Hi Carrie,

What is meant by the statement “OCD doubt is not purposeful, protective, or driven by unmet needs” is that OCD does not come from an inner agent trying to safeguard the person. The doubt may feel protective, and it often shows up in situations where the person already feels vulnerable or afraid, but that does not mean the doubt is serving a psychological purpose or expressing a need.

OCD can look as if it is warning or protecting, but that appearance comes from the structure of the obsession, not from an inner part with intention. It behaves that way because the reasoning error turns a hypothetical possibility into something that feels like a danger that must be neutralized. The process is automatic. There is no agent behind it and no emotional message being sent. It is simply the result of treating imagined possibilities as if they were real.

People can absolutely carry wounds, self-doubt, or trauma from earlier experiences. Those can make someone more sensitive to certain themes, but they do not generate OCD’s reasoning and imaginative distortions. They shape vulnerability, not the mechanism specific to OCD.

So the point is not that emotional history is irrelevant. It’s that the obsessional doubt does not arise to express an unmet need or to protect the person in any intentional sense. To treat OCD, we have to address the reasoning process that creates the illusion of danger, even when the anxiety feels meaningful.

Thanks for raising this. It is an important clarification.

I agree with much of what is said here, but I’m struggling with this section from my own experience in working with hundreds of OCD clients: “OCD doubt is not purposeful. It is not protective. It does not arise from unmet needs.”

When I hear stories of individuals who experienced everyone doubting their decision when they were growing up, it makes sense that they would have a propensity to doubt themselves. The unmet need in this scenario would be that no one instilled a sense of confidence inside them to be able to make a decision. Brining them back to their “real self” in ICBT of course is helpful here, but this is an emotional wound/unmet need.
If OCD is not purposeful, why does it get attached to things people care about?
What is the function of these compulsions? Is it not many times to keep people safe? From illness? From being hurt relationally? From eternal damnation?
Yes, the cognitive errors in OCD have to be addressed, but I hope you will also recognize that people carry emotional hurt from past trauma and relationships that also may need to be addressed alongside the cognitive work. People are complex beings, often coming in with more than one diagnosis or issue. I’m curious to hear more regarding what other therapies you don’t believe would blend well with ICBT (future blog post potential).