By Carol Goh
Ready to get help for OCD? Book an appointment, contact us, or WhatsApp us for a quicker response. Related reads: Psychotherapy, EMDR.
Obsessive–Compulsive Disorder (OCD) is known as the doubting disease. People suffering from OCD are always uncertain about themselves in their daily lives, and it causes great pain to their functioning. Because of the constant need for assurance, they feel the urge to check and re-do activities to seek certainty—yet end up more unsure and needing to re-check or re-do the same activity umpteen times.
In the process of checking, fear and anxiety build up and affect emotions and clarity of thoughts. This forms a vicious cycle, tormenting sufferers in a constant battle of the mind.
Symptoms of OCD
OCD can manifest in many forms:
- Checking stoves, locks, alarm clocks, etc.
- Washing hands many times
- Taking hours to bathe
- Counting—the need to do things a specific number of times, such as open and close a door a set number of times
- Hoarding—keeping things that are no longer needed or useful
- Need for symmetry—arranging things in a particular order
- Having blasphemous thoughts about God
- Having thoughts that might harm self or someone else
- Fearful of dirt, germs, harm—especially heightened during COVID-19
People with OCD often feel a great sense of responsibility to:
- Prevent harm or something bad happening to themselves or others
- Make amends if they think something bad might have already happened as a result of their thoughts or actions
OCD sufferers often experience thought–action fusion, fearing that an unpleasant or scary thought means it has happened or could make it happen.
For people with checking OCD (such as locking the door), the “what if I forgot?” thought creeps in. Doubt triggers another check, then another—leaving them emotionally exhausted. In more serious cases, this may lead to anxiety and panic attacks.
Compulsions
Because of obsessions, OCD sufferers set up rituals or compulsions they believe will neutralise their negative thoughts. These “safety-seeking” behaviours provide short-term relief and follow self-made rules to ward off perceived danger. Unfortunately, the relief is temporary and counter-productive, and the rituals often worsen over time.
Why anxiety and doubt spiral (the brain science)
The main part of the brain that sets off body sensations during anxiety is the amygdala.
Neuroimaging research (Shin & Liberzon, 2010) reports heightened amygdala activation in response to anxiety. The amygdala is always on the lookout for potential harm. When activated, it sets off the fear alarm to prepare the body to fight or flight.
The amygdala reacts very fast and can bypass the cortex (the centre of logic). Because of this wiring, it’s hard to use reason alone to calm the mind and body. You may realise that your anxiety rarely makes sense to your cortex—and you can’t just “reason it away.”
In repeated-checking OCD, lack of confidence in memory or action contributes to constant fear. Once fear is triggered, the amygdala activates, doubt spirals, and the cycle repeats so quickly it becomes autopilot, leaving you drained.
OCD sufferers are constantly gripped by uncertainty. The amygdala is on hyper-alert and can be triggered by the slightest cue. Since perfect certainty in life (e.g., “guaranteed promotion,” “guaranteed distinction”) is impossible, many sufferers also develop broader anxiety problems.
Prevalence of OCD in Singapore
A Singapore Mental Health Study (2016) among 6,126 residents aged 18+ found a lifetime prevalence of OCD of 3.6% (Subramaniam, 2020).
Another study noted the average gap between onset and treatment was nine years. About 20–30% make significant improvement with treatment, 40–50% make moderate improvement, and 20–40% remain ill despite treatment. One-third of OCD patients develop depression, a risk factor for suicide (Ng, 2011).
Early treatment is strongly recommended. Outcomes improve when intervention starts sooner.
Psychotherapy intervention for OCD
Medication alone is often insufficient to change ingrained thought patterns and beliefs (Lim, 2012). Psychotherapy helps you learn new responses to obsessions and disarm compulsions.
Facing your fears gradually and safely is key to recovery. There is no single method for everyone; effective treatment depends on careful assessment of your fears, history, and beliefs.
Evidence-based techniques we use:
- Exposure and Response Prevention (ERP) — systematic exposure while not performing compulsions
- Cognitive Behavioral Therapy (CBT) — align thoughts, beliefs, and behaviours; build uncertainty tolerance
- EMDR — reduce high anxiety spikes that fuel obsessions and checking urges. See EMDR
- Mindfulness — cultivate present-moment awareness to interrupt autopilot loops and lower arousal
- Visualisation & self-calming — quick skills for urges and spikes
During treatment, you first learn to accept your condition and the emotions that come with it (especially anxiety). Acceptance reduces anxiety’s power over you—feel the fear and proceed anyway, and the fear response weakens.
Once anxiety is more controlled, we layer in ERP and CBT to help you break free from rituals and compulsions. Mindfulness has shown long-term benefits for residual OCD symptoms (Cludius et al., 2020), and exposure methods help desensitise feared situations (Daflos & Whittal, 2012).
Want to understand the broader approach? See Psychotherapy for how we tailor modalities, and how it pairs with skills training.
Getting started
There is no shortcut with OCD work—it takes patience and persistence, and treatment can last months. But you don’t have to do it alone, and progress is absolutely possible.
- Book an appointment or contact us
- Prefer texting? WhatsApp us
Your life can be renewed.
Book recommendations
- Bring Me to Light: A Story of OCD — Alison Dotson
- Brain Lock — Jeffrey Schwartz
- Break Free from OCD — Fiona Challacombe
- Rewind, Replay, Repeat — Jeff Bell
- Stopping the Noise in Your Head — Reid Wilson
References
Cludius, B., Landmann, S., Rose, N., & Moritz, S. (2020). Long-term effects of mindfulness-based cognitive therapy in patients with obsessive-compulsive disorder and residual symptoms after cognitive behavioral therapy: Twelve-month follow-up of a randomized controlled trial. Psychiatry Research, 291.
Daflos, S., & Whittal, M. (2012). Exposure Therapy in OCD: Is There a Need for Adding Cognitive Elements?
Lim, L. (2012). Freedom From Fear: Overcoming Anxiety Disorders. Armour Publishing.
Ng, J. Y. (2011). ‘I am not mad.’ Most people here with mental illnesses leave it late to seek treatment: survey. Today, Nov 19.
Subramaniam, M., et al. (2020). Obsessive-Compulsive Disorder in Singapore: Prevalence, Comorbidity, Quality of Life and Social Support. Annals Academy of Medicine, Singapore, 49(1), 15–25.
Shin, L. M., & Liberzon, I. (2010). The Neurocircuitry of Fear, Stress, and Anxiety Disorders. Neuropsychopharmacology, 35, 169–191.
The information in this article is for educational purposes and isn’t a substitute for professional advice, diagnosis, or treatment.
