Dr. Ali Al Farhan
Consultant Psychologist and Psychotherapist · Associate Professor of Psychology
You check that the door is locked, then return to check again. You know you locked it, but knowing does not produce the feeling you are waiting for. The struggle may also be invisible: replaying a conversation, examining your intentions or trying to remember whether you said something hurtful. Every answer opens another question.
In this experience, the goal can become a certainty that leaves no room for possibility. Understanding OCD helps us examine what happens between an unwanted thought and attempts to remove its impact, and choose treatment suited to that cycle.
OCD involves recurrent unwanted thoughts, images or urges (obsessions), and/or visible behaviours or mental acts a person feels driven to repeat (compulsions). Assessment is warranted when they consume substantial time, cause distress or interfere with life. Examples include fears about contamination, harm and doubt, alongside washing, checking, counting and mental repetition. [1]
Liking cleanliness or precision is not sufficient for diagnosis. OCD differs from obsessive-compulsive personality disorder, which concerns a broader pattern of orderliness, perfectionism and control. They can coexist, but they are different conditions. [1, 5]
These fictional examples illustrate possible experiences. They are not client accounts or diagnoses of the reader.
"Fahad" sends a colleague a message. Minutes later, he wonders, "Was that hurtful?" He reads it ten times, asks a friend and briefly feels relieved. Later he thinks, "Perhaps my friend did not understand the tone I intended." He checks again, and the evening disappears.
The difficulty in this scene extends beyond the message. Seeking reassurance becomes something he must repeat whenever doubt returns. Others may not notice that his quiet hours are full of internal reviewing. This illustrates how a cycle may continue; it does not mean every request for reassurance is a compulsion. [2, 3]
Obsessions may involve religious, sexual or aggressive themes that distress the person and conflict with their values. Their content alone should not be treated as evidence of intention or hidden desire. Assessing intrusive thoughts differs from assessing actual wishes, plans and dangerous behaviour. [1, 3]
"Hind" might say, "I am afraid having this thought means I am a bad person." Encouraging an endless search for a hidden meaning could add another ritual: monitoring every feeling to check her morality. Accurate understanding matters more than offering an interpretation that sounds profound.
It can inform questions about the person beyond the symptoms: How do they experience mistakes? How do they treat themselves when angry? Does acceptance feel conditional on never upsetting anyone? These are exploratory questions, not assumed causes of OCD or an established treatment for its rituals.
Psychoanalytic literature, including McWilliams, discusses obsessive and compulsive personalities as part of understanding personality. This framework must be distinguished from the diagnosis of OCD and evidence for its treatment. [4]
Imagine that Fahad reduces his message-checking but still struggles to say no to colleagues. His fear of upsetting others could become a separate therapeutic focus. Repeatedly analysing each message to guarantee he hurt nobody, however, could recreate the original difficulty.
Psychodynamic therapy should not replace or delay OCD-specific treatment. Specialist sources warn against turning therapy into a repeated search for certainty or hidden intentions behind obsessions. [3]
Core treatments include cognitive behavioural therapy incorporating exposure and response prevention (ERP), and suitable medication, including selective serotonin reuptake inhibitors, according to assessment. [1, 2]
In ERP, therapist and patient develop a gradual plan to encounter obsession-related triggers without carrying out the usual ritual. Steps are collaborative, manageable and safety-conscious; exposure does not mean causing harm or ignoring genuine danger. The plan may address mental rituals and reassurance-seeking as well as visible behaviour. [2]
For Fahad, a plan might involve sending a message after an appropriate review, then returning to work without compulsive checking. The aim is not a promise that he will never make a mistake, but an increased capacity to act without demanding a complete guarantee.
With the therapist's guidance, family members can support the person without joining rituals or repeatedly providing reassurance. Change should be agreed and gradual, with compassion rather than ridicule or punishment. [2]
Progress might include regaining time for work or family, less checking, or leaving a question unanswered for a while. These are illustrative goals tailored to the individual. Improvement does not require every unwanted thought to disappear.
Reclaiming your life may mean moving forward with some uncertainty where doubt once made you stop every time.
If thoughts and rituals consume your time or disrupt life, seek assessment from a clinician experienced in OCD and ERP. Actual intent to harm yourself or others, or imminent danger, requires urgent help. This content is educational and cannot diagnose your condition.