Compulsions in OCD

Compulsions in OCD

Compulsions, also known as rituals, are behaviors people with Obsessive-Compulsive Disorder (OCD) perform in response to obsessions.  Obsessions are intrusive, unwanted thoughts that trigger anxiety, distress and uncertainty.  People perform compulsions to neutralize fears or attempt to make obsessions go away.  Compulsions are not pleasurable, but rather behaviors people feel forced against their will to perform in order to avoid a future catastrophe.  There is a sense of loss of control because of the inability to stop engaging in ritualistic behaviors, even if there is some insight that they are irrational and unproductive.

Every human does a small amount of compulsive behavior, but it doesn’t normally get in the way of a happy, healthy, and productive life.  It is a common occurrence to hear someone announce how they are “so OCD!”  Almost 100% of the time if I say I treat OCD for a living at a cocktail party, people respond by asking “Do you have a business card for this one?” gesturing to the person next to them.  It is not immediately clear if they have the fake or the real kind, but real OCD is no joke.  It is a severe and debilitating disorder that makes the sufferer feel imprisoned by simple tasks and experiences most people take for granted.  Diagnosable OCD refers to obsessions and compulsions that take at least 1 hour per day, but most often tend to steal even more time away.  Sufferers often find that compulsions are so time consuming that valued life activities often take a back seat to them.

Why are compulsions important?

Compulsions are the fuel to the fire of OCD.  By continuing to pour gasoline on OCD’s flame by performing compulsions, OCD strengthens and spreads quickly to other areas like a brush fire.  Eliminating compulsions is like placing a cover over the flame, depleting the oxygen OCD needs to continue to thrive.  In OCD treatment, there is a major focus on compulsions because they are normally the most concrete and accessible way to target the disorder.  We can’t always control our thoughts and feelings, but we can control our behavior.  Since thoughts, feelings and behaviors are interrelated, if we change our behavior then our thoughts and feelings follow.  In other words, finding a way to discontinue compulsions is the way to decondition anxiety and have less frequent and intense obsessions.  This must occur in conjunction with repeated exposure to fears using a form of behavioral therapy called Exposure and Response Prevention (ERP).

TYPES OF COMPULSIONS

Overt / Physical Compulsions – These types of compulsions are most observable by others.  The behavior is performed to gain certainty a bad outcome won’t occur, to reduce anxiety and ward off intrusive thoughts.  Relief that results from overt compulsions will often be short-lived and compulsions tend to spread to more and more areas of life without proper treatment.

Types of physical compulsions…

o   Checking

Checking is a common compulsion and can show up in response to almost every type of obsession.  A woman may check the stove, flat iron, faucet or door to ensure nothing dangerous will happen when she leaves home.  Checking can involve manually making contact with or visually checking for certainty when powering off appliances such as a coffee maker.  A person may check his temperature or blood pressure if he has health anxiety or check his eyes or tongue in the mirror if he fears he has contracted HIV.  A person may check the Internet for symptoms of depression or suicidality to be sure she won’t act out her OCD thoughts about killing herself.

A person who fears mistakes may excessively check emails to ensure he didn’t write something offensive or that it was sent to the correct person.  On many occasions, clients in my office find themselves checking their phones to ensure someone isn’t hearing their therapy sessions.  A sufferer of harm OCD may visually check behind him to ensure he hasn’t harmed the elderly woman he just passed, check his car for dents from unperceived car accidents, or check his body to make sure he is not sexually aroused by an inappropriate person such as a child or family member.  People with homosexual OCD (HOCD) may check the attributes of an attractive, same-sex person to gain certainty about sexual orientation.  In relationship OCD (ROCD), someone may check her significant other’s appearance to be sure they find him attractive enough.

o   Washing and Cleaning

People with contamination obsessions may fear not being perfectly clean , being permanently contaminated, contracting a disease from touching a contaminated object or are disgusted by the thought of being dirty.  Common contamination obsessions include bodily fluids (blood, urine, semen, feces), chemicals or cleaning supplies, garbage, and surfaces regularly touched by the general public (elevator buttons, doorknobs, gasoline pumps).  To neutralize obsessions, the contamination OCD sufferer will wash hands frequently, excessively or ritualistically.  Some do the same hand wash as a surgeon preparing for surgery.  People with OCD often lack a feeling of completeness and therefore continue to wash, waiting and failing to create the “all done” feeling non-sufferers have when they are finished washing.

