The Sneaky Nature of OCD: Why Compulsions Reinforce Anxiety and How to Break Free

Obsessive-Compulsive Disorder (OCD) is often misunderstood as simply a condition of handwashing, checking locks, or needing things to be symmetrical. But for many people, OCD is far more complex, and far more sneaky. What can look like a breakthrough on the surface may still be driven by anxiety and subtle compulsions that fly under the radar. In this article, we'll explore how OCD can sneakily maintain its grip, even when someone appears to be improving, and why comprehensive Exposure and Response Prevention (ERP) therapy is essential in overcoming it.

Example 1: Facing a Taboo Thought, with a Hidden Safety Net

A client experiencing intrusive thoughts of a sexual nature, common in OCD but deeply distressing to the person, began working on ERP by allowing these thoughts to be present without engaging in compulsive behaviours. They initially reported success, saying they were no longer immediately distracting themselves or seeking reassurance when the thoughts arose.

However, further discussion revealed that instead of direct reassurance seeking, they had developed a subtle habit of avoiding eye contact with people they perceived as linked to their intrusive thoughts. They cancelled social activities, and they also mentally repeated phrases to 'cancel out' the thought, or silently prayed as a way of neutralising the discomfort. 

While they had stopped the more obvious compulsions, the client was still engaging in covert rituals. These behaviours, though less visible, served the same function, trying to reduce anxiety and prevent a feared outcome. This example illustrates how OCD can adapt by shifting from overt to internal or behavioural safety strategies that continue to reinforce the fear. Recognising these finer details is critical for effective ERP therapy. 

Example 2: Avoiding the Shower, but Not the Ritual

Imagine a person with contamination OCD who recently achieved what seemed like a significant victory: after using the toilet, they resisted the urge to shower afterwards - a long-standing compulsion they had been working to reduce. On the surface, this looked like progress, and it was to a degree. But with further exploration, a more complicated picture emerged.

Before going to the toilet, the client removed all their clothing, fearing that their clothes would become contaminated. They sat in a rigid position (hands clasped together, arms resting on knees) to avoid touching anything perceived to be "dirty." After using the toilet, they used 40-50 baby wipes, and asked other family members to assure them they had cleaned themselves enough.

Skipping the shower was progress, but, the client was still engaging in multiple rituals designed to manage their anxiety and/or to prevent a feared outcome (I’ll be contaminated and I’ll get sick). The compulsive behaviours were less obvious but just as powerful in maintaining the OCD cycle. These kinds of compensatory rituals offer temporary relief, but they ultimately reinforce the mistaken belief that considerable danger is present and that rituals are necessary for safety.

Example 3: Saying No to Reassurance, But Not Really

A third client with intrusive harm thoughts made a conscious effort to stop asking their partner for reassurance. This was a big step in therapy, and they proudly reported no longer asking, "Do you think I would actually hurt someone?"

But when we explored further, the client had shifted from overt reassurance seeking to covert behaviours. They began obsessively Googling statistics on violent crimes and reading articles to "check" if their thoughts matched the profile of someone dangerous. They also mentally reviewed past interactions to reassure themselves they had always acted kindly, and played back these interactions to ‘remember’ that they hadn’t hurt anyone.

These mental rituals are just as potent in maintaining OCD as spoken reassurance. They're internal, private, and easy to overlook, even for the person doing them. But they still serve the same function: reducing anxiety in the short term while keeping OCD alive and stuck in the long run.

Why This Matters: The Illusion of Progress

These examples show how OCD can disguise itself. It finds new ways to stay alive by morphing into new or more subtle compulsions. This is why comprehensive OCD treatment must go beyond the surface.

ERP therapy, a gold-standard treatment for OCD, helps individuals not only resist obvious compulsions, but also identify and eliminate hidden rituals and safety behaviours. True progress comes from learning that anxiety can be tolerated without the use of rituals, and that feared outcomes rarely (or most of the time, never) come true.

An OCD therapist might say, if you leave the front door of OCD locked, it will try to sneak in the back window. That’s why vigilance, transparency, and skilled therapeutic support are crucial in treatment.

If you're struggling with OCD and want to work toward overcoming your intrusions and compulsions, consider finding a psychologist who understands the sneaky nature of the disorder and how to address it with tailored ERP therapy. Working with a psychologist trained in OCD treatment can help you uncover these hidden rituals and challenge them effectively.

If you're looking for support, our clinic provides evidence-based OCD treatment, including ERP therapy, in a supportive and collaborative environment. Reach out to an experienced OCD psychologist on the Gold Coast today and take the next step toward freedom.