Psychologist Anna Heal

Thank you for describing this so clearly, Maya. First, it makes sense that you are worried and that these rituals and intrusive thoughts are starting to interfere with work and relationships. From what you describe (intrusive contamination and harm-related images, repeated checking, arranging, avoidance, and time-consuming rituals that reduce anxiety short-term but cause problems long-term), this pattern is consistent with obsessive-compulsive disorder (OCD) or an OCD spectrum presentation. That is not a moral failing or perfectionism; it is a treatable condition.

Evidence-based therapeutic options for someone your age with these symptoms start with psychotherapy aimed specifically at OCD. The most strongly supported treatment is cognitive behavioral therapy with a focus on exposure and response prevention (ERP). ERP helps you face triggers (exposures) and intentionally refrain from the rituals that reduce anxiety (response prevention), so the brain can learn that anxiety decreases on its own and that feared outcomes are unlikely. Standard CBT that includes cognitive strategies for challenging unhelpful beliefs about responsibility, contamination, and harm is often combined with ERP. For some people, particularly when symptoms are moderate to severe or do not respond sufficiently to therapy alone, medication can be helpful in combination with CBT/ERP. Selective serotonin reuptake inhibitors (SSRIs) at therapeutic doses for OCD or, rarely, other agents under specialist guidance are commonly used. In specialized or severe cases, a psychiatrist experienced in OCD may consider other options, but as a psychologist I encourage starting with ERP-based therapy if available.

How to find a therapist who specializes in CBT and ERP. Look for licensed psychologists, clinical social workers, or therapists who explicitly list OCD or ERP on their profiles. Professional directories from reputable sources (for example national psychological associations, OCD-specific organizations, or university clinic listings) often let you filter for ERP experience. When contacting potential therapists, ask whether they use ERP for OCD, how much experience they have with young adults, and whether they offer a time-limited structured program or session recordings/homework. If waiting lists are long, ask about group ERP programs or telehealth options, which can be effective and easier to access. If you have a university counseling center, ask whether they provide ERP or can refer you to specialists.

What to expect in the first few sessions. The first session or two will focus on assessment: your history, the nature of intrusive thoughts, the specific rituals, frequency, time cost, triggers, avoidance, and how these symptoms affect work and relationships. The therapist will likely use questionnaires or scales for OCD symptoms and may ask about mood, sleep, substance use, and safety (for example any thoughts of harming yourself). You should expect collaborative goal-setting: defining what you want to change and creating a stepwise plan. Early therapy includes psychoeducation about OCD and ERP, learning the rationale for exposures, and developing a hierarchy of feared situations or thoughts to address gradually. You will also likely receive homework: planned exposures and practicing response prevention outside sessions. The therapist should explain how exposures are paced, how relapse or setbacks are handled, and how progress is tracked. A good therapist will be supportive, nonjudgmental, and willing to tailor work to your daily responsibilities, like running the website.

When medication is recommended and common medications. Medication is usually recommended when symptoms are moderate to severe, when symptoms significantly impair functioning (such as missed deadlines or loss of clients), when there is limited response to an adequate course of ERP, or when symptoms are so distressing that they prevent meaningful engagement in therapy. For young adults, the most commonly used medications for OCD are SSRIs (for example fluoxetine, sertraline, fluvoxamine, and others) prescribed at doses often higher than those used for depression. Treatment with medication should be guided by a psychiatrist or primary care clinician experienced with OCD, who will discuss benefits, side effects, time to response (often several weeks to months), and monitoring. Because you expressed concern about medication and judgment, it is reasonable to explore therapy first, and to consult a prescriber only if therapy alone is insufficient or if you prefer combined treatment. Medication does not replace ERP but can make doing ERP easier for some people.

