Example 1: Harm OCD Triggered by Media

Your OCD centres on intrusive thoughts about harming others, specifically fears that you might be capable of violence. The obsessions were always in the background, but really became a problem after watching a TV programme about a psychotic serial killer. You began to believe that having your intrusive thoughts meant you secretly wanted to harm people.

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The compulsions include mental checking (reviewing your thoughts to see if you "really" want to hurt someone), avoiding knives and other potential "weapons," staying away from situations where you'd be alone with vulnerable people, and constant reassurance seeking from your partner about whether you're a good person.

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Underlying this are some pre-existing patterns: you've always had high moral standards and a tendency to overthink. You also have some magical thinking (the belief that having a thought makes something more likely to happen) and an inflated sense of responsibility (feeling that if you think something terrible, you're somehow responsible for preventing it).

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What's maintaining it: The mental checking keeps the thoughts feeling significant and dangerous. The avoidance prevents you from learning that intrusive thoughts don't lead to actions. The reassurance seeking provides temporary relief but reinforces the idea that the thoughts are genuinely concerning.

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Where therapy would help: Psychoeducation about how common harm thoughts are (they don't mean what you think they mean). ERP would involve gradually reducing checking, avoidance, and reassurance seeking while approaching feared situations. ACT would help you see intrusive thoughts as meaningless mental noise rather than warnings. We'd work on accepting uncertainty about your thoughts rather than trying to prove you're not dangerous.

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Example 2: ROCD Driven by Perfectionism and Uncertainty

Your OCD focuses on constant doubts about whether you truly love your partner and whether this relationship is "right." You spend hours mentally checking your feelings, comparing your relationship to others, and analysing whether you feel "enough" attraction, excitement, or connection. When you notice your feelings fluctuate, you panic about what this means.

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This pattern stems from several underlying factors: you've always been perfectionistic and have high standards for yourself. You struggle with self-doubt generally, often second guessing decisions. You have a strong need for certainty, particularly around important life choices. You also have some unrealistic templates for what relationships "should" look like, possibly influenced by media, family models, or past experiences. You believe that if the relationship were right, you'd feel consistently certain and passionate.

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What's maintaining it: The constant feeling checking prevents you from ever settling into the relationship naturally. Comparing to others reinforces the idea that there's a "correct" way to feel. The need for certainty about feelings (which are inherently uncertain and changeable) creates an impossible standard. Your misunderstanding that healthy relationships involve constant intense feelings rather than normal ups and downs keeps the doubt cycle going.

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Where therapy would help: Psychoeducation about how feelings naturally fluctuate in all relationships. ERP would involve reducing feeling checking, comparison, and reassurance seeking, and practising staying in the relationship without seeking certainty. ACT would help you understand that love is a commitment and set of actions, not a constant measurable feeling. We'd work on tolerating the uncertainty and building a relationship based on values rather than trying to achieve perfect feelings.

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Example 3: Checking and "Just Right" OCD

Your OCD involves repetitive checking behaviours (locks, appliances, light switches) and needing things to feel "just right" before you can move on. You might check the hob multiple times, lock and unlock the door until it feels correct, or arrange objects symmetrically. Sometimes you know logically that everything is fine, but it doesn't feel right, so you have to keep going.

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The compulsions aren't necessarily driven by specific fears of disaster (though sometimes they are). Often it's more about an uncomfortable feeling of incompleteness or wrongness that you need to resolve. You might repeat actions a certain number of times, or until you achieve a particular feeling of "rightness."

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Underlying factors include a general need for order and control, difficulty tolerating discomfort or "off" feelings, and possibly some perfectionism. There might also be some magical thinking (believing that if you don't complete the ritual, something bad will happen, even if you can't specify what).

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What's maintaining it: Each time you perform the checking or arranging until it feels right, you get temporary relief from the discomfort. This reinforces your brain's message that the feeling was dangerous and needed to be resolved. You never learn that you can tolerate the "not right" feeling and move on anyway. The rituals are also taking up increasing amounts of time, which adds stress, which makes you more likely to rely on rituals for a sense of control.