Contamination OCD sufferers may take excessive time showering and grooming, waiting for the certainty of cleanliness to arrive.  Common compulsions include washing inanimate objects such as keyboards, cell phones and pens way more frequently than those without OCD.  Someone may only wear clothing once before she washes it again, even if it was only worn briefly.  Emotional contamination can occur when a person or object is perceived to be magically contaminated by a feared person, situation or emotional state.  For example, a young man who was bullied while away at college may perceive all belongings from his dorm room contaminated.  In this case, a person may clean, segregate or dispose of belongings from college.

o   Straightening, Arranging, and Placing

OCD sufferers with perfectionism obsessions feel the need for objects in their environment to look and feel right.  People often straighten and arrange objects to create a “just right” feeling.  OCD defines places where objects belong and it is up to the person to keep it that way.  They may arrange office supplies, papers, books and chotskis so they are lined up perfectly along the edge of the desk or night stand.  Items such as keys, wallet and cell phone must be placed in the same exact spot every evening.  Compulsive behavior may appear one way, but be motivated by an entirely different obsession.  For example, a man may notice his wife straightening the rug compulsively every time she sees a tiny wrinkle.  At first glance it looks as if she cares about perfection and feeling “just right,” but she reports thoughts and images of her family members tripping on the rug and becoming seriously injured or killed.

o   Repeating, re-picking, touching and tapping

OCD sufferers are often instructed by their OCD to repeat behaviors, touch or tap objects a safe or lucky number of times.  For example a girl may put on her shirt 3 times because she has 3 family members that she wants to remain safe.  Actions such as standing up from a chair, walking through a doorway or turning off a light switch may be repeated until the person feels “just right.”  When placing an object down, such as a glass on the table, it may not feel right if it touches the table too hard, soft, or just didn’t sound right. The person will repeat the action by picking the glass up and placing it down again trying to achieve the right sound, touch or feeling.

A compulsion may be repeated if it wasn’t performed to OCD specifications.  With contamination OCD, a person may repeat an entire hand washing ritual if the inside of the sink or the faucet was accidentally touched during the ritual.  Someone with a general fear of a bad thing happening during the day may repeatedly pick underwear out of his drawer while matching the selection to a good thought.  Picking merchandise off the shelf at a grocery store can be challenging and repeated if it doesn’t feel right, the item is ‘contaminated’ or a ‘bad’ thought came in during the selection process.

o   Avoidance

Avoidance is a common behavior those with OCD engage in to reduce the risk of a negative outcome based on a particular fear.  Almost every kind of obsession has some form of avoidance ritual.  Someone with a fear of burning the house down may avoid using the stove altogether.  A person with contamination obsessions often avoids touching door knobs, public restrooms or the phone or keyboard of another person.  After performing a washing ritual, people with contamination fears will protect their cleanliness by avoiding touching anything after the compulsion.  People may also believe ‘contamination’ can spread like wet paint.  They avoid touching objects and making contact between 2 objects.

Individuals with harm OCD may avoid giving a child a bath, using a knife, changing a diaper, or driving the car through a crowded area of town.  A man with ROCD may avoid looking at his wife in the morning before she puts her makeup on or avoid saying “I love you,” because what if it’s not really love.  A person with HOCD may avoid looking a same sex person in the eye, going into an area with a high population of gay people or watching television or movies with attractive same-sex actors.  Avoidance occurs to prevent having OCD thoughts and eliminate the possibility that the sufferer will engage in the feared behavior.  If she doesn’t go to her grandmother’s house, she will definitely not be able to go crazy and kill her.  Avoidance is also used to prevent future occurrences of unwanted thoughts.  A person with scrupulosity, imagined sin or immorality, may avoid driving by churches to avoid having blasphemous thoughts, something that will surely commit them to hell.

o   Reassurance-seeking

“Are you sure this thought doesn’t make me a bad person?”  This compulsion is performed to gain certainty that a feared outcome will not occur or to reduce anxiety by asking others for reassurance.  The OCD sufferer will often engage family, friends or professionals in lengthy conversations about his or her fear.  Reassurance does not stick and the person is often compelled to introduce new twists on the subject or challenge the person about their responses in attempt to get further information to ease anxiety.  It is very difficult for clients to resist asking for reassurance, and family members often believe they are doing something helpful by providing it.  It would not be wise to give a small child everything he asks for even if it prevents a tantrum, because misbehavior will be rewarded and increased.  While providing reassurance to someone currently suffering with an OCD spike may give them temporary relief, over time the person is learning compulsions are effective and reassurance-seeking increases.  And we all know what happens when compulsions increase.  Yep, obsessions and fears increase.  And the cycle continues…

