What is OCD?
Obsessive-Compulsive Disorder
Obsessive-Compulsive Disorder (OCD) involves unwanted, intrusive thoughts, images, urges, doubts, or sensations (obsessions), along with behaviors or mental acts (compulsions) used to reduce distress or gain a sense of certainty.
Understanding obsessions and compulsions
OCD involves a cycle of obsessions and compulsions. Understanding how each works can make the cycle easier to recognize, especially because compulsions are not always obvious.
Unwanted and intrusive
An obsession is an unwanted thought, image, urge, doubt, or physical sensation that shows up on its own and feels distressing. Having the thought is not the same as wanting it.
Intrusive thoughts are common in the general population, and most people are able to let them pass without much attention. With OCD, the thought tends to stick around and can start to feel like it means something important about the person having it.
Anything done to reduce the distress
Washing, checking, asking, avoiding, confessing, praying, researching, replaying a memory to be sure of what happened, or scanning the body for a particular feeling.
What makes something a compulsion isn't the behavior itself, but the function it serves. The same behavior may be a compulsion in one situation and not in another, including when it happens entirely internally.
Why the cycle continues
People with OCD are often told to “just stop” doing compulsions. But it’s not that simple. Compulsions stick around because they usually work in the short term. They can bring relief, reduce anxiety, or create a temporary sense of certainty. The problem is that this relief reinforces the cycle, making the urge to do the compulsion even stronger the next time OCD shows up.
Compulsions usually bring some relief, at least temporarily. That short-term relief is part of what keeps the cycle going. Treatment works on the cycle itself rather than on the content of the thought.
What OCD is not
Some common misunderstandings about OCD can make it harder for people to recognize what they are experiencing, or to get an accurate diagnosis.
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I'm so OCD about my desk.
Liking things tidy or organized isn't a mild version of OCD. OCD involves intrusive thoughts and compulsions that cause significant distress or interfere with daily life. Many people with OCD don't keep an especially tidy home at all.
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If you're thinking about it, some part of you must want it.
With OCD, these thoughts are unwanted and often deeply distressing. Having an intrusive thought is not the same as wanting to act on it. OCD often focuses on things that feel important, threatening, or difficult to be uncertain about.
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You'd know if you had it, because you'd be washing your hands.
Some people with OCD have few or no visible rituals. When compulsions happen internally, there may not be much for anyone else to notice.
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Just tell yourself it's irrational.
Many people with OCD already recognize that a fear does not make logical sense, and knowing that usually is not enough to make it go away. Insight can also vary from day to day and from situation to situation.
Compulsions aren't always visible
Mental compulsions are one reason OCD can go unrecognized, including by therapists. If your compulsions happen internally, you may have been told you have generalized anxiety, or that you tend to overthink things.
Mental compulsions include:
Rumination — working a question over and over until it feels resolved.
Mental reviewing — replaying a conversation or event to establish what really happened.
Self-reassurance — silently reciting the reasons you're fine.
Internal checking — monitoring thoughts, feelings, or bodily sensations for evidence.
Neutralizing — replacing a bad thought with a good one, or repeating a phrase or prayer.
Arguing with it — debating the thought until it feels settled.
Researching OCD can work the same way. Sometimes people find themselves repeatedly reading about OCD, comparing their symptoms to lists, or looking for reassurance that what they are experiencing really is OCD. If you notice that researching gives you temporary relief but you soon feel the need to check again, it may be worth bringing that pattern into treatment.
These serve much the same function as a visible ritual, and they generally respond to the same treatment. Because they are harder to notice, a thorough assessment can be helpful in sorting out what is going on.
Up to 75%
of actual OCD cases are not detected or diagnosed by clinicians.
Common themes
OCD can attach to almost anything. There isn't a complete list of OCD themes because obsessions can center on virtually any topic. They often involve things that feel especially important, threatening, or difficult to be uncertain about.
The examples below are some common presentations, but they aren't separate types of OCD. The content can change over time, and many people experience more than one theme. What stays consistent is the cycle of obsessions, distress, and compulsions. Select a theme to see examples of how it can show up.
Contamination
Germs, illness, chemicals, emotional contamination
Fear of germs, bodily fluids, chemicals, or of being contaminated by a person, place, or memory.
Contamination
Germs, illness, chemicals, emotional contaminationFear of germs, bodily fluids, chemicals, or of being contaminated by a person, place, or memory.
- Often looks like
- Ritualized or excessive washing, cleaning, changing clothes, refusing to sit somewhere, or discarding items.
