I need to say something that will unsettle some of my colleagues, and probably some of you too. I’m saying it anyway, because I’ve spent years sitting across from clients with OCD, and years studying the models we’re trained to use to treat it, and the longer I do both, the more convinced I become of something the standard model doesn’t want to say out loud.
For a significant number of people, especially neurocomplex people, OCD is not best understood as a certainty problem sitting there on its own, waiting to be treated with exposure and response prevention and a workbook. It is a symptom, often the most visible symptom, of something much older and much deeper. It is what complex, developmental trauma looks like once it has traveled far enough down a family line and far enough into a nervous system that it starts organizing itself around a single, quiet, unbearable question: can I trust myself, and can I trust the world.
That is the controversial part, so let me build the case for it properly, because a claim like this does not get to stand on assertion alone.
The Question Underneath the Compulsion
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