[Author's note: this post is the short version meant to provide quick, actionable advice for treating OCD. The narrative version is longer but better, in my opinion.]
Obsessive Compulsive Disorder (OCD)
OCD is an anxiety disorder that feeds on uncertainty. It affects 1% of people worldwide, and the World Health Organization ranks OCD among the top 10 most disabling illnesses.
Everyone feels uncertain from time to time, but people with OCD struggle to accept any amount of uncertainty for specific fears they have.
As an example, normal people wash their hands only once and feel a sense of satisfaction that they’ve effectively cleaned the germs off their hands. Someone with OCD, however, may not feel that sense of satisfaction with washing their hands just once, or even twice in a row. What if only 99.99% of germs are killed? And what if the leftover 0.01% of germs infects them and poisons them and rots their organs away and…and…OH GOD, SPREAD TO OTHER PEOPLE AND KILL THEIR FAMILY AND START THE NEXT GLOBAL PANDEMIC!!! So to avoid this terrible thought, someone with OCD might wash their hands 23 times in a row—to the point of rubbing their skin so much that it bleeds—in order to achieve that satisfied feeling of being clean.
This is an example of what’s known as Contamination OCD, a common subtype of the disorder. While I’ve never been a compulsive hand washer, at 7 years old I was mockingly referred to as “the shoe nazi” by my family. Anytime someone wore shoes in the house, I felt compelled to sweep everywhere they had walked. Because my family wasn’t, and still isn’t, educated on OCD, they just thought it was a weird childish quirk. Little did they know that there was a monster inside of me ordering me to clean because dirt felt dangerous. So when my mom decided to break me of my cleaning compulsion, by putting shoes on my feet and dragging my kicking legs across the floor while I screamed my head off, she didn’t realize the extent of the sheer terror she was actually causing me in my brain. Although aggressive, her tactic worked. I learned that shoes in the house don’t lead to my demise and I began tolerating them inside.
To avoid the feeling of life-ending panic at the core of OCD, people with the disorder adopt compulsive behaviors that give them an illusion of control and temporarily dampen their anxiety. This process is excellently described in psychologist George Weinberg’s 1993 book Invisible Masters: Compulsions and the Fear that Drives Them.
Every compulsion is an act of terror. It is an attempt to regulate something concrete and controllable because the person cannot identify and control some real psychological problem. The victim of a compulsion is performing a symbolic ritual as a way of subduing ideas or feelings that seem too hideous to be accepted…that feel too utterly out of control.
Because the problem is deep-rooted, a person’s engaging in any compulsive activity can bring at most momentary peace. The real underlying problem remains, and before long the person feels the need to engage in the compulsive behavior again.
The underlying dread and annihilatory sense of panic is so utterly disturbing, that the OCD sufferer’s mind will create rationalizations in order to avoid that pain. As Weinberg explains it:
Some obsessions appear so sensible that the sufferer feels delinquent not paying attention to them. The mind offers up the false logic that the cost of doing the thing, even if it was just done, is trivial, whereas the downside of not doing it may be quite serious, possibly disastrous. And so the compulsive engages in the ritual, just to be on the safe side.
Interestingly, the person with OCD doesn’t need to have obsessive thoughts or rationalizations for them to still be afflicted by the dread-to-compulsion mini-loop.
The only things required to keep this mini-loop-from-hell alive is the feeling of dread, and to perform a compulsion that legitimizes and reinforces the underlying dread. The obsessive thoughts or rationalizations are optional, and often show up when one attempts to resist a compulsion.
Obsessional thoughts merely belong to the urge, which is generated from deep inside. They are excuses for the impulse to engage in the compulsive behavior. The person would feel the same compulsive urge without any thoughts at all.
And this tracked with my cleaning experience. I never had any clear thoughts as for why I had to sweep everywhere, I just knew that I had to. And when my mom dragged me across the floor with my shoes on, that’s when the obsessive thoughts and rationalizations (ie: my brain screaming that I’m going to die) arrived to persuade me to engage in my compulsive behavior.
Deconstructing OCD into its two parts
People with OCD have: (1) severe anxiety, and (2) disordered thoughts.
(1) Severe Anxiety
Everyone has an internal panic response. If you’re driving, and suddenly a car is hurtling straight at you and you’re on the verge of colliding, you panic and veer away! Thank god for your ability to panic, because that heightened state of alertness saved your life.
The best way I can describe OCD is that my internal panic alarm (which again is a normal part of the human experience) misfires at inappropriate times. I have an exaggerated sense of what could end my life, and perform compulsions to regulate my panic. This is why so many people with OCD go without treatment for years—we’re just obediently following our bodies’ panic system, like everyone else does.[1]
(2) Disordered Thoughts
By chance, I stumbled upon this blog post in January and it completely changed my life. In it, the author explains Metacognitive Therapy (MCT).
The process of metacognition is to observe and evaluate your thoughts as if you are an outside observer. This is helpful for anyone with anxiety or depression because not all thoughts should be taken seriously.
MCT proposes that OCD thoughts manifest in three ways: the past, the present, and the future.
In the past, the OCD brain endlessly ruminates about what I could have done better, to the point of mentally beating myself up.
In the present, the OCD brain monitors for threats that could end my life, and produces a strong feeling of panic to compel me to change course or to perform a ritualistic compulsion to temporarily alleviate my life-ending fear.
In the future, the OCD brain worries about potential threats that could end my life if I'm not careful and plan accordingly. It typically manifests for me in a checking compulsion where I constantly Google variations of the same thing over and over.