Practical strategies for reducing rituals while maintaining work. Begin by mapping exactly when rituals occur and how long they take. Set small, achievable goals for reducing time spent on rituals rather than trying to stop everything at once. Use time-limited blocks: schedule focused work sessions with a fixed start and end time, and commit to not doing checking rituals during those blocks. Use environmental supports to reduce triggers: close unnecessary browser tabs, log out of admin backend between sessions, use browser extensions or phone settings to limit refreshing, and disable nonessential notifications. For checking messages, adopt a rule such as one thorough check every 60 or 90 minutes during work hours, and slowly increase that interval as you gain confidence. When an urge to retype or reorder arises, use the “delay and distract” technique: set a timer for a short delay (five to fifteen minutes), do a brief unrelated task, then see whether the urge persists; over time extend the delay. Keep a short worksheet listing the specific rituals and a graded exposure plan (start with less distressing items). Use behavioral experiments: deliberately send a message once and resist checking to test the feared outcome. Structure your day so that you do highest-priority website tasks during your most alert hours, and schedule specific low-anxiety windows for routine maintenance. When you must meet a deadline, agree to a pragmatic rule with yourself, such as one pass of editing under a time limit, then submit, with a separate plan to revisit perfectionist rechecks outside client-facing hours. Track progress with simple metrics (time spent on rituals per day, number of checks, completed work tasks) so you can see improvement. If concentration and restlessness are significant, build short physical breaks into your schedule, use the Pomodoro method (work 25 minutes, break 5 minutes), and practice grounding or brief mindfulness to reduce anxiety spikes between tasks.

How to communicate this to family and clients. With family, provide brief education: explain that intrusive thoughts and rituals are symptoms of an anxiety-related condition (OCD) that causes repetitive behaviors to reduce distress but that therapy (especially ERP) is effective. Ask for specific support: help with reminders to practice exposures, patience when you need to step away, and not minimizing the problem as mere perfectionism. Offer resources or short articles from reputable sources so they can understand the condition without guessing. With clients, be factual and professional. If you need to explain a missed deadline, a brief apology and an outline of steps to prevent recurrence is sufficient. You do not need to disclose diagnosis unless you want to; stating that you experienced a temporary personal issue and that you are implementing changes to prevent future delays is usually enough to maintain trust. If appropriate, offer a small compensatory action (discount, expedited next task) but avoid overexplaining. Clear, honest, solution-focused communication reduces misinterpretation and preserves reputation.

Workable steps during busy days. Start the day by prioritizing one or two nonnegotiable tasks to complete. Use timed work blocks and limit checks of the site backend to scheduled intervals. Prepare templates for common messages so you do not retype unnecessarily. Use visual cues to indicate a task is final (for example a “finalized” folder or a timestamped version) and deliberately leave an “edit later” tag for nonurgent perfectionist impulses. If you feel compelled to repeat an action, use the delay technique and log the urge without acting on it for at least a short interval. Keep emergency contact points (a trusted friend or therapist) for high-anxiety moments and practice quick grounding exercises to avoid spirals. Over time, pair these pragmatic changes with ERP homework so that the reductions in ritual time become more sustainable.

Red flags indicating need for urgent or inpatient care. Seek urgent help if you have persistent suicidal thoughts, intent, or plans. Also seek prompt help if intrusive thoughts shift to a level where you fear you might act on them and feel out of control, or if you begin avoiding so many activities that you cannot meet basic needs (work, nutrition, hygiene). If rituals escalate to the point where you lose major clients, cannot leave the house for essential tasks, or are experiencing severe comorbid symptoms like psychosis or severe depression, contact emergency services or your mental health provider for immediate evaluation. Otherwise, worsening functional decline should prompt expedited outpatient care but not necessarily inpatient admission; discuss concerns with a clinician who can assess risk and recommend steps.

Finally, be kind to yourself. You have already identified patterns, tried several strategies, and sought information. That is progress. Prioritize finding an ERP-trained therapist and consider combining therapy with pragmatic workplace supports. If you want, when you contact therapists you can say explicitly that you are a 19-year-old experiencing intrusive thoughts and checking rituals that interfere with work and that you are looking for ERP-based treatment; this will help find the right provider quickly.

Take care, and remember that with the right treatment people with OCD often see meaningful and lasting improvement in functioning and quality of life.