As many people are aware, those with obsessive-compulsive disorder experience disturbing obsessions of all sorts, and they perform compulsions (mental and/or physical) to try to keep these obsessions from happening. While these compulsions might temporarily relieve the anxiety of those with OCD, in the long run they only serve to strengthen the disorder, and a vicious cycle ensues. It is important to note that people with OCD typically realize that performing their compulsions makes no sense, but they feel compelled to engage in them anyway. Just in case. To be certain.

Aha. Certainty. This is the foundation of OCD — what it is based on. Those with obsessive-compulsive disease have this need for certainty and total control over their lives. The ironic thing is this elusive quest for control leads to just the opposite — loss of control over one’s life.

Let’s look at an example involving hand-washing, which is a common compulsion for those with OCD. In this case, “Kathy” is obsessed about getting deathly sick and spreading illness to her children. She is paying for her groceries at the supermarket and watches as the cashier rubs her runny nose with her hand and then hands Kathy her change, touching Kathy’s hand in the process.

This event triggers Kathy’s obsession and her anxiety is sky high. She goes home and washes her hands thoroughly. For most of us, this would be the end of the story. But for Kathy, who has OCD, it is not enough. She doubts she has washed off all the germs, and feels compelled to keep washing her hands for longer periods of time. They become raw and might even bleed, but the vicious cycle of OCD has begun. Kathy’s actions were meant to give her control over her life (stop the spreading of germs) while in reality she has lost control (can’t leave the house because of fear and constant urge to wash her hands).

The good news is that OCD is treatable, and the evidence-based therapy for OCD as recommended by the American Psychological Association (APA) is a Cognitive Behavioral Therapy (CBT) known as exposure and response prevention (ERP) therapy. In a nutshell, those with OCD are required to face their fears. In Kathy’s case, she would gradually be exposed to germs in various ways and then refrain from engaging in any compulsions (for example, no handwashing). While this therapy can be anxiety-provoking, the payoff is huge, as the person with OCD learns to live with the uncertainty of life.

The bad news is that, while the premise of ERP therapy is simple, it can often get quite complicated and some therapists who are not properly trained in ERP therapy make the mistake of reassuring their patients that “nothing bad will happen.” Aside from being impossible to guarantee, this statement is counter-productive as one of the main goals of ERP therapy is to learn to live with uncertainty.

Is it likely Kathy will spread deadly germs to her children? Probably not.

Is it possible? Well, maybe.

The future is uncertain.

Indeed, there are cases where the person with OCD’s worst fears come true. That’s life. It is filled with uncertainty, and there is no way to change that fact. Good things happen and bad things happen and we can never be sure, from one day to the next, what awaits us. Whether we suffer from OCD or not, there are bound to be challenges and surprises for all of us, and we need to be able to cope with them.

The goal of ERP therapy is not to prove everything will be fine if you don’t engage in compulsions, but rather to learn that you can stand up to fear and anxiety and not have it control you.

And when the bad things do inevitably happen? Those with OCD who have successfully undergone treatment usually cope with these times as well as those who do not have OCD.