Tuesday 1st August, 2023.
Written by General Psychologist, James Blaze.



Obsessions are thoughts, images or urges that we do not choose to experience and result in notable anxiety. Obsessive thoughts can be accompanied by feelings like disgust, doubt and fear, making them more distressing. As a result, people who experience obsessions can try and perform actions serving to escape these feelings. Common obsessions include intrusive thoughts around maintaining perfect hygiene, worry about impending disaster, fixation with symmetry, anticipating violence or performing inappropriate sexual acts.

Obsessions may be confused with

  • Occasional doubt about the safety of a loved one.
  • Some uncertainty around leaving the stove on after using it.
  • Suspicion around getting sick in response to something that may be contaminated.


Compulsions are the actions we feel driven to perform in order to immediately alleviate the anxiety experienced from obsessions. Common compulsions can involve doing things around keeping clean, having things in order or checking to make sure something is safe or present.

Compulsions may not be physical actions, but mental acts like silently reciting words or counting to a certain number a specific number of times. Compulsions can be confusing to understand because they may not be directly linked to what we might consider would logically alleviate a particular obsession. For example, someone may have the obsessive thought their friend is going to be injured in a car accident unless they immediately perform the compulsion of clapping five times after saying goodbye to them.

People with OCD can be completely aware their obsessions are untrue (“I am aware that my dog will not starve today if I don’t give him 10 bowls of dog food in the morning”), aware to some degree (“my dog will probably not starve today if I do not give him 10 bowls of dog food in the morning”) or wholeheartedly believe the truthfulness of their obsessions (“my dog will starve today if I do not give him 10 bowls of dog food in the morning) and performing the compulsion regardless of their insight.

Compulsions may be confused with

  • Having a regular bedtime routine that you enjoy
  • Practising a skill for the purpose of mastery
  • Organising items if you work in retail

What to look out for

If you suspect someone you know is suffering from OCD, pay attention to whether they are avoiding situations that you believe may trigger distressing thoughts and why. For example, they might avoid a food court due to thoughts around coming into contact with a crumb, believing it

 will completely compromise their immune system. Alternatively, you may notice they do not avoid but endure the situation and perform compulsions. For example, they sit down on a table with crumbs, but have to mentally recite a verse from their favourite song three times.


Sometimes people with OCD have little insight into how true or impairing the nature of their thoughts and behaviours are or may not even know what OCD is. Psychoeducation helps them bridge this gap in understanding by exploring what OCD is and what may look like in their life. OCD is maintained under the learning process of operant conditioning, whereby we learn to avoid obsessions by engaging in compulsions that alleviate anxiety, strengthening our resort to compulsions the next time we experience an obsession. This can rob us of opportunities to engage meaningfully in life. A highly effective treatment for OCD is called Exposure Reponses Prevention (ERP) and involves remaining in the situation/with the obsession that causes us anxiety (exposure). We are likely to experience our anxiety rise, begin to peak and look to perform a compulsion in order to relieve our anxiety. If we sit with the situation/obsession long enough without performing the compulsion (response prevention), we may notice our anxiety eventually begin to fall and soon plateau. If this process is regularly practiced, we learn that the compulsion is no longer necessary to make us feel better and we can ride out our anxiety. The more time we practice riding out our anxiety, the more we feel we can cope and the less it rises next time. This process serves to reality test our belief that we need to perform a compulsion to alleviate anxiety and reaffirm our coping skills.

OCD is a treatable condition involving the unpairing of obsessions from compulsions and management of obsessions. Other useful treatments to ask your mental health professional about include graded exposure, relaxation and breathing strategies as well as medication if you are struggling to manage OCD symptoms. If you are experiencing or notice someone experiencing symptoms of OCD, please feel free to explore the below links to learn more about OCD and connect with a mental health professional.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed). (p. 237 – 239)

BeyondBlue (no date). Fact sheet 37 What is OCD? – australasianpsychologyservices.co, Obsessive Compulsive Disorder (OCD). Fact Sheet 37. Available at: http://www.australasianpsychologyservices.co/Articles/BBOCD.pdf (Accessed: March 30, 2023).

Ferrando, C. and Selai, C. (2021) “A systematic review and meta-analysis on the effectiveness of exposure and response prevention therapy in the treatment of obsessive-compulsive disorder,” Journal of Obsessive-Compulsive and Related Disorders, 31, p. 100684. Available at: https://doi.org/10.1016/j.jocrd.2021.100684.

Simpson, H.B. and Hezel, D.M. (2019) “Exposure and response prevention for obsessive-compulsive disorder: A review and New Directions,” Indian Journal of Psychiatry, 61(7), p. 85. Available at: https://doi.org/10.4103/psychiatry.indianjpsychiatry_516_18.

Song, Y. et al. (2022). “The effect of exposure and response prevention therapy on obsessive-compulsive disorder: A systematic review and meta-analysis,” Psychiatry Research, 317, p. 114861. Available at: https://doi.org/10.1016/j.psychres.2022.114861.

What you need to know about OCD – international OCD foundation (2014). What You Need to Know About Obsessive Compulsive Disorder. Available at: https://iocdf.org/wp-content/uploads/2014/10/What-You-Need-To-Know-About-OCD.pdf (Accessed: March 30, 2023).