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Obsessive-compulsive disorder (OCD) is so much more than just liking things neat or organized. It’s a complex mental health condition that can profoundly affect someone’s daily life.
The term “OCD” often gets thrown around casually. You’ve probably heard someone say, “I’m so OCD,” because they like things a certain way. But true OCD is far more than that.
Some people assume it’s not a big deal and think those with OCD just need to relax or not worry so much. The truth is OCD can have a profound impact. It can stop a child from going to school because they are afraid they or a family member will be harmed by contamination or prevent a doctor from practicing medicine out of fear they might harm someone. OCD can create immense strain on families and relationships.
Many people also associate OCD with constantly checking locks or washing hands, but it’s not that simple. Obsessions can be about anything, and compulsions don’t always look obvious. For example, someone might repeatedly seek reassurance from others to feel confident that their fears won’t come true.
People often think you’d be able to tell if someone had OCD, but that’s not always the case. At Momentum Psychology, we work with clients who are entrepreneurs, executives, athletes, and creatives—individuals who excel in their fields and appear to have it all together. To their colleagues, friends, and even family, their OCD often goes unnoticed.
This page is here to help. We’ll dive into what OCD really looks like, especially in high-achieving individuals, dispel common misconceptions, and guide you toward recovery. We aim to inform, encourage, and empower you to take the next step. You don’t have to face this alone—there’s a path forward, and we’re here to help you to the next step.
Obsessive-compulsive disorder (OCD) is a mental health condition classified in the DSM-5 as an anxiety disorder. OCD is characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions). These obsessions and compulsions can drive significant distress, often interfering with everyday life across multiple domains including school, work, and relationships.
Obsessions cause anxiety or distress. The triggers for these obsessions can be internal or external.
Obsessions are typically defined by both:
So, if a person had a persistent fear of driving over bridges but their primary response was to avoid the bridge and nothing else happened, it would likely not meet this criteria. However, if a person had a fear of dying on a bridge and tried to replace the thought systematically or asked a partner for reassurance that they wouldn’t die on a bridge, that may look more like OCD.
With OCD, there are typically two underlying components of the obsession:
A trigger is a real stimulus in the environment such as a feared object like a dirty chair or a feared person.
Triggers can be internal or external.
A core fear is an imagined consequence of contact with that stimulus (e.g., “If I touch that dirty chair, I will get sick and die.”)
An example of this might be a person who avoids a bridge because they fear it will collapse. Usually, addressing these types of fears in therapy is more straightforward because they can be confirmed. For instance, a person could drive over the bridge and verify whether it collapses or not.
A core fear of uncertainty would typically be fear about something that is in the future and cannot be verified right now. An example might be an executive who is afraid of getting cancer. How could that be OCD? Everyone is afraid of getting cancer. The difference with OCD would be that this core fear would be linked to some kind of action, a compulsion like excessively seeking reassurance from others or searching articles for information on prevention.
Here, a person would be trying to avoid internal experiences, including physical sensations, thoughts, urges, and feelings. An example here could be avoiding going to restaurants because there is a fear of throwing up or seeing someone throw up, and the root fear is the feeling of disgust.
Compulsions temporarily reduce that distress. These can manifest as external behavior or mental activity.
Compulsions are typically defined by both:
Compulsions usually take two forms–behavioral or cognitive.
Often, the obsessions and compulsions involved in OCD don’t align with a person’s core values or self-concept (in psychology, this is called “ego dystonic”), which can further intensify guilt or confusion.
This misalignment is especially present in people who are high-achieving. Often, to complicate matters, the environments that they work in can often inadvertently reinforce OCD behaviors as being desirable. They may be promoted, paid more, or recognized, or otherwise positively reinforced for the perceived positive outcomes that were obtained through behaviors that were very difficult on the person and interfered with their lives.
Regardless OCD manifests, to meet criteria for OCD, the other diagnostic criteria must be met.
OCD can also co-occur with related disorders, such as hoarding disorder, body dysmorphic disorder, or trichotillomania (hair-pulling disorder).
