Obsessive Compulsive Disorder (OCD)

Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by the presence of obsessions, compulsions, or both. Obsessions are intrusive, unwanted thoughts, images, or urges that cause significant anxiety or distress. These obsessions often revolve around themes such as contamination/germs, harm, symmetry, or taboo subjects. Compulsions are repetitive behaviours or mental acts performed to reduce the anxiety caused by obsessions or to prevent a feared event or situation, even though these actions are not realistically connected to the outcome.

The key difference between obsessions and compulsions is that obsessions involve distressing mental experiences, while compulsions are the behaviours or rituals that an individual feels driven to perform in response to those obsessions. For example, a person might obsess over germs (obsession) and respond by excessive hand washing (compulsion).

OCD is closely related to anxiety because obsessions generate intense anxiety, and compulsions serve as a temporary relief from that anxiety. However, this relief is short-lived, often leading to a cycle where obsessions trigger compulsions, which then fail to fully alleviate anxiety, perpetuating the disorder. Understanding this cycle is critical for effective treatment, which often includes cognitive-behavioural therapy techniques such as Exposure and Response Prevention (ERP).

Symptom Checklist of OCD

DSM-5 Symptoms of Obsessive-Compulsive Disorder (OCD)

OCD is characterized by the presence of obsessions, compulsions, or both. Symptoms must be time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Obsessions

Recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, and that cause marked anxiety or distress. The person attempts to ignore or suppress such thoughts, urges, or images or to neutralize them with some other thought or action (i.e., by performing a compulsion).

Common types of obsessions include:

  • Fear of contamination

  • Doubts about having done something right (e.g., turning off the stove)

  • Aggressive or horrific impulses

  • Sexual images or thoughts

  • Need for symmetry or exactness

Compulsions

Repetitive behaviours (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly. These behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

Common types of compulsions include:

  • Excessive cleaning or hand washing

  • Ordering, arranging or symmetry rituals

  • Checking (e.g., locks, appliances)

  • Mental compulsions such as counting or repeating phrases silently

Additional Criteria

  • The obsessions or compulsions are time-consuming (take more than 1 hour per day) or cause clinically significant distress or impairment.

  • The disturbance is not attributable to the physiological effects of a substance or another medical condition.

  • The disturbance is not better explained by symptoms of another mental disorder.

This diagnostic framework supports effective assessment and treatment planning in psychotherapy.

What is Exposure and Response Prevention (ERP) ?

Exposure and Response Prevention (ERP) is a highly effective form of cognitive-behavioural therapy designed to help individuals manage and reduce the symptoms of obsessive-compulsive disorder (OCD). ERP works by gradually exposing individuals to the thoughts, images, objects, or situations that trigger their obsessions, while simultaneously preventing the compulsive behaviours that typically follow.

The process begins with identifying specific obsessions and compulsions, then creating a hierarchy of feared stimuli. Through repeated and controlled exposure to these triggers without engaging in compulsive responses, individuals learn to tolerate the anxiety and distress provoked by their obsessions. Over time, this leads to habituation—the natural decrease in anxiety—as the brain becomes less reactive to the triggers.

ERP helps individuals regain control over their behaviours and thoughts by breaking the cycle of obsession and compulsion. Instead of responding to obsessive fears with compulsive rituals, which only reinforce the anxiety, ERP encourages individuals to confront their fears directly. This exposure strengthens adaptive coping mechanisms, reduces avoidance, and ultimately diminishes the power obsessions and compulsions hold.

The therapy is typically delivered in a structured and supportive virtual setting, which can increase accessibility while maintaining personalized care. For adolescents, young adults, and parents working through challenging times with their children, ERP offers a practical, evidence-based approach to restoring clarity and improving quality of life.