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For adults
OCD in adults
OCD is one of the most treatable conditions in mental health and one of the most commonly mistreated. This page explains what is actually keeping it going and what changes it.
What OCD actually is
OCD has two parts. An obsession is an unwanted thought, image, urge or doubt that arrives uninvited and causes distress. A compulsion is anything you do to make that distress go away or to stop the feared thing happening. The compulsion works — briefly. That is the trap. Relief teaches your brain that the thought was a genuine threat and that the ritual is what kept you safe, so the next thought arrives louder.
Most people picture handwashing and light switches. In my clinic, that is a minority of what I see. Far more often the compulsions are invisible, and the person has spent years assuming they have a personality flaw rather than a well-defined and highly treatable condition.
What it actually looks like day to day
- Rereading an email six times before sending, then rereading it in your sent folder to check what you wrote.
- Asking your partner the same question in slightly different words, because the answer stopped working after about forty minutes.
- Googling symptoms, court cases, or definitions late at night to establish whether you are the kind of person you fear you are.
- Mentally replaying a conversation from three days ago, hunting for the moment you said something unforgivable.
- Avoiding being alone with your own child, or with a knife, or with someone you find attractive.
- Doing something — locking a door, closing a laptop, sending a message — and having to do it again because it did not feel right.
- Praying, counting, or silently repeating a phrase to cancel out a thought you did not choose.
- Confessing to a partner or a friend, and needing them to tell you that you are not a bad person.
The themes vary: contamination and illness, harm, symmetry and “just right” feelings, religious scrupulosity, sexual or violent intrusions, doubts about your relationship or your sexual orientation, responsibility for catastrophes. The content is almost never the point. Two people with completely different obsessions are running the same machine.
Reassurance is a compulsion
This is the single most useful thing I can tell you. Asking your partner whether you locked the door, checking your own body for a feeling, searching a forum at 1am, and running the memory back one more time are all the same behaviour wearing different clothes. Each one is a small deposit into the belief that the doubt must be resolved before you can move on.
Doubt cannot be resolved. That is what makes it doubt. Recovery does not come from finally getting certainty — it comes from being able to carry the uncertainty and get on with your day anyway.
The treatment that works
The treatment with the strongest evidence base for OCD is Exposure and Response Prevention, a specific form of CBT. NICE recommends CBT including ERP as a first-line psychological treatment for OCD in adults. It is a procedure, not a conversation.
We start by mapping the system properly: what triggers the doubt, what you do about it, what you avoid, and who else in your life has been recruited into the reassurance. Then we build a graded list of situations, from uncomfortable to genuinely difficult, and you begin deliberately approaching them without performing the ritual. Anxiety rises. You do not fix it. And — this is the part nobody believes until they experience it — it comes down on its own. Repeat that often enough and your brain learns two things it has been prevented from learning for years: the feared outcome does not arrive, and you can tolerate far more than you thought.
In practice this means agreeing homework that matters. Sending the email once. Leaving the house without the final check. Deliberately thinking the thought you have spent five years suppressing, and letting it sit there. The sessions are active and structured, and between-session practice is where most of the change happens.
Why generic therapy so often fails with OCD
A great deal of well-intentioned therapy makes OCD worse. Exploring where the thought came from, weighing the evidence for and against it, or reasoning your way to why it is unlikely all feel productive, and all function as reassurance. OCD is extremely good at converting insight into a new ritual. If you have had therapy that involved analysing the thoughts at length and you got temporary relief followed by a return, that is not a sign that your OCD is untreatable. It is a sign you were given the wrong procedure.
When OCD travels with something else
OCD rarely arrives alone. Depression is common, particularly after a long untreated history. Co-occurring ADHD changes how ERP needs to be structured and is worth identifying rather than stumbling upon. Body dysmorphic disorder, skin picking and hair pulling, and health anxiety sit in the same family and are frequently missed when the assessment only asks about handwashing.
Part of what a proper assessment buys you is knowing which of these is present, and in what order to treat them.
Working with me
I am a clinical psychologist and this is the work I have spent my career doing. I trained at the University of Washington, a leading clinical research programme, completed my internship at Seattle Children’s Hospital and Harborview Medical Center, and then a postdoctoral fellowship at the Evidence-Based Treatment Centers of Seattle, where I became Director of Training and Education and later Assistant Director of the Child Anxiety Center. I am board certified in Behavioral and Cognitive Psychology by the American Board of Professional Psychology, registered with the HCPC, and chartered with the British Psychological Society. I am currently a Clinical Instructor at the University of Washington.
I see adults online across the UK and in person near Ravenshead, Nottingham and Mansfield. Appointments run from 9am to 9pm on weekdays, so treatment does not have to cost you annual leave. Sessions are £120, with a 90-minute initial assessment at £180, and I am recognised by BUPA, AXA Health, Aviva, Vitality and WPA — the detail is on the fees page.
The first step is a free 30-minute call. You tell me what has been happening, I will tell you what I think is going on and whether I am the right person for it. If I am not, I will say so.
Common questions
I have intrusive thoughts about harming someone. Does that mean I am dangerous?
Almost certainly not. Harm obsessions are one of the most common presentations of OCD I see, and the defining feature is horror: the thought is repugnant to you, which is precisely why it sticks. People who actually intend harm do not spend their days terrified they might. What maintains the problem is not the thought but everything you do about it — checking your reaction, avoiding knives or being alone with a child, mentally reviewing whether you meant it. Treatment targets those responses, not the content of the thought.
What is Pure O, and is it a real thing?
“Pure O” is a shorthand for OCD where the compulsions are mental rather than visible — reviewing memories, mentally arguing with a thought, checking internally for a feeling, praying in a set way, silently reassuring yourself. It is not a separate disorder and it is not compulsion-free. The rituals have simply moved inside your head, which makes them harder to spot and easier to do hundreds of times a day. It responds to the same treatment, once we have identified what the mental rituals actually are.
How long does treatment for adult OCD take?
For a straightforward presentation, expect somewhere in the region of 12 to 20 sessions after the initial assessment, usually weekly at first and then spaced out as you take over the work yourself. Longer histories, severe avoidance, or OCD alongside depression or another anxiety disorder can take longer. Progress is usually visible well before the end. After the assessment I will give you an honest estimate and a plan rather than an open-ended arrangement.
Will I have to do something horrifying in the first session?
No. Nothing is sprung on you and nothing happens without your agreement. The first session is a 90-minute assessment: history, what the OCD demands of you, what you avoid, what the rituals are, and what else is going on. We then build a graded list together and start somewhere genuinely manageable. Exposure work is collaborative by design — if you are not choosing the step, it is not being done properly.
Do I need medication as well as therapy?
NICE recommends CBT including exposure and response prevention as a first-line psychological treatment for OCD, with SSRI medication considered alongside it for more severe presentations or where therapy alone has not been enough. Plenty of people do well with therapy alone. I am a psychologist and do not prescribe, but I work alongside GPs and psychiatrists where medication is being considered, and I will say plainly if I think it is worth discussing with your doctor.
I have had CBT before and it did not help. Is this different?
Often, yes. General CBT for OCD — examining the evidence for a thought, rating how likely it is, challenging it rationally — tends to fail, because it becomes another form of reassurance and OCD absorbs it. Exposure and response prevention is a different procedure with a different logic. If your previous therapy involved talking about the thoughts rather than deliberately changing what you do when they arrive, you have not really had the treatment yet.
Related pages
Not sure whether this is the right fit?
Start with a free 30-minute call. We will talk through what is going on, I will tell you honestly whether I think I can help, and if I cannot I will try to point you to someone who can. There is no obligation and no charge.