When OCD Isn’t Cleanliness: Exploring the Taboo Obsessions Few Talk About

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Content Warning: This post discusses intrusive thoughts related to harm, sexuality, and moral concerns. While we approach these topics with care and clinical accuracy, please prioritise your wellbeing and consider reading when you feel emotionally prepared.

For those struggling with unrecognised OCD symptoms beyond cleaning and organising, this comprehensive guide explores taboo obsessions, provides research-backed insights, and offers practical tools for healing using neuroaffirming approaches.

About the Author

I’m a neurodivergent advocate, hypnotherapist, meditation teacher, Reiki Master, and EFT practitioner living with OCD, ADHD (combined type), dyslexia, and dyspraxia. Through my work at Exceptional Individuals and my personal journey, I support others navigating the complex intersections of mental health and neurodivergence. My approach combines evidence-based practices with neuroaffirming, holistic tools that honour how different brains actually work.

Introduction: Beyond the Cleaning Stereotype

When most people picture OCD, they imagine germs and cleaning. Sparkling kitchens. Shoes neatly lined at the door. Hands rubbed raw from washing.

And yes — for some of us, cleaning is part of it. I’ve always had rules like no shoes in the house, and I know the comfort of things being “just so”.

But my OCD goes much further than what people see on TV or in awareness campaigns. It shows up on the train, where my anxiety spikes and thoughts won’t let me rest. It looks like battling intrusive thoughts about myself, others, and the world — thoughts I never asked for, but that stick like glue.

The medication I take (Sertraline, increased from 50mg to 100mg) has given me enough breathing room to notice what’s happening instead of being completely consumed by it. This breathing space has been crucial for my healing.

I also live with ADHD (combined type), dyslexia, and dyspraxia. That mix means my brain often swings between chaos and control. One part chases stimulation, another craves certainty, while dyslexia and dyspraxia add their own layers of overwhelm.

Understanding this intersection has been vital: my OCD doesn’t exist in isolation — it threads into all the ways my neurodivergence shows up.

This blog is for anyone who’s ever thought, “My OCD doesn’t look like the stereotype, so maybe it’s not real.” It is real. And you’re not alone.

What OCD Really Is: The Disease of Doubt

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OCD isn’t just about germs or cleaning rituals. While cleaning and order can be part of it — they are for me — OCD is much broader and more complex.

Mental health experts have described OCD as fundamentally rooted in doubt. This isn’t a new concept — historically, OCD has been called “the doubting disease” (folie du doute).

Research from Johns Hopkins reveals the profound role doubt plays in OCD. Dr Gerald Nestadt, who has studied OCD for over 30 years, explains that doubt here is a behavioural trait — a lack of confidence in one’s own memory, attention and perception — rather than a simple knowledge gap.

At its heart, OCD is about the way the brain latches onto certain fears or ideas and won’t let go, no matter how much reassurance or checking you do. This doubt-driven cycle becomes self-perpetuating, as research shows that compulsive rituals provide temporary relief of anxiety but ultimately reinforce the negative self-model driving the obsessions.

Further reading: What is OCD? | 5 Main Types of OCD

The Two Core Components

Obsessions: unwanted, distressing thoughts, images, or urges that feel intrusive and disturbing.
Examples include:

• Sudden thoughts about harming someone you love

• Doubts about whether you locked the door (even after checking multiple times)

• Intrusive sexual images that contradict your values

• Fear that you’ve accidentally said something offensive

Compulsions: behaviours or mental rituals performed to ease the anxiety those thoughts create. Relief is temporary; the obsessions return and the cycle resumes.
Examples include:

• Checking locks, switches, or emails repeatedly

• Mental counting or repeating phrases

• Seeking reassurance from others constantly

• Avoiding certain places, people, or situations

The Science of Doubt in OCD

 

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Johns Hopkins research involving 1,182 adults with OCD assessed doubt with questions such as: “After you complete an activity, do you doubt whether you performed it correctly?” and “Do you feel you don’t trust your senses?” Findings were striking: the more severe the doubt, the greater the functional impairment; most with extreme doubt showed extreme dysfunction.

The Cruel Twist of OCD

Here’s what makes OCD particularly tormenting: it often targets what matters most to you. Common themes include contamination (“I may be sick or dirty”), responsibility for harm (“I may harm people or myself”), inability to control thoughts (“I may lose control of my mind”), or moral threat (“I may be evil or a bad person”). Doubts persist despite contradictory evidence because they’re tethered to negative core beliefs about the self.

