OCD: The Many Ways It Lives in Secret
When most people hear “OCD,” they think of colour-coded Tupperware drawers or frequent hand-washing. While this can be the case, Obsessive Compulsive Disorder (OCD) is often far more complex, misunderstood, and debilitating than you may know.
OCD is a condition where unwanted thoughts (obsessions) create intense anxiety, and the person feels driven to perform certain actions or mental rituals (compulsions) to relieve that distress. These patterns can be completely invisible from the outside, which is why so many OCDers go unnoticed or misdiagnosed for years.
For those of you who are a little more on the nerdy side and would like a dose of science with your blog and morning coffee, read the next paragraph. If you’re just here to get to the point, scroll down.
OCD is increasingly understood as involving a neurobiological imbalance in something called the cortico-basal ganglia-thalamo-cortical circuit (talk about a double-barrel surname!)(1,2). This is essentially a loop in the brain that helps regulate thoughts and behaviours. In OCD, one pathway in the basal ganglia (the direct pathway)(3), becomes overactive and really excited, which means the brain is sending too many “go” signals. This makes it hard to inhibit or switch off certain thoughts or behaviours, which is why someone might feel stuck replaying thoughts or repeating actions, even when they don’t want to. OCDers also have other, less direct pathways that are underactive, which usually act like a red or yellow light, helping pause, stop, or filter out unnecessary or unhelpful actions. This imbalance can make it hard to shift focus, suppress intrusive thoughts, or stop compulsive behaviours, contributing to the core challenges of OCD: cognitive inflexibility, intrusive obsessions, and repetitive compulsions.
Below are just some of the ways OCD can show up in everyday life - often quietly, privately, and with deep emotional exhaustion attached.
Mental Rituals
Not all compulsions are visible. Many happen entirely inside the mind.
People might:
Repeat a phrase or count in their head until it feels “just right.”
Mentally review conversations to check they didn’t offend anyone.
Silently pray or repeat words to neutralise a “bad thought.”
Try to “erase” an intrusive image by replacing it with a “good” one.
These mental loops can be just as distressing as physical compulsions, but they’re often dismissed because no one else can see them.
Checking and Reassurance
The urge to be sure can dominate someone’s day.
It might look like:
Re-reading an email dozens of times before sending.
Asking friends or partners, “Are you sure you’re not mad at me?”
Checking locks, appliances, or even your own pulse repeatedly.
Scrolling through texts to make sure you didn’t say something wrong.
Underneath it all is a desperate need for certainty and safety - not just what looks like perfectionism.
Ordering and “Just Right” Compulsions
Sometimes it’s not about fear of harm, it’s about the unbearable feeling that something is off.
People might:
Arrange objects symmetrically until balance is achieved.
Touch or tap things a specific number of times.
Restart sentences, emails, or tasks until they feel “right.”
Avoid stepping on certain cracks or colours on the floor.
This “just not right” sensation can be physically uncomfortable, like an itch in the brain that won’t go away.
Harm or Contamination Obsessions (Beyond “Germs”)
Yes, some OCD experiences involve contamination fears, but not always about dirt or illness.
They can include:
Fear of accidentally harming someone (“What if I ran someone over?”).
Avoiding knives or sharp objects in case of losing control.
Worrying you’ll shout something offensive or violent.
Replaying taboo or distressing intrusive thoughts you never want to act on.
These thoughts don’t mean someone is dangerous - they mean they care deeply about not causing harm.
Moral, Religious, or Existential Obsessions
OCD can latch onto values and beliefs, turning them into a source of constant doubt:
Obsessing over being a “good person.”
Feeling guilty for thoughts you didn’t act on.
Repeatedly confessing or apologising for imagined wrongs.
Questioning if you truly believe in your faith—or if you believe “correctly.”
Spiralling over the meaning of life or whether reality is real.
This form of OCD is sometimes called “Pure-O” (when it’s mostly happening in the mind and isn’t as obvious), but the compulsions are still there - they’re just mental.
Relationship and Identity OCD
Even love and identity aren’t safe from OCD’s grip.
You might find yourself:
Analysing your feelings constantly (“Do I really love them?”).
Obsessing over your sexual orientation or gender identity.
Seeking certainty that you’re with the “right” person.
Monitoring body sensations to “test” your attraction.
It’s not about doubt in the relationship itself - it’s about needing 100% certainty in a world where that’s impossible.
Body, Health, and Sensory Compulsions
For some, OCD centres on the body and internal sensations:
Checking for signs of illness or imperfection.
Googling symptoms again and again for reassurance.
Becoming hyper-aware of sensations like breathing, blinking, or heartbeat.
Avoiding doctors out of fear they’ll confirm something terrible.
It’s not attention-seeking, it’s a brain stuck in “threat detection” mode.
Avoidance Behaviours
When triggers become too distressing, avoidance becomes a strategy of survival:
Avoiding places, people, or objects that spark intrusive thoughts.
Putting off tasks until it “feels safe.”
Refusing to write certain words or numbers.
Skipping songs, shows, or media that might trigger a “bad” thought.
Avoidance can provide temporary relief, but it often strengthens the OCD cycle over time.
The Internal Experience
Perhaps the hardest part?
So much of OCD happens in silence:
Feeling taunted by your own brain.
Knowing a fear is irrational, but being unable to stop the loop.
Spending hours in invisible mental review.
Feeling drained from hiding compulsions to appear “normal.”
OCD is not a quirk or personality trait. It’s a condition that deserves understanding, compassion, and proper care. Next time you hear someone joke about being “so OCD” because they had to straighten a picture or prefer to be tidy, lovingly and gently call them out for us, will you?
A Neuroaffirming Perspective
At The Psych Hive, we approach OCD through a neuroaffirming lens - one that recognises these experiences as part of how the brain tries to find safety, not as personal failures. Recovery isn’t about “stopping the thoughts.” It’s about learning to relate to them differently, reduce fear responses, and create a life built around safety, not certainty.
If this sounds familiar, know you’re not alone - and that support is available. Understanding is the first step.
If you would like to learn more about OCD, feel free to attend our upcoming OCD Chats Webinar - free and for the community, run by myself (Brianna Thomas) and my colleague Chloe Hulse. 29th October 2025, 6pm Sydney time. Sign up here: www.trybooking.com/DFAPS.
References:
Bijanki KR, Pathak YJ, Najera RA, et alDefining functional brain networks underlying obsessive–compulsive disorder (OCD) using treatment-induced neuroimaging changes: a systematic review of the literatureJ ournal of Neurology, Neurosurgery & Psychiatry 2021;92:776-786.
Swerdlow, N. R. (1995). Serotonin, obsessive compulsive disorder and the basal ganglia. International Review of Psychiatry, 7(1), 115–129. https://doi.org/10.3109/09540269509022980
Macpherson, T. and Hikida, T., 2019. Role of basal ganglia neurocircuitry in the pathology of psychiatric disorders. Psychiatry and clinical neurosciences, 73(6), pp.289-301.
