one wants to hurt oneself or others (without any actual suicidal or homicidal intent).



When you have OCD, you don't simply experience obsessions. OCD also makes you engage in compulsions (also called rituals) in order to get the obsessions out of your head. As an example, if you're struggling with contamination obsessions and get the thought that the doorknob you just touched was contaminated with germs, you might engage in the compulsion of handwashing in order to get rid of your contamination worry. Generally, compulsions work in the short term (i.e lower your present discomfort) but strengthen your OCD symptoms in the long term. When you have OCD you feel the need to perform your compulsions/rituals even if you know they don't exactly make sense and appear unusual to others. Some examples of common compulsions include:

  • Hand-washing: This is usually excessive in frequency and/or duration, and can sometimes include additional elements such as blinking, counting, and repeating.

  • Reassurance-seeking: These are behaviors (usually questions or statements) meant to elicit reassurance from others that one is okay and/or safe. Reassurance seeking, then, is a ritual that involves other people. Those who are providing the reassurance usually have to do so with some regularity.

  • Praying: Excessively ritualized prayers at certain times of day and/or when one believes that he or she may have done something wrong.

  • Checking/Re-checking: Examples include reviewing one's homework/test answers over and over again, going back to the house or car to check locks, and repeatedly checking bathroom signs to making sure one is using the correct bathroom (men's vs. women's).

  • Ordering: This may include doing one's tasks at work in the same order every day, or following a specific routine in the shower. While routines are typical for everyone, in OCD the person is unable to tolerate doing things a different way.

  • Avoiding: Sometimes simply avoiding can be a compulsion. This can include avoiding certain foods, no longer entering certain stores, and not watching certain movies.


Unwanted Feelings

An often overlooked aspect of OCD is that people with OCD also experience uncomfortable emotions when their obsessions are triggered. In completing your rituals, you are not only trying to get rid of your obsessive thoughts or urges, but also seeking relief from certain, uncomfortable feelings. Some examples of emotions that are typically triggered by OCD are:

  • Anxiety: This is a sense of unease or worry that can range from slight to overwhelming. It is one of the most common OCD feelings.

  • Disgust: This often accompanies contamination concerns. You may feel disgusted or "gross" when you imagine yourself to be contaminated.

  • Shame: This is often triggered by "bad thoughts" OCD (see Obsessions section above). It is also a common feeling for people with OCD to feel about their mental health struggles in general, particularly when they know, or suspect, that their symptoms seem strange to others.

  • Incomplete or "not right:" This is a feeling that many individuals with "just right" OCD experience when things aren't done the way their OCD wants them to be done.

  • Agitation: This is another common feeling that people with OCD experience when they are not able to complete their rituals.

  • Boredom: Some people with OCD describe feeling this when they are required to do something that they usually avoid doing. Having to sit down and complete certain tasks can feel "boring."

It is often these unwanted feelings, more than anything else, that can make individuals with OCD believe the obsessions in their head. You may think to yourself “I must have made a mistake on my homework if I’m feeling this anxious about it” or "There must have been germs on that doorknob if I'm feeling this disgusted." It is also worth noting that some people with OCD develop a lower tolerance for uncomfortable emotions. In some cases, a goal 'to never feel anxious' develops, even though this is a feeling that almost all people experience on a daily basis.


Learn More About OCD

Mayo Clinic on OCD

WebMD on OCD




Michael Parker, LCSW   |   2526 Monroeville Blvd #208, Monroeville, PA 15146   |   412.256.8256   |   Treatment for OCD and Anxiety in Pittsburgh, PA

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