Mental Compulsions  – These types of compulsions occur in the mind and are not observable by others.  They are performed silently by thinking, analyzing, reviewing, and replaying thoughts, situations, and memories mentally.  Until OCD sufferers learn about mental rituals, they may not believe they are performing any rituals at all.  Just as physical compulsions are used to ward off obsessions and feared outcomes, OCD sufferers may also engage in ritualistic thinking for the same reasons.

Mental rituals are less obvious than physical compulsions and a person may mistake them for obsessions.  Often times, an obsession is just a momentary suggestion from OCD to examine something scary, and the mental ritual is the thoughts that occur for a much longer period of time.  Obsessions and mental compulsions can be intertwined and difficult to discern from each other.  When clients say, “I’m obsessing all day long,” they probably mean that they are responding to obsessions with mental compulsions all day long.

OCD sufferers mistakenly feel that mental compulsions will be productive in reducing suffering.  They believe that once they’ve ironed out all the details of their obsession, then the unwanted thoughts will go away and they will feel comfortable and certain.  Nothing could be further from the truth.  The more time spent trying to figure out intrusive thoughts, the more convoluted, confusing and uncertain they become.

Since mental compulsions are thoughts, they are not always possible to stop.  Remember, we cannot always control our thoughts.  Sometimes they are so habitual that reassuring thoughts just pop into the mind spontaneously.  The best way to think about handling mental compulsions is to understand their purpose and label them as rituals when they occur.  The awareness of what is happening changes it from a compulsive behavior to simply watching that thing the mind does and therefore, regularly cuts them short.

Types of Mental Compulsions…

o   Mental Review – A person examines past memories and events to determine if the feared obsession occurred or to make sure there isn’t any historical evidence that supports the OCD fear.  For example, a man with HOCD may mentally review all of his positive, heterosexual experiences to feel more certain about being straight.  A woman may lie in bed mentally reviewing all of the physical actions she took when placing her infant in the crib, to ensure she didn’t suffocate her baby with the pillow.  “I remember placing the pillow on the rocking chair before bringing the baby to her room.”  An individual may also review his past thoughts and events to gain certainty he is not in denial of the existence of his sinister inner core.

An example of a mental review process may look something like this, “My niece was over the other day and she sat on my lap.  Why did I let her do that?  What if I wanted her to sit on my lap because I am sexually aroused by her?  I think she may have initiated the contact though.  Yes, she got up off the floor and approached me.  Did I pick her up or did she climb up herself?  I’m pretty sure she climbed up herself.  Okay, well what if it doesn’t matter that she climbed up herself?  What if it is still creepy that I allowed it or that I didn’t ask her to get down sooner?  I am the adult after all.  Okay well many people allow kids to sit on their laps.  Was I aroused during this?  I think I felt something.  Well I did let her down when I felt the tingling sensation.  She said goodbye to me and so she must not have been traumatized by what I did.”

o   Mental Checking – Checking the brain is just a non-physical way to ensure an OCD fear is not realized, and serves the same purpose as door or stove checking.  A mental checklist may be recited to be sure all bases are covered.  The OCD sufferer may bring up OCD thoughts intentionally for the purpose of checking if the thoughts still bother them.  They may fear that the presence of uncertainty and anxiety mean that the thought is therefore true.  The intensity of OCD thoughts and feelings can fluctuate from day to day and moment to moment.  Because of the good feeling sufferers get when intrusive thoughts don’t produce as much anxiety or uncertainty as usual, they may compulsively “check” their reactions to thoughts to hopefully replicate this experience.  The problem is continued checking becomes the reinforcement for OCD thoughts and feelings.

o   Mental Rehearsal – A person spends time mentally preparing or rehearsing a future situation to determine it is safe for themselves or others in this compulsion type, which is the exact opposite of mental review where the past is examined.  Examples include rehearsing a future medical appointment to be sure the all right medical information will be provided and all the right questions are asked to guarantee health.  A groom with ROCD fears may mentally rehearse the upcoming wedding vows to examine if he feels strongly enough about each point to marry his future wife.