Funnily enough while writing this, I realized that my blog post last December titled “Your Digital Footprint Could Make You Unemployable” was actually a manifestation of my future worry OCD. Oops! While the logic of the post is somewhat sound, what you didn't see (because I didn't write about it) was the two weeks I spent compulsively Googling myself, trying to quell the annihilatory panic I wound myself into. I was worried that employers will not approve of my public blog presence, and that I'll end up blacklisted and unemployed forever, destitute and forced to live on the streets, and then I'll get AIDS and die. That's usually how a lot of my disordered thinking goes: all roads lead to becoming destitute on the street, getting AIDS, and dying. Fun!
So what caused me to finally get help with my OCD?
Throughout 2025, my brain was slowly trying to convince me that I might be developing a fatal skin disease. Did I actually have one? No. But my brain was convinced. So to quell my fear, I would compulsively check all over my body to look for symptoms. By November of last year, just 6 months ago, I was spending 3 to 4 hours each day performing my checking compulsion. But as I did the compulsion more and more, the relief from my fear became more and more temporary. I thought I was losing my mind.
I’ve always kind of known that I might have OCD (it’s ~40% heritable and my grandfather had it), so I sought out an OCD specialist. I winced at the price—$200/hour—but ultimately gave it a try because I was starting to not be able to function at work.
Agreeing to see a therapist made me feel pathetic (you know, cuz classic male conditioning tells us that asking for help makes us weak). Additionally, I felt apprehensive that all this stuff was just in my head and that I don't actually have OCD (which I later learned is a classic tactic by OCD). After neurotically ranting at my therapist for 20 minutes on all the reasons why I might have OCD (because I wanted to justify my being there), she sympathetically looked at me and smiled, “Yes honey, sounds like OCD.”
That validation was the best thing I got out of my two visits with her. I felt seen. I didn't feel irrationally crazy anymore. And I got help. I learned one basic technique to manage my skin disease checking compulsion[2], and after a few weeks the fear went away!
Solutions
As mentioned previously, OCD is primarily a mismanagement of the feeling of severe panic, and secondarily reinforced with disordered thoughts that are attempting to be helpful, but are unfortunately producing avoidant/compulsive behaviors and thoughts that legitimize the panic. I found three therapeutic practices to be effective.
Acceptance and Commitment Therapy (ACT) — Feelings are not problems that need to be solved. Feelings just want to be felt. So if we compulsively avoid negative feelings, like anxiety or panic, we unintentionally make them stronger. (Kind of like trying really hard to not think about a pink elephant—it'll only make you think of it more). But when we relax and sit in uncomfortable feelings, they get felt, processed, and then usually go away.
Exposure and Response Prevention (ERP) — If we voluntarily expose ourselves to experiences that give us anxiety, and we prevent a response by refusing to perform avoidant behaviors, we train ourselves to tolerate the feeling of anxiety. We learn that while the feeling of anxiety (or even panic) is unpleasant, it's not going to kill us.
Metacognitive Therapy (MCT) — Just like feelings, thoughts also like to be acknowledged and not suppressed. With OCD, ruminative thoughts, threat monitoring, and worrying about the future are unhelpfully trying to “solve” for unsolvable things in life. MCT suggests we observe these thoughts and label them non-judgmentally when they happen.
I combined all three of these into something I call “Panic Meditation”. Strap in, cuz this is about to get crazy.
The first week of February, I laid down on my bed and prepared to confront one of my fears that my OCD brain said would kill me: eye contact with beautiful women. (OCD preys on your innermost fears—mine was that women could potentially see me as a creep).
First, I told myself that whatever negative feelings come up are okay to feel (ACT). Second, that any thoughts that arose to rationalize taking me out of the experience were part of my disordered thinking to try to keep me safe (MCT). With those two things in mind, I voluntarily exposed myself (ERP) to something that normally causes me terror: I imagined myself sustaining eye contact with a beautiful woman.
Panic Meditation
Immediately 8-out-of-10 pain shot across my body as my internal alarm system began blaring, “CODE RED. CODE RED.” My body started seizing and I gripped onto my sheets for dear life, reminding myself that I'm safe on my bed, meanwhile my brain screamed, “YOU’RE GOING TO DIE MOTHERFUCKER!!!”
Rationally, I knew that eye contact with a woman was not a life-threatening experience, yet emotionally my brain and body were signaling otherwise.
After a minute of excruciating pain, my brain recognized that I was refusing to respond to the alarm system, so it decided to send in the cavalry: disordered thoughts.
My brain: “Dude, bail, you’re in a ton of pain right now.”
Me: “No,” I grimaced, “I’ll be okay if I stay in this experience.”
My brain: “No you won't, you're going to die. I've been protecting you your whole life, and you've listened to me your whole life, and guess what? You've never died. I'm trying to help you. When I send you the panic signal, you listen—that's our deal.”
Me: “Eye contact isn't going to kill me. Normal people do it all the time.”
This is where I messed up with my initial attempt at Panic Meditation. Disordered OCD thoughts shouldn't be taken seriously or debated. They'll win every time. So I lost the edge next.
My brain: “OH YES EYE CONTACT CAN KILL YOU! All you have to do is think about it for just half a second and you'll recognize that. But you're too stupid to do that on your own, so it's a good thing that I'm here. Put simply: with eye contact, a woman could intuit that you're attracted to her, but you're a terrible person that nobody could ever love, so it's only a matter of time until she feels creeped out by you, and then you're in BIG trouble, because she could start a rumor that ruins your reputation.”
Me: “So I can't even look at a woman?”
