Obsessive-compulsive disorder (OCD) involves persistent, unwanted obsessions and compulsions.
With OCD, obsessive thoughts usually trigger compulsive actions meant to help dispel the thoughts and reduce distress. But this usually only provides short-term relief and doesn’t make the obsession go away.
Obsessions and compulsions can become a cycle that’s difficult to stop. The time you spend on compulsions might begin to take up so much of your day that you find it hard to get anything else done. This can affect your school, work, or personal life, leading to even more distress.
Read on to find out more about obsessions and compulsions, including examples of how they might occur together for someone and when it might help to talk to a mental health professional.
Obsessive thoughts can interrupt your daily life, upsetting you and making it hard to do things you want to do. Even if you’re aware they aren’t real and know you won’t act on them, you may still feel distressed and worry you could act on them. As a result, you might try to avoid everything that triggers these thoughts.
There are several types of obsessions, and it’s common to experience more than one type. Symptoms generally depend on the type.
Here’s a look at some common themes.
Obsessions related to contamination
These obsessions involve thoughts and worries about things that could make you dirty or sick, such as:
- mud and dirt
- bodily fluids
- radiation, pollution, or other environmental hazards
- germs and illness
- poisonous household items (cleaning products, insect spray, and so on)
Obsessions about taboo behaviors
These obsessions might come up as images or urges. They can be extremely upsetting, because you know you really don’t want to act on them. They could involve:
- sexually explicit thoughts about family members, children, or any aggressive or harmful sexual activity
- unwanted thoughts about sexual behaviors you don’t have interest in
- worry about acting violently toward others
- fear of acting in a blasphemous way or worries you’ve offended God (scrupulosity)
- fears that ordinary behaviors are wrong or immoral
It’s important to keep in mind that having these kinds of obsessive thoughts doesn’t mean you’re going act on them. Part of what makes them so distressing is that you don’t want to act on them.
Obsessions about losing control or acting on your impulses
It’s not uncommon to worry you’ll act on impulses or intrusive thoughts. For example, you might worry about:
- hurting yourself or someone else
- stealing something or breaking other laws
- having an outburst of aggressive, rude, or obscene language
- acting on unwanted images or intrusive thoughts
Again, having these obsessions doesn’t mean you’ll act on them.
Obsessions about causing accidental harm
With this type of obsession, you might worry you’ll cause an accident or disaster. Some examples include:
- poisoning someone by using the wrong ingredient or accidentally including a toxic substance when cooking
- accidentally hitting a person or animal when driving
- unintentionally leaving the stove on or an appliance plugged in and causing a fire
- forgetting to lock your home or office, which could be burglarized as a result
Obsessions about needing things to be orderly or perfect
This type of obsession goes beyond perfectionist traits. Instead of getting a sense of satisfaction from things that are tidy or symmetrical, you may feel extremely upset when something is slightly askew and need to make adjustments until it feels “just right.”
Other symptoms include:
- fearing you’ll forget, or have forgotten, something important
- needing objects or furniture to face a specific direction or be in a specific order
- needing objects (foods, items around your house, etc.) to be even or symmetrical
- worrying about throwing things away in case they’re important or you need them later
In casual conversation, people often use the term “obsession” to refer to something they really, really like. But in the context of OCD and related conditions, obsessions are anything but enjoyable.
Saying things like, “I’m obsessed with crime documentaries,” or talking about a football “obsession” can minimize the experience of people living with OCD and related conditions and contribute to confusion about what these conditions really involve.
Compulsions refer to mental or physical responses or behaviors to obsessions. You may feel the need to repeat these behaviors over and over even though you don’t actually want to be doing them. This can take up hours of your day.
Carrying out these compulsions brings about a sense of relief from an obsession, but this feeling is usually short-lived.
Sometimes compulsions are related and relevant to an obsession. For example, you might check, unlock, and relock your front door seven times before leaving to prevent a break-in.
But in other cases, they might be totally unrelated. For example, you might tap a specific area of a wall before leaving the house because you feel it helps to prevent getting in a car accident on your way to work.
Like obsessions, compulsions often fit into a few major categories.
Compulsions related to checking might involve:
- making sure you didn’t or can’t hurt anyone — for example, by hiding knives or retracing driving routes
- making sure you didn’t hurt yourself
- going over your work again and again to be sure you didn’t make a mistake
- making sure appliances are turned off
- making sure doors and windows are locked
- checking your body to make sure you don’t have physical symptoms
Mental or thought rituals often include:
- counting to a specific number
- repeating words or numbers in a specific pattern or for a set number of times
- numbering or making lists about tasks or actions
- reviewing or going over events or conversations that have happened
- mentally undoing or cancelling out a negative word or image by replacing it with a positive one
These compulsions might involve cleaning parts of your environment or your body, such as:
- washing your hands multiple times
- avoiding touching specific objects or people to prevent contamination
- needing to follow a specific washing ritual
- following specific hygiene rituals that most people would consider excessive
- cleaning your house, work environment, or other areas repeatedly or a specific number of times
Repeating or arranging compulsions
These compulsions might involve doing things a certain number of times or until something looks or feels “just right.” For example:
- doing something a specific number of times
- touching parts of your body multiple times or in a specific order
- tapping or touching things when you enter and leave a room
- turning all of a certain object in the same direction
- arranging things in a specific pattern
- making body movements, like blinking, a certain number of times
Other compulsions could include:
- seeking reassurance from friends, family members, or religious figures
- feeling driven to confess certain actions over and over
- avoiding triggers or any situation likely to lead to a compulsion
In general, most people with OCD experience an obsessive thought, and then feel compelled to perform an action (compulsion) to help relieve the anxiety or stress associated with the obsession.
