Living in Terror: The Reality of OCD

There’s the popular joke “I’m so OCD” often tossed around when someone keeps their car spotless or alphabetizes their spice rack. But that joke minimizes the reality of what people with actual Obsessive Compulsive Disorder endure.

Yes, OCD can involve cleanliness or organization. But it's rarely that simple, or that tidy. OCD often goes far beyond avoiding handshakes or color-coding your calendar. It can look like hours of mental anguish, intrusive thoughts that won’t stop, and compulsive behaviors that feel impossible to control.

Let’s break it down in a way that’s not overly clinical because if you truly understood what it looks and feels like, that “I’m so OCD” joke might not be as funny.

So… what is OCD, really?

OCD is a debilitating mental health disorder that can affect anyone, regardless of age, gender, or lifestyle. How it shows up can be just as diverse. It’s made up of two parts: obsessions and compulsions.

Obsessions are unwanted, intrusive thoughts, images, or urges that feel disturbing or scary. They show up out of nowhere. These aren’t everyday worries. They’re often irrational, intensely distressing, and they feel impossible to shake. These thoughts can be horrifying and create a nightmare that plays out entirely inside a person’s mind, usually unnoticed by others.

I know this because not only do I specialize in treating OCD as a clinician, but it’s also something I’ve lived with for as long as I can remember. Even people closest to me, reduce my OCD to being organized, a "germaphobe", or just a little “quirky.” It’s not their fault. OCD is incredibly hard to understand if you haven’t experienced it.

That confusion is compounded by deep embarrassment and guilt. Many people with OCD live in silent torment, terrified and ashamed to share what is really happening in their minds. This fear keeps many from seeking professional help. They worry that their thoughts might get them arrested, locked away, or harshly judged by a therapist or doctor. But in reality, those thoughts are symptoms of the disorder, not reflections of who they are.

Think:

“I had a bad thought about someone. Did I just curse them? Will they die now?”

“What if I suddenly drive my car off this bridge?”

“What if the food I cooked was expired and it killed my entire family?”

Even when the person knows these thoughts don’t make sense, they still feel terrifyingly real.

Compulsions are the things someone does to try to neutralize or “undo” the obsession. Sometimes they’re visible, like washing hands repeatedly, checking locks, or re-reading things. Other times, they’re entirely mental, like repeating prayers in their head, going over events to "make sure" nothing bad happened, or avoiding certain people or places altogether.

The compulsions bring a temporary sense of relief… but the thoughts always come back. And over time, the cycle becomes exhausting to the point that the compulsions no longer neutralize the thoughts, yet the person is still compelled to do them.  

One of the reasons OCD is so misunderstood is because it wears many masks. People often assume it’s all about hand-washing or lining things up, but OCD can latch onto any thought that feels taboo, terrifying, or “off.” And once it does, it doesn’t let go easily.

Let’s break down some common subtypes of OCD. Keep in mind, OCD isn’t always neatly categorized. A person can experience more than one type, and symptoms can shift over time. But understanding these subtypes helps us see just how complex and often misunderstood this disorder really is.

Some Common OCD Subtypes

Harm OCD

This involves intrusive thoughts or mental images of accidentally or intentionally hurting someone—often a loved one.

Examples:

“What if I lose control and stab someone with this kitchen knife?”

“Did I just hit someone with my car and not realize it?”

Even when the person has no history of violence, the fear can feel overwhelming and paralyzing.

Relationship OCD (ROCD)

People with ROCD obsess over their relationships, romantic or otherwise, and seek constant certainty about their feelings or their partner’s.

Examples:

“What if I don’t really love my partner?”

“Did I say something wrong in that conversation and ruin everything?”

Contamination OCD

This isn’t just about germs. It can also include fear of chemicals, illness, bodily fluids, or even spiritual “contamination.”

Examples:

Avoiding certain people or places for fear of being “contaminated”

Excessive cleaning, hand-washing, or discarding belongings that feel tainted 

Sexual OCD

This subtype involves intrusive, unwanted sexual thoughts that go completely against the person’s values, identity, or sense of safety. These thoughts can be extremely disturbing and are almost always the opposite of what the person wants or finds arousing.

Examples:

Fear of being a pedophile despite never having acted inappropriately

Graphic sexual images or urges that appear at random, causing intense shame

Hoarding OCD

Though hoarding has its own classification now, it can still exist within OCD, especially when driven by intrusive thoughts or perfectionism.

Examples:

Keeping items to avoid the fear of making the “wrong” decision

Holding onto things because they feel emotionally significant or essential

“Just Right” / Perfectionism OCD

This subtype is about needing things to feel exactly right. It might involve symmetry, order, or mental “clicks” that need to happen before someone can move on.

Examples:

Rewriting emails over and over to avoid mistakes

Spending hours arranging or touching objects until the discomfort fades

Pure O (Primarily Obsessional OCD)

People with this form experience mostly mental compulsions rather than outward rituals. They may replay events, analyze thoughts, or try to neutralize obsessions internally.