My brain: “Correctamundo, amigo! With your reputation ruined in your community, somebody might try to cancel you online and you'll be the new face of #MeToo. And, of course, at this point you'll get fired from your job. Need I remind you what will inevitably happen next?”
Me: “Jesus, what?”
My brain: “Branded as a sex offender, you’ll never be able to get a job again, you'll soon run out of money, get kicked out of your apartment, end up on the street, get AIDS and then die. Case closed.”
At this point, my overall pain was a 9-out-of-10. Almost unbearable. My body's alarm system was blaring. My brain was egging me on to quit and save myself while I still could. I had sweat a puddle on my bed.
Only 5 minutes had passed.
Gripping my bed sheets, I remembered what MCT taught me, and I whispered aloud the softest, “no…”
My brain, taking a victory lap, scoffed, “What was that, champ?”
Me, more firmly: “No.”
My brain: “Excuse me??”
Me: “No, you’re wrong.”
My brain: “Ho ho! You've never bested me before,” cracks knuckles, “but you can try—let's dance!”
Me, weakly: “No, I'm not going to debate you. But I do have some magic spells I'm going to cast on you.”
My brain: “What a fucking nerd you are. Fine, taste this Hellfire! YOU'RE A FAILURE AND YOU MAKE EVERY WOMAN AROUND YOU UNCOMFORTABLE!”
Me: “I acknowledge that thought, but I’m going to label you as one of the three MCT categories: Threat Monitoring!”
My brain: “... … …pffft, you think that scares me? That’s nothing. Here’s another variation. WOMEN HATE YOU AND YOU SHOULD BE ASHAMED TO EVEN LOOK AT THEM!”
Me, more forcefully: “I acknowledge that thought, but still—threat monitoring.”
My brain: “... … …yeah, well, of course I’m monitoring for threats. That’s my job. Look dude, we already covered this. You’ll end up destitute with AIDS and die!”
Me: “I acknowledge that thought, but you’ve switched and are now doing the second MCT category. I label you: Worrying!”
My brain, sputtering: “You fucking idiot and loser. Need I remind you of the past? Every woman you’ve ever liked hasn’t reciprocated your interest, at least not for long. Let’s quit this silly business and go analyze every past mistake you’ve ever made with a woman, for hours and hours, like we usually do. It’s one of your favorite hobbies. Plus, who knows, maybe you’ll finally uncover the real reason you failed so that you can be certain to not fuck up again.”
Me: “I acknowledge that thought, but you’ve again switched to the third MCT category. I label you: Ruminating!”
My brain: “Oh you’ve done it now, bucko. I was trying to protect you, but now I’m going to make your life a living hell!”
We clashed for the next 10 minutes. My brain sent me increasingly more convincing rationalizations, each one more subtle than the last in an effort to get me to bail from the experience. But each time I caught on and started responding with the one-word labels of “ruminating”, “threat monitoring”, or “worrying”. Additionally, my brain sent me other random thoughts, like song lyrics or what I planned to eat for lunch, but I ignored those, too, and kept returning to imagining making eye contact with a woman, which kept my anxiety level high. I wanted to stay in the feeling of panic and not allow myself to escape it.
Each time I started clenching my sheets and my whole body seized with pain, I would deliberately practice unclenching and relaxing—ERP is about preventing a stress response to a stimulus. ACT reminded me that this feeling is part of who I am and it’s not something I have to avoid. And MCT was there to help me label my disordered thoughts. After those 10 minutes, both me and my brain were exhausted.
My brain: “... … …fuck you.”
Me: “I acknowledge that thought and—”
My brain, interrupting: “—oh put a sock in it. I’m done here…for now. But enjoy this parting gift.”
Me: “What gift?”
My internal alarm system and pain shot through the fucking roof. I hung on for dear life, as if I was riding a roller coaster with tons of bolts missing. I kept reminding myself, “I’m not in danger, I’m safe on my bed. I’m not in danger, I’m safe on my bed. I’m not in danger…”
I rode out the feeling of annihilation for another 5 minutes, then finally got up. My first ever session of Panic Meditation lasted a total of 20 minutes. I took a shower to get the sweat off.[3]
After my shower, I remembered there was a run club meetup that night. When I showed up, I accidentally made eye contact with this cute woman I normally ignore because looking at her causes a micro-panic sensation in me (like I’m getting punched in the gut and having the wind knocked out of me). But this time…I didn’t feel panic! I let this register for a moment. My god, I don’t feel panic right now! Ha hah!! OH MY GOD!!! THIS IS SO WEIRD! And then it got better.
I started talking to her. I made her laugh. The rest of the night I talked to a bunch of new people and didn’t feel any social anxiety. My god…what have I discovered?
Over the course of just one week of daily 20 minute Panic Meditation sessions, my feeling of life-ending panic shriveled up because I repeatedly refused to react to it. By week two, I could no longer induce the feeling of annihilatory panic in myself, and instead could only feel a mild (yet still unpleasant) feeling of anxiety.
From talking to a random stranger at a coffee shop weeks later (who turned out to be a psychologist), I learned that what I invented with Panic Meditation is actually already an established psychotherapeutic technique called “flooding”. With flooding, patients voluntarily trigger incredibly strong/stressful emotions, and then try not to react to the experience so that they get used to it and not run away. This psychologist said that patients seldom agree to try flooding because it’s incredibly painful. It's kind of like ripping off a Band-Aid—quick short term pain, versus the prolonged pain of exposure therapy over many weeks, months, or years. He was astonished that (a) I independently created flooding without knowing about it, and (b) that I stuck with it despite the pain I experienced. Him saying that made me feel proud of myself.
