OCD Therapist in Boston

Obsessive-Compulsive Disorder (OCD) is comprised of two parts: obsessions and compulsions. Obsessions are unwanted and intrusive thoughts or feelings that cause anxiety and distress, thereby interrupting daily tasks. In response to these thoughts or feelings, the person begins to engage in repetitive behaviors that reduce the anxiety, called compulsions or rituals. The compulsion is used to neutralize or counteract the anxiety. Although most sufferers recognize that their obsessions are irrational, the compulsive behavior feels gratifying and causes the individual to feel less anxious and distressed.

Approximately 1-2% of the general population suffers from OCD, a condition that typically presents in adolescence or early adulthood, but symptoms present in very young children as well. Symptoms often flare-up during periods of increased stress. Many OCD sufferers do not seek treatment, often citing feelings of shame or embarrassment about the nature of their obsessions and/or compulsions. Studies suggest that OCD sufferers go between 12-17 years from the onset of symptoms before getting treatment from an Exposure and Response Prevention (ERP) specialist.

Obsessions May Include:

• Fear of dirt, germs, or illnesses

• Getting things just right

• Self-harm or harm to others

• Anxiety about order, symmetry and/or lack of

• Undesirable thoughts such as profanity, sexual, or religious

• Magic numbers or sequences of movement with superstitious avoidance

• Perfectionism

• Excessive doubt

Compulsions May Include:

• Decontamination and excessive bathroom routines

• Checking locks, appliances, and doors

• Mentally reviewing situations

• Rearranging and ordering things in special ways

• Reassurance seeking

• Ritualistic religious behaviors

• Counting

• Tapping, blinking, and touching objects repeatedly

Pure Obsessional OCD (Pure O)

Also known as Pure O, Pure obsessive-compulsive OCD is a type of OCD that consists of intrusive thoughts, feelings, urges, and images without physical or overt compulsions. The main differentiator between Pure O and other types of OCD is that compulsions occur within someone’s mind rather than visible actions. To gain a better understanding, consider examples such as mentally replaying events repeatedly in your mind, internally reassuring yourself or reciting phrases silently. Pure O can arrive in many forms, and usually centers around harm, sexuality, relationships, and gender. People experiencing these types of forms often feel confused or unsure if what they are experiencing is true OCD, which can lead to feelings of guilt or shame. Overall, individuals with Pure O are often terrified of sharing their inner experiences, fearing judgment from others around them. 

OCD Treatment in Boston, MA

Exposure and Response Prevention (ERP) is considered the gold standard, most effective treatment of OCD. Treatment is particularly important for people who have developed ritualized, repetitive behaviors such as compulsions. ERP is a necessary component of CBT for most anxiety conditions, particularly OCD. The two components include exposures—facing fears in a systematic, gradual, and purposeful manner to elicit anxiety—and response (or ritual) prevention—actively resisting safety behaviors and other avoidant strategies that only offer a short-term reduction of symptoms but maintain the cycle of anxiety and avoidance in the long-term. Our therapists will guide you to progressively face the situations and thoughts that provoke your OCD while learning how not to react with rituals, compulsions, reassurance seeking or avoidance.

Other Types of OCD

• Contamination OCD: Consists of intrusive thoughts about being contaminated, contaminating others, and feeling disgusted by other people. It includes obsessions, unwanted thoughts, feelings, urges, and images about “feeling dirty” that trigger behavioral or mental compulsions to relieve stress. Fears of germs, dirt, or lack of cleanliness are common. 

• Harm OCD: Features unwanted thoughts, images, feelings, or urges of hurting others or yourself. It consists of deeply disturbing thoughts, leading to physical or mental compulsions to relieve stress from obsessions. 

• Scrupulosity: It is a type of OCD that involves religious or moral obsessions. People diagnosed with this form of OCD are overly concerned that something they did or thought about could be a sin or a moral doctrine, while also wondering what their thoughts mean. 

• Relationship OCD (ROCD): Involves consistent and distressing doubts about romantic relationships. This includes the nature of the relationship, the compatibility between the partners, the partner’s appearance, and their current partner’s previous partners, among other factors. The obsessions include compulsive behavior and mental rituals such as constant questioning, comparisons, and constantly seeking reassurance. 

What Does Pure O OCD Feel Like?

It is common to have an intrusive thought, impulse, or urge; the difference for people without OCD is that it only lasts a few seconds with few signs of stress. On the other hand, people with Pure O have these types of thoughts very frequently, and they are very disturbing. Escaping these thoughts can feel impossible as they tend to feel very real, important and/or relevant. It can be easy to overlook them being part of OCD since the compulsions are not observable. People with Pure O may feel the urge to prove or disprove their intrusive thoughts, while struggling to sit with uncertainty. There are circumstances where they doubt they are diagnosed with Pure O, thinking that their intrusive thoughts have meaning. 

1. Harm OCD

• Intrusion: A sudden mental image of stabbing a loved one while cooking.

• Mental Compulsions: Reassuring oneself (“I’d never do that”), mentally reviewing past actions for “proof” they’re safe, or praying to counteract the thought.
  

2. Sexual Orientation OCD (SO-OCD)

• Intrusion: An unwanted thought like, “What if I’m actually gay/straight and have been lying to myself?”

• Mental Compulsions: Analyzing attraction levels to different people, replaying past romantic experiences in their head to check for feelings.

3. Scrupulosity / Religious OCD

• Intrusion: “What if I blasphemed without realizing and God is angry at me?”

• Mental Compulsions: Mentally reciting prayers perfectly, replaying conversations to see if they said anything wrong.

4. Relationship OCD (ROCD)

• Intrusion: “What if my partner isn’t ‘the one’ and I’m making a huge mistake?”

• Mental Compulsions: Running through lists of their partner’s qualities, replaying interactions to check feelings, comparing them mentally to others.

5. Existential OCD

• Intrusion: “What if none of this is real and I’m just imagining life?”

• Mental Compulsions: Mentally analyzing reality, checking for “proof” of existence, trying to feel “certain” that life is real.