Harm
Violent intrusive thoughts
Fear of harming someone, often someone close to you, or of losing control and doing something terrible.
Harm
Violent intrusive thoughtsFear of harming someone, often someone close to you, or of losing control and doing something terrible.
- Often looks like
- Hiding knives, avoiding being alone with a child or partner, checking that no harm was done, or mentally reviewing your own intentions.
Health & Somatic
Health anxiety, illness obsessions
Fear of having or developing a serious illness, or that a symptom means something serious has been missed.
Health & Somatic
Health anxiety, illness obsessionsFear of having or developing a serious illness, or that a symptom means something serious has been missed.
- Often looks like
- Body scanning, symptom searching, repeated appointments and tests. Some people avoid doctors entirely instead.
Sensorimotor OCD
Hyperawareness of bodily processes
Persistent awareness of automatic sensations or processes such as breathing, swallowing, blinking, heartbeat, or eye contact, along with fear that the awareness will never go away.
Sensorimotor OCD
Hyperawareness of bodily processesPersistent awareness of automatic sensations or processes such as breathing, swallowing, blinking, heartbeat, or eye contact, along with fear that the awareness will never go away.
- Often looks like
- Monitoring the sensation, testing whether you still notice it, trying to distract yourself, researching, or seeking reassurance that you will eventually stop noticing it.
Sexual Intrusive Thoughts
Taboo sexual obsessions, POCD
Unwanted sexual thoughts or images that feel disturbing, confusing, or inconsistent with how the person sees themselves. The content can involve children, family members, animals, or almost anything else, along with fear about what having the thought might mean.
Sexual Intrusive Thoughts
Taboo sexual obsessions, POCDUnwanted sexual thoughts or images that feel disturbing, confusing, or inconsistent with how the person sees themselves. The content can involve children, family members, animals, or almost anything else, along with fear about what having the thought might mean.
- Often looks like
- Avoidance, checking one's own reactions, mentally reviewing past behavior, confessing, or seeking reassurance.
Sexual Orientation OCD
SO-OCD, sexual orientation obsessions
Persistent doubt or fear about sexual orientation, often accompanied by a need to figure out with certainty what thoughts, feelings, attractions, or bodily responses mean.
Sexual Orientation OCD
SO-OCD, sexual orientation obsessionsPersistent doubt or fear about sexual orientation, often accompanied by a need to figure out with certainty what thoughts, feelings, attractions, or bodily responses mean.
- Often looks like
- Checking attraction, monitoring bodily responses, reviewing past relationships or experiences, comparing reactions to different people, researching, or seeking reassurance.
Relationship OCD
ROCD
Relentless doubt about whether you love your partner, whether they love you, or whether the relationship is right.
Relationship OCD
ROCDRelentless doubt about whether you love your partner, whether they love you, or whether the relationship is right.
- Often looks like
- Testing your feelings, comparing your relationship to others, seeking reassurance, or replaying moments for evidence.
Religious & Moral Scrupulosity
Scrupulosity
Fear of having sinned, blasphemed, or acted immorally, and of the consequences of not being certain.
Religious & Moral Scrupulosity
ScrupulosityFear of having sinned, blasphemed, or acted immorally, and of the consequences of not being certain.
- Often looks like
- Repeated prayer or confession, seeking clergy reassurance, avoiding worship, or replaying past actions for moral fault.
Perinatal & Postpartum OCD
Pregnancy and postpartum OCD
Intrusive thoughts, images, or fears about harm coming to a baby, causing harm accidentally or intentionally, contamination, illness, or making the “wrong” parenting decision.
Perinatal & Postpartum OCD
Pregnancy and postpartum OCDIntrusive thoughts, images, or fears about harm coming to a baby, causing harm accidentally or intentionally, contamination, illness, or making the “wrong” parenting decision.
- Often looks like
- Repeated checking, excessive cleaning or sterilizing, avoiding being alone with the baby, seeking reassurance, mentally reviewing interactions, or avoiding certain caregiving tasks.
Responsibility OCD
Hyper-responsibility
Fear that something terrible could happen because you failed to prevent it, made the wrong decision, or weren't careful enough.
Responsibility OCD
Hyper-responsibilityFear that something terrible could happen because you failed to prevent it, made the wrong decision, or weren't careful enough.
- Often looks like
- Repeated checking, warning others, reviewing decisions, taking excessive precautions, asking for reassurance, or avoiding responsibility altogether.
