How OCD and People-Pleasing Work Together

Guest post by Cameron Staudacher, Presented by BetterHelp.


People-pleasing and conflict-avoidance behaviors are commonly reported in those diagnosed with obsessive-compulsive disorder (OCD), as well as those diagnosed with a similar condition, obsessive-compulsive personality disorder (OCPD). The strong compulsions associated with OCD may prevent someone from asserting their wants or needs, or it may make it difficult for them to do what is best for them in all circumstances. This article will look at OCD, people-pleasing behavior, and how the two are sometimes related. 

Understanding OCD

OCD is a complex mental health condition characterized by a pattern of unwanted thoughts and fears (obsessions) that lead to repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily activities and may cause significant distress. Individuals with OCD might feel driven to perform certain actions compulsively in a bid to ease their anxiety or to prevent imagined dreaded events; however, these compulsive behaviors often only provide temporary relief and can become self-perpetuating.

OCD is more than just being overly tidy or preferring things a certain way; it’s a serious disorder that can significantly impact someone’s quality of life. Obsessions can vary widely, including fears of contamination, having things in order, harm coming to oneself or others, or severe social consequences. Compulsions might involve cleaning, checking, counting, orderliness, or following rigid routines. Despite common misconceptions, these actions aren’t enjoyable for the person with OCD but are felt as necessary to prevent negative outcomes or to reduce anxiety.

The exact cause of OCD is unknown, but a combination of genetic, neurological, behavioral, cognitive, and environmental factors are believed to play a role. Treatment often involves a combination of psychotherapy, particularly cognitive behavioral therapy (CBT), with a focus on exposure and response prevention (ERP) and medication, such as selective serotonin reuptake inhibitors (SSRIs). Check out this article from BetterHelp explaining more about the primary psychotherapy for OCD. 

The nature of people-pleasing

People-pleasing is typically described as a behavior pattern where individuals prioritize the happiness and approval of others above their own needs, desires, or feelings. While it may seem like a benign attempt to maintain harmony, at its core, people-pleasing often stems from a deep-seated fear of rejection, a longing for acceptance, and an often unconscious belief that one’s worth is determined by the ability to make others happy. This behavior can lead to a cycle of overcommitment, resentment, and emotional exhaustion, as a people-pleaser’s own needs and boundaries are consistently sidelined.

Unlike healthy altruism, where acts of kindness are driven by genuine care and a balanced sense of self and other’s needs, people-pleasing is marked by an imbalance. A people-pleaser often neglects self-care and personal boundaries while pursuing external validation. This relentless quest for approval can be particularly intense in individuals with underlying anxiety disorders, such as OCD, where the fear of making mistakes or displeasing others might trigger compulsive people-pleasing behaviors.

People-pleasers often struggle with saying no and setting healthy boundaries. They also tend to find themselves in one-sided relationships where their efforts are not reciprocated. This pattern can affect mental and emotional well-being and strain relationships, as the lack of balance in giving and receiving can lead to resentment and disconnection.

How people-pleasing and OCD work together

Individuals with OCD often experience intense anxiety and fear about making mistakes, causing harm, or being judged unfavorably by others. These obsessions can drive a compulsive need to engage in behaviors that they believe will mitigate these fears, leading to people-pleasing as a form of compulsion. The desire for control and certainty, hallmark traits of OCD, likely manifests in the pursuit of approval and acceptance from others.

People-pleasing behaviors in those with OCD can serve multiple purposes. They often act as a strategy to prevent the perceived adverse outcomes associated with the obsessive component of OCD. For example, someone obsessed with the idea of causing disappointment might go to great lengths to accommodate others, even at their own expense. People-pleasing behaviors might also be a way to reduce the discomfort associated with the uncertainty of social situations. By attempting to ensure that others are always happy and content, the individual seeks to create a predictable and controlled social environment.

A compulsive need to please can exacerbate OCD symptoms, creating a cycle where an individual’s sense of self-worth becomes increasingly tied to their ability to please others. The temporary relief provided by people-pleasing behaviors reinforces the belief that such actions are necessary for social survival, likely further entrenching those patterns.

Treating OCD and addressing people-pleasing behaviors

Treatment strategies for OCD and people-pleasing behaviors tend to focus on both the compulsive behaviors driven by the OCD and the individual’s need for external validation. Some of the more common treatment strategies are outlined below: 

  • Cognitive Behavioral Therapy (CBT): CBT, particularly Exposure and Response Prevention (ERP), is the gold standard for treating OCD. By gradually exposing individuals to their fear triggers without allowing them to engage in their usual compulsive responses, ERP helps break the cycle of compulsions. Incorporating elements that specifically target people-pleasing behaviors can enhance this treatment by encouraging individuals to confront situations where they cannot control others’ reactions, thereby reducing the reliance on people-pleasing as a coping mechanism.


  • Assertiveness Training: Communicating one’s needs and boundaries assertively is likely crucial for those stuck in people-pleasing patterns. While not specific to OCD, assertiveness training can help individuals recognize their right to express their thoughts and feelings without fear of rejection or the need to appease others constantly. 


  • Mindfulness and Acceptance Techniques: Techniques drawn from Acceptance and Commitment Therapy (ACT) can help individuals with OCD and people-pleasing tendencies better tolerate uncertainty and discomfort. Mindfulness practices encourage a non-judgmental awareness of the present moment, reducing the urge to engage in compulsive behaviors to alleviate anxiety. Acceptance strategies help individuals acknowledge their thoughts and fears without needing to act on them compulsively.


  • Social Skills Training: For some, people-pleasing behaviors stem from a lack of confidence in social situations. Social skills training can equip individuals with the tools needed to interact with others in a more authentic, less anxiety-driven way. This training can help those with OCD or other anxiety disorders navigate social interactions without resorting to compulsive people-pleasing, fostering more genuine and satisfying relationships.


  • Family and Group Therapy: Engaging in family or group therapy can provide a supportive environment where individuals can explore the impact of their OCD and people-pleasing behaviors on relationships. These settings offer opportunities for learning and practicing new skills, gaining feedback from others, and building a support network.


Addressing OCD and people-pleasing together involves challenging deeply ingrained patterns of thought and behavior. Generally, treatment for OCD is supervised by a therapist or other mental health professional. People-pleasing in the absence of OCD may be significantly easier to address, and any person challenged by obsessions, compulsions, or chronic people-pleasing could likely benefit from meeting with a therapist. 


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