Examples:

Mentally repeating phrases to counteract a “bad” thought

Replaying memories to “make sure” nothing inappropriate or harmful happened

Religious or Scrupulosity OCD

This subtype focuses on morality or religious observance. The obsessions may involve fear of sinning, blasphemous thoughts, or not being “pure enough.” The compulsions often include repeating prayers, seeking reassurance from spiritual leaders, or avoiding anything that feels morally “gray.”

And for the purpose of helping others alleviate the shame and guilt around these thoughts, I’ll share one of mine.

I started experiencing internal signs of religious OCD in elementary school. Around that time I began learning about the Bible. I took the teachings very literally back then and became deeply afraid of going to hell. I remember having a Bible in my room and refusing to let any other books (or anything at all) sit on top of it. If I had a stack of ten books, the Bible had to be on top, anything else felt disrespectful. Other times, if I had a bible on a shelf, I couldn't allow other books to touch it.

That particular compulsion wasn’t especially disruptive or time-consuming, but the fear of damnation was another story.

Trying not to go to hell became an obsession. Because if you take the Bible literally, it’s hard not to come to the conclusion that we’re all doomed. As a child, without the critical thinking skills I have now, I began to develop what would become a lifelong struggle: an obsession with seeking redemption for simply being an imperfect human.

By high school, I was highly religious. and around puberty I started having inappropriate sexual thoughts about the pastor during church service. It did not matter what church I went to, I still had the thoughts.

I would turn red. My body would betray me by activating signs of arousal despite being utterly horrified and disgusted by my own thoughts. I’d sit through the entire service believing I was most certainly going to hell.

It didn’t matter if the pastor was literally the last person I would find attractive in the real world. 

As soon as I left the church, the thoughts would stop but I would still be left with the guilt and shame which caused me to feel the need to go to church more. I went to a Wednesday night youth group in high school. I even led the Bible club. I carried my Bible from class to class. I went to Saturday night service, then back again on Sunday.

My family thought I was just a goodie two-shoes, when really, I was on a covert mission to save myself from eternal damnation for my vulgarity.

The best part? I just subjected myself to more and more of the thoughts every time I entered a church. Can you see how this would be like living in complete torment?

I’ve done decades of work. And I still get those thoughts in church to this day. The difference now? They don’t always come. And when they do, they don’t stay long (usually... I did have a super hot pastor once). And as you can probably tell from my tone, I no longer feel like I’m going to hell over it. I’ve done way worse things I’ll probably go to hell for (kidding... mostly).

These are just a few of the subtypes I’ve either experienced personally or worked with in my clinical practice. There are many more, and occasionally, a new one will cross my path that I haven’t heard before. But honestly, it doesn’t really matter. The obsession, the compulsion, or both will share the same foundational structure: a deeply rooted anxiety disorder that consumes more than an hour a day (usually much more or most of the day and can also show up during sleep), impairs social or occupational functioning, and causes significant distress.

The presentation often changes throughout a person’s life. There’s often an ebb and flow. Times of increased stress, major life changes, or even seemingly random triggers can reignite symptoms after a period of calm. The subtype may shift entirely. Someone who once had religious obsessions may later develop identity-based or magical thinking OCD. Some individuals may struggle more with the obsessive aspect at one point, then transition into more visible compulsions.

For a more detailed list of OCD subtypes and how they can show up, the International OCD Foundation (IOCDF) offers an excellent resource:

👉 https://iocdf.org/about-ocd/types/

The good news is that help is available! Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), Transcranial Magnetic Stimulation (TMS), and even legal use of Ketamine Therapy have all shown promise in reducing the intensity and severity of symptoms.

Personally, I still have random bursts of symptoms. Certain obsessions or compulsions have stuck around but are not usually too impactful on my life. Most of the time, people write them off as my "quirks" and major flare-ups are rare.

I’ve also walked beside clients through their own OCD journeys, witnessing the same ebb and flow, along with a steady decrease in both frequency and intensity. That’s the goal: progress, not perfection.

My "religious" beliefs have evolved into a more "spiritual" direction, that feels more loving and less judgmental But I still go to church once in a blue moon. And despite the occasional intrusive thought, I leave feeling good. Uplifted, even.

Moral of the story? You can absolutely have a full, high-functioning life with joy, safety, love, and purpose, despite living with OCD.

If you think you might be struggling with OCD but feel afraid to seek help, please know that you are safe to do so. A therapist will not judge you, or even be shocked by the things that you share. We understand this disorder and the many ways it can show up. You are not alone, and with the right support, you can learn tools that truly help you to feel better.

Wishing you peace on your journey! 

and if any of you are going to hell, 

well... 

I’ll see you there ;-)

Cristina Chinchilla, LCSW