When Thoughts Get Stuck - Understanding OCD and the Path to Recovery

What is OCD?

OCD is characterised by two key features: obsessions and compulsions.

Obsessions are recurring, intrusive thoughts, images, or urges that feel unwanted and distressing. These thoughts are often described as “stuck” thoughts because they can repeatedly enter a person’s mind, even when they do not reflect their values, beliefs, or intentions.

For example, someone may experience thoughts such as:

• “Did I leave the stove on?”
• “What if I accidentally harm someone?”
• “What if I am a bad person?”

These thoughts are known as ego-dystonic, meaning they feel inconsistent with the person’s sense of self and are often deeply distressing.

Compulsions are repetitive behaviours or mental acts that a person feels driven to perform to reduce distress or prevent something bad from happening.

Examples may include:

• Repeatedly checking locks, appliances, or messages
• Washing or cleaning excessively due to fears of contamination
• Seeking repeated reassurance from others
• Mentally reviewing conversations or events
• Repeating words, numbers, or phrases in the mind

This creates a cycle:

1. An intrusive thought, image, or urge appears
2. Distress or anxiety increases
3. The person performs a compulsion to feel relief
4. Relief occurs temporarily, but the thought returns

Over time, this cycle can become exhausting and difficult to break without appropriate support.

Is OCD the same as anxiety?

OCD and anxiety disorders share some similarities, including feelings of fear, worry, and distress. However, they are not the same.

With OCD, distress is often linked to intrusive, unwanted thoughts or images and the urge to perform compulsions to reduce that distress.

For example, someone with OCD may repeatedly check whether the stove has been turned off, not because they simply worry about it, but because they feel compelled to check repeatedly to gain certainty or prevent harm.

Anxiety disorders can involve excessive worry, fear, and avoidance, but they do not typically involve the same pattern of obsessions and compulsions.

It is also common for people with OCD to experience other anxiety conditions, which is why a thorough assessment is important to ensure the right treatment approach.

How can OCD appear in everyday life?

The common stereotype of OCD being only about cleaning and organisation means many people do not recognise their symptoms.

OCD can appear in many different ways, including:

• Persistent fears about morality, guilt, or being a “bad” person (sometimes called scrupulosity)
• Fear of causing harm to loved ones and repeatedly checking or seeking reassurance
• Intrusive sexual, violent, or disturbing thoughts that create shame or secrecy
• Mental rituals such as counting, repeating phrases, reviewing memories, or analysing thoughts
• Avoiding situations, objects, or conversations that trigger distress
• Constantly seeking certainty or reassurance

Many people experience OCD internally, without obvious physical behaviours. They may spend significant amounts of time ruminating, analysing, or mentally checking, which can be incredibly distressing and isolating.

What treatments are available for OCD?

The good news is that OCD is highly treatable. Evidence-based treatment can significantly reduce symptoms and improve quality of life.

Treatment is tailored to each person and may involve psychological therapy, medication, or a combination of both.

Psychological therapy: Exposure and Response Prevention (ERP)

Exposure and Response Prevention (ERP) is considered one of the most effective psychological treatments for OCD.

ERP involves:

• Learning about the OCD cycle and understanding how compulsions maintain symptoms
• Gradually facing feared thoughts, situations, or triggers in a structured way
• Practising resisting compulsions and learning that anxiety can decrease without performing rituals

The goal of ERP is not to eliminate every uncomfortable thought or feeling. Everyone experiences unwanted thoughts at times. Instead, ERP helps people develop confidence in managing uncertainty and reduces the power OCD has over daily life.

Medication: SSRIs

Medication can also play an important role in OCD treatment.

Selective Serotonin Reuptake Inhibitors (SSRIs) may be prescribed and are often used alongside psychological therapy.

Important points include:

• OCD treatment may require higher doses of SSRIs compared with treatment for depression
• Improvement can take several weeks and often requires patience
• Medication decisions should always be made with a qualified healthcare professional

Supporting someone with OCD

Supporting someone with OCD can be challenging, particularly when family members or loved ones want to reduce their distress.

Helpful approaches include:

• Learning about OCD and understanding that compulsions are part of the condition
• Offering encouragement and support to seek treatment
• Avoiding repeatedly providing reassurance or participating in compulsive behaviours, as this can unintentionally reinforce the OCD cycle
• Showing patience and compassion while encouraging evidence-based treatment

The path forward: recovery is possible

Living with OCD can be overwhelming, particularly when symptoms are misunderstood or hidden. However, with the right support and evidence-based treatment, many people experience significant improvement.

Recovery does not mean never having an unwanted thought again. It means learning skills to respond differently to thoughts, reducing the impact OCD has on daily life and being able to focus on what matters most.

If you recognise signs of OCD in yourself or someone you care about, seeking professional support is an important first step. Early recognition and targeted treatment can help people regain confidence, control, and hope.

When to seek help

Consider reaching out for professional support if OCD symptoms:

• Take significant time each day
• Cause distress or interfere with relationships, work, study, or daily activities
• Lead to avoidance or ongoing reassurance-seeking
• Feel difficult to manage alone

Listen to the podcast

To learn more about OCD, listen to our podcast featuring Professor Brakoulias and Craig Willson as they explore the realities of OCD, including intrusive thoughts, obsessions and compulsions, the often-hidden ways it can present, and the evidence-based treatments that help people regain control: Aurora Podcast - Season 2 Episode 3 | Aurora Healthcare