A teacher may fear she is not adequately understood when she speaks and never feels she can explain things perfectly enough.  She may engage in a mental ritual where she rehearses her lesson plans mentally to ensure the children succeed.  Mental rehearsal might look something like this for someone suffering from ‘hit and run’ OCD, “I know Main Street has a lot of mothers pushing strollers in the afternoon.  I will have to take another street since I will be going out for lunch today.  Second Street might be less congested.  How will I know if it is safe for me to drive?  I can ask my co-worker to ride along with me and he will be able to hear if I hit someone.”

o   Self-Reassurance – Just like reassurance-seeking from others, the purpose of self-reassurance is to mentally provide certainty that the feared outcome won’t occur or that one is not as bad or evil as the OCD leads them to believe.  A person may tell themselves positive affirmations about being a good person when their OCD produces thoughts about harm, pedophilia, etc.  They commonly run through a mental list of reassurances they have received from family, friends or professionals.  An example off the self-reassurance process may look something like this, “My priest said I did not sin when I accidentally took home the song book from mass.  But wait, did he know that I was the one who put it the bag and not my child?  Yes, he told me that it didn’t matter if I did it or my child did it.  I returned it to the church the next day and it was an accident.  I am a good person.  I’ve never stolen anything in my life!”

o   Thought neutralization – This occurs when a person mentally replaces unwanted, unpleasant thoughts or images with pleasant or more neutral ones.  A woman tries to imagine her child sitting in a field of flowers after having a thought about him getting kidnapped from the playground at daycare.  Another woman brings in an image of herself beside her neighbor, a woman still healthy and vibrant at age 83, to neutralize an intrusive thought about potentially getting cancer. A young man with HOCD may imagine a sexy girl in a short dress after noticing an attractive man walk by him on the street.

o   Prayer, mantras, and special phrases – A person may repeat a prayer or phrase to neutralize an intrusive thought.  Clients with intrusive thoughts may say a prayer, “God is good,” or a compulsively say a phrase, “Good conquers evil,” following any panic-inducing OCD thought.  The phrase, “It’s not me, it’s my OCD” is a good way to recognize and categorize intrusive thoughts as OCD brain blips that don’t need attention.  It is a helpful reminder to avoid responding to OCD thoughts compulsively.  Any phrase can become compulsive, however, if it is used repeatedly and excessively with the motive of convincing oneself with certainty that a bad outcome will not occur, seeking comfort or attempting to rid oneself of thoughts.  Have awareness of your motive for using any phrase, even the helpful ones provided by your OCD specialist.  Normal religious prayer may also be repeated compulsively to neutralize fears about having done the prayer incorrectly or that they have sinned by having inappropriate thoughts while praying.

o   Solving and wishing – Sometimes people become less concerned with the possibility of acting out their thoughts and more concerned that the thoughts will plague them forever and will cause of life of misery.  This has been referred to as “Obsessing about Obsessing.”  Individuals often spend time “wishing” for the thoughts to go away and comparing their life to a life they would have if they weren’t obsessing.  An OCD sufferer’s compulsions may also be focused on “solving” their OCD puzzle by excessively thinking about what they need to do to fix their OCD.  These compulsions send a message that the OCD is more important than it is, and as a result makes OCD more powerful.

o   Self-punishment – A person who has fears of being a bad person which results in excessive amounts of guilt may engage in a mental ritual called self-punishment.  The person will abuse themselves mentally in order to feel they are not getting away with a crime that has gone unpunished.  The self-abuse temporarily relieves some guilt because they feel they haven’t gotten away with something they ‘should’ be punished for.  It also leads to a sense that they are on the same side of the population as people who hate killing, pedophilia and incest, etc.  Just letting these ideas sit around is not acceptable.  Obviously, putting oneself through this process is uncomfortable and often very depressing, but letting oneself off the hook does not feel like an option.  “I am a horrible person for having these thoughts.  What kind of good person would think about sex with his sister?  This is really sick.  I am a demented and depraved individual and don’t deserve to live!”

If you don’t see your compulsions listed above, there is no need to panic.  There are millions of different and creative ways to run from OCD.  You may be so innovative that you have invented compulsions that you can’t find in any book or on any website.  As long as you have an obsession that is followed up by some physical or mental behavior to gain certainty, reduce distress or prevent thoughts you are playing the OCD game.  It is quite amazing however, that even the most obscure compulsions I have ended up seeing in more than one client through the years.  There is someone out there like you…believe me!