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Where therapy would help: ERP would involve gradually resisting the urge to check or arrange, sitting with the uncomfortable "not right" feeling without resolving it. We'd work on reducing checking behaviours systematically. ACT would help you tolerate the discomfort and incompleteness without needing to act on it. We'd focus on choosing actions based on your values (getting to work on time, spending time with family) rather than based on achieving a feeling of rightness.

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Example 4: Contamination OCD Following Health Crisis

Your OCD centres on contamination fears, particularly around illness and germs. You wash your hands until they're raw, avoid public spaces, and have elaborate cleaning rituals when you return home. You won't touch door handles without tissues, and you've stopped using public transport entirely.

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This intensified significantly after your father's cancer diagnosis two years ago. Before that, you'd always been somewhat health conscious, but it was manageable. The illness in your family seemed to flip a switch. You became hypervigilant about any potential source of contamination, reasoning that if you were careful enough, you could prevent illness in yourself and others.

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Underlying factors include an inflated sense of responsibility (feeling it's your job to keep everyone safe) and intolerance of uncertainty (needing to be absolutely sure you haven't been contaminated). There's also some all or nothing thinking: if there's any possibility of germs, it's treated as certain contamination.

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What's maintaining it: The washing and cleaning provide immediate but temporary relief from anxiety. The avoidance means you never learn that you can touch "contaminated" objects and be fine. Each time you complete a ritual and nothing bad happens, your brain credits the ritual rather than learning that the danger wasn't real in the first place.

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Where therapy would help: ERP would involve a gradual hierarchy of exposure to "contaminated" items without washing or cleaning. We'd start small (perhaps touching a door handle and waiting 5 minutes before washing) and build up. ACT would help you tolerate the anxiety without needing to eliminate it through compulsions. EMDR might be helpful for processing the trauma of your father's diagnosis, which seems to be the emotional fuel beneath the contamination fears.

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Example 5: POCD (Paedophile OCD) in a Teacher

Your OCD involves intrusive thoughts about being sexually attracted to children, specifically your students. You experience these as deeply distressing images or thoughts that make you feel physically sick. You're terrified that having these thoughts means you're dangerous.

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The compulsions are predominantly mental: you constantly check whether you felt any arousal when near children, you review interactions to make sure you didn't do anything inappropriate, and you seek reassurance online about whether "normal" people have these thoughts. You've also started avoiding being alone with students, making excuses when you're asked to supervise them individually.

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Underlying factors: You've always had a strong moral compass and high anxiety about doing the right thing. You have significant thought action fusion (the belief that thinking something is morally equivalent to doing it). You also have magical thinking (believing that thinking about something makes it more likely to happen).

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What's maintaining it: The mental checking keeps the thoughts feeling meaningful and dangerous. The reassurance seeking provides brief relief but reinforces the idea that the thoughts are a genuine concern. The avoidance prevents you from learning that you can be around children without acting on intrusive thoughts, and it's making your job increasingly difficult.

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Where therapy would help: Psychoeducation about how common these thoughts are (they don't mean what you think they mean). ERP would involve gradually reducing mental checking and reassurance seeking, and approaching situations you've been avoiding (like being alone with students). ACT would help you understand that thoughts are just mental events, not reflections of character or desires. We'd work extensively on accepting these thoughts as meaningless brain noise rather than trying to prove you're not dangerous.

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Example 6: Hit and Run OCD

Your OCD centres on fears that you've hit someone while driving but didn't notice. After driving, you experience intense doubt: "Did I feel a bump? Was that person too close to the road? Did I actually check my mirrors properly?" You spend hours mentally reviewing your journey, and you've started driving back along routes to check for accidents or ambulances.

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This started after you witnessed a serious car accident last year. Since then, you've become hypervigilant while driving. The doubts feel incredibly real, even though logically you know you'd notice if you'd hit someone.

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Underlying factors include inflated responsibility (feeling it's your job to prevent all harm), intolerance of uncertainty (needing to be absolutely sure nothing bad happened), and some attention bias (you're now hyperaware of every sensation and sound while driving).

