OCD obsessions are unwanted, intrusive thoughts, images, urges, feelings, or sensations that cause significant anxiety or distress. They are one of the two main symptoms of obsessive-compulsive disorder (OCD). Obsessions often feel uncontrollable and conflict with a person’s values or sense of self.
Everyone experiences intrusive thoughts from time to time, and most are harmless. In fact, research shows that more than 1 in 4 people experience obsessions, but only a small percentage of them meet the criteria for OCD. The difference is that OCD obsessions are persistent, intense, and often lead to compulsions—repetitive physical or mental acts intended to relieve distress or prevent something bad from happening.
Keep reading to get deeper insights into obsessions and what you can do to manage OCD symptoms.
How are OCD obsessions different from normal intrusive thoughts?
Most people can quickly dismiss an odd or unpleasant thought. In OCD, obsessions are repetitive, cause overwhelming distress, and feel impossible to ignore without engaging in compulsions.
Common types of OCD obsessions
OCD obsessions can take many forms. Each subtype below describes a common theme people experience:
Contamination obsessions
Fear of germs, illness, chemicals, or environmental toxins. May lead to excessive cleaning, frequent handwashing, or avoidance of public spaces.
Harm obsessions
Fear of intentionally or accidentally harming yourself or others. May involve avoiding sharp objects or checking repeatedly to ensure no harm was caused.
Sexual obsessions
Intrusive, unwanted sexual thoughts or images that cause shame or anxiety, such as those related to gender identity, sexuality, or possible attraction to children. These thoughts do not reflect desire or intent. Sexually intrusive thoughts may lead to checking for groinal response or avoiding certain places or situations.
Scrupulosity or religious obsessions
Fear of offending a deity, committing a sin, or breaking moral rules. It can involve excessive prayer or confession.
Perfectionism or “just right” obsessions
A need for symmetry, exactness, or things feeling “perfect.” May lead to arranging, counting, or repeating actions until they feel right.
Existential obsessions
Persistent questioning about life’s meaning, reality, or the nature of existence often leads to distress and rumination.
What causes OCD obsessions?
OCD obsessions likely result from a mix of genetic, neurological, and environmental factors.
- Genetics: First-degree relatives of people with OCD are more likely to develop the disorder.
- Brain structure and function: Research shows differences in brain circuits involving the orbitofrontal cortex, anterior cingulate cortex, and basal ganglia.
- Neurochemistry: Imbalances in serotonin and other neurotransmitters may play a role.
- Life events: Stress, trauma, or significant changes (e.g., getting married, a new job, having a baby, losing a loved one, etc.) can trigger or worsen symptoms.
When to seek help
While it’s normal to have intrusive thoughts, if they:
- Are re-occurring
- Are causing distress
- Lead to compulsive behaviors
… it could be a sign of OCD.
An OCD specialist can help you make sense of your experiences and help you manage your symptoms so you can start feeling more like yourself again.
How are OCD obsessions treated?
The most effective treatment for OCD obsessions is exposure and response prevention (ERP) therapy. ERP is a specialized form of cognitive behavioral therapy (CBT) proven to be effective for OCD. General CBT, if not tailored for OCD, can sometimes be unhelpful or even worsen symptoms.
ERP helps people face feared thoughts or situations without engaging in compulsions, allowing anxiety to decrease naturally over time.
Studies show that ERP therapy is highly effective, with 80% of people with OCD experiencing a significant reduction in their symptoms.
Other approaches that may help include:
- Medication (typically SSRIs)
- Mindfulness-based strategies
- Acceptance and commitment therapy (ACT)
These are typically done in combination with ERP therapy, depending on the individual’s needs.
Severe or treatment-resistant OCD may benefit from the following therapies:
- Intensive outpatient programs (IOPs)
- Partial hospital programs (PHPs)
- Residential treatment centers (RTCs)
- Transcranial magnetic stimulation (TMS)
- Deep brain stimulation (DBS)
- Gamma knife radiosurgery (GKRS)
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
Bottom line
OCD obsessions are intrusive, distressing mental events that can dominate a person’s life—but they are treatable. ERP therapy, often combined with medication, can help people reduce symptoms and regain control. With the right support, recovery is possible.
Key takeaways
- OCD obsessions are intrusive thoughts, images, feelings, sensations, or urges that cause distress.
- Common themes include contamination, harm, sexual, religious, perfectionism, and existential worries.
- Causes may include genetics, brain circuit differences, and environmental triggers.
- ERP therapy is the most effective treatment, sometimes combined with medication and supplemental approaches like mindfulness and ACT.