Stacey Kuhl Wochner, LCSW is a psychotherapist in private practice in Los Angeles, CA specializing in the treatment of OCD.  Follow her on Facebook.

 

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26 Comments

  1. Eric Bjork April 28, 2014 at 9:41 am - Reply

    This article has opened my eyes to some mental compulsions I’ve been doing that I didn’t realize were compulsions. Thanks for the comprehensive list.

    One of my difficulties is mental compulsions after I lay down to go to sleep. Any advice? I want to sleep so badly and I want to make sure that I’m not obsessive that I end up making myself obsessive.

    Thanks

    • Stacey Kuhl-Wochner May 27, 2014 at 5:55 pm - Reply

      Hi Eric, I’m glad you found my article and that it clarified some things for you about mental compulsions. Mental compulsions can be very sneaky and a lot of people don’t know what is reinforcing their OCD. Mindfulness is a great way to help with both falling asleep and working with mental compulsions. In both cases, the first step it to come to terms with the idea that you cannot force yourself to sleep and cannot force thoughts out of your head. Acceptance is key because you will have to accept that you are not currently sleeping and / or that you are having intrusive thoughts. Since mental compulsions are also thoughts you cannot always stop them, but labeling them changes them from compulsions to something in the moment you are observing. Mindfulness is the practice of experiencing the current moment with openness and non-judgment. When you are falling asleep you can practice using your five senses to notice what is present with you in the room, such as what the pillow feels like under your face, the heaviness of the blanket on your legs or the sounds of the cars driving by. When you have intrusive thoughts and / or if you begin to engage in a mental compulsion label it like this, “That was self-reassurance,” then return your focus to items in the room. You may want to take up a formal meditation practice to help with this skill.

  2. NIkki June 8, 2014 at 7:53 pm - Reply

    Is it possible that someone’s harm ocd can transfer to another person so to speak? Meaning can you become obsessed with the thought that someone has harmed you in the past? I keep trying to tell myself that my thoughts are illogical but there is always this nagging doubt and there’s always a “what if” or a “but maybe..” I keep searching for evidence that this person hurt me though and I know I should stop but I can’t. I keep looking through memories and that’s only confusing me more.

    For a while I was absolutely convinced that this person has harmed me in the past. There’s a part of me that’s desperate to go to her and ask her if she did it but I know I can’t because she would be devastated if she knew I thought she was capable of such a thing and there’s also the fact that..if it’s true she wouldn’t admit to it anyway!

    I feel like I can’t trust my thoughts or memories because I keep misinterpreting old memories and even creating things that I know aren’t true. (I hope at least). I’m so confused. I’ve spent hours upon hours searching through forums and googling things trying to figure out what’s going on and I’m exhausted. (this has been going on for days) I can’t stop thinking about it because the person I keep thinking may have harmed me is someone very close to me.

    It seems like an endless cycle. I go through my memories looking for evidence, I “find” it, analyze it to death, disprove it after probably believing it’s true and stressing about it for a while, and repeat. I’ve even joined several mental heath forums and made posts, hoping that someone would be able to make sense of what’s going on. Is it true? Is it fake? Am I going insane?

    The worst part is I can’t stop. I calm myself down for a while (sort of) and then something starts it up again and I’m in this endless loop again.

    I’m not sure I have OCD but the more I read about it the more I feel like I do. I’ve always known that there was something wrong but I could never but a name to what. (although I feel myself doubting that constantly as well) I have some pretty disturbing intrusive thoughts at times and they used to drive me insane until I learned what they were.

    Before this I was absolutely convinced I had schizophrenia. I even thought I was hallucinating at times. (all my “hallucinations” had explanations for the msot part and I now know that my mind was just playing tricks on me) but that just goes to show that my mind is capable of playing tricks on me I guess.

    My thoughts and behaviors have always had a very obsessive component to them now that I think about it. I remember the most telling experience was when I was in 2nd grade (I’m 18 now) and our teacher decided to tell us that plant fertilizer and house hold cleaners were very dangerous. For some reason that stuck with me. My mom told me that if I thought I had touched those things I would wash my hands until they bled. She said she seriously considered OCD and getting me some help but for some reason my parents decided against it (I eventually stopped)

    Sorry for the long post. I have no one else to go to with this.

