The One Diagnosis All Therapists Should Understand
It pertains to limits of confidentiality and keeping clients safe.
Updated September 3, 2025 | Reviewed by Abigail Fagan
Therapists are intimately familiar with limits of confidentiality and mandated reporting laws. They understand what is required of them to keep their clients safe and protect others. However, the lack of understanding about one particular diagnosis often deters therapists from protecting their clients. This diagnosis is Obsessive Compulsive Disorder (OCD).
You may be thinking, “What does a love of organization or a lot of hand-washing have to do with limits of confidentiality?” If you’re asking that question, that is exactly why you should be reading this.
OCD is commonly portrayed in the media as a quirky personality trait of people who love to organize their closets by color or keep their coffee tables tidy. Reality star Khloe Kardashian, with a following of 140+ million people on Instagram and Twitter alone, created a series titled “Khlo-C-D” to highlight her love of organizing her pantry (among other things). Loving to organize is not OCD. It is no wonder why OCD is so misunderstood. While the general population might not have an investment in learning about the disorder, every single therapist should because of its relation to the limits of confidentiality.
Diagnostically, OCD is characterized by the presence of obsessions and compulsions. Obsessions are repetitive, intrusive and unwanted thoughts, images, and "urges" that are distressing to the person experiencing them. Compulsions are physical or mental acts that the sufferer carries out to alleviate distress, prevent a dreaded outcome from happening, reassure oneself, neutralize obsessions, etc. OCD is an egodystonic condition, meaning that the obsessions are opposite to a person's desires, beliefs, values, and self-concept .
While the contamination obsessions and sanitizing compulsions the most well-known, the reality is that contamination concerns make up a small percentage of obsessional themes.
Obsessions of OCD vary widely and often involve the very content that makes up mandated reporting laws. Below is a list of a few common obsessional doubts that you may not be aware of, along with common compulsions associated with these obsessions (including, but not limited to):
It can be confusing for clinicians without an understanding of OCD to hear clients say things such as, “I have repetitive thoughts and images about harming myself” or, “I keep having an image of smashing my baby’s head on the wall." As it is a therapist’s greatest responsibility to keep their clients safe, words like “suicide,” “pedophile,” and “kill” can (rightfully) be triggering for them. We are taught in our graduate programs, trained in our internships, and reminded by our supervisors that we must assess for danger when we hear such words.
What therapists are often not taught about is Obsessive-Compulsive Disorder and the treatment of it. If I did not suffer from one of the “taboo” obsessional themes myself, I likely would know very little about the ways that OCD manifests because there are so many misconceptions about the condition.
People with OCD do not carry out their obsessions. Rather, they perform excessive, time-consuming rituals (mental and physical) to prevent the obsession from coming true. However, because the client’s thoughts are comprised of content similar to mandated reporting laws, a therapist who does not understand OCD may misdiagnose or break confidentiality when the client is the farthest thing from being of danger to themself or others.
A pedophile knows that they're attracted to children. A person with OCD knows that they're not, but may doubt what they know because of the unwanted thoughts and images. A person who wants to end their life aligns with the wish. Someone with suicidal obsessions knows that they're not suicidal, but may doubt what they know because of the unwanted thoughts and images. A person who desires killing others knows that they want to carry out violent acts. A person with violent obsessions knows that they do not desire hurting others, but may doubt what they know because of the unwanted thoughts and images.
While it is not always clear-cut, a few key characteristics of OCD are as follows:
On average, studies show that those with OCD suffer 14 to 17 years from the onset of their symptoms to the time they access proper treatment. This is the result of shame that many people with OCD experience because of the content of their obsessions, misconceptions about the disorder, and an overall lack of understanding about OCD by clinicians and sufferers alike.
The good news is that OCD is treatable. A particular form of Cognitive Behavioral Therapy called Exposure & Response Prevention (ERP) is the most evidence-based treatment for OCD. Additional treatments for OCD can be found here . If you would like to learn more about OCD and it’s treatment, reach out to an OCD specialist for consultation or visit the below resources. By doing so, you could save people years of suffering. You could save people time and money spent on ineffective treatment for OCD (such as traditional talk therapy). You could save lives.
Additional OCD Resources:
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Alegra Kastens, MA, is a Licensed Marriage & Family Therapist who received her Master’s degree in Clinical Psychology from Pepperdine University.
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This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.