OCD and the Paradox of Doubt

When most people think of Obsessive-Compulsive Disorder (OCD), they picture someone excessively tidy, washing their hands repeatedly, or double-checking locks. But this stereotype barely scratches the surface of what OCD really is.

At its core, OCD is a disorder of doubt—not just any doubt, but a relentless, intrusive, and distressing form of uncertainty that feels impossible to ignore. It convinces you that if you don’t do something—whether it’s mentally checking, ruminating, or seeking reassurance—you’ll be stuck with the anxiety forever, or worse, your worst fear might come true.

What makes OCD so difficult to live with is that it tricks you into trying to achieve certainty through the feeling of doubt—which, of course, is a paradox. The more you try to feel sure about something, the more uncertain you become.

As a therapist and someone who has personally struggled with OCD, I know firsthand how convincing it can be. I also know that understanding the condition is the first step toward breaking free from it.

Understanding the Obsession-Compulsion Cycle

OCD is made up of two key components:

• Obsessions – Unwanted, distressing, and intrusive thoughts, images, or urges that trigger anxiety.
• Compulsions – The mental or physical actions used to relieve the distress caused by obsessions.

People assume compulsions always involve physical behaviours like hand-washing or checking doors, but for many, compulsions happen entirely in the mind—constantly reviewing past memories, mentally arguing with intrusive thoughts, or endlessly seeking reassurance.

This is why the term Pure O (Purely Obsessional OCD) is misleading, because even when compulsions aren’t visible, they still exist.

Common Types of OCD

OCD can attach itself to anything you care about, making you question your thoughts, identity, or even past actions. Some of the most common types include:

• Relationship OCD (ROCD): Obsessing over whether you love your partner, whether they’re “the one,” or if you made a mistake in your relationship.
• Harm OCD: Fears of losing control and hurting someone, even though you don’t want to.
• Sexual and Taboo OCD: Intrusive thoughts about inappropriate, distressing, or unwanted sexual themes.
• Checking OCD: Repeatedly locking doors, re-reading texts, or checking the stove for fear of making a catastrophic mistake.
• Health Anxiety (Health OCD): Obsessing over potential illnesses, Googling symptoms, and seeking repeated medical reassurance.
• Real Event OCD: Ruminating over past events and wondering if you did something wrong, even if it was years ago.
• Somatic OCD: Becoming hyper-aware of bodily sensations, like breathing or blinking, to the point where they feel unbearable.

While these themes may seem different, they all share the same structure:

obsession → anxiety → compulsion → temporary relief → repeat

OCD Weaponises Guilt

One of the hardest aspects of OCD is that it doesn't just bring on anxiety; there's an overwhelming sense of guilt that comes with it:

• If I had this thought, does that mean I’m a bad person?
• If I don’t feel distressed enough, does that mean I don’t care?
• If I stop checking, does that mean I’m irresponsible?

OCD uses your values against you, making you believe that letting go of a thought means you agree with it. But the truth is that everyone has intrusive thoughts. The difference is that people without OCD don’t always react to them.

Research shows that guilt plays a major role in maintaining OCD symptoms (Shafran et al., 1996). This is why treatment isn’t about getting rid of thoughts; it’s about changing how you respond to them.

Reassurance Addiction: Why OCD Makes You Chase Short-Term Relief

Reassurance-seeking is one of the biggest traps in OCD. Anxiety is uncomfortable, and OCD convinces you that the only way to get rid of it is to check, ask, or Google one more time.

Some common reassurance-seeking compulsions include:

• Asking a loved one, “Do you think I would ever do this?”
• Replaying past interactions to “check” if you did something wrong.
• Searching Reddit or forums for others with the same thoughts.

The problem? Reassurance only works temporarily. The relief fades, and you’re back in the loop again.

A study by Abramowitz et al. (2011) found that reassurance-seeking strengthens OCD in the long run, reinforcing the belief that doubt is dangerous and must be eliminated.

The Gold Standard Treatments

The best evidence-based treatments for OCD include:

OCD Essential Reads

Is It Disordered Eating or OCD?

Is Medication Needed to Treat Obsessive-Compulsive Disorder?

• Exposure and Response Prevention (ERP): Gradually exposing yourself to fears while resisting compulsions.
• Inference-Based Cognitive Behavioural Therapy (ICBT): A newer approach that challenges the faulty reasoning behind OCD’s doubts.

Both therapies help you develop tolerance for uncertainty, rather than trying to eliminate it.

My Own Experience

For years, OCD ruled my life. I thought I had to solve every thought, check every symptom, and be 100% sure of everything. What I didn’t realise was that my compulsions were the problem, not the thoughts themselves.

It wasn’t until I stopped reacting to my intrusive thoughts and started accepting uncertainty that OCD lost its power over me.

Final Thoughts

OCD is a disorder of doubt. It convinces you that you need certainty, but the more you chase it, the further away it feels.

The way out isn’t through reassurance-seeking or avoidance. It’s through allowing doubt to exist without reacting to it.

Recovery is possible, and you don’t have to do it alone.

If you struggle with OCD, see my e-book, Unravel Your Intrusive Thoughts, in which I break down the OCD cycle and explain how to retrain your brain. You can also listen to our Disordered Podcast, on which we explore OCD, anxiety, and recovery strategies.

To find a therapist, visit the Psychology Today Therapy Directory.