Answering Your Hardest OCD Questions (Therapist Q&A)

You Asked, I'm Answering

You keep asking questions in the comments.

And I keep saying "I'll answer them."

Well, today I'm actually doing it.

I went through my video from 8 months ago and pulled your real questions. The ones you're actually struggling with.

Not the easy stuff. The hard stuff.

As a licensed clinical social worker specializing in OCD treatment for over 15 years, I've heard thousands of questions. But the ones from my community hit different—because you're in the trenches right now.

Here are the questions I answered, and what you need to know.

Question: How Do I Deal with ADHD and OCD Together?

"The impulsivity from ADHD can absolutely make it harder to not respond to the thoughts that feel important in the moment. It also just generally makes my mind feel louder. Has anyone else experienced this?"

The Answer

Yes, there can definitely be a combination of ADHD and OCD.

And they complicate each other in specific ways:

• ADHD impulsivity makes it harder to resist responding to intrusive thoughts
• Your mind feels louder and more chaotic
• It's harder to pause before doing a compulsion

We try to treat whatever is interfering most in your life.

When thoughts feel important, we already know it's OCD.

So learning skills for impulsivity becomes crucial:

• Deep breathing techniques
• Meditation or mindfulness practices
• Reducing sensory input to be more present
• Creating pockets of calm throughout the day

The goal is giving yourself a better chance at responding differently to OCD instead of reacting impulsively.

Question: I Used Self-Harm as a Compulsion. Is That Normal?

"I have self-harmed as a compulsion. My thinking was if I hurt myself, it will stop me from hurting somebody else. I'm not like that now, but it was a scary time."

The Answer

This happens. And it's one of the most heartbreaking aspects of OCD.

Here's what's going on:

OCD attacks what we care about and comes up with any "solution" possible—even solutions that make no logical sense.

The brain says: "If you hurt yourself, maybe it meets the criteria of not hurting somebody else."

Even though this makes zero sense, the person thinks: "I'd rather hurt myself than somebody else."

It can be a really scary time.

What Helps

I've seen people who have been in this pattern before.

For some, medication was the only thing that kicked them out of it.

They later said: "I can't believe I was doing that."

Competing Responses

We can also use something called a competing response:

If your compulsion involves hurting yourself with your hands, fold your arms instead.

Sit with the uncertainty.

Your brain will say: "Something bad is going to happen!"

You respond: "Yeah, maybe. I don't know. Possibly. We'll see."

Cool. Awesome. Sweet.

Until the brain finally says: "Okay, let it go. I won't make you do this. At least for now."

You're sitting with the discomfort instead of giving in to the compulsion.

Question: How Do I Deal with Pure O?

"Please make a video that talks about pure O. Where there's no compulsions happening physically and all day long it feels like there's just this feeling of doom over us."

The Answer

Pure O (pure obsessional OCD) can feel super tricky.

Your brain is just going, going, going all day.

There are no visible compulsions—no hand washing, no checking locks.

But here's the thing: the compulsions are still there. They're just mental.

Mental Compulsions Look Like:

• Pushing thoughts away
• Trying to "make sense" of the thought
• Mental reviewing or ruminating
• Reassuring yourself mentally
• Sometimes subtle physical things like a head shake

Treatment Works the Same

We use Exposure and Response Prevention (ERP):

1. Engage with the things that cause thoughts in your brain
2. Watch triggering videos, write exposure scripts, whatever creates anxiety
3. Respond differently to the thoughts—don't avoid, don't push away
4. Repeat over and over

The goal is teaching your brain that these thoughts don't need special handling.

Question: How Long Will Anxiety Last with ERP?

"I have pure O as well. This morning I will start ruminating about things that happened in the past and it makes me worried—how long will this feeling of anxiety stay if we do ERP?"

The Answer

Here's the honest truth: We don't figure that out.

Anxiety might stay forever.

It might stay for a day.

It could stay for a few minutes.

But we're willing to have it just be there if it wants to be there.

Cool. If you're feeling anxious? Cool.

"Hey, I'm still feeling it!"

"Yay, this is so awesome. Sweet. Sweet."

