Is It OCD, or Is It Real? The Question You Cannot Stop Asking
Is it OCD or is it real? Nobody can answer that from a webpage, and a clinician who tried would be performing your compulsion for you. What an assessment can do is examine the whole pattern, including the invisible compulsions, and establish whether it is consistent with OCD. That is a workable question.
Sources: World Health Organization and published epidemiological reviews of obsessive-compulsive disorder prevalence; research on treatment delay in OCD; National Mental Health Survey of India, NIMHANS.
- The question "is it OCD or is it real" is the same question in every version of this, the content changes, the mechanism does not.
- Nobody can answer the content question from outside, and answering it is itself the compulsion.
- What can be examined is the whole pattern: obsessions, compulsions, time taken, and the effect on your life.
- Where reassurance gives only brief relief and has to be repeated, that may point to an obsession–compulsion cycle. On its own it establishes nothing.
- Diagnosis requires more than one feature, which is precisely why it is an assessment rather than a checklist.
- Exposure and response prevention is the first-line psychological treatment, and it is a different activity from talking it through.
- You do not need to be certain before you come. Certainty is what you are coming for, and research does not produce it.
By the time someone reaches this page they have usually been researching for months. They know the acronyms. They can define ego-dystonic. They have read the reassuring paragraph on nine different sites.
And they are still awake at three in the morning, because none of it settled anything.
I am not going to add a tenth reassuring paragraph, and I would ask you to notice that reading one is what you came here to do. When reassurance gives only brief relief and has to be repeated, that may indicate an obsession–compulsion cycle. It does not establish anything on its own, but it is a reason why a focused assessment is likely to be more use to you than further reading.
People arrive having read everything. They can quote the research better than some clinicians. What they cannot do is hold on to it for longer than about twenty minutes, and that gap, between knowing something and being settled by it, is what I want to look at rather than argue with. — Dr. Prerna Kohli, PhD & M.Phil, Psychologist, Gurugram
It Is Always the Same Question
The content varies enormously and the people who have it believe their version is uniquely terrible. It is not. Underneath, it is one question wearing different clothes.
| What people call it | The question that will not stop |
|---|---|
| SO-OCD, also searched as HOCD, sexual orientation OCD | What if I have got my own orientation wrong and have been lying to myself? |
| Harm OCD, intrusive thoughts of violence | What if I actually want to do it? What if I lose control? |
| ROCD, relationship OCD | What if I do not really love my partner and I am wasting both our lives? |
| Real event OCD, a memory replayed for years | What if what I did back then means I am actually a terrible person? |
| Scrupulosity, religious and moral OCD | What if I have blasphemed, or sinned, or am damned without knowing it? |
| Postpartum OCD | What if these thoughts about my baby mean I am dangerous to her? |
| Pure O, no visible rituals | Any of the above, with the compulsions happening silently inside your head. |
Every one of these is is it OCD, or is it real? And every one of them is maintained by exactly the same thing: the search for an answer.
Why I Will Not Answer the Content Question
I want to be direct about this rather than let you discover it after three sessions.
If you ask me whether your thought means you are dangerous, or gay, or in the wrong marriage, and I tell you no, I have just done for you what you have been doing for yourself at three in the morning for six months. It will feel enormously better. It will last a short while. And it will make the next episode worse, because I will have confirmed that the question was serious enough to need a professional answer.
That is not coldness. Supportive therapy may provide real relief, but where sessions repeatedly resolve the obsessional doubt without addressing the compulsions, the cycle underneath can remain unchanged. Treatment for OCD is compassionate throughout, it simply does not resolve the doubt on your behalf, because the resolving is the mechanism.
The moment I recognise it is when someone asks me the same question a third time in slightly different words. Not because they did not hear the first answer, they heard it, and it dissolved on contact. That is not a memory problem or a stubbornness problem. It is the mechanism of the disorder happening in front of me, and it tells me more than any questionnaire.
What Can Actually Be Established
Here is what a focused assessment examines. It is a different offer from the answer you came for, and in my experience a considerably more useful one.
A Composite Case, The Man With Forty Tabs Open
This is a composite illustration, not a real client. It is assembled from patterns common to many people I have seen; any resemblance to a specific person is unintended.
He was twenty-six, an engineer, and he began the first session by telling me he had probably wasted my time because he already knew what I was going to say. He had read all of it. He could explain the mechanism to me and very nearly did.
What he wanted, in the end, was for me to look at him properly and tell him it was OCD and not the other thing. He had asked his brother. He had asked two friends, in a roundabout way. He had asked a previous therapist, who had told him warmly and repeatedly that of course it wasn't, and he had felt wonderful for the rest of that afternoon and terrible by the next morning.
I did not answer the question. What I did instead was ask him how many times he had checked his own reaction that week, watched his own body for a response, to see what it would tell him. He knew the number. It was not a small number, and he had never once described it to anyone, because it had not occurred to him that it was part of the illness rather than a reasonable way of finding out.
He did not get the answer he came for. What the session produced instead was a description of what was actually happening, including a compulsion he had never recognised as one. In a pattern of this kind the work that follows focuses on identifying the checking, reducing the attempts to obtain certainty, and learning to leave the doubt unresolved rather than solving it again.
What Treatment Is
The first-line psychological treatment for OCD is exposure and response prevention, a form of cognitive behavioural therapy. It involves approaching what triggers the anxiety while resisting the compulsion that usually follows, so that over time you learn that uncertainty and anxiety can be tolerated without checking, confessing, researching or seeking reassurance, and that the compulsion was never the thing keeping you safe.
It is done in a graded way, agreed with you in advance, never sprung on anyone. It is uncomfortable and it works, and it is a categorically different activity from talking your worries through.
Where medication may be helpful, the psychological work is coordinated with the prescribing clinician so both parts of the plan work together. Dr. Kohli is a clinical psychologist and does not prescribe.
For the local and practical detail, clinic, fees, online availability, see OCD psychologist in Gurgaon. For the condition in general, the overview of OCD.
You will not research your way to certainty.
An assessment establishes what this actually is, what has been maintaining it, and what would change it, in one session, with someone who has seen every version of it. In-clinic in Gurgaon, or online from anywhere in the world. Sessions from ₹6,000.
- National Institute for Health and Care Excellence, Obsessive-Compulsive Disorder and Body Dysmorphic Disorder: Treatment, Clinical Guideline CG31, cognitive behavioural therapy including exposure and response prevention as a first-line psychological treatment.
- International OCD Foundation, on exposure and response prevention, and on reassurance-seeking as a compulsion.
Clinical observations are Dr. Kohli's own, drawn from over 30 years of practice. Statements about treatment reflect the guidance above. This page is information only and is not a clinical assessment or a diagnosis of any individual.
Frequently Asked Questions
How do I know if it's OCD or if the thought is true?
Why doesn't reassurance work any more?
What happens during an OCD assessment?
Can it be established in one appointment?
What if the assessment suggests it is not OCD?
What happens after the assessment?
I've already had therapy and it didn't help. Why would this be different?
Do I have to say the thought out loud?
Can this be assessed online?
How long does OCD treatment take?
What does an OCD assessment cost?
Is it confidential?
Should I stop researching?
A note before you close this tab
If you have been at this for months, you have probably noticed that every new article gives you about an hour of relief, and then it wears off and you open something else.
I am not going to tell you what that means. What I would say is that reading has now been tried thoroughly, and an assessment is the thing that has not.
It is a better use of an evening than the fortieth tab.