Where I’m at today
A couple months later, sometimes intrusive thoughts arise, I gently label them, and they drift away. I’ve found that regular meditation 10 minutes per day is super helpful for decreasing the frequency of disordered thoughts. That, and regular exercise. They’re both probably working by lowering my overall stress levels.
After just two weeks of daily Panic Meditation at the start of February, I rarely experience annihilatory panic now. My nervous system has reset and is better calibrated to reality. When I do occasionally feel that I’m on the verge of imminent death, I don't allow that feeling to bother me.
I still do the occasional Panic Meditation session when I need to process something that makes me feel nervous, or if I want to pre-experience the feeling of anxiety before a social event. But it’s never as intense as that first session I did.
I still experience general anxiety, but it’s likely the normal variety that we all sometimes have. I’m no longer disturbed by the feeling of anxiety or allow it to bully me. In fact, I get a little excited when I feel anxious because that usually means I’m on the edge of my social skills—a chance to level up if I push through!
With everything that OCD touched, my world got smaller: seemingly innocuous social interactions felt like life-or-death, minor decisions during my day became indictments of my moral character, spending money nearly induced panic-attacks (because I’ll soon become penniless, destitute on the streets, get AIDS, and die), touching “unclean” objects could give me an infectious disease, and flirting with women carried the weight of a potential prison sentence. Having OCD, I imagine, is like living in North Korea—any small misstep and you, and your entire family, could be sent off to prison for the rest of your lives, or executed.
I wrote this blog post because I don’t want my suffering to be in vain. I have three friends in my life who also have OCD, and many more friends that struggle with social anxiety (which I strongly suspect my techniques will equally work for treating; social anxiety seems to be a subset of OCD where a person obsesses about avoiding disapproval, and then compulsively restricts their behavior or speech to ensure that nobody dislikes them).
So to my fellow sufferers, I can say this. The good news is that OCD is incredibly predictable (ie: it will always try to escape uncertainty by producing anxiety, or generating unhelpful, overprotective thoughts), and therefore I’ve been able to treat it in such a short span of time (~95% of my symptoms resolved in just a couple weeks, and I continue to feel good several months later). So give Panic Meditation a try, if you want short term results. Or perhaps see an OCD therapist to ease you into treatment. Use ACT to embody and accept negative feelings, ERP to habituate to the feeling of panic while refusing to respond to it, and MCT to label disordered thoughts (and to not negotiate with terrorists). Hopefully you can escape like I did. Good luck.[4]
What first set me on the path to escaping my cycle of terror was psychologist Bruce Tift’s book Already Free: Buddhism Meets Psychotherapy on the Path of Liberation.
In his book, Tift explains that many people incorrectly treat uncomfortable feelings, such as anxiety, like they’re problems that need to be fixed. Whereas Buddhism teaches that feelings cannot be solved or avoided. Feelings are simply signals from the body. Attempting to escape the feeling of anxiety by ignoring it, or using coping behaviors, only makes it worse in the long term.
Some people go their whole lives avoiding the feeling of anxiety. But, paradoxically, the way to resolve anxiety, according to Tift, is to embrace it head-on.
The daily end-of-the-world panic I feel is a part of me. That will never change. So I can either choose to avoid that terrifying feeling like I have my whole life (and use compulsions to temporarily alleviate my pain), or I can learn to have a relationship with my panic and accept that it's part of the uniqueness of who I am.
What Tift is describing in Buddhism, has a western counterpart called Acceptance and Commitment Therapy (ACT). With ACT, you voluntarily accept any negative feelings that arise, and you don’t allow them to inhibit you from living your daily life. In doing this, those negative feelings never go away, but they lose their power over you. They can't control you anymore.
Let me repeat that: disturbing feelings will never go away. We can either accept them in all their ugliness, or forever go on coping for them with avoidant behavior.
I can't do the latter. not anymore. After a lifetime of being a prisoner to my fear and compulsions, I’m dead tired from exhaustion.
We each held onto the end of a rope, then we stood on opposite sides of the room. She told me to imagine that between us was this chasm that represented my greatest fear. She then started pulling on the rope. I pulled back to avoid falling in. She pulled harder. I pulled harder. After a minute of this, she asked, “Can you imagine another way to avoid falling in the chasm?” I thought about it, then dropped the rope. That was the point. Our greatest fears can only haunt us if we interact with them.
It’s important to note that, for the context of telling my story, I separated “me” and “my brain” into two different characters—it’s more entertaining that way. But inside my head there’s only one voice for my thoughts. So when I started experimenting with all this stuff, it was difficult to know which thoughts were OCD-thoughts and which ones were normal thoughts.
In January of this year I joined a hot Pilates studio (because that would be a good place to be around lots of new people, especially women, and to practice preventing myself from doing OCD-based threat monitoring behaviors). Ironically, the one connection I made there was with a man, who turned out to be an OCD therapist! I asked him how people with OCD can distinguish between their thoughts. He gave me a simple heuristic: if you’re spending time wondering if a specific thought is OCD related, it probably is. I have found that to be true every time.
Not all therapists are trained to treat OCD. You’ll want to find a specialist. Like I mentioned, mine charged me $200/hour. Your insurance might cover it, or not. Either way we’re talking about your health, which in my opinion, is worth spending money on. If you’re already informed on how OCD works (from reading this blog post and from consuming the following resources I’ve included below), then you’ll save time/money in therapy, and perhaps only need the therapist to guide you through some techniques for you to practice at home.
My friend recommended me Psychology Today which is how I found my OCD therapist.
There’s also NOCD, a reputable online OCD therapy service.
Here’s a short film the folks at NOCD made showing the disordered thoughts and images of someone living with OCD.
