What OCD Really Looks Like (and What Healing Involves)

OCD shows up regularly in my practice, but rarely in the way people expect.

Forget the stereotype of someone who just loves a tidy house or a colour-coded bookshelf. Real OCD is distressing, irrational, and all-consuming. It’s not about being particular or organised. It’s about feeling like something terrible might happen unless you perform a specific ritual or thought pattern, over and over again.

It deserves to be understood with far more nuance and compassion than it usually gets.

Let’s clear up some of the misconceptions, talk about what OCD actually is, where it can come from, and what healing might look like.

What is actual OCD?

OCD is made up of two components: obsessions and compulsions.

• Obsessions are intrusive, unwanted thoughts, images, or urges that pop into your mind and won’t let go. They’re not just worries. They feel like emergencies, and as such, they don’t respond to logic. Even when someone knows their fear doesn’t make sense, their nervous system is still shouting: “Danger!” Their whole body responds as if there’s a real threat.

  
  

  Imagine your brain screaming, “Did you leave the oven on?” every ten minutes when you’re out for a walk, and you checked three times before leaving. Imagine being awakened at night and unable to go back to sleep because you're not sure you flicked your light switch exactly the right number of times.

  
  

  These thoughts can be deeply distressing: fears of harming someone, of being contaminated, of something terrible happening if you don’t perform a ritual “just right.”

• Compulsions are the behaviours or mental rituals someone feels they have to do in response to the obsession. They're like an unbearable itch—something inside screams that if you don't do the ritual, something awful will happen.

  
  

  Counting, checking the door lock 15 times, washing your hands until they’re raw, repeating phrases in your head, avoiding cracks in the pavement, compulsions come in many forms. Some are visible, some are completely internal.

  
  

  And here’s the thing: doing the compulsion does bring temporary relief. It takes the anxiety from say, a 10 to a 5. But it never fully calms the storm. The relief doesn’t last, and soon, the cycle starts again.

OCD is not logical—it’s about survival

A question people often ask is: “Why can’t I just stop?”

Because when your brain is in fear mode, it’s not your rational brain in charge—it’s your amygdala, the part responsible for detecting threats. If it senses danger, it won't matter if the threat is real or not. It will ring the alarm loudly until you do something about it.

The compulsion will feel like the only thing standing between you and disaster. Even if a tiny voice inside says, “This is ridiculous,” the fear is bigger. So you do the ritual. And for a moment, just a moment, you feel a tiny bit better.

At this point, you may be wondering how the brain ends up misfiring like this in the first place.

Where does OCD come from?

For many people, OCD develops as a complex mix of factors: genetic predisposition, temperament, and early life experiences.

If a child doesn’t feel consistently safe or emotionally held, especially between ages 0–3, their nervous system may get stuck in high alert. Because of how vulnerable and reliant we are on our caregivers, it doesn’t take some “big T” trauma for this to happen. A lack of attunement is enough.

Over time, this hyper-vigilance becomes a background hum of anxiety. The brain searches for an explanation: "Why am I feeling this way?" OCD steps in with a theory: “Maybe it’s because I didn’t do X. If I do it, maybe I’ll feel safe.”

So, compulsions become a way to create control where there is none. A false solution to an invisible threat.

How do we treat OCD?

OCD is treatable, but not with toxic positivity or having rational debates with your thoughts. Here's what healing can involve:

Step 1: Understand what’s happening.

Understanding that OCD isn’t a personality flaw, but an overprotective amygdala doing its best to keep you safe, can reduce shame.

It’s also helpful to know: trying to challenge intrusive thoughts with logic won’t work. That’s not a failure on your part. It’s just how our nervous system works.

Step 2: Build emotional awareness.

Before we can shift patterns, we need to notice them.

This means learning to name your emotions, observe how they show up in the body, and rate your level of distress. With practice, you start building a relationship with your internal world and start listening to your body more.

Step 3: Regulate the nervous system.

When the nervous system is in survival mode, nothing else works.

Developing a toolkit of regulation strategies like grounding exercises, breathwork, movement, and more is key. These techniques allow you to ride the wave of distress without resorting to compulsions. It takes time, as we're literally rewiring your brain, but it makes a massive difference.

Step 4: Exposure therapy.

Exposure therapy is a gold-standard treatment for OCD.

This involves gently and gradually facing the obsession without performing the compulsion, while using the regulation tools you’ve learned. Over time, your brain learns: this is uncomfortable, but not dangerous. The amygdala stops ringing the alarm so loudly. The fear gets quieter.

Step 5: Address deeper roots.

For many people, OCD is also tied to unmet emotional needs, especially for safety, attunement, and reassurance.

This is where inner child work and trauma-informed therapy can be powerful. We’re not just rewiring behaviours, we’re helping the scared parts of you feel safe, seen, and supported.

A note on self-compassion

If you live with OCD, you’re likely exhausted. You might feel frustrated or ashamed that you “can’t just stop.” Please hear this:

It’s not your fault.

You’re not broken.

Your brain learned this pattern for a reason.

Living with OCD can feel like being stuck on a hamster wheel with no way off. You deserve compassion, patience, and support on that journey.