It is important to note that to be diagnosed with OCD there must be evidence that the person is experiencing clinically significant distress or impaired functioning. With high-functioning people, identifying this through observation and sometimes even surface-level questions to the individual can be difficult.
When OCD presents this way, it is sometimes called high-functioning OCD. While it’s not a formal diagnosis, it describes people who meet the criteria for OCD but experience less visible functional impairment or have learned to mask it well—even from themselves.
Let’s say you’re an entrepreneur who struggles to delegate or let go of a need to micromanage. You spend enormous amounts of time focusing on things that you don’t have to instead of going home to be with your family. Alternatively, you could be a college student pushing relentlessly toward academic goals, or an athlete perfecting your craft but engaging in habits that might be holding you back. Either way, OCD could be playing a more significant role than you realize.
Often, when a person is functioning at a high level in work or school, the results of their OCD (e.g., higher grades, better work performance, exceptional athletic or creative performance) are praised and supported by others. In behavioral terms, the symptoms of OCD are positively reinforced.
OCD often involves secrecy, so the individual may not be telling parents, a partner, supervisors, or coaches what they are actually doing to accomplish these results.
Often the way that OCD is discovered is that engaging in the behaviors eventually stops working or causes impairment that is observable to others.
While the exact causes of OCD aren’t fully understood, several risk factors may contribute to its development, including:
OCD affects every aspect of life—from personal relationships to workplace performance. For high achievers like executives, students, or athletes, the relentless mental loop of obsessions and compulsions can feel paralyzing, leading to missed opportunities and burnout.
However, OCD is manageable. Understanding its patterns and learning evidence-based strategies can help you regain control and thrive in every space of your life.
The good news? Effective treatment is available. Research-backed therapies and approaches show promising results for managing OCD.
These methods combine cognitive and behavioral methods.
Exposure and Response Prevention (ERP) works by exposing clients to the situations that trigger anxiety or compulsions while preventing the typical response (such as a compulsion, avoidance, or reassurance-seeking) they would normally use to reduce that anxiety.
ERP for OCD is considered the gold standard treatment, with studies showing that around 50-60% of patients experience clinically significant improvement in their OCD symptoms following ERP, with many achieving long-term symptom reduction; however, it takes commitment from the client and a great relationship with the therapist. The drop-out rates for ERP are high, which makes sense given it feels like “touching the fire” of your fear.
The exposure piece involves developing a hierarchy of behaviors that require the client to experience the feared stimulus. The hierarchy is developed from low to high intensity, rated on a ten-point scale. Feared stimuli that are between a 1 and a 3 would elicit lower levels of distress while those at a 7 to 10 would elicit very high levels. Typically, you try to start at a lower level on the hierarchy. Let’s say a lawyer has an intense fear that he is going to send out a contract or email with the wrong information in it, and his client is going to be harmed. He spends a great deal of time on “final” checks of things he is sending out.
For example, a lower level exposure trial might be his sending out an email checking it only 1 time for no more than 3 minutes (using a timer) versus his usual 10 times and 20 minutes. A higher level trial might be doing something similar with a complex with his final review of an agreement.
At the same time, the therapist and client develop a response prevention plan to ensure that the client doesn’t engage in their typical safety behaviors. (Safety behaviors are accommodations or alterations to behavior that a person engages in to lower the intensity of the fear).
In the example above, the lawyer might engage in safety behaviors like running the email through Grammarly multiple times or asking for his partner’s reassurance that his email was good. His plan might include limits on the time he can spend checking and how many times he can spend checking, depending on what’s reasonable or not. In general, any type of checking could be called a “safety behavior,” but you are always asking WTF? Sorry. What’s the function of the behavior? A lawyer checking a complex legal document is an adaptive and necessary behavior. The question is more how much is too much.
Acceptance and Commitment Therapy (ACT) is a “third-wave” and more modern version of CBT that helps reframe obsessive thinking as thoughts to acknowledge—not fears to control.
ACT also adds the concept of values clarification and values-based action, which can be combined with ERP to yield powerful results.
For instance, a client can rate the hierarchy using the typical SUDS scale and also add ratings on how much engaging in the experimental exposure behavior would align with their values of things like autonomy, authenticity, courage, etc. Mindfulness helps individuals observe intrusive thoughts without judgment, diffusing their power.
