When Doubt Won’t Let Go: Understanding OCD
by Caroline Freedenberg, LICSW, LCSW, LCSW-C, PMHC
Obsessive-compulsive disorder (OCD) is often misunderstood as being about cleanliness or liking things labeled and arranged a certain way. In reality, OCD is defined by:
Obsessions: intrusive, unwanted thoughts, images, or urges
Compulsions: repetitive behaviors or mental acts (rituals) done to reduce anxiety caused by those thoughts
OCD has some common themes (harm, moral scrupulosity, contamination, sexual, false memory, just right, etc.), but it isn’t really about germs, morality, or safety. At its core, it’s about an intense intolerance of uncertainty.
While everyone experiences doubt, OCD demands absolute certainty. It craves assurance that nothing bad did or will happen, that a mistake wasn’t made, and that a thought doesn’t “mean” something terrible. To try to satiate that need for certainty, people may engage in mental rituals (worrying, reviewing, researching, scanning memories) or physical rituals (checking, cleaning, confessing, seeking reassurance, avoiding).
These rituals may bring temporary relief. But over time, they train the brain to associate doubt with danger and compulsions with safety. The more someone tries to feel certain, the more uncertain they feel. That’s why it’s not as simple as “just stop” or trying to convince someone that the thoughts are not rational. Often, people have tried to stop and to rationalize or ritual their way out of this cycle for years before seeking treatment.
OCD Targets What Matters Most
OCD tends to latch onto what a person values most. Intrusive thoughts are ego-dystonic, meaning they clash with who the person is and what the person cares about.
A loving parent may have intrusive thoughts about harming their child.
A deeply moral person may obsess over being “bad.”
Someone who values their relationship may think, “What if I don’t really love my partner?”
Intrusive thoughts are not intentions. In fact, the intense distress they cause often signals strong values, not hidden desires.
Because these thoughts feel shameful or taboo, many people withdraw or hide them. Some people delay seeking help for years out of fear of being judged or misunderstood.
Supporting Someone With OCD
When someone we care about has OCD, it’s natural to want to help by giving reassurance, checking things for them, or trying to reduce their distress. This is called accommodation, and while it comes from love, it can unintentionally strengthen OCD over time.
Being supportive doesn’t mean stepping in to fix things. Instead, it means:
Listening and validating: “I can see this is really stressful right now.”
Encouraging healthy strategies: “What would your therapist suggest in this moment?”
Offering presence with loving boundaries, not reassurance: “I love you and I want to support your recovery, so I will sit with you and listen, but I won’t be giving reassurance.” “I care about you deeply. I’ll stay nearby and be supportive, but I won’t do the compulsion for you or rearrange my life around it.”
Educating yourself about OCD International OCD Foundation
The key is to be patient, caring, and non-judgmental; this helps your loved one feel seen and understood without participating in rituals. This helps them safely practice facing uncertainty and builds long-term resilience against OCD.
Treatment: Learning to Tolerate Uncertainty
Healing begins with reducing shame. In therapy, clients learn that thoughts are mental events, not moral verdicts. Shame tells people to hide. Healing begins when they realize they don’t have to hide because having a thought does not make it true, dangerous, or reflective of who they are.
Exposure and Response Prevention (ERP) is the gold-standard treatment for OCD. ERP gently helps people face feared thoughts without performing compulsions. Over time, the brain learns:
Doubt is uncomfortable but not dangerous
Anxiety rises and falls on its own
Certainty is not required for safety
ERP does not eliminate uncertainty. It builds the capacity to tolerate it.
ERP is collaborative and gradual; treatment starts with lower-intensity exercises and slowly builds toward more challenging ones. Therapist and client work as a team against OCD, with consent and shared decision-making guiding every step. The goal is to strengthen the client’s ability to tolerate uncertainty and anxiety, and to help them separate what they want from what OCD is demanding.
ERP works best when clients feel understood rather than judged or rushed. As shame decreases and confidence grows, clients spend less time stuck in rituals and more time living their lives with greater freedom and a stronger sense of agency.
Caroline Freedenberg, LICSW, LCSW, LCSW-C, PMHC, is passionate about supporting women and families during the journey into parenthood. She has extensive experience helping clients navigate perinatal mental health concerns, including anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress during pregnancy and the postpartum period. She also supports individuals and couples facing infertility, pregnancy and infant loss, medical complexity, and the emotional challenges that can arise while trying to conceive or adjusting to life with a new baby.
Caroline works to create a compassionate, nonjudgmental space where clients can build self-compassion, strengthen relationships, and reconnect with their sense of purpose and resilience. She’s here to support you through life transitions and help you move toward a life with greater balance, confidence, and connection.
