Many people with OCD understand that their thoughts and behaviors are out of the norm. Just knowing this can be stressful, feeling tormented by thoughts they cannot control. Symptom awareness is not enough for effective management. Without treatment, people with OCD live through many moments of embarrassment, isolation and shame. They often have a sense of hopelessness about their situation. Even knowing that their thoughts are irrational, they may have difficulty discarding them. For example, they may understand that rechecking the fire alarm one more time won’t make any difference. But their fears about their house burning down may be so convincing that they can’t ignore the urge to check again.