We want to teach the brain that anxiety means nothing unless we give it power.

The moment you start tracking "how long will this last," you're turning anxiety into the problem that needs solving.

Instead, we practice: "Anxiety can stay as long as it wants. I'm living my life either way."

Question: What About Thought-Action Fusion and Religious OCD?

"As a small child, I was taught verbatim that anything you think, say, or do that displeases God is a sin. This sounds a lot like thought-action fusion."

The Answer

This is a huge issue for people with religious OCD (scrupulosity).

Thought-action fusion is the belief that having a thought is the same as doing the action.

Here's my question that exposes the flaw:

Why does this only apply to negative things?

If thinking something makes it true, why doesn't thinking positive things change the world?

You could think positively about ending world hunger over and over and over.

But that won't actually end world hunger.

You can have a good positive attitude, but there's a lot of action that comes with actual change.

Action Is What Matters

You can have blasphemous thoughts that are intrusive and unwanted.

But action is what really matters.

What are you doing about the thought?

• I had a lustful thought—am I acting on it or just having a thought?
• I had a violent thought—am I planning violence or just experiencing an intrusive image?
• I had a blasphemous thought—am I intentionally being disrespectful or is my brain throwing unwanted content at me?

OCD loves for people to think that just because you have the thought means it's true, it's accurate, you're a bad person, you're sinning.

That's not true. It's a lie.

That's why we do this treatment—to teach our brain: "You're a liar, man."

So when my brain says I'm sinning, I respond: "Cool. I'm sinning. Sweet. Awesome. Thanks for that thought. You're welcome to keep coming back if you want."

I just don't care about it anymore.

Question: What If My Fear From Exposure Therapy Actually Happened?

"I tried exposure therapy. Then one of my fears actually happened. So now I'm scared to try exposure therapy again."

The Answer

I'm curious what fear happened.

But here's the truth: Sometimes fears do happen.

It's absolutely accurate.

• Someone worried about hitting a pedestrian might actually hit one someday
• Someone with emetophobia (fear of vomiting) might actually throw up
• Someone worried about saying something embarrassing might actually say something awkward

These are outliers, but they're real.

But Here's What People Miss

People look at these big outliers and think: "So you're saying I could actually harm someone? I could actually be blasphemous?"

No. That's not what it means.

It means you're human. We all make mistakes. Things happen.

Let's keep living life.

And if a problem happens, we keep going forward. We problem-solve when the time comes.

Not "just in case." Not endless prevention.

You Can Still Do Exposures

If the fear actually happens and it's still a fear, you can actually still do exposures with it.

Maybe it happens again. Maybe not.

But either way, that's my only choice—because if I don't do treatment, I'm going to keep feeling anxious about it.

The Best Strategy: Separate Yourself From OCD

One of my favorite questions led to this advice:

"I'm mostly pure O. How can I deal with the fear, disgust, and anger that it causes?"

The Answer: Separation

Let's separate OCD from you.

You're over here. OCD is over there.

The guilt, the shame, the disgust, the anger? That's OCD talking.

You? You're you.

Give OCD a Name

If it helps, give it a name:

• Stella
• Jimmy
• Bully Brain
• Whatever ridiculous name you want

Separate it and say: "These feelings I'm feeling that don't belong? That's OCD. I'm over here."

So what am I going to do with my life?

• I'm going to this event
• I'm going to work
• I'm going to drive my car
• I'm going to hang out with my kids

Have the intrusive thoughts AND go cook dinner.

Have the intrusive thoughts AND go on a date.

That's where life belongs.

The Reminder Everyone Needs

It doesn't matter what OCD theme you have:

• Harm OCD
• Pure O
• Religious OCD
• Contamination OCD
• Relationship OCD
• Real event OCD

The treatment absolutely works.

Exposure and Response Prevention.

You just have to trust it.

It works. It just has to.

Keep asking questions. Keep doing the work. Keep living your life.

Nathan Peterson, LCSW
OCD and Anxiety Specialist
Creator of "OCD and Anxiety" YouTube Channel
Developer of Master Your OCD Online Course