"Why Do I Keep Checking?" Understanding Obsessive Compulsive Disorder (OCD)

Most of us have had moments when we have wondered whether we locked the front door, switched off the oven or remembered to send an important email. We might go back and check once, reassure ourselves that everything is fine and then carry on with our day.

For somebody experiencing obsessive compulsive disorder, or OCD, this can feel very different.

The doubt does not necessarily disappear after checking. Instead, another thought arrives: What if I didn't check properly? What if I only think I locked the door? What if something terrible happens because I made a mistake?

Before long, something that initially seemed like a simple worry can become an exhausting cycle of doubt, anxiety and attempts to gain certainty.

OCD is also one of those conditions that is frequently misunderstood. People sometimes use the term casually to describe being tidy, organised or particular about how things are arranged. In reality, OCD can be a distressing mental health condition that has very little to do with being neat.

What Are Obsessions?

Obsessions are unwanted thoughts, images, doubts or urges that repeatedly enter someone's mind.

They can take many different forms.

Someone may repeatedly worry that they have accidentally harmed another person. They may become frightened that something is contaminated or unsafe. They might experience unwanted thoughts about subjects they find deeply upsetting or completely inconsistent with their values.

One of the most important things to understand is that having an intrusive thought does not mean somebody wants that thought to happen.

In fact, OCD often focuses on precisely the things that matter most to the person.

Someone who cares deeply about protecting their family may become preoccupied with the possibility of accidentally harming them. Someone who places great importance on behaving morally may become consumed by doubts about whether they have done something wrong.

The distress often comes precisely because the thoughts feel so inconsistent with who the person knows themselves to be.

What Are Compulsions?

When an obsession creates anxiety, people naturally look for something that will make the anxiety disappear.

This is where compulsions can develop.

A person worried about contamination may wash their hands repeatedly. Someone worried that the door is unlocked may check it again and again. Another person may repeatedly ask family members for reassurance that they have not done something wrong.

Compulsions are not always visible.

Some people repeatedly review events in their mind, silently repeat certain phrases or try to replace an unwanted thought with a "safe" one.

Whatever form they take, compulsions usually have the same purpose: to reduce anxiety or create a feeling of certainty.

Why Does Checking Make Things Worse?

This is one of the most frustrating aspects of OCD because checking usually does make someone feel better.

At least temporarily.

Imagine that you suddenly become worried that you left the front door unlocked. You return home, check it and immediately feel relieved.

Your brain has just learnt something important: When I feel uncertain, checking makes me safe.

The next time the doubt appears, the urge to check becomes even stronger.

Over time, the person may need to check several times before they feel reassured. Eventually, even repeated checking may no longer provide much certainty.

What began as an attempt to control anxiety has unintentionally strengthened it.

OCD Is Often About Certainty

People sometimes assume that the goal of treating OCD is to prove that the person's fears are irrational.

It is usually more complicated than that.

Many people with OCD already recognise that their fears are unlikely. The difficulty is tolerating the tiny possibility that they could be wrong.

"I know I probably locked the door, but what if I didn't?"

"I know my hands are probably clean, but what if they're contaminated?"

"I know I wouldn't deliberately hurt somebody, but what if that thought means something about me?"

OCD repeatedly asks for complete certainty.

Unfortunately, life rarely provides it.

Learning to live with reasonable uncertainty is therefore an important part of overcoming OCD.

Why Reassurance Doesn't Always Help

Family members understandably want to help when someone they care about is distressed.

They may repeatedly reassure them that everything is fine.

"Of course you didn't hurt anyone."

"Yes, the door is definitely locked."

"No, you don't need to wash your hands again."

This reassurance often reduces anxiety in the moment, but it can sometimes become another form of compulsion.

The person gradually becomes dependent on somebody else providing the certainty that OCD is demanding.

This can be difficult for families because helping someone with OCD does not always mean helping them feel completely reassured.

Sometimes support means helping them tolerate not knowing with absolute certainty.

OCD Is Treatable

The good news is that effective treatments for OCD are available.

One of the main psychological treatments is a form of cognitive behavioural therapy known as exposure and response prevention, usually shortened to ERP.

The basic principle involves gradually facing situations that trigger obsessive fears while resisting the compulsion that would normally follow.

For example, someone who repeatedly checks whether a door is locked might gradually practise locking it once and then leaving despite experiencing uncertainty.

Initially, this can feel uncomfortable.

Over time, however, the brain begins learning something new: anxiety can reduce without performing the compulsion and uncertainty can be tolerated without something terrible happening.

Medication, particularly certain antidepressants, can also play an important role in treating OCD and may be used alongside psychological therapy depending on the individual's circumstances.

A Final Thought

One of the reasons I think OCD is so important to understand is that people can live with it for years before recognising what is happening.

They may feel embarrassed by their thoughts or worry about what those thoughts say about them. Others simply assume that their repeated checking, reassurance seeking or mental rituals are part of their personality.

Understanding OCD changes the way we look at these experiences.

The unwanted thought is not the problem by itself. All of us experience strange, uncomfortable or unwanted thoughts from time to time.

The difficulty arises when the brain begins treating those thoughts as significant and demands certainty before allowing us to move on.

Recovery does not necessarily mean reaching a point where you never experience an intrusive thought again.

It means reaching a point where the thought no longer controls what you do next.

And for many people with OCD, learning that they do not have to answer every "What if?" can be an enormously important step towards getting their life back.

Dr James Glass
MBChB MRCPsych
Medical Director, WMI Psychiatry