Dr. K on YouTube is a mental health expert who makes excellent videos. Here’s his technical breakdown of OCD, statistics related to it, and why he’s an advocate of ERP for treating it.
Anti-anxiety medication
Besides therapy, medication is the other gold standard for treating OCD. I didn’t mention it in this blog post because I don’t have any personal experience with it. I’ve heard from one of my friends, who has OCD, that anti-anxiety pills reduce their anxiety to a manageable level so that they can function in their daily life.
I’m still in the middle of reading this book, but it’s good. The author is a psychiatrist at the UCLA School of Medicine and is a world-renowned expert on OCD. He’s done all kinds of studies showing that neurologically, the brains of people with OCD work differently than neurotypical brains. He's helped thousands of people with his recommended solutions for overcoming OCD. It might have been nice if I had found this book a long time ago, but inventing my own solution to OCD was also a fun journey for me.
Excellent series of stories of real people dealing with compulsions, as told by the author/psychotherapist who’s trying to treat them. Between stories, he also includes short chapters on some of the psychoanalytic theory behind compulsive behavior.
Excellent book that informed me about ACT and embodying negative feelings. Great read for anyone who has general anxiety, or for anyone who is interested in how western treatment of mental health differs from eastern Buddhism.
I’ve read this blog post about MCT at least two dozen times. (It’s also pretty funny, in my opinion). Incredibly useful for anyone who has social anxiety and wants to understand how their anxious behavior is (unintentionally) making their anxiety worse.
It explains that the reason people feel socially anxious is because they’re deathly afraid of social disapproval. But guess what? You’ll be okay if some people don’t like you—they weren’t meant to be your friend. You can move on.
This is a college student’s memoir of growing up and dealing with OCD symptoms. It’s brutally honest and made me feel seen. The author also experienced hospitalization for his symptoms (something, fortunately, I’ve never gone through). He’s quite sarcastic which makes it a fun read.
Having aphantasia (which I’ve written about) prevents me from experiencing disturbing, intrusive mental imagery that other people with OCD have to reckon with. (Here’s a YouTube video displaying what that’s like).
She talks about surviving a few other common subtypes called Homosexual OCD and Pedophilia OCD—the (unfounded) fears that she may be homosexual or a pedophile.
Everyone with OCD follows the same pattern of fear, optional obsession, and compulsion. But how it manifests is always different. These authors’ experiences were different from my own.
Additionally, it was interesting to hear testimonies of people with other mental health disorders besides OCD.
John Green is one of the OGs of YouTube with his brother Hank Green, together they started the channels VlogBrothers and CrashCourse. He’s also written various other YA novels that have gotten critical acclaim, such as The Fault in Our Stars. He also has OCD, and wasn’t diagnosed until he was an adult (like me).
The reason I like this novel is that the main character, a teenage girl with OCD, is going on an adventure with her friend. OCD is merely a part of her, but does not define her. It’s a fun story.
If you enjoyed this post and want more, consider reading the longer narrative version that explores the inner workings of my mind.
[Author's note: this post is the short version meant to provide quick, actionable advice for treating OCD. The narrative version is longer but better, in my opinion.]
Obsessive Compulsive Disorder (OCD)
OCD is an anxiety disorder that feeds on uncertainty. It affects 1% of people worldwide, and the World Health Organization ranks OCD among the top 10 most disabling illnesses.
Everyone feels uncertain from time to time, but people with OCD struggle to accept any amount of uncertainty for specific fears they have.
As an example, normal people wash their hands only once and feel a sense of satisfaction that they’ve effectively cleaned the germs off their hands. Someone with OCD, however, may not feel that sense of satisfaction with washing their hands just once, or even twice in a row. What if only 99.99% of germs are killed? And what if the leftover 0.01% of germs infects them and poisons them and rots their organs away and…and…OH GOD, SPREAD TO OTHER PEOPLE AND KILL THEIR FAMILY AND START THE NEXT GLOBAL PANDEMIC!!! So to avoid this terrible thought, someone with OCD might wash their hands 23 times in a row—to the point of rubbing their skin so much that it bleeds—in order to achieve that satisfied feeling of being clean.
This is an example of what’s known as Contamination OCD, a common subtype of the disorder. While I’ve never been a compulsive hand washer, at 7 years old I was mockingly referred to as “the shoe nazi” by my family. Anytime someone wore shoes in the house, I felt compelled to sweep everywhere they had walked. Because my family wasn’t, and still isn’t, educated on OCD, they just thought it was a weird childish quirk. Little did they know that there was a monster inside of me ordering me to clean because dirt felt dangerous. So when my mom decided to break me of my cleaning compulsion, by putting shoes on my feet and dragging my kicking legs across the floor while I screamed my head off, she didn’t realize the extent of the sheer terror she was actually causing me in my brain. Although aggressive, her tactic worked. I learned that shoes in the house don’t lead to my demise and I began tolerating them inside.
To avoid the feeling of life-ending panic at the core of OCD, people with the disorder adopt compulsive behaviors that give them an illusion of control and temporarily dampen their anxiety. This process is excellently described in psychologist George Weinberg’s 1993 book Invisible Masters: Compulsions and the Fear that Drives Them.
The underlying dread and annihilatory sense of panic is so utterly disturbing, that the OCD sufferer’s mind will create rationalizations in order to avoid that pain. As Weinberg explains it:
Interestingly, the person with OCD doesn’t need to have obsessive thoughts or rationalizations for them to still be afflicted by the dread-to-compulsion mini-loop.
