I have met many individuals in my therapy room, many like Matthew (name changed) who had been suffering with OCD for decades, but with changing themes.
Matthew’s story illustrates the complex and shifting nature of OCD.
As a child, Matthew experienced high levels of anxiety. He tried to make sense of his world by organising his possessions and controlling his environment. As he moved into secondary school, his OCD theme changed to fears about his sexual orientation. Later, at university, his obsessions focused on relationships, with relentless doubts about whether he truly loved his partner or whether his feelings were genuine.
After university, Matthew’s OCD evolved again. He began to experience existential worries, sometimes referred to as “existential OCD”, where he was plagued by doubts about the nature of reality, the meaning of life, and his own existence. By the time Matthew sought specialist treatment with myself at age thirty-five, he was exhausted by years of trying to find certainty and relief through compulsive behaviours. These included researching online, seeking reassurance from others, and mentally reviewing past events. Each attempt to gain certainty offered only temporary relief, and the cycle of doubt and compulsion continued.
As a previous Senior Psychotherapist at the OCD and Anxiety Disorders Service at South London and Maudsley NHS Foundation Trust, I have worked with hundreds of individuals like Matthew. My clinical experience has been further enriched by giving talks at national and international conferences for the British Association for Behavioural and Cognitive Psychotherapies (BABCP), and publishing research with Professor David Veale, a leading expert in the field.
OCD is commonly misunderstood. Many assume it is simply about being tidy, clean or organised, but OCD is far more complex. The disorder is characterised by intrusive, unwanted thoughts (obsessions) and repetitive behaviours or mental acts (compulsions) performed to reduce distress or prevent a feared event. These compulsions can take many forms, such as checking, counting, washing, or seeking reassurance. Often, people with OCD recognise that their behaviours are excessive or irrational but feel powerless to stop.
The themes of OCD are highly variable. Common obsessions include fears of contamination, causing harm, sexual orientation, relationships, religious or blasphemous thoughts, and existential doubts. What is consistent is the underlying intolerance of uncertainty and the urgent need to feel “just right” or certain. OCD is sometimes called the “doubting disorder” because sufferers struggle to tolerate any ambiguity in their thoughts, feelings, or experiences.
Diagnosing OCD requires a careful and thorough assessment. It is important to distinguish OCD from other conditions such as health anxiety, generalised anxiety disorder, or depression. At the Maudsley NHS OCD Service and now in my private practice, we use structured interviews, validated questionnaires, and detailed clinical histories to ensure an accurate diagnosis. This process also helps us understand the individual’s specific triggers, compulsions, and the impact of OCD on their life.
Once a diagnosis is made, the most effective treatment for OCD is Cognitive Behavioural Therapy (CBT) with Exposure and Response Prevention (ERP). ERP involves gradually facing feared situations or thoughts without performing compulsions, allowing anxiety to decrease naturally over time. This approach helps retrain the brain to tolerate uncertainty and reduce the power of intrusive thoughts.
In Matthew’s case, we developed behavioural experiments designed to help him sit with uncertainty and resist the urge to seek reassurance. For example, when he felt compelled to research a question online, he practised delaying the behaviour and noticing the rise and fall of anxiety. Over time, Matthew learned that the discomfort of uncertainty was tolerable, and that compulsions were maintaining his distress rather than solving it. He became able to allow thoughts to pass without “hooking” into them, and his quality of life improved significantly. He is planning to take a year out and do a trip around the world, without over planning!
Other evidence-based treatments may be integrated depending on the individual’s needs. For those with severe or treatment-resistant OCD, medication such as selective serotonin reuptake inhibitors (SSRIs) can be helpful. In some cases, additional therapies such as Compassion Focused Therapy (CFT) or Eye Movement Desensitisation and Reprocessing (EMDR) may be used, especially when there is co-occurring trauma or high levels of shame.
A key part of effective treatment is psychoeducation, helping individuals and families understand what OCD is and how it operates. OCD can be isolating and stigmatising but knowing that it is a common and treatable condition can offer hope. Involving family members in therapy can also be valuable, as loved ones often become unwitting participants in reassurance-seeking or avoidance behaviours.
Ongoing research continues to refine our understanding of OCD and improve treatment outcomes. I am committed to delivering the highest standards of care, informed by the latest evidence and clinical expertise.
If you or someone you care about is struggling with OCD, specialist help is available. With the right assessment and treatment, recovery is possible. As Matthew’s story shows, learning to tolerate uncertainty and resist compulsions can lead to lasting change and a life less dominated by doubt.
Contact
You can connect with Tara O’Donoghue, an OCD therapist in London and Lyndhurst, by clicking here. Home-based sessions are also available and are especially helpful during ERP treatment.
To discuss CBT and ERP treatment options, book a Zoom session or in-person home visit by clicking here or emailing: info@homebasedtalkingtherapy.com