A conversation with a person with OCD (with David Adam)

Dec 10, 2025 1h 17m 15 insights Episode Page ↗
David Adam, author and journalist, discusses his journey with OCD, differentiating it from OCPD and psychosis. He explains how obsessions and compulsions reinforce each other, the role of ego-dystonic thoughts, and the effectiveness of Exposure and Response Prevention (ERP) and SSRIs in managing the condition.
Actionable Insights

1. Seek Professional Help for OCD

If you suspect you have OCD, seek professional medical help because it is a serious psychiatric condition that requires treatment and will not go away on its own. Most people who receive treatment experience significant improvement.

2. Break Obsession-Compulsion Cycle (ERP)

To overcome OCD, you must stop performing compulsions when intrusive thoughts occur, as this is the only thing you can control and it prevents the reinforcement of the thought-behavior loop. This allows anxiety to naturally decay, reducing the frequency and intensity of intrusive thoughts over time.

3. Recognize Intrusive Thoughts as Normal

Understand that most people experience weird, random, and often distressing intrusive thoughts; learning this helps normalize the experience and shifts focus from the thought content to how one responds to it. This realization can make you feel more normal and empower you to address how you process these thoughts.

4. Avoid Accommodating Compulsions

If a loved one has OCD, avoid accommodating their compulsions (e.g., checking a door for them) because this inadvertently reinforces the obsession and feeds the cycle. While it may seem helpful in the short term, it encourages the intrusive thoughts to return.

5. Be Cautious with Reassurance

When a loved one shares an obsession, avoid directly reassuring them about the content of the thought, as this acts as a compulsion and makes the thought more likely to return. Instead, validate their feeling of having weird thoughts to build connection without reinforcing the OCD cycle.

6. Listen and Empathize with Sufferers

Offer a listening ear and try to understand the experience of someone with OCD, as this provides comfort and addresses the secondary pain of isolation and secrecy. This helps them feel less weird and more connected, especially since they may be sharing something for the first time.

7. Don’t Wait for OCD to Go Away

Understand that OCD is a condition that does not typically resolve on its own; waiting for it to disappear will likely lead to prolonged suffering. Active treatment is necessary for improvement.

8. Consider SSRIs for Treatment

SSRIs can be an effective component of OCD treatment, often at higher doses than for depression, and may be taken long-term to maintain remission. The speaker continues to take them daily as “what gets you well, keeps you well.”

9. Understand Thought-Action Fusion

Be aware of the psychological pattern of “thought-action fusion,” which is the belief that thinking something is equivalent to doing it, as this can make individuals more susceptible to developing OCD. Recognizing this pattern can help challenge the underlying belief.

10. Understand Inflated Responsibility

Recognize that an “inflated sense of responsibility” for potential negative outcomes can contribute significantly to OCD behaviors. Individuals with this trait feel compelled to prevent unlikely harms, even if they are not truly responsible.

11. Recognize “Zero-Risk” Striving

Understand that OCD often involves an intense desire for “zero risk,” even when the actual risk is infinitesimally small, leading to endless checking and compulsions. This striving for absolute certainty is impossible to achieve and fuels the compulsive cycle.

12. Recognize Impact of Repeated Checking

Be aware that repeatedly checking something can paradoxically degrade memory confidence and make it harder to remember if the action was performed. This phenomenon contributes to the cycle of doubt and further checking in OCD.

13. Distinguish OCD from OCPD

Understand that OCD is characterized by ego-dystonic, distressing thoughts and compulsions performed to relieve anxiety, whereas OCPD involves ego-syntonic perfectionism and a desire for order. This distinction is crucial for correct diagnosis and treatment.

14. Distinguish OCD from Psychosis

Recognize that OCD involves awareness of the irrationality of one’s thoughts and resistance to them, unlike psychosis where delusions are perceived as real and not resisted. This “intact reality testing” is a key clinical marker.

15. Maintain Medication for Remission

If prescribed SSRIs for OCD, continue taking them as directed by a psychiatrist, even if symptoms are managed, to prevent relapse. The speaker takes a high dose daily and finds it helps maintain his recovery.