OCD Convinces You Compulsions Prevent Harm... They Don't - Get to know OCD

Summary4 min read

Episode Summary:

Podcast: Get to Know OCD
Host: Dr. Patrick McGrath (NOCD’s Chief Clinical Officer)
Episode: OCD Convinces You Compulsions Prevent Harm... They Don't
Date: May 10, 2026

Main Theme

In this episode, Dr. Patrick McGrath dives deep into the core misconception at the heart of obsessive-compulsive disorder (OCD)—the belief that compulsions prevent harm. He explores why resisting compulsions feels so uncomfortable, how OCD tricks us into believing these actions keep us and others safe, and what needs to change for true recovery. The episode is both informative and supportive, offering relatable examples, therapeutic strategies, and encouragement to those facing OCD.

Key Discussion Points & Insights

1. The Internal Logic of OCD

Dr. McGrath explains that those with OCD often feel that resisting compulsions is "wrong" because OCD convinces them these actions keep disaster at bay (00:00).
Quote:
"Part of the reason is you've been tricked into believing that compulsions are actually good and helpful and are the reason why everything is okay. This is a lie that OCD tells, and people are, unfortunately easily duped by a very persuasive OCD." (00:23)

2. The 'What If' Trap

The core worry for many is, “What if something bad happens because I didn’t do my compulsion?” This leads to guilt and increased anxiety around not performing rituals (01:02).
Practical Example:
- Not checking if the stove is off before leaving for vacation, followed by a persistent fear that the house may burn down, leading to repeated checks (03:30).
- Worrying about not scheduling a doctor’s appointment for every small ache and fearing lifelong regret if something serious is missed (04:05).

3. How Compulsions Reinforce OCD

Performing compulsions may bring momentary relief, but they make the cycle worse by lowering the threshold for future doubt and compulsive behavior.
Quote:
"When you do that, and the more that you check, the more doubt you're actually going to have. And so that 10 time check of the stove probably turns into 20 or 30." (04:20)
Compulsions quickly escalate, making OCD more intrusive over time. The emotional “what if” is the hook that makes the cycle hard to break (02:46).

4. The False Sense of Responsibility

OCD creates a feeling of control and responsibility for preventing harm, often in irrational ways.
Illustrative Story:
- Dr. McGrath shares a scenario about his mother falling down the stairs coinciding with the act of closing a car door “the wrong way”—highlighting that OCD creates emotional links where no real causation exists (01:40).
- Quote:
  "OCD is trying to keep in control. OCD says you can control your environment in your world by doing compulsions. But if that were actually the case, wouldn't everybody be doing compulsions all the time?" (06:00)

5. The Illogical Extension of Compulsive Control

Dr. McGrath takes the OCD logic to the extreme: if compulsions truly prevented harm, everyone would do them, and no bad events would ever occur.
Memorable Analogy:
- If everyone stopped driving to avoid hurting people, society would grind to a halt—no groceries, no work, no utilities, and eventual societal collapse (06:30).
- Quote:
  "If we did that society would end within a few months... In doing that, we end up, well, no more us, right? That's, that's really what happens." (07:40)

6. Recovery: Doing the Opposite

Recovery requires doing the opposite of what OCD wants—resisting compulsions and reducing safety behaviors (08:04).
Quote:
"If you want to strengthen OCD, do more compulsions and other safety behaviors. If you want to lessen OCD, reduce safety behaviors and compulsions." (08:10)

7. Effective Treatment: ERP and Medication

Exposure and Response Prevention (ERP) combined with medication is the gold standard in treatment.
Quote:
"It's meds and ERP. So we at NOCD can provide that ERP for you if you're looking for help for OCD and you want a trained therapist to guide you through the process at a very manageable pace." (09:00)
Medications are helpful but not curative without ERP to change behavior (08:50).

8. Encouragement for Listeners

Dr. McGrath offers reassurance about the support available and how ERP is a gradual process—"we're not going to throw you in the deep end of the pool." (09:33)

Notable Quotes & Memorable Moments

“OCD is going to just be like this driving, annoying, itch stone in your shoe... you could do something just to make it go away. But... the more that you check, the more doubt you're actually going to have.”
— Dr. Patrick McGrath (04:25)
"Doing the opposite of what OCD wants... that’s how OCD loses its power."
— Dr. Patrick McGrath (08:06)
"We're sticking a toe in the water and seeing how it feels."
— Dr. Patrick McGrath reassuring listeners about starting ERP (09:35)

Timestamps for Important Segments

00:00: Introduction to the false promise of compulsions
01:40: Example of emotional links and illogical connections
03:30: Common real-life compulsions—checking the stove, health anxieties
04:20: Escalation of compulsions and dropping thresholds
06:00: The logical fallacy of compulsions controlling the world
08:04: Doing the opposite—foundation of recovery
09:00: Why ERP + medication is the best treatment combo
09:35: Supportive onboarding to ERP therapy

Conclusion

Dr. Patrick McGrath’s episode demystifies why compulsions feel crucial and why the only path to freedom from OCD is to resist them with evidence-based therapy. His compassionate, pragmatic approach, illustrated with real examples and vivid analogies, provides both insights and hope for listeners struggling with OCD.

