Understanding OCD — and the Forms You Might Not Expect
When many people think of Obsessive-Compulsive Disorder (OCD), they picture the more visible symptoms: excessive handwashing, constant checking of locks, or meticulous organization. While these can certainly be part of OCD, they are far from the whole picture. OCD is a complex condition with many possible presentations, and some of them might not be what you expect.
At Heights Family Counseling, we work with clients of all ages and presentations—helping each person and their support network understand how OCD works and how to break free from its grip using Exposure and Response Prevention (ERP) therapy, the gold-standard treatment for OCD.
What OCD Really Is
OCD is defined by a cycle:
Obsessions – unwanted, intrusive thoughts, images, or urges that cause distress.
Compulsions – mental or physical acts done to neutralize or relieve that distress.
It’s not the topic of the thought that defines OCD—it’s the way the brain reacts and the behaviors that follow.
Atypical OCD: The Presentations That Might Surprise You
OCD can show up in ways that don’t fit the “cleaning and checking” stereotype. Here are some examples that can be just as impairing but often go unrecognized:
Relationship OCD (ROCD) – persistent doubts about a relationship (“Do I really love my partner?”) leading to mental checking, reassurance-seeking, or avoidance.
Moral/Scrupulosity OCD – fears about sinning, breaking religious rules, or doing something morally wrong, resulting in excessive prayer, confession, or rule-checking.
“Just Right” OCD – the need for things to feel “perfect” before moving on, whether it’s the way a sentence is worded, a shirt feels, or an object is positioned.
Harm OCD – intrusive fears of harming yourself or others, even without any desire to do so, leading to avoidance of sharp objects, driving, or being alone.
Contamination OCD Beyond Germs – fears of contamination from certain people, substances, or ideas, not just illness or dirt.
Sensorimotor OCD – hyper-awareness of bodily sensations (blinking, breathing, swallowing) and fear of never being able to stop noticing them.
Extreme Rigidity in Children – inability to tolerate changes in routine, insistence on rituals, or significant distress when plans shift.
Because these forms can look like anxiety, perfectionism, stubbornness, or even personality traits, they are often missed—especially in kids and teens.
How We Treat OCD: Exposure and Response Prevention (ERP)
At Heights Family Counseling, we use ERP therapy with children, teens, and adults. ERP helps clients face feared thoughts or situations (exposures) without performing compulsions (response prevention). Over time, the brain learns that the distress decreases naturally, without rituals.
Our ERP process includes:
Education: Helping clients and families understand OCD and the cycle that keeps it going.
Identifying Triggers: Pinpointing the situations, thoughts, or feelings that spark obsessions.
Gradual Exposure: Starting with less distressing triggers and working up to more challenging ones.
Response Prevention: Supporting clients in resisting compulsions so they can experience anxiety fading on its own.
Skill-Building: Teaching tools to handle discomfort, uncertainty, and intrusive thoughts.
Involving Support Systems
For children and teens—and for adults who have close family or caregiver involvement—we bring support systems into the process. This might mean:
Educating family members on OCD and ERP.
Coaching them on how to respond to compulsions in ways that don’t reinforce the cycle.
Coordinating strategies for home and school.
This collaboration not only empowers clients but also equips their loved ones to help maintain progress outside of sessions.
OCD is treatable, even in its less recognized forms. If you or your child are struggling with symptoms—whether they look “typical” or not—our team can help you find relief, confidence, and a return to the activities and relationships that matter most.