People with OCD often recognize that their fears may not always be rational—but that doesn’t make them any less distressing. What if I hit someone and didn’t notice? What if I’m secretly a bad person and my entire persona is a lie? But what happens when OCD fears latch onto more realistic concerns? Thoughts like: What if this plane crashes? What if I’m detained by the police? What if a climate disaster destroys my home?
These aren’t necessarily imaginary scenarios—they could be real-life possibilities, even if they’re still very unlikely. And because they can happen, OCD makes them feel all the more distressing. That’s because OCD turns “technically possible” into “highly probable,” pulling you into anxiety spirals and pushing you to avoid things that actually matter to you.
How OCD can turn care into compulsions
It’s completely normal to care about real-world risks and current events. You might be worried about the environment, feel uneasy about flying, or feel a strong responsibility to avoid doing something wrong. But OCD often tips you from thoughtful concern into compulsive behavior, mental spirals, or a need for certainty that can’t ever be guaranteed.
Tracie Ibrahim, Chief Compliance Officer and Therapist at NOCD, explains that the difference often lies in what’s reasonable versus unreasonable. You might care about recycling, for example, but OCD turns that concern into constant intrusive thoughts about where every piece of trash you’ve ever discarded has ended up. Here, the issue isn’t about caring too much. It’s about feeling responsible for preventing every possible bad outcome, even ones completely outside of your control.
Ibrahim encourages us to shift our focus away from what has already happened—or what might happen far into the future—and instead ask, “What can you do about that thing you care about today, right now, in this moment?” The answer is almost always something simple, like properly sorting your trash or looking into community composting and volunteer programs. It’s not about beating yourself up for using a plastic water bottle or convincing yourself that the world will end because of it—even if your OCD says it will, it won’t.
Why your brain skips over best-case scenarios
One of OCD’s defining traits is that it zeroes in on worst-case outcomes. You imagine only the panic attack on the plane, the unexpected arrest, or the climate disaster, and your brain forgets that other outcomes even exist. The likelihood of something going right feels completely irrelevant when OCD is in the driver’s seat.
“When we’re worrying, we’re not thinking about the best-case scenarios,” Ibrahim says. “And those are just as likely.”
She explains that many people with OCD avoid flying not just because of safety fears, but because of thoughts like: What if I panic and can’t calm down? What if I do something dangerous mid-flight? What if I freak out and ruin everything? A Member Ibrahim worked with had avoided flying for years due to these fears—but exposure and response prevention, or ERP, therapy gave her the tools to try again.
When an intrusive thought told her to punch out the window during a flight, she sat with the discomfort, rather than running from it. ERP didn’t teach this Member to be fearless—it helped her make space for fear without letting it control her. In the process, she gained opportunities to travel and make joyful memories she would have otherwise missed out on.
How ERP helps with real-life fears
Just because a fear is rooted in reality doesn’t mean you have to treat it like an emergency. ERP therapy is designed to help people with OCD tolerate uncertainty, even when the thing they fear could happen.
ERP teaches you to stay present, sit with discomfort, and resist the urge to avoid or neutralize every perceived threat. Over time, this helps reduce the intensity of the fear and builds confidence in your ability to handle uncertainty.
This doesn’t mean ignoring your values. In fact, ERP often helps people live more in line with what they care about, because they’re no longer engaging in avoidance. Whether it’s flying to see a loved one, fighting for climate justice without spiraling into anxiety, or simply stepping outside despite fears of danger, ERP can help you move toward a life that feels meaningful.
As Ibrahim puts it, “Don’t avoid things that give you a good quality of life, because you have worries that may or may not happen. Lots of things are possible.” But, not everything that’s possible is probable, and not everything that’s uncomfortable needs to be fixed.
Bottom Line
When OCD latches onto realistic or real-world fears, it can feel especially convincing. But, you can care without catastrophizing. You can act on your values without trying to control every outcome. And you can live fully, even when fear is still whispering in the background.
ERP therapy won’t erase risk, but it can help you carry it differently—so fear doesn’t get the final say.