If you value safety, OCD might bombard you with violent “what ifs”. If you value faith, it might fill your head with blasphemous doubts. If you value love and relationships, it might whisper endless questions about your partner.

Having intrusive thoughts doesn’t mean you want them. It means you have OCD.

OCD and Neurodivergence: Understanding the Connections

While OCD can affect anyone, research reveals important overlaps with other neurotypes that help explain why some of us experience multiple conditions simultaneously.

Research-Backed Connections

Autism and OCD: Autistic people are about twice as likely to experience OCD compared to the general population. Sometimes OCD symptoms can overlap with autistic routines or sensory responses, which can complicate accurate diagnosis and treatment approaches.

ADHD and OCD: A comprehensive review found that these conditions frequently co-occur, with rates as high as ~30% in some studies. The impulsivity and distractibility of ADHD can mask or amplify compulsive cycles, making diagnosis more complex.

Other Neurotypes: Conditions like dyslexia and dyspraxia don’t directly cause OCD, but managing multiple neurodivergent traits can increase overwhelm, shame, or delays in seeking appropriate help.

My Personal Experience with Multiple Conditions

For me, ADHD’s constant restlessness often fuels my compulsions. When my brain is seeking stimulation, it sometimes latches onto compulsive behaviours as a way to feel “productive” or “right”.

Meanwhile, dyslexia’s information-processing struggles and dyspraxia’s coordination challenges can magnify feelings of “not getting it right”. OCD, in turn, seizes on those vulnerabilities, amplifying the voice that says: “See? You’re failing. You need to check again. You need to be more careful.”

This intersection taught me that treating OCD in isolation wasn’t enough — I needed approaches that honoured my entire neurodivergent profile.

The Taboo Obsessions: Signs of OCD That Rarely Get Discussed

 

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Here are the OCD themes that rarely make it into awareness campaigns or TV dramas, but affect countless people. Recognising these patterns can be life-changing for those who’ve suffered in silence.

1. Harm-Related Obsessions

What it looks like:

• Intrusive thoughts about harming someone “accidentally”

• Fear that you’ll lose control and act violently towards loved ones

• Images of pushing someone in front of a train or off a balcony

• Worry that you’ve already harmed someone without realising it

Common compulsions:

• Constantly checking that family members are safe

• Avoiding sharp objects like knives or scissors

• Mentally reviewing your actions to ensure you didn’t hurt anyone

• Seeking reassurance that you’re not dangerous

Reality check: People with harm obsessions are statistically less likely to act violently. The distress you feel about these thoughts shows they go against your values.

2. Sexual Obsessions

What it looks like:

• Intrusive thoughts about inappropriate or taboo scenarios

• Doubts about your sexual orientation that feel distressing and unwanted

• Unwanted sexual images involving people you respect or inappropriate situations

• Fear of acting on unwanted sexual urges that contradict your values

Important note: The distress isn’t about desire — it’s about the thought being completely opposite to your values and identity.

Common compulsions:

• Avoiding certain people or social situations

• Constantly checking your body’s responses for “evidence”

• Seeking reassurance about your character or orientation

• Mental reviewing of past interactions

 

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3. Religious and Moral Obsessions (Scrupulosity)

What it looks like:

• Fear of offending God or committing unforgivable sins

• Obsessive worry about having impure thoughts during prayer

• Doubt about whether you’ve confessed everything properly

• Fear that you’re secretly evil or immoral

Common compulsions:

• Excessive praying or religious rituals

• Confessing repeatedly to religious leaders

• Seeking constant reassurance about your spiritual state

• Avoiding religious spaces due to fear of blasphemous thoughts

4. Relationship Obsessions

What it looks like:

• Constant doubts about whether you truly love your partner

• Obsessive analysis of your feelings and attraction levels

• Fear that you’re with the wrong person

• Comparing your relationship to others constantly

Common compulsions:

• Seeking reassurance from friends about your relationship

• Endlessly replaying conversations with your partner

• Checking your emotional responses to your partner

• Researching “signs of true love” online

 

Further reading: What not to say to someone with OCD

Signs of OCD in Women: Why Symptoms Are Often Overlooked

When we talk about recognising signs of OCD, women are often left out of the conversation. This oversight has serious consequences for diagnosis and treatment.

