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You check the door three times before you can leave the house. Or you don't - your version is quieter than that, and harder to explain.
Maybe it's a thought that arrives uninvited and won't leave. A violent image. A sexual thought that disgusts you. A sudden certainty that you've done something terrible and can't remember it. You spend hours examining it, testing yourself against it, trying to prove to your own satisfaction that you're not the kind of person who would think such a thing.
Or maybe it's the mental reviewing. Going back over conversations, emails, decisions, checking and rechecking for mistakes you might have made, harm you might have caused, offence you might have given. A courtroom in your head where you're permanently on trial.
Whatever form it takes, the experience is the same: your brain has found something it won't let go of, and all your attempts to resolve it only feed it.
The popular image of OCD is hand-washing and light switches. Neat, visible, almost quaint. Something a sitcom character might have.
The reality is far more brutal. OCD is a grinding, exhausting war with your own mind. It doesn't look tidy from the inside. It looks like hours lost to mental rituals nobody can see. Like avoiding places, people, objects that trigger the thoughts. Like being terrified of your own brain.
And because the popular image is so limited, many people with OCD don't recognise what they have. If you're not washing your hands raw, you assume it must be something else - anxiety, maybe, or just being a worrier. You certainly don't associate it with the intrusive thoughts, because those feel too dark, too shameful, too far from the stereotype to be the same thing.
So you carry it alone, convinced that the thoughts mean something terrible about you.
They don't. But the fact that they arrived at all - that's worth being curious about.
OCD gets treated as a malfunction. A brain that misfires. A faulty alarm system that needs recalibrating.
And there's truth in that, at the neurological level. But it's an incomplete picture. Because if you look at what the obsessions are actually about - control, contamination, harm, morality, certainty - they're not random. They cluster around the things that matter most to you, the things that feel most dangerous to get wrong.
The person terrified of contamination often grew up in an environment where things felt chaotic and unsafe. The rituals create a tiny island of control in a world that felt uncontrollable. They're not irrational - they're a logical response to an illogical situation, just one that outlived its usefulness.
The person plagued by intrusive violent thoughts is often someone who is terrified of their own anger. Somewhere along the way, anger became so forbidden, so dangerous, so associated with damage, that the mind treats any aggressive thought as evidence of moral catastrophe. The obsessive checking isn't madness - it's a desperate attempt to contain something that feels genuinely threatening.
The rituals aren't the problem. They're the solution your mind invented for a problem it couldn't solve any other way.
This is where it gets uncomfortable, because looking underneath the rituals means looking at what they're protecting you from.
Often it's feelings. Rage you were never allowed to express. Need that felt dangerous to show. Grief that was never given space. Guilt about something real, not imagined, that got buried and calcified into obsession.
Sometimes it's a fundamental uncertainty about yourself. Am I a good person? Could I be capable of that? Do I deserve what I have? These aren't questions OCD invented - they're questions that were already there, already unresolved, and OCD attached itself to them like a parasite.
The rituals keep you from having to sit with the uncertainty. Every time you check, review, repeat, confess, seek reassurance, you're briefly relieved - and then the doubt returns, because the underlying question was never answered. It can't be answered through ritual. It can only be sat with.
Why ERP isn't the whole story
Exposure and Response Prevention works. It teaches you to tolerate the anxiety without performing the ritual, and for many people the symptoms reduce significantly.
But it doesn't ask why. Why you needed that level of control. Why anger feels so dangerous. Why uncertainty is so unbearable. Why these particular thoughts, about these particular fears, in this particular person.
These aren't academic questions. They're the difference between managing symptoms and understanding yourself. Between learning to resist the compulsion and no longer needing it in the same way.
The psychodynamic work is slower. It doesn't give you a protocol or a hierarchy of exposures. It gives you a relationship where you can explore what's underneath the rituals without having to perform certainty or correctness. Where the feelings that drive the obsessions can surface without being immediately neutralised.
This isn't anti-ERP. Both can be useful. But if you've done the behavioural work and the thoughts keep shifting - new obsessions replacing old ones, new rituals emerging - it might be because the engine underneath hasn't been addressed.
One of the hardest things about OCD is how alone it makes you feel. The thoughts are often so dark, so bizarre, so at odds with who you believe yourself to be, that telling anyone feels impossible.
You're not going to tell your partner about the intrusive image. You're not going to tell your friends about the hours spent mentally reviewing whether you're a paedophile because you smiled at a child in a supermarket. You're not going to explain that you can't eat dinner until you've silently counted to seven three times.
So you carry it, and the carrying itself becomes exhausting. The energy that goes into concealing the rituals, the shame about the thoughts, the loneliness of a battle nobody can see.
Bringing it into the room - saying the unsayable - is often the first relief. Not because it fixes anything, but because the secret loses some of its power when it's no longer a secret.