    • Stacey Kuhl-Wochner June 10, 2014 at 12:37 am - Reply

      Hi Nikki, Thank you for your comments. With OCD you can become stuck on almost any concept or idea. So yes, I have seen many OCD clients who obsess that someone may have done something to them in the past, despite no memory of the incident. The nagging “what if” thoughts keep them hooked. For example, when a person is asked the question if they were molested in their childhood, his or her OCD may become spiked and latches onto this possibility. Because past events are virtually impossible to prove, it is an excellent target for OCD because you will search forever without an answer. The person may get stuck in mental rituals to prove or disprove the experience, as you describe. The other symptoms you mention (fear of being Schizophrenic & chemical contamination fears) are also very common in OCD.

      There are some compulsions you have the most control over (e.g. excessive online research & asking outwardly for reassurance) and those you have less control over (e.g. mental rituals). Try to start with discontinuing the rituals you have most control over. Next, try to at least label which mental rituals you find yourself performing, even if you have trouble stopping it. We cannot always stop our thoughts, but labeling them as a ritual often changes it. I will be posting a new article about fears of things happening in the past, so check back in the next few days. I recommend finding an OCD specialist to have an assessment. Feel free to contact me through email if you need help in this process.

  3. Alex June 25, 2014 at 1:23 pm - Reply

    I just wanted to thank you and Jon for your insightful and sensitive articles about OCD. I was diagnosed 5 years ago with OCD but rarely sought help. Now, I’m finally in the “right” kind of treatment for OCD and am doing much better, in part because of your writing. OCD threatened to take away everything I cared about and I was on the track to be completely disabled by it. So, thanks again and keep fighting the good fight.

    • Stacey Kuhl-Wochner June 25, 2014 at 5:23 pm - Reply

      Hi Alex, It is great that you are getting CBT for your OCD. It really helps you to feel more in control in a situation that used to feel so helpless. Thanks for your comments, I’m glad you found the blog helpful!

  4. WM July 11, 2014 at 8:53 pm - Reply

    Stacey

    Thanks again for all these encouraging and insightful posts. Regarding compulsions, I find myself obsessing over the thought “do I want to, or do I not want to” question which leads to anxiety because not knowing for sure is killer especially when dealing with some of the more severe OCD themes. This is always looming in my mind and has become an obsession in itself. I’m wondering if you encounter this often, and how to use ERP on this.

    • Stacey Kuhl-Wochner July 23, 2014 at 4:52 pm - Reply

      Hello WM, Uncertainty is a hallmark of OCD and allowing yourself to stay with uncertainty will change your relationship with it. Please clarify, “Do I want to, or do I not want to” so I can best answer your question. Some people may question if they want to watch a TV show or go for a walk. They then become obsessed over the perfect action to take. Take the action before you feel you have made the “correct” decision and avoid spending time doing mental compulsions to determine the best course of action. I am only guessing since you didn’t specify and you referred to it as a benign obsession compared to others, which by the way can cause just as much suffering. Specific exposures will be different depending on the fear. But generally, do the thing that makes you feel the most uncertainty and anxiety.

      • WM July 23, 2014 at 5:12 pm - Reply

        Meaning “do I want to commit this horrible act, or do I not want to”. Or another might be “did I want to look at that person in a sexual way or not”. So not only is it the obsession itself, but the question that I obsess about.

  5. Stacey Kuhl-Wochner July 23, 2014 at 5:33 pm - Reply

    Ah, yes. Thanks for clarifying. This is very common because planting uncertainty in your mind is the best method your OCD has in getting you to feed it with certainty-seeking compulsions. Nobody has certainty about these things, even people without OCD. How do any of us prove that our thoughts don’t mean something bad? Impossible! So your only option is to find a way to live with uncertainty. A good exposure is to say aloud, write or record and listen to, “Maybe I did look at that child / family member / dog / same-sex person in a sexual way because I secretly want to have sex with them. I could be in denial of my true desires. There is no way for me to find out for sure so I am willing to live with the possibility. I will not destroy my life any further by trying to analyze the impossible. If this means I am sexually attracted to the wrong things, than so be it!”

