Almost everyone has had an unpleasant thought that wouldn’t go away, or has double-checked that the front door is locked just to be sure. With obsessive-compulsive disorder (OCD), thoughts and behaviors like these take up so much space that they can seriously limit daily life. In this article, we explain what actually happens in OCD, which themes are common, and what treatment looks like.
What is OCD?
Obsessive-compulsive disorder consists of two closely linked parts: obsessions and compulsions.
Obsessions are recurring thoughts, images, or urges that intrude on a person’s mind and trigger anxiety, disgust, or distress. People usually experience these thoughts as unwanted, and often as out of line with who they actually are, which adds another layer of tension.
Compulsions are repetitive behaviors or mental rituals performed to reduce the anxiety the obsession causes, or to prevent something bad from happening. Common examples include handwashing, checking things repeatedly, counting, or silently repeating certain words.
The self-reinforcing cycle
What keeps OCD going is a cycle that feeds itself. An obsessive thought triggers anxiety. The compulsion brings short-term relief, which teaches the brain that the ritual is “necessary” to bring the anxiety down. In the long run, the opposite happens: the obsession actually gains strength, because there is never a chance to learn that the anxiety would also have decreased on its own, without the ritual. As a result, avoidance and rituals tend to take up more and more space over time when left untreated.
Common themes
OCD can show up in different ways. Some themes that are seen often include:
- Contamination fears: fear of dirt, germs, or chemicals, followed by excessive washing or cleaning.
- Checking: repeatedly checking whether the stove is off, the door is locked, or an email was sent correctly.
- Symmetry and order: a need to arrange objects in a precise way, or a sense that something only feels “right” once it has been done in a particular manner.
- Intrusive thoughts: unwanted thoughts about harm, aggression, or taboo subjects that do not match who the person actually is or wants to be.
It is worth emphasizing that having thoughts like these is not unusual on its own. Almost everyone experiences odd or unwanted thoughts from time to time. What sets OCD apart is that the thoughts persist, cause significant distress, and are followed by compulsions.
How is it diagnosed?
OCD is identified by a BIG-registered clinician through a careful intake process. This involves looking at the nature of the thoughts, the time spent on rituals, and how much they limit day-to-day functioning. This can lead to a preliminary DSM-5 classification, which serves as a starting point for treatment and may be adjusted as the process continues.
Treatment: CBT with exposure and response prevention
The most widely recognized, evidence-based treatment for OCD is cognitive behavioral therapy (CBT), specifically the variant that includes exposure and response prevention (ERP). In this approach, a person is gradually exposed, in close collaboration with their therapist, to situations that trigger obsessive anxiety, without performing the accompanying compulsion. This allows the brain to safely learn that the anxiety also decreases without the ritual, and that the feared catastrophic outcomes usually do not occur.
This can sound daunting, and it is a real challenge, but it always takes place in small, manageable steps within a safe and supportive setting. Alongside CBT, pharmacotherapy can also be part of treatment, for example as an addition when symptoms are more severe. At Mavera GGZ, the right combination of treatment methods is considered individually for each person.
OCD is treatable
The encouraging news is that OCD responds well to treatment. Many people experience a clear reduction in symptoms and regain a sense of control over their daily lives. It is important to seek help early: the longer avoidance and rituals go untreated, the more space they tend to take up. Recognizing the signs early and starting treatment sooner often makes the process shorter and easier.
When is it time to seek help?
Not sure whether your thoughts and behaviors are “normal” or whether something more is going on? A useful guideline is this: if the thoughts or rituals take up more than an hour a day, or if they interfere with work, relationships, or social life, it is worth discussing this with your GP (huisarts). A referral from your GP is required to access specialist mental healthcare (GGZ), such as treatment at Mavera GGZ.
If you are ever in crisis, for example experiencing acute panic or thoughts of self-harm, always call 112 (in the Netherlands) or go to A&E. Mavera GGZ does not provide acute crisis care.
Support at Mavera GGZ
Mavera GGZ in Rotterdam offers treatment for OCD through BIG-registered clinicians, including CBT with exposure and response prevention. Care is available in Dutch, Turkish, English, Ukrainian, Polish, Uyghur, and Arabic. If you have a referral from your GP and would like to find out whether treatment with us is a good fit, contact us at 010 - 254 38 96 or info@maveraggz.nl, or visit us at Rozenlaan 115 in Rotterdam.
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