A conversation with a person with OCD (with David Adam)

Where is the line between ordinary intrusive thoughts and an OCD pattern that hijacks the day? How do obsessions and compulsions condition each other so that brief relief entrenches the loop? What clinical markers - ego-dystonic content and intact reality testing - separate OCD from psychosis? How do thought–action fusion, inflated responsibility and “zero-risk” striving amplify checking and covert mental rituals? Why does repeated checking degrade memory confidence and widen doubt? How should ERP be structured to target hidden mental rituals as well as visible behaviors, and what metrics best define success? When are SSRIs a helpful platform for ERP, and why are effective doses often higher than for depression? What boundaries and scripts help families avoid reassurance and accommodation while staying empathic? How do culture and news cycles shape obsession themes without changing the underlying mechanism? What relapse-prevention practices keep gains durable - normalizing setbacks, tracking triggers, and refocusing on work, love, and presence?

David Adam is an author and journalist, who covers science, environment, technology, medicine and the impact they have on people, culture and society. After nearly two decades as a staff writer and editor at Nature and the Guardian, David set up as a freelancer in 2019. David's book - The Man Who Couldn’t Stop - is his attempt to understand the condition and his experiences with OCD, where he explores the weird thoughts that exist within every mind and explains how they drive millions of us toward obsession and compulsion.

Links:

• The Man Who Couldn't Stop: OCD and the True Story of a Life Lost in Thought

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