  6. WM July 24, 2014 at 4:38 pm - Reply

    Wow Stacey, when you put it that it takes a heavy load off, simply being OK with the uncertainty. Kinda starts to deflate the fear. But the question that begs to be asked is, how does a sufferer interact with say a spouse, in this way of thinking. If someone (like your spouse) were to ask you point blank the question of “would you do this/would you want to” or “did you desire to read that disturbing scene in that book” how do you reply without feeling like you might be lying if you are in doubt/uncertainty? If we are supposed to be OK with uncertainty what side of the line do we view ourselves, good, bad? Thats one thing that keeps me in bondage is the fear that I’m somehow lying to my spouse, and covering up some evil thing. Even if you are somehow uncertain if you are a bad person, does the sufferer just believe on the side of “I’m a good person no matter what” and move on?

    Hope this makes sense.

    • Stacey Kuhl-Wochner July 26, 2014 at 2:41 pm - Reply

      Hi WM, If your spouse tries to pin you down on an answer to your obsessions, she should be educated about OCD so this no longer occurs. Since obsessions take place in your head, she won’t know when you have an obsession. In other words, if you aren’t confessing the intrusive thoughts she shouldn’t be asking about them. I imagine this is a fear of yours and not a reality so don’t spend time analyzing this possibility because that would be a compulsion. If someone asks something like, “Why did you watch that rape scene in a movie?”, you can reply “Because I’m really into rape.” Although the idea of someone asking this seems very far-fetched to me and sounds like an obsession. You can’t know for sure if you are a good or bad person before you accept uncertainty, that defeats the purpose of accepting uncertainty. Practice living your life normally even though your OCD tells you that you may be a bad person hiding a terrible secret from your wife. That is part of the exposure.

  7. Chris August 28, 2014 at 12:12 am - Reply

    A wonderful job. Super helpful inoomratifn.

  8. Jennifer October 17, 2014 at 3:17 pm - Reply

    My 6 year old daughter has significant difficulties with OCD. I think I understand that when she counts (and MANY other rituals), she is somehow getting some temporarily relief. therefore when I try to talk to her about finding ways to help her, she becomes almost hysterical, begging me not to take it away from her – that she “NEEDS her counting thing” as she calls it. I’ve always been one to believe that change has to come from within; I cannot impose on her that she should get help with OCD. But of course I know she is only 6, so I basically need to make the decision for her… but I simply cannot figure out a way to get her to go along with therapy….I can’t seem to find the language to convince her to WANT to get rid of OCD compulsions… Thank you for any help!

    • Stacey Kuhl-Wochner November 5, 2014 at 1:02 am - Reply

      Hi Jennifer, It is very complicated since she is so young and will find it difficult to understand that compulsions are not helpful when they are giving her temporary relief. OCD can get worse if is not treated, so you are correct that you will have to make the decision for her and bring her to therapy when you feel it is time. OCD specialists who work with children can explain OCD in a way children can understand. They can also help set up a reward system to motivate her to eliminate compulsions. They may help her to see that her compulsions are not helpful since she probably becomes stuck counting and recounting, something that is more stressful than relieving. Identifying the OCD as a character with a name can help her to separate herself from her OCD thoughts and possibly stop responding to OCD’s demands.

  9. cINDY November 26, 2014 at 12:31 am - Reply

    What is the best way to reassure a 16 year old about the intrusive thoughts she is having? How can i help her ? Do I allow her to tell me every intrusive thought or do i tell her no? What can i tell her when she questions-Is she a bad person to have that thought? Or did I mean to do that or am I attracted to a cat…or whatever
    Thanks for any advice

    • Stacey Kuhl-Wochner December 16, 2014 at 5:46 am - Reply

      Hi Cindy, The idea is that the content of OCD thoughts do not matter and should not be paid attention to or discussed. I teach my clients to focus on the idea that they are having a thought that makes them uncomfortable and the content of the thought doesn’t matter, it could be anything. Trying to cope with a uncomfortable thought, feeling or uncertainty is more important than getting reassurance about the content of the thought. If she says, “Did this thought mean I am attracted to the cat?” you might say, “That is an uncomfortable thought just like all your other uncomfortable thoughts. They always pass. See if you can sit with the thought and the uncertainty about what the thought means until it passes on it’s own.” Also, you may want to find her an OCD specialist if she doesn’t have one already.

  10. M.J. January 16, 2015 at 4:23 pm - Reply

    Thank you so much for this breakdown! I thought I was the only one that did some of these things….