And this tracked with my cleaning experience. I never had any clear thoughts as for why I had to sweep everywhere, I just knew that I had to. And when my mom dragged me across the floor with my shoes on, that’s when the obsessive thoughts and rationalizations (ie: my brain screaming that I’m going to die) arrived to persuade me to engage in my compulsive behavior.
Deconstructing OCD into its two parts
People with OCD have: (1) severe anxiety, and (2) disordered thoughts.
(1) Severe Anxiety
Everyone has an internal panic response. If you’re driving, and suddenly a car is hurtling straight at you and you’re on the verge of colliding, you panic and veer away! Thank god for your ability to panic, because that heightened state of alertness saved your life.
The best way I can describe OCD is that my internal panic alarm (which again is a normal part of the human experience) misfires at inappropriate times. I have an exaggerated sense of what could end my life, and perform compulsions to regulate my panic. This is why so many people with OCD go without treatment for years—we’re just obediently following our bodies’ panic system, like everyone else does.[1]
(2) Disordered Thoughts
By chance, I stumbled upon this blog post in January and it completely changed my life. In it, the author explains Metacognitive Therapy (MCT).
The process of metacognition is to observe and evaluate your thoughts as if you are an outside observer. This is helpful for anyone with anxiety or depression because not all thoughts should be taken seriously.
MCT proposes that OCD thoughts manifest in three ways: the past, the present, and the future.
Funnily enough while writing this, I realized that my blog post last December titled “Your Digital Footprint Could Make You Unemployable” was actually a manifestation of my future worry OCD. Oops! While the logic of the post is somewhat sound, what you didn't see (because I didn't write about it) was the two weeks I spent compulsively Googling myself, trying to quell the annihilatory panic I wound myself into. I was worried that employers will not approve of my public blog presence, and that I'll end up blacklisted and unemployed forever, destitute and forced to live on the streets, and then I'll get AIDS and die. That's usually how a lot of my disordered thinking goes: all roads lead to becoming destitute on the street, getting AIDS, and dying. Fun!
So what caused me to finally get help with my OCD?
Throughout 2025, my brain was slowly trying to convince me that I might be developing a fatal skin disease. Did I actually have one? No. But my brain was convinced. So to quell my fear, I would compulsively check all over my body to look for symptoms. By November of last year, just 6 months ago, I was spending 3 to 4 hours each day performing my checking compulsion. But as I did the compulsion more and more, the relief from my fear became more and more temporary. I thought I was losing my mind.
I’ve always kind of known that I might have OCD (it’s ~40% heritable and my grandfather had it), so I sought out an OCD specialist. I winced at the price—$200/hour—but ultimately gave it a try because I was starting to not be able to function at work.
Agreeing to see a therapist made me feel pathetic (you know, cuz classic male conditioning tells us that asking for help makes us weak). Additionally, I felt apprehensive that all this stuff was just in my head and that I don't actually have OCD (which I later learned is a classic tactic by OCD). After neurotically ranting at my therapist for 20 minutes on all the reasons why I might have OCD (because I wanted to justify my being there), she sympathetically looked at me and smiled, “Yes honey, sounds like OCD.”
That validation was the best thing I got out of my two visits with her. I felt seen. I didn't feel irrationally crazy anymore. And I got help. I learned one basic technique to manage my skin disease checking compulsion[2], and after a few weeks the fear went away!
Solutions
As mentioned previously, OCD is primarily a mismanagement of the feeling of severe panic, and secondarily reinforced with disordered thoughts that are attempting to be helpful, but are unfortunately producing avoidant/compulsive behaviors and thoughts that legitimize the panic. I found three therapeutic practices to be effective.
I combined all three of these into something I call “Panic Meditation”. Strap in, cuz this is about to get crazy.
The first week of February, I laid down on my bed and prepared to confront one of my fears that my OCD brain said would kill me: eye contact with beautiful women. (OCD preys on your innermost fears—mine was that women could potentially see me as a creep).
First, I told myself that whatever negative feelings come up are okay to feel (ACT). Second, that any thoughts that arose to rationalize taking me out of the experience were part of my disordered thinking to try to keep me safe (MCT). With those two things in mind, I voluntarily exposed myself (ERP) to something that normally causes me terror: I imagined myself sustaining eye contact with a beautiful woman.
Panic Meditation
Immediately 8-out-of-10 pain shot across my body as my internal alarm system began blaring, “CODE RED. CODE RED.” My body started seizing and I gripped onto my sheets for dear life, reminding myself that I'm safe on my bed, meanwhile my brain screamed, “YOU’RE GOING TO DIE MOTHERFUCKER!!!”
Rationally, I knew that eye contact with a woman was not a life-threatening experience, yet emotionally my brain and body were signaling otherwise.
After a minute of excruciating pain, my brain recognized that I was refusing to respond to the alarm system, so it decided to send in the cavalry: disordered thoughts.
My brain: “Dude, bail, you’re in a ton of pain right now.”
Me: “No,” I grimaced, “I’ll be okay if I stay in this experience.”
My brain: “No you won't, you're going to die. I've been protecting you your whole life, and you've listened to me your whole life, and guess what? You've never died. I'm trying to help you. When I send you the panic signal, you listen—that's our deal.”
Me: “Eye contact isn't going to kill me. Normal people do it all the time.”
This is where I messed up with my initial attempt at Panic Meditation. Disordered OCD thoughts shouldn't be taken seriously or debated. They'll win every time. So I lost the edge next.
My brain: “OH YES EYE CONTACT CAN KILL YOU! All you have to do is think about it for just half a second and you'll recognize that. But you're too stupid to do that on your own, so it's a good thing that I'm here. Put simply: with eye contact, a woman could intuit that you're attracted to her, but you're a terrible person that nobody could ever love, so it's only a matter of time until she feels creeped out by you, and then you're in BIG trouble, because she could start a rumor that ruins your reputation.”