Why Women’s OCD Gets Missed

Research suggests OCD affects men and women at similar rates, but women are more likely to be misdiagnosed with depression or anxiety instead. A comprehensive review of epidemiological and clinical gender differences reveals several interconnected factors:

Diagnostic delays and misdiagnosis: Vignette-based studies reveal concerning patterns in OCD recognition. One study of 208 primary care physicians found that OCD symptoms were misdiagnosed about half (50.5%) of the time overall, with particularly high misidentification rates for sexual obsessions and aggression themes. Similar findings among mental healthcare providers show over 50% misdiagnosis for sexual obsessions and ~42% for harm-related symptoms.

For women specifically, research demonstrates that onset often occurs during or after puberty or pregnancy, and women tend to report significantly higher depression and anxiety than men. This higher comorbidity rate means women’s OCD symptoms often get attributed to these co-occurring conditions rather than being recognised as OCD itself, contributing to the misdiagnosis of taboo-themed OCD in women.

Stereotype mismatch: When symptoms don’t fit the cleaning stereotype, intrusive thoughts about harm, morality, or relationships get dismissed as “normal stress” or “overthinking”.

Invisible compulsions: Women are more likely to engage in mental compulsions — like silent counting, praying, or mental checking — that happen entirely under the surface, leaving no visible clues.

Socialisation factors: Women are often socialised to hide distress and internalise blame, making them less likely to seek help or describe their experiences accurately.

Common Signs of OCD in Women

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Parental fears: New mothers might experience intrusive thoughts about accidentally harming their baby, leading to excessive checking or avoidance of caring for the child alone.
Example: A mother who can’t stop checking that her baby is breathing, even when the child is clearly healthy and safe.

Relationship perfectionism: Obsessive analysis of romantic relationships, friendships, or family dynamics.
Example: Spending hours replaying conversations to check for signs that someone is upset with you.

Moral responsibility: Excessive guilt about minor mistakes or perceived wrongs.
Example: Feeling overwhelming guilt about a small lie told years ago and repeatedly seeking forgiveness.

Body-focused concerns: Obsessions about appearance, health, or bodily functions that go beyond typical self-consciousness.

(Internal link opportunity: “Supporting Women with Neurodivergent Conditions”)

The Delay in Recognition

The shame factor is particularly strong for women experiencing taboo obsessions. Many internalise the message that having intrusive thoughts makes them a “bad mother,” “bad partner,” or “bad person”.

This silence not only delays diagnosis but deepens the cycle of self-blame. Research shows substantial delays in OCD recognition and treatment — recent work found a mean duration of around 12–13 years between symptom onset and diagnosis, with historical studies reporting delays up to 17 years to receive adequate therapy. These delays are particularly pronounced for taboo-themed OCD, where shame and misunderstanding compound recognition challenges.

This pattern was true for me. Because my visible OCD behaviours — like the no-shoes rule — fit expectations, they got noticed and validated. But the real distress came from the thoughts I kept hidden, and those took years to properly identify and address.

My Treatment Journey: What Helped and What Didn’t

After years of struggling to find effective support, I learned that healing from OCD isn’t one-size-fits-all — especially when you’re neurodivergent. Here’s what my journey taught me about different treatment approaches.

Traditional Approaches: Mixed Results

ERP (Exposure & Response Prevention): Often called the “gold-standard” therapy for OCD, but it didn’t work for me. The reason wasn’t the approach itself, but how it was delivered.

Instead of building safety and understanding my neurodivergent needs, ERP often felt like more shame and “pushing through”. I’m not alone in this experience. A systematic review of 21 studies involving 1,400 participants found a weighted mean dropout rate for ERP of 14.7% (95% CI 11.4–18.4%), with overall attrition estimated around 18.7% when including treatment refusal.

Moreover, Johns Hopkins research shows that doubt severity impacts treatment outcomes. Dr Nestadt explains: “Typically, 60 to 70 percent of people respond to cognitive-behavioural therapy. But in patients with severe doubt, only about 35 percent respond. That’s where antidepressants come in.”