    I ask my parents for reassurance of me being “a good person,” and ask if they “hold anything against me” from things that happened in the past.

    I reply conversations in my head to make sure I said “all the right things,” and it’s almost like I’m watching a movie. I analyze the dialogue, try to figure out what could’ve made the whole situation better, and become angry that I once again, “messed up.” (if I even did, which I probably didn’t!) Then I laugh to myself and say “I bet these/this people/person doesn’t even remember this convo! I bet even if you brought it up, they wouldn’t even know what you were talking about?” I actually cringe and relive feelings from past experiences. It could be a casual moment in a coffee shop, at a party, at the grocery store. It doesn’t have to be memorable, just so long as my brain decides that I need to analyze it. – I’ve gotten pretty good at doing that.
    Thankfully I’m able to separate myself and stop on over to the reasonable part of my brain, so to speak. I think of my brain as having many parts. The OCD part needs constant supervision from the “Jiminy Cricket” part. I’m not sure which side has more points, but I do know that in the end, OCD gets bored and has nowhere to go, but out my eyes in tears.

    Though seeing someone new (after seeing over 10 people in my lifetime!) would probably help, I’m at this point stubborn. I’ve seen some pretty horrible people! I probably need therapy from my past bad therapy.

    At least I’m totally aware of when I’m in the middle of an OCD storm, I just still haven’t unlocked the key to not letting the thoughts take over and make me feel uncomfortable. For some things, I’m able to laugh and understand what’s going on. For other things, not so much. It’s always something new in my world of OCD. Once I conquer a thought or other, it moves on to something more challenging. Never a dull moment!

    Anyway, thanks for the information. I wish there was someone I could say I trusted that was local that I would be willing to see. Supposedly I’ve seen “the best,” in my area. You seem pretty awesome though, and on target. It’s been lovely stumbling upon your articles. I don’t feel as crazy, or alone. 🙂

    Sorry for the long post! I was inspired. Now I’ll step away and not obsessively go through this email checking for grammar! Okay, maybe just once…..

    • Stacey Kuhl-Wochner January 26, 2015 at 7:33 pm - Reply

      Hi M.J., Thanks for your post. It sounds like your OCD uses your desire to be a good person against you. For that reason, your therapy would be to allow yourself to be an imperfect person, which will take away OCD’s ammunition. For example, if the OCD says that you may have offended someone in a social situation you might reply, “Yes, it is true. I did offend him when I said [blank]. Too bad for them. I’m my own person and I can say whatever I want.” Your OCD only wins if you are unwilling to be bad for one moment in time. This essentially stops you from doing compulsions that fuel the OCD. If you are looking for an OCD therapist, feel free to contact me through email.

  11. Eric Bjork January 22, 2015 at 10:52 pm - Reply

    Thanks for your reply Stacey. I haven’t been to this site in a while!

    I am meditating (using Jon’s book on mindfulness) and have found this to be very helpful when it comes to dealing with the mental compulsions. I have discovered that what I used to think was helping was actually making the OCD louder.

    Any advice on how to deal with OCD when it is extra loud, due to stress? I am a minster and certain scenarios, such as funerals and working with end-of-life issues, tend to make me anxious and, therefore, obsessive.

    Thanks!
    Eric

    PS–I’m conducting a funeral in 2 days!

    • Stacey Kuhl-Wochner January 26, 2015 at 8:12 pm - Reply

      Hi Eric, I’m glad you are using meditation to help yourself become more mindful of your mental compulsions. I recommend exposure and response prevention (ERP) to help re-program your brain’s response to your obsessions. In between funerals, try exposures to triggers such as movies, articles, Youtube videos, or write your own stories about the ideas that trigger you. When it comes time to experience it in person, your brain will be less reactive to the words and phrases that normally cause anxiety during funerals, for example. Working with an OCD therapist can help with ERP exercises.

  12. Eric Bjork January 29, 2015 at 11:05 pm - Reply

    Thanks Stacey.

    As it happens, I had to conduct a funeral for a 42 day old infant just a few days after I did the funeral mentioned in the comment above. Using your advice, I was less obsessive (but it was very sad nonetheless).

    Eric

    • Stacey Kuhl-Wochner February 24, 2015 at 5:25 pm - Reply

      Hi Eric, Wow that really puts things into perspective. It sounds like you have a very challenging job. I’m glad I was of some help.

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