I want to talk about another disorder called Obsessive-Compulsive Disorder—OCD. OCD is marked by two main things: obsessions and compulsions. Obsessions are intrusive thoughts. These are thoughts that enter your mind without permission. They repeat themselves again and again. And the most important part is that you do not want them. You are not choosing them. You are not inviting them. They come, and they keep returning, even when you try to push them away.
Compulsions are different. Compulsions are actions—an excessive urge to do something. You feel driven to do it, even when you know it does not make sense, even when you do not want to do it. The action feels like it is forcing itself out of you. You may tell yourself, “I shouldn’t do this,” but still find yourself doing it.
One thing that stands out in OCD is that many people who have it often know what is happening. They know the thoughts are unwanted. They know the actions are excessive. They can even say, “I don’t want to think like this,” or “I don’t want to do this,” but the cycle continues. That is part of what makes OCD painful—because a person is aware, yet still trapped in repeating thoughts and repeating urges.
And I want to say something important here. Symptoms differ from one person to another. The severity differs. The specific obsessions and compulsions differ. That is why, in mental health care, what helps most is person-centered care. This means the care is customized to the person. The treatment is not given as a blanket solution. It is tailored to how that particular person experiences the disorder. One person may be affected mildly. Another may be affected severely. One person may have obsessional thoughts but fewer actions. Another may have strong compulsions that interfere with daily life. So this disorder is not identical in every person, even though the main pattern is the same.
When we come to symptoms, OCD can show itself in many ways. One kind of obsession is the fear or thought of harming someone—or the belief that you have harmed someone. A person may keep thinking, “What if I hurt someone?” even though they have no desire to hurt anyone. Sometimes they think, “I have harmed someone,” even when they have not. The mind keeps replaying the fear, and the person cannot relax. It is not because they are a violent person. It is because the brain keeps producing an intrusive thought that they do not want.
Another obsession is doubt about whether something was done correctly. This is where you see people rechecking things repeatedly. They check the stove again and again. They check the door again and again. They check the tap again and again. And this doubt can become so strong that someone can leave home, start going to work, and then panic and return back home to check again. Not because they are careless, but because the mind keeps producing doubt that will not settle. The person is trying to relieve anxiety, but the relief does not last, so the checking repeats.
There are also obsessions that involve unpleasant sexual images—images a person does not want, images that disturb them. There are also obsessions about saying inappropriate things in public. A person may fear shouting something shameful. They may fear blurting out something wrong. They may be obsessed with the idea that they will embarrass themselves in front of others. They don’t want to do it. But the fear and thought keeps returning.
Now when we come to compulsions—the actions—this is where OCD becomes very visible. Some people have compulsive handwashing. I have lived around someone like this. Every day, they wash their hands repeatedly—sometimes every thirty minutes. They feel an urge to wash even when it is not necessary. They may say, “I came from the toilet,” even when they did not. They may say, “I touched something dirty,” even when they only touched something ordinary. The action is not just about hygiene. It is driven by an inner urge that keeps returning.
Others compulsively count things. I have seen people count their money again and again. They count it, then count it again, then count it again—more than ten times in a day. They may not even want to do it, but the urge does not leave them alone until they repeat the action.
Others compulsively check things—checking the stove, checking the door, checking the tap—again and again. It becomes a cycle: doubt rises, anxiety rises, the person checks, they feel relief for a short moment, then doubt returns, and they check again.
This is what people must understand about OCD. It is not about being “too clean.” It is not about being “too careful.” It is not simply a personality habit. It becomes a disorder when it is repetitive, when it becomes excessive, when it interferes with daily life, and when the person feels trapped by it. It is normal to remember once in a while, “Did I lock the door?” It is normal to check once. It is normal to be careful. But when it becomes repetitive—when thoughts and actions keep repeating regularly and uncontrollably—then it crosses into disorder.
When we talk about causes, I keep returning to what we have said throughout this book: mental disorders begin in the brain. OCD is linked to changes in the brain—changes in the systems that regulate thoughts, anxiety, and behavior. Something in the brain’s functioning shifts, and the cycle of obsessions and compulsions begins.
When it comes to treatment, OCD is managed through medication and psychotherapy. Medication can help reduce the intensity of the obsessions and compulsions. Psychotherapy—talk therapy—helps a person understand what is happening, explore the patterns, and learn how to respond differently. A therapist helps the person face the symptoms without being controlled by them, step by step. The person is taught skills for managing the urges and reducing the power those intrusive thoughts have over their life.