Me: “So I can't even look at a woman?”
My brain: “Correctamundo, amigo! With your reputation ruined in your community, somebody might try to cancel you online and you'll be the new face of #MeToo. And, of course, at this point you'll get fired from your job. Need I remind you what will inevitably happen next?”
Me: “Jesus, what?”
My brain: “Branded as a sex offender, you’ll never be able to get a job again, you'll soon run out of money, get kicked out of your apartment, end up on the street, get AIDS and then die. Case closed.”
At this point, my overall pain was a 9-out-of-10. Almost unbearable. My body's alarm system was blaring. My brain was egging me on to quit and save myself while I still could. I had sweat a puddle on my bed.
Only 5 minutes had passed.
Gripping my bed sheets, I remembered what MCT taught me, and I whispered aloud the softest, “no…”
My brain, taking a victory lap, scoffed, “What was that, champ?”
Me, more firmly: “No.”
My brain: “Excuse me??”
Me: “No, you’re wrong.”
My brain: “Ho ho! You've never bested me before,” cracks knuckles, “but you can try—let's dance!”
Me, weakly: “No, I'm not going to debate you. But I do have some magic spells I'm going to cast on you.”
My brain: “What a fucking nerd you are. Fine, taste this Hellfire! YOU'RE A FAILURE AND YOU MAKE EVERY WOMAN AROUND YOU UNCOMFORTABLE!”
Me: “I acknowledge that thought, but I’m going to label you as one of the three MCT categories: Threat Monitoring!”
My brain: “... … …pffft, you think that scares me? That’s nothing. Here’s another variation. WOMEN HATE YOU AND YOU SHOULD BE ASHAMED TO EVEN LOOK AT THEM!”
Me, more forcefully: “I acknowledge that thought, but still—threat monitoring.”
My brain: “... … …yeah, well, of course I’m monitoring for threats. That’s my job. Look dude, we already covered this. You’ll end up destitute with AIDS and die!”
Me: “I acknowledge that thought, but you’ve switched and are now doing the second MCT category. I label you: Worrying!”
My brain, sputtering: “You fucking idiot and loser. Need I remind you of the past? Every woman you’ve ever liked hasn’t reciprocated your interest, at least not for long. Let’s quit this silly business and go analyze every past mistake you’ve ever made with a woman, for hours and hours, like we usually do. It’s one of your favorite hobbies. Plus, who knows, maybe you’ll finally uncover the real reason you failed so that you can be certain to not fuck up again.”
Me: “I acknowledge that thought, but you’ve again switched to the third MCT category. I label you: Ruminating!”
My brain: “Oh you’ve done it now, bucko. I was trying to protect you, but now I’m going to make your life a living hell!”
We clashed for the next 10 minutes. My brain sent me increasingly more convincing rationalizations, each one more subtle than the last in an effort to get me to bail from the experience. But each time I caught on and started responding with the one-word labels of “ruminating”, “threat monitoring”, or “worrying”. Additionally, my brain sent me other random thoughts, like song lyrics or what I planned to eat for lunch, but I ignored those, too, and kept returning to imagining making eye contact with a woman, which kept my anxiety level high. I wanted to stay in the feeling of panic and not allow myself to escape it.
Each time I started clenching my sheets and my whole body seized with pain, I would deliberately practice unclenching and relaxing—ERP is about preventing a stress response to a stimulus. ACT reminded me that this feeling is part of who I am and it’s not something I have to avoid. And MCT was there to help me label my disordered thoughts. After those 10 minutes, both me and my brain were exhausted.
My brain: “... … …fuck you.”
Me: “I acknowledge that thought and—”
My brain, interrupting: “—oh put a sock in it. I’m done here…for now. But enjoy this parting gift.”
Me: “What gift?”
My internal alarm system and pain shot through the fucking roof. I hung on for dear life, as if I was riding a roller coaster with tons of bolts missing. I kept reminding myself, “I’m not in danger, I’m safe on my bed. I’m not in danger, I’m safe on my bed. I’m not in danger…”
I rode out the feeling of annihilation for another 5 minutes, then finally got up. My first ever session of Panic Meditation lasted a total of 20 minutes. I took a shower to get the sweat off.[3]
After my shower, I remembered there was a run club meetup that night. When I showed up, I accidentally made eye contact with this cute woman I normally ignore because looking at her causes a micro-panic sensation in me (like I’m getting punched in the gut and having the wind knocked out of me). But this time…I didn’t feel panic! I let this register for a moment. My god, I don’t feel panic right now! Ha hah!! OH MY GOD!!! THIS IS SO WEIRD! And then it got better.
I started talking to her. I made her laugh. The rest of the night I talked to a bunch of new people and didn’t feel any social anxiety. My god…what have I discovered?
Over the course of just one week of daily 20 minute Panic Meditation sessions, my feeling of life-ending panic shriveled up because I repeatedly refused to react to it. By week two, I could no longer induce the feeling of annihilatory panic in myself, and instead could only feel a mild (yet still unpleasant) feeling of anxiety.
From talking to a random stranger at a coffee shop weeks later (who turned out to be a psychologist), I learned that what I invented with Panic Meditation is actually already an established psychotherapeutic technique called “flooding”. With flooding, patients voluntarily trigger incredibly strong/stressful emotions, and then try not to react to the experience so that they get used to it and not run away. This psychologist said that patients seldom agree to try flooding because it’s incredibly painful. It's kind of like ripping off a Band-Aid—quick short term pain, versus the prolonged pain of exposure therapy over many weeks, months, or years. He was astonished that (a) I independently created flooding without knowing about it, and (b) that I stuck with it despite the pain I experienced. Him saying that made me feel proud of myself.
