People with OCD may perform compulsions and mental rituals to try to reduce the anxiety or stressful discomfort that they feel. Compulsions can be overt physical acts (like checking a lock or touching an object) or they can be mental rituals that are carried out in the mind (like counting or thinking a specific thought).
Compulsions are defined by the Diagnostic and Statistical Manual as:
- Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2.The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
Common Compulsions/Mental Rituals
The following are examples of compulsions, but this is not a comprehensive list.
Avoiding (examples: avoiding a perceived contaminant, avoiding a place, avoiding touching certain things)
Mental Review- reviewing an event in your mind to try to make sure it was ok
Mental Rehearsing- going over potential future scenarios to check for likelihood of a catastrophe
Checking- physically going back to check something (classic examples would be like checking a door lock or oven settings)
Mentally Checking- carefully thinking a thought to ‘undo’ a bad or unacceptable thought or reviewing something in your mind to make sure
Washing- hand washing, showering (to remove perceived contaminant) or achieve a sense of feeling right or clean
Reassurance Seeking- asking others repeatedly to try to make sure of something
Thought Neutralization- using a “good” thought to neutralize a “bad” thought
Hoarding- buying or failing to throw away useless items
Memory hoarding- trying mentally over-attend to the details of an event or person or thing in an attempt to mentally store it for safekeeping
Symmetry Compulsion- repeating behaviors to try to make things feel equal
Compulsive Prayer- often used to counteract or neutralize “unacceptable” thoughts
Self-Punishment- forcing feelings of guilt and negative self-thoughts to achieve a feeling of being adequately punished
Counting- a form of distraction to avoid other unwanted thoughts or to keep something bad from happening or simply an obsession
Compulsions and mental rituals may offer temporary relief to someone suffering from OCD, but they never help you get free from obsessive unwanted thoughts. They actually reinforce the idea that your thoughts represent real threats. You want to get to a place where any thought is just a thought. You want to be free to have any thought and not feel the need to do a compulsion. To do this, you will need to desensitize to the thought by allowing the scary thoughts and resisting doing the compulsions. You want to sit with that uncomfortable feeling that the thought gives you. You want to feel the urge to complete the compulsion but not act on it. The more time you spend with the uncomfortable feelings and urges without acting, the sooner the power of those feelings and urges will diminish. But you have to spend time there. It will feel horrible, but know that in time, those feelings WILL diminish. This is the path to recovery and freedom!
First you want to identify what compulsions/mental rituals you might be using. Some compulsions may be overt and obvious- like the compulsion to count or check. Some compulsions are carried out entirely in the mind- like purposefully thinking about something to undo or neutralize the threatening thought. Avoiding can be a compulsion. Sometimes compulsions can become such a normalized part of an individual’s experience, he may not always be aware of the way OCD thoughts are shaping his behaviors. Try to consider how OCD thoughts may be influencing the way that you interact with the world around you.
When you start to feel anxious and uncomfortable and you want to do a compulsion to avoid or relieve the discomfort/anxiety, you want to resist the compulsion. You want to sit with the feelings of anxiety and discomfort. The discomfort can be extreme. But the more time you spend with those uncomfortable feelings (without doing the compulsion), the sooner they will fade. The things (thoughts, feelings, situations) that once brought you such discomfort and fear and anxiety will no longer be able to do so.
When you feel the urge to do a compulsion, wait. Just wait in that space of discomfort. Spend a little time there. Your brain will be urging and compelling you to act. Be an observer of yourself. Notice how it feels in your brain and in your body when you are waiting in that space. Become familiar with those feelings and those urges. Stay in that space. Observe and feel and allow and accept. And resist the urge complete the compulsion.
Allow all the thoughts that will try to scare you into completing the compulsion. Look at them. Fear will rage through your body and mind, but try to adopt a stance of curiosity as you observe these fearful thoughts and feelings that are assaulting you. Your brain may scream at you that certain thoughts or feelings will always torment you until you complete the compulsion. Your brain may scream that something bad will happen or something will be ruined if you do not complete the compulsion. Let those thoughts scream.
When you are in that waiting space (after the fearful thoughts but before the compulsion), your mind will likely bombard you with fearful threats, ideas, or questions. If you don’t do this compulsion, then…. Your fear brain will remind you of all the reasons that you “must” act. Allow these thoughts, but do not let them bully you into doing a compulsion. These threatening thoughts can feel very real, but they are not. They are just thoughts. You may have thoughts come up like- what if this always bothers me… what if I never get better… what if this doesn’t work for me… what if this makes it worse…. what if this is a real threat…? These are all fearful thoughts. Lean into them; allow them. Spend time with them. In time, even these thoughts will not be able to alarm you. (see Absolute Hope page for more details about how to desensitize to fearful thoughts).
And remember, your job is not to answer these questions or respond to the ideas in the fearful thoughts, but to sit with the uncertainty and allow them. For example, if an individual has the fearful thought, what if always associate this memory with this bad thought? Rather than try to answer that question or reassure oneself, the individual can allow the question to be there, allow the discomfort to be there… and ask the question again to intentionally sit in that space of uncertainty and discomfort.
Experiencing the Wave
When the woman’s body is preparing to birth the baby, she experiences painful contractions. Each contraction starts with a dull pain and then builds up to a peak, intense pain before the pain begins to lessen again. Some women use the imagery of a wave crashing over them to help them ride through the pain. The wave approaches, crashes over you, and then passes. And then you may have a small break before another wave approaches. The knowledge that the wave will come and pass, can help the woman to get through the peak of pain.
The discomfort of that fearful thoughts cause in the body can also be like a wave. If you are resisting a compulsion or exposing yourself to a trigger, the discomfort will begin to rise in your body. It will likely ramp up as you wait in that space. Allow the discomfort to rise and peak, and then it will diminish some. Another wave of discomfort may follow quickly. Continue to allow these waves to crash by you. In time, you will desensitize, and the intensity of the discomfort continues to diminish.
Feeding the Beast
OCD is like a monster demanding to be fed. When you give into compulsions, you feed the monster and keep it alive.
You Are in Control of Your Actions
I remember feeling like I was losing my mind. You may feel that your thoughts are completely out of control, and this may cause you to worry that you may act out of your control. However, no matter what thoughts are raging in your mind, you are in control of actions. You can test this. Sitting in a chair, think to yourself “stand up”, but choose to remain sitting. Let your thoughts yell and scream at you to stand up, but choose to remain seating. Your thoughts can scream at you, but you remain in control of your actions.
Graduated Approach
You may choose to do a graduated approach to recovery where you address certain compulsions at a time. You may choose to expose yourself to less threatening thoughts first before you move onto thoughts that are the most uncomfortable/fearful for you. I encourage you to work with a therapist who has experience with OCD to help you in your recovery process.