Understanding "What If" Thoughts

Many people with Obsessive-Compulsive Disorder (OCD) experience intrusive “what if” thoughts — sudden, unwanted questions that feel urgent, disturbing, or impossible to ignore.

These thoughts aren’t dangerous, meaningful, or predictive. They’re a symptom of how OCD targets uncertainty and doubt.

The problem isn’t the question itself. It’s the feeling that you have to resolve it in order to feel okay.

Common Examples of “What If” Thoughts

Below are examples of the types of questions OCD tends to latch onto. These are not meant to be answered, but to show the patterns OCD uses to keep anxiety going.

Harm-Related Thoughts

• What if I hurt someone?
• What if I lose control?
• What if I act on a thought?

Relationship-Focused Thoughts

• What if I don’t really love my partner?
• What if I chose the wrong person?
• What if I’m lying to myself?

Sexual or Taboo Intrusive Thoughts

• What if this thought means something about me?
• What if I secretly want this?
• What if thinking it makes it more likely?

Health, Contamination, or Responsibility

• What if I missed a symptom?
• What if I contaminated someone?
• What if I caused harm without realizing?

Different themes — same mechanism.

Why These Questions Stick

OCD isn’t interested in answers. It’s 

interested in certainty.

When a “what if” thought shows up, OCD creates the sense that the question must be solved right now — by analyzing, checking, researching, mentally reviewing, or seeking reassurance.

That relief is temporary. But it teaches your brain that the question was important.

Over time, the brain learns to send the same questions again — louder, more urgent, and harder to ignore.

How ERP Treats “What If” Thoughts

Exposure and Response Prevention (ERP) is the gold-standard, evidence-based treatment for OCD.

ERP doesn’t try to eliminate intrusive thoughts or provide certainty. Instead, it helps you change how you respond to them.

In ERP, you practice:

• Allowing “what if” thoughts to be present
• Resisting compulsions like checking, analyzing, or reassurance-seeking
• Staying with uncertainty long enough for your nervous system to learn that anxiety rises and falls on its own

Over time, the thoughts lose their power — not because they were answered, but because your brain learns they don’t require action.

You Don’t Need to Figure This Out Alone

If these questions feel familiar, you’re not broken — and you’re not failing. You’re experiencing a well-understood OCD pattern that responds to the right treatment.

Matt Baker, MSW, LCSW is an ERP expert serving adults with OCD across California -via secure telehealth, providing structured, evidence-based ERP for OCD and related anxiety disorders.

Learn more about ERP

Use the OCD self-screener reflection tool

Work with Matt Baker, LCSW - of Whatif Therapy