CBT (Cognitive Behavioural Therapy): While reviews note CBT is effective for many, I found traditional CBT too focused on changing “thought errors”, which felt invalidating when my neurodivergent brain processes information differently. Even “successful” CBT is typically associated with ~40% symptom reduction — meaningful, but not a cure-all.

What Actually Worked

DBT (Dialectical Behaviour Therapy): This approach clicked. DBT gave me:

• Emotion regulation tools that worked with my ADHD brain

• Distress tolerance strategies for intense OCD spirals

• Ways to notice urges without immediately acting on them

• Structure and compassion that honoured my neurodivergence

Medication (SSRIs): Sertraline has been genuinely helpful in reducing the intensity of obsessions and the urgency of compulsions. Medication doesn’t eliminate OCD, but it creates enough space for other tools to work effectively.

Somatic & Holistic Tools: As a hypnotherapist, meditation teacher, Reiki Master, and EFT practitioner, I lean heavily on these practices:

• Meditation and hypnotherapy help me create distance from intrusive thoughts

• Reiki grounds me in my body when anxiety tries to pull me into my head

• EFT (tapping) calms my nervous system when spirals begin

These aren’t “cures”, but they’re powerful regulation tools that make the difference between overwhelm and resilience.

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Why Talking About Taboo OCD Matters

Breaking the silence around lesser-known OCD symptoms creates ripple effects that extend far beyond individual healing.

Validation: Openly discussing harm obsessions, sexual intrusions, or moral scrupulosity validates experiences that feel unspeakable.
Challenging shame: Intrusive thoughts aren’t moral failings or secret desires — they’re symptoms of a treatable condition.
Creating hope: Even if ERP wasn’t right for you, other pathways exist (DBT, ACT, medication, holistic tools).
Preventing misdiagnosis: Better recognition across presentations leads to more accurate diagnoses and appropriate treatment.

For me, the turning point was reframing: from “I’m having violent thoughts” to “My OCD is producing violent thoughts”. That small shift opened the door to self-compassion — and change.

Evidence-Based Treatment Options for OCD

• CBT with ERP: Effective for many, especially when delivered flexibly and compassionately for neurodivergent needs.

• DBT: Strong for emotion regulation and distress tolerance; particularly helpful with ADHD/autism/trauma intersections.

• ACT: Accept difficult thoughts/feelings while taking values-based action.

• Medication (SSRIs): Sertraline, Fluoxetine, Fluvoxamine, etc., can significantly reduce obsessional intensity/compulsion urges.

• Somatic & Holistic Approaches: Meditation, EFT, Reiki, hypnotherapy, and other body-based practices to support nervous system regulation.

A Practical Toolkit for Managing Intrusive Thoughts

Step 1 — Name it: “That’s my OCD, not me.”

• Creates distance; reminds you thoughts aren’t facts or predictions.

Step 2 — Regulate:

• EFT tapping: “Even though I’m having this thought, I am safe and I accept myself.”

• Breathwork: one hand chest, one belly; slow diaphragmatic breaths.

• Reiki self-treatment: hands over heart centre/solar plexus; imagine calm flowing through.

• Progressive muscle relaxation: tense–release from toes upwards.

Step 3 — Reorient:

• Set a gentle 2–5 min timer; return to your task. Use music, a fidget, or a written prompt. If attention drifts, return to Step 1 without judgement.

Step 4 — Track patterns (without judgement):

• Which thoughts appeared? What helped? How long to re-regulate?
  This isn’t about grading severity — it’s about learning what works for your brain.

How Exceptional Individuals Supports OCD and Neurodivergence

At Exceptional Individuals, we understand that managing OCD alongside other neurodivergent traits requires specialised, compassionate support that honours how your brain actually works.

Individual Coaching: Build a personalised intrusive-thought toolkit that works with your neurotype (ADHD, autism, dyslexia, dyspraxia).
Workplace Support: Access to Work assessments and ongoing adjustments, anxiety-management coaching, and employer advocacy.
Training and Workshops: For teams/employers to understand OCD and neurodivergence, reduce stigma, and create supportive environments.

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Moving Forward: Your Next Steps

 

If you’re struggling with intrusive, taboo thoughts, here’s what I want you to know:

You are not your thoughts. Intrusive thoughts don’t define you, predict your actions, or reflect your true desires. They’re symptoms of a treatable condition.

You are not alone. Thousands of people experience OCD that has nothing to do with cleaning or organisation. Your experience is valid, even if it doesn’t match the stereotype.