Compulsions are different. Compulsions are actions—an excessive urge to do something. You feel driven to do it, even when you know it does not make sense, even when you do not want to do it. The action feels like it is forcing itself out of you. You may tell yourself, “I shouldn’t do this,” but still find yourself doing it.
One thing that stands out in OCD is that many people who have it often know what is happening. They know the thoughts are unwanted. They know the actions are excessive. They can even say, “I don’t want to think like this,” or “I don’t want to do this,” but the cycle continues. That is part of what makes OCD painful—because a person is aware, yet still trapped in repeating thoughts and repeating urges.
And I want to say something important here. Symptoms differ from one person to another. The severity differs. The specific obsessions and compulsions differ. That is why, in mental health care, what helps most is person-centered care. This means the care is customized to the person. The treatment is not given as a blanket solution. It is tailored to how that particular person experiences the disorder. One person may be affected mildly. Another may be affected severely. One person may have obsessional thoughts but fewer actions. Another may have strong compulsions that interfere with daily life. So this disorder is not identical in every person, even though the main pattern is the same.
When we come to symptoms, OCD can show itself in many ways. One kind of obsession is the fear or thought of harming someone—or the belief that you have harmed someone. A person may keep thinking, “What if I hurt someone?” even though they have no desire to hurt anyone. Sometimes they think, “I have harmed someone,” even when they have not. The mind keeps replaying the fear, and the person cannot relax. It is not because they are a violent person. It is because the brain keeps producing an intrusive thought that they do not want.
Another obsession is doubt about whether something was done correctly. This is where you see people rechecking things repeatedly. They check the stove again and again. They check the door again and again. They check the tap again and again. And this doubt can become so strong that someone can leave home, start going to work, and then panic and return back home to check again. Not because they are careless, but because the mind keeps producing doubt that will not settle. The person is trying to relieve anxiety, but the relief does not last, so the checking repeats.
There are also obsessions that involve unpleasant sexual images—images a person does not want, images that disturb them. There are also obsessions about saying inappropriate things in public. A person may fear shouting something shameful. They may fear blurting out something wrong. They may be obsessed with the idea that they will embarrass themselves in front of others. They don’t want to do it. But the fear and thought keeps returning.
Now when we come to compulsions—the actions—this is where OCD becomes very visible. Some people have compulsive handwashing. I have lived around someone like this. Every day, they wash their hands repeatedly—sometimes every thirty minutes. They feel an urge to wash even when it is not necessary. They may say, “I came from the toilet,” even when they did not. They may say, “I touched something dirty,” even when they only touched something ordinary. The action is not just about hygiene. It is driven by an inner urge that keeps returning.
Others compulsively count things. I have seen people count their money again and again. They count it, then count it again, then count it again—more than ten times in a day. They may not even want to do it, but the urge does not leave them alone until they repeat the action.
Others compulsively check things—checking the stove, checking the door, checking the tap—again and again. It becomes a cycle: doubt rises, anxiety rises, the person checks, they feel relief for a short moment, then doubt returns, and they check again.
This is what people must understand about OCD. It is not about being “too clean.” It is not about being “too careful.” It is not simply a personality habit. It becomes a disorder when it is repetitive, when it becomes excessive, when it interferes with daily life, and when the person feels trapped by it. It is normal to remember once in a while, “Did I lock the door?” It is normal to check once. It is normal to be careful. But when it becomes repetitive—when thoughts and actions keep repeating regularly and uncontrollably—then it crosses into disorder.
When we talk about causes, I keep returning to what we have said throughout this book: mental disorders begin in the brain. OCD is linked to changes in the brain—changes in the systems that regulate thoughts, anxiety, and behavior. Something in the brain’s functioning shifts, and the cycle of obsessions and compulsions begins.
When it comes to treatment, OCD is managed through medication and psychotherapy. Medication can help reduce the intensity of the obsessions and compulsions. Psychotherapy—talk therapy—helps a person understand what is happening, explore the patterns, and learn how to respond differently. A therapist helps the person face the symptoms without being controlled by them, step by step. The person is taught skills for managing the urges and reducing the power those intrusive thoughts have over their life.
And I want to end this chapter the same way I end many chapters—by reminding us why we are learning this. If you see something like OCD in yourself, seek help early. If you see it in someone else, don’t mock them. Don’t shame them. Don’t call them crazy. Encourage them to seek support early. Because when people wait until things become extreme, it becomes more complex, and the suffering becomes deeper. Early help can make a huge difference.
