What OCD Can Look Like (Beyond the Stereotypes)
When most people hear ‘OCD’, they imagine someone repeatedly washing their hands or checking that the door is locked. While those are valid experiences of Obsessive-Compulsive Disorder, they are far from the whole picture. The reality, for many, is much quieter. It’s an internal, exhausting battle against your own thoughts.
It could be a sudden, unwanted thought that feels utterly alien to who you are. A frightening image that flashes into your mind, or a persistent doubt about your health, your relationship, or your own morality. This is something many people bring to online therapy, often feeling deeply ashamed or confused because it doesn’t fit the stereotype. They worry what these thoughts mean about them as a person.
What I've noticed in my work is that these hidden forms of OCD often revolve around a few core themes:
- Intrusive Thoughts: Unwanted thoughts or images about causing harm to yourself or others, often leading to intense guilt and fear.
- Relationship OCD (ROCD): Constant, obsessive doubting of your feelings for your partner, their feelings for you, or the ‘rightness’ of the relationship.
- Health Anxiety & Somatic OCD: A hyper-awareness of bodily functions and sensations, with a deep fear that they are a sign of a serious, undiagnosed illness. This is why health anxiety can feel so convincing.
- Existential OCD: Getting stuck on unanswerable questions about the nature of reality, the universe, or your own existence, to the point it causes severe distress.
The Compulsion Part Isn't Always Physical
The ‘C’ in OCD stands for Compulsions. These are the things you do to try and get rid of the anxiety caused by the obsession. But they aren't always actions you can see.
Often, the compulsions are mental rituals. They are just as rigid and demanding as any physical check, but they happen entirely inside your head. You might not be washing your hands, but you could be spending hours a day trying to scrub your mind clean.
Some of these mental compulsions include:
- Mental Review: Constantly replaying memories to check for ‘evidence’ that your feared thought isn't true.
- Reassurance Seeking: Asking friends, family, or even Google for certainty. For someone with health anxiety, this might look like constantly searching for symptoms online.
- Thought Neutralising: Trying to cancel out a ‘bad’ thought by thinking a specific ‘good’ thought or repeating a certain phrase in your head.
- Avoidance: Steering clear of people, places, or situations that might trigger an obsessive thought. This can slowly make your world feel smaller and smaller.
How Online Therapy for OCD Works
When you’re trapped in this cycle, the instinct is to fight the thought, to argue with it, to prove it wrong. But the more you fight, the stronger it seems to get. This is where a specific type of Cognitive Behavioural Therapy (CBT) called Exposure and Response Prevention (ERP) can be so effective.
Put simply, ERP helps you learn to react differently to the thoughts. Instead of performing the compulsion (whether physical or mental), you learn to sit with the discomfort and uncertainty. It sounds scary, and it’s why it’s so important to do this with a trained therapist who can guide you at your own pace.
Working with an online therapist, we can gently and collaboratively build up your ability to let the thoughts just be thoughts, rather than urgent commands. You learn that you can feel anxious and still not do the ritual. Over time, your brain learns that the alarm is false, and the anxiety begins to fade on its own. It’s not about getting rid of thoughts, but changing your relationship with them.
The convenience of online therapy means you can do this important work from the comfort and privacy of your own home, which some people find less daunting. If you’re feeling apprehensive, you’re not the only one. It's a question we hear a lot, and you can read more about it in our post: I’m Not Sure About Online Therapy… Is It Just Me?.
Frequently Asked Questions about Online Therapy for OCD
It’s natural to have questions before starting. Here are a few common ones we hear.
Is online therapy as effective as face-to-face for OCD?
Yes. Research has consistently shown that online CBT and ERP are just as effective as in-person sessions. For some, being in their own environment can actually be helpful for practicing the strategies we discuss in sessions.
Will I have to talk about things I'm ashamed of?
The thoughts that come with OCD can feel very personal and shameful. A therapist’s role is to provide a completely non-judgemental space. You are in control, and you only need to share what you feel comfortable with, when you feel ready.
How much does it cost and how does it work?
Our fee is £68 for a full hour session. We work on a session-by-session basis, so you are always in control and there’s no long-term commitment required. You can book a one-off session or have them as regularly as you feel you need to.
Understanding what’s really going on is the first step. It’s not a character flaw or a sign that you’re a bad person. It’s the pattern of OCD, and it’s something that can be managed.
If you recognise yourself in this post and want to find a way to quieten the noise, we are here to help. You can book your first online session through our secure online system. Please get in touch if you have any questions.
Written by Sian Jones, Founder of Online CBT Counselling. Sian has extensive experience helping individuals manage anxiety, stress, low mood and other emotional challenges.