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What's maintaining it: The mental reviewing keeps the doubt alive and significant. The driving back to check provides temporary relief but teaches your brain that the doubt was dangerous and needed investigation. You're also starting to avoid certain routes or driving at certain times, which prevents you from building confidence.

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Where therapy would help: ERP would involve gradually resisting the urge to check (mentally or physically), staying with the doubt without resolving it. We'd work on driving without reviewing the journey afterwards. ACT would help you tolerate the uncertainty rather than seeking certainty. We'd also work on attention retraining so you're not hypervigilant to every sensation while driving.

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Example 7: Scrupulosity (Religious OCD)

Your OCD centres on fears of sinning or offending God. You have intrusive blasphemous thoughts or images that horrify you. Your compulsions include excessive prayer, constant confession, avoiding certain words or numbers you've associated with evil, and seeking reassurance from religious leaders about whether you're truly faithful.

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You've always been religious, but this intensified after a period of significant stress at work. What used to bring you comfort (your faith) now feels like a source of constant anxiety. You're terrified that having these blasphemous thoughts means you're evil or that God will punish you.

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Underlying factors include thought action fusion (believing that thinking something blasphemous is as bad as doing it), magical thinking (believing your thoughts can cause harm or displease God), and perfectionism about moral/spiritual purity. There's also some all or nothing thinking: if you're not perfectly faithful, you're completely unfaithful.

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What's maintaining it: The prayer and confession rituals provide temporary relief but reinforce the idea that the thoughts are genuinely sinful and dangerous. The avoidance of certain words or numbers has expanded your OCD's territory. Seeking reassurance from religious leaders might feel like the spiritual thing to do, but it's actually a compulsion that's strengthening the OCD.

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Where therapy would help: Working with your faith tradition (not against it) to understand the difference between thoughts and actions. Many religious texts acknowledge intrusive thoughts. ERP would involve gradually reducing rituals, sitting with blasphemous thoughts without praying them away, and reducing reassurance seeking. ACT would help you understand that having unwanted thoughts doesn't make you unfaithful. It's what you choose to do (your values and actions) that reflects your faith, not what random thoughts your brain generates.

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Example 8: Somatic/Sensorimotor OCD

Your OCD centres on hyperawareness of automatic bodily processes, particularly your breathing and blinking. You've become so conscious of breathing that it feels like you have to manually control it. If you try to ignore it, you panic that you'll stop breathing. You're also hyperfocused on blinking, swallowing, and your heartbeat.

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This started after a panic attack where you felt you couldn't breathe properly. Since then, you've been monitoring your breathing constantly. It's exhausting and it's affecting your sleep, your concentration at work, and your ability to relax.

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Underlying factors include anxiety sensitivity (being frightened of bodily sensations), intolerance of uncertainty (needing to be sure your body is functioning correctly), and a misunderstanding that you need to consciously control automatic processes.

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What's maintaining it: The constant monitoring keeps the sensations in your awareness. The more you check that you're breathing, the more unnatural it feels. Trying to manually control automatic processes creates a paradox where you're overriding your body's natural systems. The anxiety about the sensations makes you monitor more, which increases awareness, which increases anxiety.

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Where therapy would help: Psychoeducation about automatic bodily processes and how attention affects perception. ERP would involve intentionally focusing on breathing or blinking for set periods (to learn it doesn't cause the feared outcome) then practising redirecting attention elsewhere without checking. ACT would help you accept the uncomfortable awareness without needing to control or monitor. We'd work on learning to trust your body's automatic processes again.

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These examples show how different OCD presentations have distinct patterns, but all share the same basic structure: intrusive thought → anxiety → compulsion → temporary relief → strengthening the cycle. Understanding your specific version of this cycle is the first step toward breaking it.

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Back to OCD homepage | Assessment Page | How I Work with OCD

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Jack Brown
BABCP Accredited CBT Therapist | EMDR Practitioner
Specialising in OCD, Anxiety, and Trauma

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Contact: jbpsychotherapies@outlook.com