Obsessive compulsive disorder can cause a lot of distress and get in the way of you living the life you want. If you’re dealing with these symptoms, I know you’re struggling with a unique kind of misery.

How does OCD develop?

OCD sets up a cycle of anxiety through obsessions (the thoughts) and behaviors done to cope with the anxiety (the compulsions) that comes from the obsessions. The cycle starts with an intrusive thought. Maybe the thought is that something has germs or is contaminated, or that you might accidentally harm someone, that something terrible might happen to someone you love, that you’ll make a major mistake, or that you have a serious illness. That thought leads to anxiety, which in turn, you might try to manage with a certain behavior. These behaviors might include washing or cleaning, checking or replaying events, getting reassurance from others, or doing internet searches for information. Although these behaviors might help you to feel better in the short term, the feeling never lasts and the cycle starts all over again.

Examples of common obsessions and compulsions

Some common obsessions include:

  • Fear of contamination from germs, bodily fluids, or household chemicals
  • Fear of losing control and acting on an impulse to blurt out something inappropriate or an impulse to harm someone
  • Fear of harming others through not being careful enough or being responsible for something terrible happening to others (fire, burglary, dropping something that might cause someone to trip and hurt themselves)
  • Fear of forbidden sexual thoughts (about incest, children, homosexuality, or aggression)
  • Fear of offending God or concerns about morality
  • Fear of developing a serious disease
  • Perfectionism, including fears of losing or forgetting things, indecision, and concerns about evenness

Some common compulsions/rituals include:

  • Washing and cleaning
  • Mental review of conversations or interactions
  • Prayer
  • Counting or special numbers
  • Checking
  • Arranging things until they feel “right”
  • Repeating body movements (tapping, blinking)
  • Repeating routines (setting items down, getting in and out of chairs, going through doors)
  • Seeking reassurance from others

How do you treat OCD?

The gold-standard intervention for OCD is called exposure and response prevention (EX/RP). This treatment has decades of research to support it and is the most effective strategy for decreasing symptoms of OCD. Exposure therapy is designed to help you systematically confront things that you’re afraid, giving yourself a chance to learn that anxiety is temporary and the thing you’re most afraid of is unlikely to happen. Exposure is about getting out of old patterns so that new learning can occur. The second part of EX/RP is response prevention. This means working together to eliminate time consuming rituals.

With exposure therapy, you’re always in the driver’s seat. I’ll be right there with you on the passenger side, giving directions, encouragement, and sometimes pushing you out of your comfort zone but you control the treatment process. We work together to develop exposure tasks to help you get the most out of treatment. I’ll never suggest an exposure task that I wouldn’t do myself and whenever possible, we’ll do them together to start. You are not alone in this!

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