Antidepressants, like selective serotonin reuptake inhibitors (SSRIs), can alleviate symptoms and improve focus for therapeutic work.
Joining support groups or connecting with others managing similar experiences can provide a sense of belonging and shared strategies.
(Please note: Support groups are never a substitute for clinical treatment. Also, it’s generally recommended that support groups are supervised or managed by a licensed mental health professional with experience working with OCD in individuals like you.)
Recovery is not about “curing” OCD—it’s about mastering it. With the right tools, individuals can disarm their OCD patterns and live fulfilling values-driven lives.
OCD behaviors can become a thing that they do or used to do, but not who they are. Yet there is self-compassion that the part of them that engages in those behaviors is not “bad” or “flawed” but using an unhelpful behavior to avoid pain, which is a fundamental reality of the human condition.
We understand that high-functioning individuals often face unique challenges when it comes to seeking help for OCD. You’re likely managing significant responsibilities at work, home, and within your personal goals. Time is scarce, and the idea of therapy might feel like yet another “task.”
Here’s how our new service is tailored specifically for you:
Want to help a loved one with OCD? Here’s how to provide meaningful support:
Recognize that OCD is a medical condition. Avoid minimizing their struggles.
Often, family members participate in OCD rituals often without knowing it.
If a child with OCD has contamination fear and a parent changes their behavior (e.g., won’t touch door knobs, buys the child gloves), then the parent’s behavior is facilitating the OCD performance ritual. If you feel that you may be doing this for a partner or child, please know that this is not your fault. This is SO hard to spot!
The default human rule is to avoid pain, and with someone you love, the default is to prevent them from experiencing pain. Avoidance is the fuel of most mental health disorders, and yes, that is the target. However, it is very difficult to recognize that your behavior is being ruled by avoiding pain with people you love, even for some therapists with their family members! Although reducing accommodation will likely be a component of the treatment for the individual, it is not recommended to do this unilaterally with your loved one.
“Going cold turkey” with accommodation can have negative outcomes. It is recommended that you work through this with a licensed mental health professional. If accommodation is stopped suddenly without support, the individual can react negatively with anger outbursts. However, if the individual is at risk for suicide, risk could increase).
Because accommodation is such a problem with OCD behaviors, especially with children, some people believe that you can’t listen or validate a person with OCD. Not true, and actually doing that would be counterproductive.
Communications combine two things:
Validating what’s valid means that when a person expresses an unhelpful thought or attitude, etc. you try to find the valid part (usually an emotion). You are telling the person that their feelings make sense, and you believe they are feeling that way.
For example, if a person says, “I feel like if I don’t check my paper 10 times, I’m going to fail the class.” You would say, “It sounds like the thought of not doing that is really scary” or “I can see how having that thought would be so scary” but you would not say “That totally makes sense!”
Expressing confidence would be combining that validation move with another statement that expresses belief in the person’s ability to violate the unhelpful thought to do the values-aligned behavior.
With the same example, it would sound like:
“I can see how having that thought would be so scary” PLUS “At the same time, I believe in you that you could check it a few times less and work through that feeling.”
Notice that you are not praising outcome or a fixed mindset so you’re not saying “I believe that you could check it less and it will all work out!” That is more like thought suppression, which actually can enhance OCD thoughts.
(Please note that support groups are not a substitute for treatment).
Are you ready to overcome the challenges of high-functioning OCD? Contact us today to schedule your first session. Together, we can help you reclaim your time, energy, and peace of mind.
Book your consultation now and take the first step toward freedom from OCD.
Your path to change starts here.
As well as having extensive training and experience in the treatment of burnout and stress-related issues, our team of therapists also offers a wide variety of online therapy services in North Carolina and all PSYPACT states. We work with lawyers, entrepreneurs, students, parents, and teens who are dealing with ADHD, trauma and loss, anxiety and panic, depression, and life transitions. We also offer SPACE, Supportive Parenting for Anxious Childhood Emotions. Our goal is to help you find success both professionally and personally so you can gain Momentum to excel in a bright future.
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