When “Anxiety” Gets Weird — Why OCD Often Gets Missed in Trauma Therapy
“What if I have OCD?” a client once asked me.
Internally, I sighed.
At the time, OCD felt like the newest TikTok-driven mental health trend — another label being over-applied to anxiety. Externally, I did what I had been trained to do. I went through the DSM-5 criteria, confirmed that what the client was experiencing fit better with a diagnosis of Generalized Anxiety Disorder, reassured them (sigh) that they didn’t have OCD, and we moved on with session.
Fast forward about a year.
Thanks to some personal experiences and deeper professional exposure, my understanding of OCD expanded — and suddenly, things that hadn’t made sense before clicked. I found myself returning to that earlier conversation and realizing the client might have been right.
I remember saying, “I wonder if you were right. I wonder if this could be OCD. Would you be open to exploring that together?”
There was also an apology and repair. I had missed something important.
“Weird Anxiety” — Wait..
As I began learning more, I noticed a pattern that I suspect many trauma-informed therapists encounter.
Clients would come into session with intense anxiety. We’d explore history, work with parts, process memories, build insight and self-compassion. By the end of session, they often felt calmer and clearer.
Then they’d come back the next week just as distressed.
They weren’t “resistant.”
They weren’t avoiding the work.
They weren’t lacking insight.
If anything, they were thoughtful, highly reflective, and deeply motivated.
What I had come to lovingly refer to as “weird anxiety” was, in fact, OCD.
OCD often masquerades as generalized anxiety, trauma responses, or relational insecurity — especially in high-functioning, insight-oriented clients. The distress isn’t primarily driven by fear in the body or unresolved memory networks. It’s driven by doubt.
“What if I missed something?”
“What if this means something about me?”
“What if I can’t ever be sure?”
Clients can understand where the fear comes from and still feel completely hijacked by it.
This is where many trauma-informed approaches quietly stall.
IFS helps us understand parts, but OCD doesn’t resolve simply by unburdening emotion.
EMDR can bring relief, but obsessional doubt often reconstitutes itself.
Insight brings understanding — not resolution.
That doesn’t mean these approaches are wrong. It means OCD requires something additional.
Making a Clinical Shift
I sought out supervision and learned how to properly assess for OCD using the Y-BOCS II. Almost immediately, my entire practice shifted.
I know “transformative” is an overused word — but in this case, it’s accurate.
Suddenly, patterns I had been working around for years made sense. Clients I had felt quietly stuck with were finally moving forward. Many times, just the validation of a diagnosis was relieving in and of itself.
As I explored different treatment approaches, I came across the work of Melissa Mose, and it opened up a whole new world. Melissa was talking about treating OCD using Internal Family Systems (IFS) — not in a way that bypassed the disorder, but in a way that honored both the emotional system and the structure of OCD.
I joined one of her consultation groups that met four hours a month and was struck by her depth of knowledge and clinical wisdom. In those groups, I was introduced to Inference-Based CBT (I-CBT) — a model that conceptualizes OCD not as an anxiety disorder, but as a disorder of reasoning and inference.
I completed training in I-CBT and began integrating it into my work right away. The results were striking.
What I-CBT lacked, IFS provided.
What IFS couldn’t fully address, I-CBT clarified.
Together, they fit beautifully.
Why Consultation is Essential in OCD Treatment
OCD can be uniquely disorienting for therapists.
It often:
Pulls clinicians into subtle reassurance or analysis
Activates over-responsibility
Creates confusion about whether treatment is “working”
Leaves even experienced therapists doubting themselves
This is why consultation matters so much when working with OCD — not just for technique, but for orientation and support.
Having a place to slow down, reality-check conceptualizations, and think collaboratively prevents therapists from getting pulled into the disorder’s logic.
About OCD Consultation with Me
I now exclusively use IFS and Inference-Based CBT to treat OCD. Most of my clients move from severe Y-BOCS II scores to non-clinical ranges by the end of the 12-module I-CBT curriculum.
I created my OCD consultation cohort for therapists who:
Work with OCD or suspect it’s showing up more than they realized
Are IFS-informed and want to apply parts work responsibly with OCD
Are curious about I-CBT as a non-exposure-based approach
Want thoughtful, relational consultation rather than rigid protocols
If you’ve been sensing that something about your “anxiety” cases doesn’t quite fit — you’re probably not wrong.
OCD often reveals itself not when therapists fail, but when they’re paying close attention. If you’d love to have community in this process, I’d love to have you join us in a cohort this year! Details are available here, and I’d love to answer any questions for you!