Obsessive-compulsive disorders are among the most common mental illnesses—yet they are often accompanied by shame for those affected. Many people wait years before seeking help because they perceive their own thoughts as “crazy” or hide their rituals from others. However, obsessive thoughts and compulsive behaviors are well researched and can be successfully treated. To understand how OCD develops, it is worth taking a look at the development of our thinking—especially so-called magical thinking in childhood.

Magical Thinking: A Completely Normal Childhood Phenomenon

Almost every child at some point believes that their thoughts or wishes can influence the world. A child might think, “If I don’t step on the cracks in the sidewalk, nothing bad will happen to mom.” Or they believe that a strongly wished-for event will really come true tomorrow, like snow falling. This magical thinking is completely normal and even necessary for mental development.

Children do not yet have fully developed logical thinking. Fantasy, emotions, and reality often blend together. Rituals—such as a bedtime song or certain “lucky actions”—provide security in an often overwhelming world. This behavior is by no means pathological. On the contrary, it helps children structure their environment and cope with their first emotional challenges.

As children grow older and their cognitive abilities mature, they learn to distinguish more realistically between thoughts, actions, and consequences. Magical thinking gradually loses its everyday relevance.

When Does Magical Thinking Become a Problem?

By adulthood, magical thinking should largely disappear. Of course, many people keep small rituals or superstitions—like carrying a lucky charm before exams. This is harmless as long as it does not limit or burden daily life.

It becomes problematic when thoughts or rituals are experienced as compulsive, accompanied by intense anxiety or shame—and when they begin to control the lives of those affected. At this point, we no longer speak of a harmless quirk but of an obsessive-compulsive disorder (OCD).

What Is Obsessive-Compulsive Disorder?

OCD is a mental illness characterized by obsessive thoughts and/or compulsive behaviors. Both may occur together but don’t have to.

Obsessive Thoughts (Obsessions)

Obsessive thoughts are recurring, intrusive thoughts, impulses, or images that forcibly enter the mind against the person’s will. Those affected usually perceive them as senseless, exaggerated, or distressing. They typically cause intense anxiety or disgust.

Examples of obsessive thoughts:

• Fear of harming oneself or others (“What if I push my child down the stairs?”)
• Worries about causing a disaster through carelessness (“Did I turn off the stove?”)
• Disgust about germs and contamination (“I could catch a disease by shaking hands.”)
• Blasphemous or sexually taboo thoughts (“Why am I suddenly thinking something immoral?”)

Important: These thoughts do not reflect the wishes or beliefs of the affected person. They cause severe inner conflict—a key difference from psychotic experiences.

Compulsive Behaviors (Compulsions)

Compulsive behaviors are repetitive actions or mental acts performed in response to obsessive thoughts—often in hopes of reducing anxiety or preventing a feared disaster.

Examples:

• Checking (repeatedly checking door locks, stove, etc.)
• Washing (excessive hand washing or showering)
• Counting, praying, or repetitive mental rituals
• Symmetry or ordering compulsions (objects must be “perfectly” arranged)

Even though the person knows these behaviors are excessive or irrational, they feel compelled to perform them, often under great distress.

How Does OCD Develop?

The exact causes are complex and individual. Usually, it is a combination of:

• Biological factors: Studies show increased activity in certain brain regions (especially fronto-striatal circuits). Genetic influences also play a role.
• Psychological factors: People with strong responsibility feelings, perfectionism, or insecurity are more prone to compulsive behavior.
• Learning mechanisms: Compulsions reduce anxiety short-term—this relief reinforces the ritual long-term, a classic case of operant conditioning.

Symptoms often first appear in adolescence but may also manifest in adulthood triggered by stress or life events.

Diagnosis and Differentiation

Diagnosis is made by psychiatrists or psychotherapists according to ICD-11 or DSM-5 criteria. Symptoms must last at least one hour per day and cause clinically significant distress or impairment.

Differentiation from other mental disorders is important, such as depression (with rumination), psychosis (with delusions), autism spectrum disorders (with stereotyped behaviors), or anxiety disorders.

Treatment of OCD

OCD: symptoms and treatment! Good news: OCD is treatable—with psychotherapy, medication, or a combination.

1. Cognitive Behavioral Therapy (CBT)

The evidence-based first-line treatment is CBT with Exposure and Response Prevention (ERP). Patients are gradually exposed to anxiety-provoking thoughts or situations—without performing the usual compulsive rituals.

Example: A patient with washing compulsions touches a public door handle and consciously refrains from washing hands afterwards. Through repeated practice, they learn that feared outcomes (e.g., severe illness) do not occur even if the ritual is omitted. Anxiety diminishes over time.

The cognitive part challenges dysfunctional thoughts like excessive responsibility or perfectionism.

2. Medication

In severe cases or when therapy alone is insufficient, selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, sertraline, or fluvoxamine are prescribed. These affect brain serotonin and help reduce symptom intensity.

Medication should always be taken under professional supervision and is not a substitute for therapy but can facilitate it.

Living with OCD: What Helps in Daily Life?

Besides professional help, the following measures can ease daily challenges:

• Psychoeducation: Knowledge reduces shame and strengthens self-acceptance.
• Open communication: Confiding in trusted persons benefits affected individuals.
• Mindfulness and acceptance strategies: Help observe compulsive thoughts without immediately acting on them.
• Patience and relapse prevention: Symptoms may fluctuate even after successful therapy—this is part of the process, not failure.

Conclusion

OCD is more than just “quirks” or habits. It can severely restrict life, strain social contacts, and consume enormous energy. But it is important to understand: No one is helpless against their compulsions.

The boundary between childhood magical thinking and clinically relevant OCD lies in freedom and functionality: While rituals provide security to children, they often drain energy and freedom in adults. Those who seek help early have very good chances of improvement—through effective psychotherapy, possibly combined with medication.

If compulsive thoughts or behaviors start to dominate your life, seeking support is a sign of strength, not weakness.

OCD: symptoms and treatment – if you recognise yourself in the symptoms described and would like to find out what the origin of your obsessive thoughts might be, as well as learn how to deal with your compulsive behaviour, let’s talk about it in a free initial session!

References:

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Arlington, VA: American Psychiatric Publishing.

World Health Organization (2022). International Classification of Diseases 11th Revision (ICD-11).

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