Just Right & Symmetry
Sensory-driven OCD
Actions repeated until they feel complete or correct, driven by a physical sense of wrongness rather than a feared outcome.
Just Right & Symmetry
Sensory-driven OCDActions repeated until they feel complete or correct, driven by a physical sense of wrongness rather than a feared outcome.
- Often looks like
- Redoing, rereading, rewriting, arranging, evening things up, or repeating a movement until it lands right.
Real-Event & False Memory OCD
Real-event obsessions
Fixation on something that actually happened, with persistent doubt about whether it was as bad as it feels.
Real-Event & False Memory OCD
Real-event obsessionsFixation on something that actually happened, with persistent doubt about whether it was as bad as it feels.
- Often looks like
- Reconstructing the memory, confessing repeatedly, or seeking reassurance that you are not a bad person.
Existential OCD
Existential obsessions
Persistent doubt about reality, existence, consciousness, free will, the meaning of life, or questions that cannot be answered with certainty.
Existential OCD
Existential obsessionsPersistent doubt about reality, existence, consciousness, free will, the meaning of life, or questions that cannot be answered with certainty.
- Often looks like
- Hours of thinking or researching, mentally testing whether things feel real, debating philosophical questions, or repeatedly seeking an answer that finally feels certain.
Perfectionism & Fear of Mistakes
Perfectionism, mistakes & decision-making
Fear of making the wrong choice, overlooking something important, or doing something imperfectly and facing consequences.
Perfectionism & Fear of Mistakes
Perfectionism, mistakes & decision-makingFear of making the wrong choice, overlooking something important, or doing something imperfectly and facing consequences.
- Often looks like
- Rechecking work, rereading emails, excessive editing, difficulty making decisions, starting over, or taking much longer than necessary to complete tasks.
Don't see your experience here?
OCD can attach to virtually any subject, and themes often change over time. You do not need to fit neatly into one of these categories for OCD to be worth considering.
How OCD is treated
OCD tends to respond well to treatment when the approach is a good fit. General talk therapy is often not enough on its own, and it can sometimes become another place where reassurance gets sought. The approaches below have research support for OCD specifically.
Exposure and Response Prevention (ERP)
ERP has the strongest research support for OCD. In ERP, people gradually approach the thoughts, situations, and sensations that OCD tells them to avoid, while practicing not doing the compulsion that usually follows.
Over time, this allows people to practice experiencing discomfort and uncertainty without having to resolve it through a compulsion.
ERP is collaborative and paced by the client. You and your therapist build the plan together and start where you are able, and nothing happens without your agreement. It can be uncomfortable at times, and for many people it is time-limited rather than open-ended.
Inference-Based CBT (I-CBT)
I-CBT focuses on how obsessional doubt develops in the first place. Clients learn to notice when they have moved from the information actually in front of them into an imagined possibility, and to trust their own direct experience.
It can be a good option for people who have not responded well to ERP, or who find it too difficult to begin. Relatively few clinics in Minnesota offer I-CBT, and our clinicians are trained in it.
SPACE for parents
A parent-based program from the Yale Child Study Center. The child does not attend. Parents learn to reduce family accommodation and respond differently to anxiety and OCD symptoms. Learn more about OCD Parent Coaching & SPACE.
Treatment is individualized
Depending on the person, treatment may also incorporate ACT, mindfulness, RO DBT, recreational therapy, parent work, and medication. Your treatment plan should reflect both how OCD is showing up and what else may be going on alongside it.
Medication is a common part of OCD treatment for many people. SSRIs are the usual first choice, and for OCD they are typically prescribed at higher doses and given longer to work than they would be for depression.
Starting treatment with us
We are an OCD-specialty clinic in Saint Paul, and our clinicians receive specialized training in evidence-based treatment for OCD and related conditions.
- Who we see
- Children, adolescents, and adults
- Where
- 370 Selby Ave, Saint Paul, plus telehealth anywhere in Minnesota
- Payment
- We are a private-pay practice and do not bill insurance directly. Individual sessions are $175 to $250. Full rates and CPT codes.
- Using insurance
- If your plan has out-of-network benefits, we provide superbills you can submit for reimbursement. HSA and FSA cards are accepted.
- If cost is a barrier
- We have a limited number of sliding-scale spots, and the OCDMN Access Fund provides financial assistance for eligible Minnesota clients.
About this page
We review and update this page as the evidence changes. If something here is unclear or inaccurate, please let us know.
- International OCD Foundation. America's OCD Care Crisis, December 2025. Full report (PDF).