The obsession and compulsion may have some relation to each other, but this isn’t always the case.
Here are some examples of how obsessions and compulsions might look in real life. Just keep in mind that people experience OCD and other mental health conditions in different ways. Though not comprehensive, this table is meant to help you better understand the differences between obsessions and compulsions, as well as how they relate to each other.
|“I know I’m straight. I’m attracted to women. I have a girlfriend. But what if I am attracted to men too?”
|Searching the internet for photos of “attractive men” and looking through pages of photos to see if they cause arousal.
|“What if the baby stops breathing in the night?”
|Setting an alarm to go off every 30 minutes through the night to check on the baby.
|Having an intrusive thought of taking off clothes in the middle of a work meeting.
|Spelling “quiet” backward mentally each time the thought comes up until it goes away.
|“This office is contaminated. If I touch anything, I’ll get sick.”
|Washing hands three times, for a minute each time, whenever you touch or think you’ve touched something.
|“What if I forget something important?”
|Needing to save every piece of mail, notification, or document, even when they’re out-of-date and no longer have a use.
|“Dad will have an accident at work if I don’t tap each foot against the back of each leg 12 times.”
|Tapping your foot against your leg for the set number of times, and starting from the beginning if you make a mistake.
|“What if I jerk the wheel while I’m driving and intentionally hit another car?”
|Slapping your head seven times on each side to dispel the thought each time it pops up, and repeating the ritual to be sure the thought doesn’t come back.
|“What if I accidentally touch someone inappropriately?”
|Making sure to walk or stay out of arm’s reach of any other person, immediately moving away when you get too close, and frequently asking, “Was that too close? Was that inappropriate?”
|“If I forget to confess one of my sins, God will be angry at me.”
|Drafting long lists of all potentially “wrong” or sinful behaviors and making a new confession or praying each time you remember a new one.
|“If I look at the clock when it changes from 11:59 to 12:00, the world will end.”
|Turning all clocks around, avoiding looking at any clock or phone close to the time, and checking multiple times to make sure the clocks are turned around or hidden, just in case.
|“If I don’t step on every third crack, my boyfriend will lose his job.”
|Stepping on every third crack, and going back and doing it again just to be certain.
|Having an intrusive thought of needing to say a specific word.
|Saying the word to everyone you see, even after trying to fight the urge to do so.
|Having an intrusive thought of putting your finger into an electric socket.
|Covering all outlets with plastic covers and checking each one three times every time the thought comes up.
|“What if I have a tumor?”
|Visually and physically checking your entire body for lumps multiple times a day to make sure none have appeared.
While we typically think of obsessions and compulsions in the context of OCD, there’s a lesser-known variation of OCD that some refer to as “pure O.” The name comes from the idea that it involves only obsessions.
Pure O commonly involves intrusive thoughts and images of:
- hurting yourself or other people
- sexual acts, particularly those you consider wrong, immoral, or harmful to others
- blasphemous or religious thoughts
- unwanted or unpleasant thoughts about romantic partners and other people
You might worry about acting on these thoughts or spend a lot of time worrying they make you a bad person. These thoughts can actually be part of a compulsion. They just aren’t as visible and concrete as the compulsions people usually think of.
It’s also common to spend a lot of time tracing thoughts to understand them and reassure yourself you won’t act on them. You might also pray or repeat specific phrases to cancel out an image or thought.
While the Diagnostic and Statistical Manual of Mental Disorders acknowledges that people can have obsessions without compulsions and vice versa, pure O isn’t recognized as a formal diagnosis.
Anyone can experience brief mental fixations, obsessive and intrusive thoughts, or unexplainable urges to carry out a specific task or action. In general, obsessions and compulsions only indicate OCD when they:
- take up a significant part of your day
- are unwanted
- negatively affect your personal life and relationships
Feeling a need to clean a lot because you enjoy cleaning and like the look of a tidy house wouldn’t be a sign of OCD, since you take pleasure in the activity and pride in the result.
What could indicate OCD, for example, is fearing your child might develop a serious illness if you don’t have a completely clean and germ-free house. As a result of this persistent worry, you clean several hours each day but still worry you missed something and feel distressed until you start cleaning again.
If you have any OCD symptoms, talking to a mental health professional can help. A therapist can help you identify obsessions and compulsions and begin addressing them to reduce the impact they have on your life.