OCD FAQ: Expert Answers to Your Most Common Questions

As an OCD specialist, I receive many questions about this challenging condition. Below, I've compiled answers to the most common questions to help you better understand OCD and its treatment.

How Do I Know If My OCD Is Getting Worse?

This seems like it would have an obvious answer, but it's not always clear. When evaluating OCD severity, I look for what's getting in the way of someone's life:

• Are you suddenly late for work more often?
• Having trouble getting in and out of your car?
• Not hanging out with your kids?
• Avoiding using knives or going swimming?

OCD is worsening when more periods of your life are being consumed by compulsions. Compulsions are behaviors people perform to feel better—whether it's washing hands, checking something, or asking for reassurance.

Many people think having more intrusive thoughts means their OCD is getting worse, but we're not actually looking at the thoughts—we're looking at the behaviors. What are you doing because of these thoughts?

The Solution: Replace Compulsions with Exposures

Instead of avoiding the pool because you don't want to go swimming, make sure you visit that pool every single day. Make it meaningful by creating exposures to face your fear. Use "maybe, maybe not" statements and resist compulsions.

If you're experiencing many intrusive thoughts, eventually we can reduce their impact by recognizing they're just thoughts—annoying and pesky, perhaps, but not as significant as we believe them to be.

Can OCD Cause Physical Tics?

Yes, I've observed many people performing compulsions that resemble tics. These might include:

• Moving an arm in a specific way because it provides relief
• Repetitive prayers that involve head movements
• Tapping motions (tapping something five times)
• Moving objects a certain number of times

These can look like physical tics. However, if someone has diagnosed Tourette's syndrome, that's a separate condition with potentially different treatment approaches.

If someone is performing a tic-like behavior specifically because of OCD, our approach is to help them resist that urge, experience the uncomfortable feeling, and let that feeling rise and fall naturally. Any repetitive physical movement done in response to an intrusive thought could be considered an OCD-related tic.

How Do I Cope with Intrusive Thoughts During Intimate Moments?

Intrusive thoughts tend to appear at the most unwanted times—during intimate moments, at church, with friends, or with your spouse. When these thoughts occur during intimate moments, the key is to simply let them happen.

If you're constantly thinking, "I cannot have these thoughts, it would be horrible if I had intrusive thoughts while being intimate," you're actually making these thoughts more likely to occur. Instead, try an approach of acceptance:

"I hope these thoughts don't happen, but maybe they will, maybe they won't. You're welcome to come my way if you'd like. I'm about to be intimate, and whatever thoughts you want to bring, that's fine."

The key word here is allow—allow the thoughts to happen, let them come in, let them leave. Don't fight them.

Can OCD Be Misdiagnosed as ADHD?

Yes, this happens frequently. Many people I've worked with say they have both OCD and ADHD, diagnosed since childhood. Interestingly, after effective OCD treatment, their ADHD symptoms often decrease significantly.

Why does this happen? Both OCD and ADHD involve many thoughts. When someone is performing compulsions or trying to avoid fears, they can appear easily distracted and fidgety. It's absolutely possible to have both conditions, but I typically find that when we treat the OCD effectively, the supposed ADHD symptoms often diminish or disappear entirely.

Are There Specific Coping Strategies for Pure O?

Pure O refers to OCD where people experience intrusive thoughts but don't engage in visible physical compulsions. Instead, their compulsions are mental—thought stopping or rumination ("I'm trying to figure this out, I need to know if this is true").

You might not even realize they're performing a compulsion. For coping strategies, we use the same treatment as for all OCD: exposure and response prevention (ERP).

How Can I Retrain My Brain?

You can teach your brain that your thoughts don't matter as much as it believes they do. One strategy is to actually welcome the thoughts, even if they're disturbing:

"I might just enjoy these thoughts even if they're gross, horrible, or go against my values. I'll have the thoughts and might even smile. This is great, awesome, please come back thoughts, don't leave me, I want these to be here."

This may sound counterintuitive, but it's effective. Sometimes I have people set timers throughout the day—12 or 15 times daily—to intentionally sit with these thoughts. When the timer goes off, they lie down, smile, and welcome the thoughts.

Whatever compulsions you're doing inside your mind, stop doing them. Stop trying to figure things out. The thoughts are neither good nor bad—they simply are what they are.

Can OCD Lead to Self-Harm Behaviors?

Unfortunately, yes. I typically see this when someone feels an urge to punish themselves because of their thoughts: "I deserve this." They might hit their head against the wall, punch themselves, or engage in other self-harming behaviors.

This provides momentary relief—it's the ultimate compulsion that says, "You deserve this." But it doesn't teach your brain anything positive; it only reinforces shame and guilt. These self-harming behaviors briefly relieve anxiety, but the relief doesn't last.

I typically view these as compulsions—actions someone takes to feel better following a distressing thought, feeling, or sensation. My advice: don't do them. They're not worth it.

How Do I Handle OCD Triggers in Public Places?

Practice, practice, practice. If you get triggered every time you go to the store, go to the store often—every day, multiple times a day if necessary. If the toy aisle triggers you, spend most of your time in that aisle. Walk up and down, up and down, practicing relaxation techniques.

Act like you don't care: "Whatever thoughts are going to happen—you're this, you're that, you could do this—maybe, I don't know, cool, thanks for the thoughts."

Eventually, your brain learns that you're in charge—you're doing what you want, not what your OCD demands. These urges, sensations, feelings, and thoughts will gradually diminish.

To handle triggers in public places, expose yourself to those places more frequently without performing compulsions. If you haven't learned about exposures yet, check out my online course "Master Your OCD" in the description below.

Can OCD Be Triggered by Major Life Changes?

Absolutely. OCD typically attacks people's value systems during significant life transitions:

• New relationship: "Is this the right relationship for me? Am I making the wrong choice? Will I harm this person I love so much?"
• New degree or career: "Are you sure you made the right choice? What if you do something inappropriate in your professional role?"

Intrusive thoughts latch onto major life events, attacking new values and priorities. Be prepared for this possibility during your next major life change. My response to these thoughts? "Maybe you made the wrong choice... maybe not. Maybe, maybe not to everything. I don't know, who knows? I guess we'll see."

How Do I Support a Loved One with OCD?

Love them. If they're willing, sit down together and write out all their compulsions. Consider how you can help them—not by forcing anything, but by choosing how you'll respond to their OCD behaviors.

For example, stop providing reassurance. When they ask, "Is there going to be a fire?" respond with "I don't know, maybe." If they ask, "How do I know if I picked the right person?" say "I don't know, maybe you didn't, maybe you did."

They may stop coming to you with these questions when you stop providing reassurance, which is actually beneficial for their recovery. Find a therapist if needed—I also have an online course for parents.

Consider having a daily check-in: "What one thing did you do well in your treatment today? What's one thing you could work on tomorrow?"

Most importantly, love them. They need comfort and support, but that might mean not giving the reassurance they're seeking.

What questions do you have about OCD? I'd love to answer them in another article. Thank you so much for reading!