Understanding and Managing OCD: A Patient Guide
Adapted from the Comprehensive OCD Treatment Guide by David Puder, M.D. and colleagues (2024)
What Is OCD?
Obsessive-Compulsive Disorder (OCD) is a condition where people experience repeated, unwanted thoughts (obsessions) and feel driven to perform behaviors or mental actions (compulsions) to reduce anxiety or prevent something bad from happening. It affects about 1 in 40 adults and often begins in childhood or early adulthood.
Obsessions are intrusive thoughts, images, or urges that cause distress. Example: "What if I accidentally hurt someone?"
Compulsions are things you do to feel better or more certain. Example: Repeatedly checking if the door is locked.
The problem isn’t the thought itself, but how much importance your brain gives that thought, and how you respond to it.
What Keeps OCD Going?
OCD is known as the "doubting disorder." People with OCD struggle to feel certain. You may do things (compulsions) to feel sure, but these only give temporary relief. Over time, they make the doubt worse.
Performing a compulsion teaches your brain, "This thought was dangerous. Good thing I acted on it." That cycle keeps the obsession and anxiety alive.
How Do We Treat OCD?
The gold standard is Exposure and Response Prevention (ERP) therapy. ERP helps you:
Face the things you fear (Exposure)
Learn to resist the urge to do the compulsion (Response Prevention)
The goal is not to get rid of the thought, but to learn to live with it without acting on it.
You might start with smaller exposures and work up. Over time, your brain learns the anxiety goes down on its own.
Common OCD Themes
Contamination OCD: Fear of germs or illness
Harm OCD: Fear of hurting others
Existential/Moral OCD: Worry about right vs. wrong or meaning of life
Checking OCD: Fear of making a mistake (locking doors, leaving the stove on)
ERP is tailored to your specific symptoms. No two people with OCD are exactly alike.
Skills You Will Practice in Therapy
Sitting with uncertainty: Learning to live with "maybe."
No reassurance: Avoid asking others or googling for comfort.
Script writing: Writing and reading out loud your feared outcome.
Audio exposure: Listening to triggering statements repeatedly until they're boring.
Homework: Facing fears a little at a time, every day.
Examples of Exposure Steps
If you fear harming someone while driving, your exposure steps might include:
Reading stories about car accidents.
Saying out loud: "Maybe I did hit someone."
Driving past a bump in the road and not turning back.
This is hard work, but very effective.
Important Reminders
OCD is treatable. With ERP and support, most people see major improvement.
Thoughts are not facts. Having a thought doesn't make it true.
Reassurance can backfire. It feels helpful in the moment, but feeds the OCD cycle.
Progress is not linear. Expect ups and downs, but stay committed.
Tips for Loved Ones
Don’t give reassurance ("You’re fine," "That won’t happen").
Support your loved one by encouraging ERP.
Learn about OCD so you can understand what they’re working through.
Final Thought
Getting better doesn’t mean getting rid of thoughts. It means learning to live with them and to stop fighting them, and to focus on what matters most in your life.
For More Help:
This guide is adapted from David Puder, M.D.'s 2024 OCD Treatment Guide and Fred Penzel, Ph.D.'s clinical work.