Obsessive-Compulsive Disorder (OCD)
What OCD actually is
At its core, OCD is a problem of taking your own thoughts too seriously.
Everybody has strange, unwanted, intrusive thoughts. Research has shown this repeatedly: the content of intrusive thoughts in people with OCD is essentially the same as the content of intrusive thoughts in everyone else. What differs is the meaning attached to them. Most people register an odd thought, shrug, and move on. In OCD, the thought is treated as significant, as a warning, a moral event, a sign of what kind of person you are, or evidence that something must be done.
Once a thought is treated that way, it makes complete sense to act on it. And that is the second half of the problem: the things people do to make the thought go away, to feel certain again, or to prevent the feared outcome.
Obsessions and compulsions
Obsessions are recurring thoughts, images, urges, or doubts that feel intrusive and distressing. They tend to latch onto whatever you care about most, which is part of what makes them so painful.
Compulsions are what you do in response. They can be visible actions, washing, checking, redoing, arranging, seeking reassurance, confessing, but just as often they happen entirely inside your head:
mentally reviewing an event to work out what really happened
replaying a conversation to check whether you said something wrong
arguing with the thought, or trying to prove it false
mentally neutralising a "bad" thought with a "good" one
counting, praying, or repeating phrases silently
monitoring your own body, feelings, or reactions for evidence
searching online for reassurance
Alongside these sits avoidance: steering clear of the places, people, objects, words, or situations that set the thoughts off. Avoidance is quiet and it looks sensible from the inside, but it is often what does the most damage to a person's life. It is common for someone to arrive in my office having gradually given up work, friendships, travel, or time alone with their own children, one small concession at a time.
The trap is that compulsions work, briefly. Relief arrives, and the brain learns that the thought was dangerous and that the compulsion is what saved you. The next time the thought comes, it comes louder. This is why OCD tends to grow rather than settle, and why willpower and self-reassurance are not enough to shift it.
Why OCD is so often missed
OCD is one of the most misunderstood problems in mental health, and it is common for people to have carried it for years, sometimes decades, before anyone names it correctly.
There are a few reasons for that. The public image of OCD is narrow: handwashing, tidiness, light switches. Many people with OCD have never washed a thing compulsively. Where the compulsions are mental, there is nothing for anyone to see, and the person themselves may not recognise their rumination as a compulsion at all, it feels like thinking, or problem-solving, or being responsible.
Shame plays a large role too. Some of the most common obsessional themes are the ones people are least willing to say out loud: unwanted violent or sexual intrusions, blasphemous thoughts, doubts about their own sexuality or their relationship, fears of having harmed someone without realising. These themes are well documented, well understood clinically, and highly treatable, but they are frequently held in silence for years, and they are sometimes mishandled when they are finally disclosed.
It is worth stating plainly: intrusive thoughts of this kind are a symptom, not an intention. Their presence says nothing about your character or what you are likely to do.
Some of the forms OCD takes
OCD is far more varied than its reputation suggests. Presentations I work with regularly include:
contamination and illness fears, including fears of spreading harm to others
harm-related obsessions and fears of losing control
responsibility and checking, including fears of having caused an accident
taboo intrusive thoughts, sexual, violent, or religious (scrupulosity)
perfectionism and "not just right" experiences
symmetry, ordering, counting, and repeating
relationship-focused OCD
health-focused obsessions that overlap with health anxiety
magical thinking, superstition, and thought-action fusion
"purely obsessional" presentations, where the compulsions are entirely mental
The last two are areas I have researched directly. I have published on the role of magical thinking in maintaining OCD, and much of my clinical specialisation over the past decade has been in atypical and complex presentations, the ones that do not look like the textbook, and that have often not responded to previous, more generic treatment.
How OCD is treated
The good news about OCD is that we have a theoretically coherent, well-tested treatment for it. That is genuinely unusual, and it is one of the reasons I find this work so compelling.
The core of treatment is cognitive behaviour therapy incorporating Exposure and Response Prevention (ERP). Broadly, treatment involves:
Understanding your own model
We map out precisely how the cycle runs for you — the triggers, the interpretation, the compulsions (including the invisible ones), and the avoidance. Most people find this stage a relief in itself, because the problem stops looking like a personal flaw and starts looking like a mechanism.
Working on the meaning
We examine the beliefs that give the thoughts their power: inflated responsibility, the need for certainty, over-importance of thoughts, and the conviction that anxiety itself is dangerous.
Exposure and response prevention
Gradually and collaboratively, we approach what you have been avoiding while dropping the compulsions that keep the fear alive. This is always planned together, nothing is sprung on you, and you set the pace. The aim is not to grit your teeth through distress, but to learn something your OCD has insisted could never be true.
Building it into real life
Treatment gains hold when they are practised outside the session, in the situations that actually matter to you.
Measurement throughout
I administer psychometric assessments before every session, so we can see whether treatment is working rather than guess. If the data says something is not shifting, we change the approach.
Where medication is part of the picture, I am happy to work alongside your physician or psychiatrist.
Working with me
I have been fortunate to train and practise at clinics regarded in their cities, Sydney and Vancouver, as leading centres for OCD treatment, and I have specialised in complex OCD for the past 2 decades. I am a registered psychologist in British Columbia, a CACBT-certified cognitive behaviour therapist, and I have been registered at the highest level in the UK, Australia, and Iceland. I also serve on the Board Executive of the Canadian Association of Cognitive and Behavioural Therapies (2024–2027).
Therapy begins with an initial assessment of approximately 90 minutes, in which we build a detailed understanding of the problem and decide together on the best course of action. Subsequent sessions are 50 minutes. Sessions are available mostly online. However, I do face-to-face work in Vancouver and North Vancouver, and I see clients in both English and Icelandic.
Getting started
We are currently accepting new referrals. Intake appointments are posted in our online booking system as they become available, on a first-come, first-served basis.
If you would like to connect first, we offer a complimentary 15-minute compatibility call before you commit to an intake. Email admin@drfjola.com or call +1 604 449 8588.