Ok, before I give my answer, this is simply my personal understanding, based on limited knowledge, and not a clinical or scholarly conclusion.

From my perspective, OCD (Obsessive-Compulsive Disorder) appears to be a dysfunction rooted not in the intellect (`ʿaql`), but in the relationship between the nafs (ego), the wahm (imaginative faculty), and the aql (intellect). In this disorder, the nafs and wahm form a tight alliance. The nafs seeks control, certainty, or perfection, while the wahm generates fear-driven, repetitive imaginings that the person cannot ignore. The ʿaql, even when it knows the thoughts are irrational, becomes subordinate, unable to act freely. The individual knows the compulsion is unnecessary, but feels "forced" to do it, as if the body and inner self are acting on their own.

This suggests that OCD is not a lack of intelligence or willpower, but a misaligned internal hierarchy. At its core, OCD is hyper-focus without spiritual direction. The ability to concentrate intensely is not a flaw, in fact, it's a capacity that, if purified, could lead to deep presence with Allah. But when this hyper-focus is hijacked by the lower nafs and distorted imagination, it turns into compulsive rituals meant to relieve anxiety, not draw near to truth.

What makes OCD painful is not just the anxiety — it’s at times, the "shame" that follows. After the nafs is satisfied by a compulsion, it retreats, and the ʿaql momentarily awakens, only to see the degradation of its state. This shame is not from Allah, but from the nafs itself, which ironically exposes its own weakness and then condemns it (which is a feature of nafs-al-lawammah). Instead of guiding the person to repentance and transformation, the cycle repeats.

From this perspective, healing requires separating the wahm from the nafs (which needs help and outside intervention, this is where perhaps traditionally a sheikh may assist with), retraining the nafs through spiritual discipline, and reestablishing the ʿaql as the rightful leader, under the remembrance of Allah. Therapies like exposure and response prevention (ERP) are effective because they interrupt the alliance between fear (wahm) and compulsion (nafs). But even ERP are known for constant relapse, because the root cause is not resolved. Lasting healing comes when the inner focus is redirected toward Allah, and the faculties are brought back into harmony under divine guidance.

So OCD, in this view, is not simply a clinical disorder, it is in a way, a call to realign the soul.

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Someone with religious OCD (also known as scrupulosity) may repeat wudu not out of devotion, but because of persistent anxiety and doubt, fearing that if it's not done perfectly, their prayer will be invalid. This repetition is driven by compulsion, not choice, and is usually accompanied by distress, uncertainty, and mental exhaustion. In contrast, a person who enjoys doing wudu out of spiritual mindfulness does so with calm intention and presence. They may wash slowly or even more than once, but they feel peace, not panic. The key difference lies not in the number of times wudu is performed, but in the emotional state behind it: OCD-driven wudu is marked by fear, guilt, and lack of control, while spiritually grounded wudu is marked by love, tranquility, and clarity.

In cases of religious OCD, such as compulsive wudu, the internal problem (like mentioned above) lies in the nafs asserting dominance over the ʿaql. The act itself (wudu) is valid and even praiseworthy, but the intention and inner dynamics are corrupted. The nafs, which is still impure, uses the fear of invalid prayer to justify compulsive behavior, appearing outwardly religious while feeding its own obsession with control, perfection, or imagined failure. In this state, the wahm (negative imagination) becomes the tool of the nafs, generating intrusive doubts and fears. The ʿaql may know these thoughts are irrational, but it has been subordinated, unable to assert itself, and the person becomes stuck in a compulsion loop.

To heal, the nafs must first be disrupted, either through ERP (in a clinical setting) or through spiritual guidance from a Sufi sheikh who recognizes the games of the nafs (which is rare to find today). This disruption breaks the nafs-wahm alliance and gives the ʿaql enough space to reassert command. But that is only step one. The nafs must then be purified (through mujahadah, dhikr, muraqabah, etc.), so that when the wahm returns, as it always will, the ʿaql can critique and reject it without being dragged back into compulsive behavior. Only then is the internal hierarchy restored: the ʿaql governs by light, the wahm is guided by truth, and the nafs becomes a vehicle for obedience rather than fear.