Obsessive-Compulsive Disorder: Understanding Obsessions and Compulsions
- Donald St Pierre, MSN, RN-BC
- Nov 8, 2025
- 4 min read
Many people say, “I’m so OCD, I like my room clean.”But obsessive–compulsive disorder (OCD) is not just about being neat or organized.
Mental health organizations describe OCD as a disorder where people have:
Obsessions – unwanted, upsetting thoughts, images, or urges that keep coming back
Compulsions – actions or mental rituals they feel they must do to try to feel less anxious
These obsessions and compulsions take a lot of time, cause real distress, and get in the way of school, work, and relationships.
Your picture shows one common pattern:
Thought (obsession): “I’m so bad, I made a mistake.”
Action (compulsion): “I’d better wash my hands.”
Let’s break OCD down in kid-friendly language so anyone can understand and reteach it.
What Are Obsessions?
Obsessions are:
Thoughts, pictures, or urges that pop into the mind over and over
Often scary, embarrassing, or upsetting
Hard to control or ignore
Common examples:
Fear of germs, dirt, or getting very sick
Fear of hurting someone by accident
Fear that something terrible will happen if things are not “just right”
Strong need for things to be perfectly even, lined up, or in a certain order
Disturbing thoughts or images that do not match the person’s values
“Obsessions are like a bossy, scary thought that keeps yelling in your brain, even when you don’t want it there.”
What Are Compulsions?
Compulsions are:
Actions or mental rituals a person feels they have to do
Done to try to get rid of the bad feeling from the obsession
They may help for a short time, but then the obsessions come back
Common compulsions:
Washing or cleaning – washing hands or showering again and again
Checking – doors, stoves, locks, homework, or messages over and over
Repeating – words, prayers, numbers, or actions until it “feels right”
Arranging and ordering – lining things up in a perfect way
Mental rituals – silently saying special words, counting, or “undoing” bad thoughts
“Compulsions are the things someone does over and over because the bossy thought tells them, ‘Do this, or something bad will happen.’”
The OCD Cycle: Thoughts → Fear → Actions → More Thoughts
You can think of OCD as a cycle:
Obsession – A scary or upsetting thought pops up.
“My hands are full of germs.”
Anxiety or guilt – The person feels very scared, grossed out, or like a bad person.
Compulsion – They wash their hands again and again to feel safer.
Short relief – They feel better for a little while.
Cycle repeats – The thought comes back, often stronger.
Over time, this cycle can:
Take hours each day
Make it hard to go to school, work, or hang out with friends
Leave the person tired, ashamed, and stuck
“The more the person obeys the bossy thought, the stronger the bossy thought gets.”
OCD Is More Than Being “Neat”
There’s a big myth that OCD is just being clean or organized.
Preference: “I like my room tidy.” → You can stop cleaning and feel fine.
OCD: “If my room isn’t perfect, something awful will happen and it’s my fault.” → You feel intense fear or guilt until you do your rituals.
Liking things clean is a choice.OCD feels like a fight you didn’t pick and can’t just stop.
“Liking clean is okay. OCD feels like you have to do things, even when you don’t want to.”
Who Can Have OCD?
OCD can affect children, teens, and adults.
It shows up in people of all genders and backgrounds.
Symptoms often start in late childhood or the teen years, but can begin earlier or later.
Having OCD does not mean someone is dangerous or “crazy.”It means their brain is stuck in a fear-and-ritual loop that needs support and treatment.
How Is OCD Treated?
The good news: OCD is treatable.
The main treatments are:
1. Cognitive Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP)
A special type of therapy where people gradually face their fears in small, safe steps
They practice not doing their compulsions
Over time, the brain learns: “I can feel worried and still be okay.”
This is considered the gold-standard therapy for OCD.
2. Medication
Some people also take medicines (often SSRIs, a type of antidepressant) that can:
Lower anxiety
Make obsessions and compulsions easier to manage
A mental health professional (like a psychiatrist) decides if medicine might help.
“Therapy helps people practice not listening to the bossy thoughts. Medicine can sometimes help the thoughts be less loud.”
When Should Someone Get Help?
It may be time to reach out for help when:
Obsessions and compulsions take more than an hour a day
They get in the way of school, work, or family life
The person feels ashamed, very anxious, or hopeless
They hide their rituals or feel like they must do them to feel safe
If you notice these signs in yourself or someone you love:
Talk kindly.
“I’ve noticed you seem really worried and washing your hands a lot. I care about you. Want to talk?”
Encourage professional help.
Suggest seeing a therapist, psychologist, or psychiatrist who understands OCD.
In a crisis
If someone talks about hurting themselves or others, or feels completely overwhelmed, call your local emergency number or a crisis line (for example, 988 in the U.S.) right away.
“Education You Can Wear”: OCD Thoughts and Actions Tee
OCD is often hidden because people feel embarrassed by their thoughts and rituals.But talking about it can reduce shame and help people get treatment sooner.
Your design shows:
A person counting ceiling tiles and thinking,
“I messed up. I’m a bad person.”
Then washing hands again to try to feel better.
This simple image teaches three big points:
OCD is a cycle of thoughts → feelings → actions.
The thoughts are not chosen; they are unwanted and upsetting.
The actions give only short-term relief and keep the cycle going.
Every time someone wears or sees this shirt, it can start a short, powerful conversation:
“What’s the difference between an obsession and a compulsion?”
That’s education you can wear—spreading real understanding instead of jokes or stereotypes.
References (alphabetical by organization)
American Psychiatric Association. (n.d.). Obsessive-compulsive disorder.
Anxiety and Depression Association of America. (n.d.). Obsessive-compulsive disorder (OCD).
Cleveland Clinic. (n.d.). Obsessive-compulsive disorder (OCD).
Harvard Health Publishing. (n.d.). Obsessive-compulsive disorder.
International OCD Foundation. (n.d.). About OCD.
Mayo Clinic. (n.d.). Obsessive-compulsive disorder (OCD).
National Alliance on Mental Illness. (n.d.). Obsessive-compulsive disorder.
National Institute of Mental Health. (n.d.). Obsessive-compulsive disorder.
Peace of Mind Foundation. (n.d.). What is OCD?
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