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Transcript1 lines

[00:01]
A
You may wonder why doing the right thing, at least when we're talking about ocd, that means resisting compulsions, feels so wrong and so uncomfortable. And part of the reason is you've been tricked into believing that compulsions are actually good and helpful and are the reason why everything is okay. This is a lie that OCD tells, and people are, unfortunately easily duped by a very persuasive ocd. Foreign. Here's what we know. Resisting compulsions is the key component to getting your life back from ocd. But people often really fret about this. They feel guilty about stopping these behaviors because of the what if? Component that comes in here. Like, well, what if I don't do it and then something bad happens? Wouldn't that be my fault? Because all these other times I did it and nothing bad happened. So now what I really think is the reason nothing bad happened is because I did these things. So what if I stopped doing these things and then something bad happens? And this is the crux of what therapy is going to be all about and how OCD keeps you stuck. Right? Let's talk about that. Let's talk about what's going on and how you can handle it. OCD has gotten you to believe that compulsions prevent harm. Harm. Okay? And we can even say this because we know that there doesn't have to be a relationship between compulsions. I may get a call from my dad that says, mom fell down the stairs. And so I rush to the hospital, and I see that she's okay, a little bumped and bruised. I come back home, and, oh, by the way, when I got that call, I happened to be closing my car door at the same time that I got the call. So I get home now, and I close the car door, and you know what? It just doesn't feel quite right. And so I quickly open it again, and I close it again. And now it feels right. It has that right sound when it closes. And guess what? No phone call. Huh? You know why my mom fell down the stairs? Probably because I closed the car door wrong. And now if I want to make sure that she doesn't do that again, what's going to be the best thing for me to do? Close the car door the right way. Of course, now, logically, there seems to be no relationship between closing the car door and my mom falling down the stairs. But emotionally, what if? Right? And we just need that what if on that emotional side in order to really hook us in to do compulsions. So that's what's happened. If we don't do the compulsions we feel reckless, irresponsible, that we're dangerous, or that we're promoting danger or something like that. And if a bad outcome does occur, we are like, oh, see, the OCD was right. I really should have done that thing. So maybe you're leaving for a vacation and you're not checking the stove 10 times and you're holding onto this notion of what if the house burns down though, while we're gone? It'll be my fault. That'll be terrible. Maybe I should just go back in and check that stove one more time just to be sure. Maybe you're not scheduling a medical appointment for every new ache and pain and you're stuck in this notion of what if it's serious this time and I regret this forever, that I missed something, right? OCD is going to just be like this driving, annoying, itch stone in your shoe kind of experience where it's just like you could do something just to make it go away. But we also know this, that when you do that, and the more that you check, the more doubt you're actually going to have. And so that 10 time check of the stove probably turns into 20 or 30. Those medical appointments. Well, your threshold gets lower and lower for what it takes to set them. Now it's. Oh, that was a cough. I don't know why I coughed. Maybe she just called the doctor just to see if I have any thing. Maybe it's tuberculosis or something like that and I just want to be sure, right? And our thresholds get lower and we give in more and more to ocd. So there's this really false sense of responsibility, right? OCD is trying to keep in control. OCD says you can control your environment in your world by doing compulsions. But if that were actually the case, wouldn't everybody be doing compulsions all the time? And then nothing bad would actually happen ever in the world? Because why? Well, we've listened to OCD and we've done compulsions. And therefore there wouldn't be any more car accidents. There wouldn't be any more deaths. There wouldn't be any trips and falls. There wouldn't be any harm coming to anyone in any way whatsoever because all of us would be doing compulsions as a way to prevent them from happening. Now, I would contend that if we did that society would end within a few months because no one would drive anymore. Because, you know, I don't want to get anyone hurt by driving. Which means no groceries get delivered, no one goes to work, which means no one runs the plants that, you know, purify water, make electricity, give us natural gas, and then we're stuck in our homes because we can't go outside. And we're stuck on one floor of our homes because I don't want to go up and down the stairs in case I fall, and I don't want to go outside because what if I go outside and I say something offensive to one of my neighbors? So now I'm just stuck inside and then I'm going to eat all the food that I have and once it's gone, I'm just going to starve to death because, well, OCD said it would be best to just make sure I don't do anything wrong. And in doing that, we end up, well, no more us, right? That's, that's really what happens. It's time to start to practice doing the opposite of what OCD wants. That's how OCD loses its power. If you want to strengthen ocd, do more compulsions and other safety behaviors. If you want to lessen ocd, reduce safety behaviors and compulsions. It's the only way we know how to make it work right now. It's the only way that we know how to get better. It can be combined with medications. Those can be really helpful in the situation, but even those aren't the curative component because adding the ERP is what's really going to get the behavior to change. And so it's key that, that you do both together if you're going to be working on both. Even the American Psychiatric Association's recommendations say meds alone are not the key component to the treatment. It's meds and erp. So we at NOCD can provide that ERP for you if you're looking for help for OCD and you want a trained therapist to guide you through the process at a very manageable pace. Right. We're not going to throw you in the deep end of the pool. We're sticking a toe in the water and seeing how it feels. We can walk you through exposure and response prevention. So reach out to us@nocd.com or download the NOCD app and we'd be happy to set up a free 15 minute call with you and our care team so that we can chat with you about all the things that we have available to assist. And we can get you set up with a licensed therapist in your area who is trained in exposure and response prevention and can start you on the path of living the life you want to live and not the life that OCD wants you to live.