Where I’m at today
A couple months later, sometimes intrusive thoughts arise, I gently label them, and they drift away. I’ve found that regular meditation 10 minutes per day is super helpful for decreasing the frequency of disordered thoughts. That, and regular exercise. They’re both probably working by lowering my overall stress levels.
After just two weeks of daily Panic Meditation at the start of February, I rarely experience annihilatory panic now. My nervous system has reset and is better calibrated to reality. When I do occasionally feel that I’m on the verge of imminent death, I don't allow that feeling to bother me.
I still do the occasional Panic Meditation session when I need to process something that makes me feel nervous, or if I want to pre-experience the feeling of anxiety before a social event. But it’s never as intense as that first session I did.
I still experience general anxiety, but it’s likely the normal variety that we all sometimes have. I’m no longer disturbed by the feeling of anxiety or allow it to bully me. In fact, I get a little excited when I feel anxious because that usually means I’m on the edge of my social skills—a chance to level up if I push through!
Because most of my waking thoughts are no longer spent hating myself, or spiraling about imagined scenarios, I have way more time to write. Last month I wrote a guide on how to stop ruminating. Two weeks ago in another blog post, I wrote a section on how to stop threat monitoring with respect to social anxiety.
With everything that OCD touched, my world got smaller: seemingly innocuous social interactions felt like life-or-death, minor decisions during my day became indictments of my moral character, spending money nearly induced panic-attacks (because I’ll soon become penniless, destitute on the streets, get AIDS, and die), touching “unclean” objects could give me an infectious disease, and flirting with women carried the weight of a potential prison sentence. Having OCD, I imagine, is like living in North Korea—any small misstep and you, and your entire family, could be sent off to prison for the rest of your lives, or executed.
I wrote this blog post because I don’t want my suffering to be in vain. I have three friends in my life who also have OCD, and many more friends that struggle with social anxiety (which I strongly suspect my techniques will equally work for treating; social anxiety seems to be a subset of OCD where a person obsesses about avoiding disapproval, and then compulsively restricts their behavior or speech to ensure that nobody dislikes them).
So to my fellow sufferers, I can say this. The good news is that OCD is incredibly predictable (ie: it will always try to escape uncertainty by producing anxiety, or generating unhelpful, overprotective thoughts), and therefore I’ve been able to treat it in such a short span of time (~95% of my symptoms resolved in just a couple weeks, and I continue to feel good several months later). So give Panic Meditation a try, if you want short term results. Or perhaps see an OCD therapist to ease you into treatment. Use ACT to embody and accept negative feelings, ERP to habituate to the feeling of panic while refusing to respond to it, and MCT to label disordered thoughts (and to not negotiate with terrorists). Hopefully you can escape like I did. Good luck.[4]
What first set me on the path to escaping my cycle of terror was psychologist Bruce Tift’s book Already Free: Buddhism Meets Psychotherapy on the Path of Liberation.
In his book, Tift explains that many people incorrectly treat uncomfortable feelings, such as anxiety, like they’re problems that need to be fixed. Whereas Buddhism teaches that feelings cannot be solved or avoided. Feelings are simply signals from the body. Attempting to escape the feeling of anxiety by ignoring it, or using coping behaviors, only makes it worse in the long term.
Some people go their whole lives avoiding the feeling of anxiety. But, paradoxically, the way to resolve anxiety, according to Tift, is to embrace it head-on.
The daily end-of-the-world panic I feel is a part of me. That will never change. So I can either choose to avoid that terrifying feeling like I have my whole life (and use compulsions to temporarily alleviate my pain), or I can learn to have a relationship with my panic and accept that it's part of the uniqueness of who I am.
What Tift is describing in Buddhism, has a western counterpart called Acceptance and Commitment Therapy (ACT). With ACT, you voluntarily accept any negative feelings that arise, and you don’t allow them to inhibit you from living your daily life. In doing this, those negative feelings never go away, but they lose their power over you. They can't control you anymore.
Let me repeat that: disturbing feelings will never go away. We can either accept them in all their ugliness, or forever go on coping for them with avoidant behavior.
I can't do the latter. not anymore. After a lifetime of being a prisoner to my fear and compulsions, I’m dead tired from exhaustion.
We each held onto the end of a rope, then we stood on opposite sides of the room. She told me to imagine that between us was this chasm that represented my greatest fear. She then started pulling on the rope. I pulled back to avoid falling in. She pulled harder. I pulled harder. After a minute of this, she asked, “Can you imagine another way to avoid falling in the chasm?” I thought about it, then dropped the rope. That was the point. Our greatest fears can only haunt us if we interact with them.
It’s important to note that, for the context of telling my story, I separated “me” and “my brain” into two different characters—it’s more entertaining that way. But inside my head there’s only one voice for my thoughts. So when I started experimenting with all this stuff, it was difficult to know which thoughts were OCD-thoughts and which ones were normal thoughts.
In January of this year I joined a hot Pilates studio (because that would be a good place to be around lots of new people, especially women, and to practice preventing myself from doing OCD-based threat monitoring behaviors). Ironically, the one connection I made there was with a man, who turned out to be an OCD therapist! I asked him how people with OCD can distinguish between their thoughts. He gave me a simple heuristic: if you’re spending time wondering if a specific thought is OCD related, it probably is. I have found that to be true every time.
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