You deserve support that fits your brain. ERP isn’t the only path to healing. DBT, holistic practices, medication, or a blended approach might be exactly what you need.

Try This Week

1. Label one intrusive thought as “OCD” instead of accepting it as “truth” about yourself.

2. Experiment with one nervous system regulation tool like EFT tapping, breathwork, or the 5-4-3-2-1 grounding technique.

3. Reach out for support that understands and affirms your neurodivergent experience.

Ready for personalised support? At Exceptional Individuals, we offer neuroaffirming coaching, Access to Work assessments, and workplace training that truly understands how OCD intersects with other neurodivergent traits. Our team combines evidence-based approaches with holistic practices to help you build a toolkit that works with your brain, not against it.

 Learn About Access to Work Support | Workplace Training for Teams

References

Abramowitz, J. S., et al. (2009). Scrupulosity in OCD: A review and recommendations for treatment. Journal of Anxiety Disorders, 23(6), 837–846.

Abramovitch, A., Mittelman, A., Henin, A., & Geller, D. A. (2015). Comorbidity between ADHD and OCD across the lifespan: A systematic and critical review. Harvard Review of Psychiatry, 23(4), 245–262.

Berrios, G. E. (1989). Obsessive-compulsive disorder: its conceptual history in France during the 19th century. Comprehensive Psychiatry, 30(4), 283–295.

Cleveland Clinic. (2023). OCD (Obsessive-Compulsive Disorder): Symptoms & Treatment. Retrieved from https://my.clevelandclinic.org/health/diseases/9490-ocd-obsessive-compulsive-disorder

Glazier, K., Swing, M., & McGinn, L. K. (2015). Half of obsessive-compulsive disorder cases misdiagnosed: vignette-based survey of primary care physicians. Journal of Clinical Psychiatry, 76(6), e761-767.

Grant, J. E., Pinto, A., Gunnip, M., et al. (2007). Sexual obsessions and clinical correlates in adults with obsessive–compulsive disorder. Depression and Anxiety, 24(6), 451–460.

International OCD Foundation. (n.d.). Types of OCD.

Johns Hopkins Medicine. (2017). The Role of Doubt in OCD. Retrieved from https://www.hopkinsmedicine.org/news/articles/the-role-of-doubt-in-ocd

Mathes, B. M., Morabito, D. M., & Schmidt, N. B. (2019). Epidemiological and clinical gender differences in OCD. Current Psychiatry Reports, 21(4), 36.

McKay, D., et al. (2015). Efficacy of cognitive-behavioral therapy for obsessive–compulsive disorder. Psychiatry Research, 225(3), 236-246.

Nestadt, G., et al. (2016). Doubt and the decision-making process in obsessive-compulsive disorder. Comprehensive Psychiatry, 75, 1-10.

Nikodijevic, A., et al. (2015). Fear of self, doubt and obsessive compulsive symptoms. Journal of Behavior Therapy and Experimental Psychiatry, 49(Pt B), 164-172.

Ong, C. W., Clyde, J. W., Bluett, E. J., Levin, M. E., & Twohig, M. P. (2016). Dropout rates in exposure with response prevention for obsessive-compulsive disorder: What do the data really say? Journal of Anxiety Disorders, 40, 8-17.

Öst, L. G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive–compulsive disorder: A systematic review and meta-analysis. Behaviour Research and Therapy, 62, 158–168.

Pérez, M. I., Limon, D. L., Candelari, A. E., et al. (2022). Obsessive-compulsive disorder misdiagnosis among mental healthcare providers in Latin America. Journal of Obsessive Compulsive and Related Disorders, 32, 100693.

Pitman, R. K. (1987). Pierre Janet on obsessive-compulsive disorder (1903). Review and commentary. Archives of General Psychiatry, 44(3), 226-232.

van Steensel, F. J. A., et al. (2011). Autism spectrum disorders and obsessive–compulsive disorder: An updated review. Research in Autism Spectrum Disorders, 5(1), 112–121.

Ziegler, S., Bednasch, K., Baldofski, S., & Rummel-Kluge, C. (2021). Long durations from symptom onset to diagnosis and from diagnosis to treatment in obsessive-compulsive disorder: A retrospective self-report study. PLOS ONE, 16(12), e0261169.