Obsessions vs. Compulsions: The Cycle of OCD, Explained

It's normal to experience intrusive or unwanted thoughts from time to time. Not all intrusive thoughts are a sign of a problem. But if you find your intrusive thoughts are increasingly frequent and you're engaging in repetitive behaviors to try to ease distress caused by those thoughts, you may have what's called obsessive-compulsive disorder (OCD) .

OCD is a common but serious mental health condition characterized by a cycle of uncontrollable and unwanted thoughts or fears (obsessions) and repetitive behaviors or rituals intended to control those thoughts (compulsions).

Here's what you need to know about these common symptoms of OCD, the most common types of obsessions and compulsions, and treatment options for OCD.

Obsessions vs. Compulsions

Obsessions are "unwanted thoughts, images, or urges that the person might find distressing or intrusive," says Jon Hershfield , the director of the Center for OCD and Anxiety at Sheppard Pratt in Baltimore.

On the other hand, "Compulsions are repetitive behaviors (but sometimes repetitive mental acts like excessive counting) that the person feels driven to do in response to an obsession," says Katharine Phillips, MD , a psychiatrist at Weill Cornell Medicine and NewYork-Presbyterian in New York City. "They aim to reduce distress or anxiety caused by obsessions or prevent a dreaded event (such as harm occurring)."

Although these rituals are intended to help a person with OCD feel better, they ultimately do little to stop the unwanted thoughts and anxiety from returning.

Ultimately, the obsessions and compulsions of OCD become a vicious cycle and have a significant negative effect on quality of life. People with OCD may spend at least eight hours a day dealing with unwanted thoughts and various rituals they use to try to cope with those thoughts, says Hershfield. They may struggle to choose between priorities they value, such as spending time with family, and engaging in compulsions to try to dispel their obsessive thoughts.

This cycle is not sustainable. It often disrupts normal thinking patterns, leads to impairment, takes up a significant amount of time and energy, causes avoidance of triggering environments or situations, and interferes with daily functioning, says Hershfield.

Common Obsessions in OCD

Obsessive thoughts often have similar themes for many people with OCD. The most common obsessions include:

• Difficulty with uncertainty, which can include persistent and distressing doubts that you turned off the stove or locked the door, for instance
• Fear that you will lose control and harm yourself or others in ways like driving a car into a crowd of people
• Fear of contamination or illness from touching objects that others have touched
• Excessive need for symmetry, order, and perfection
• Excessive, unwanted thoughts or images related to sex, religion, or aggression toward others

Common Compulsions in OCD

For people with OCD, obsessions trigger compulsions as an attempt to soothe the anxiety and distress caused by the obsessions.

For example, fear of contamination can trigger compulsions like excessive handwashing until your skin becomes raw, or fear of the house burning down may cause someone to check that the stove is off an excessive number of times before leaving the house, says Dr. Phillips.

Other common compulsions among people with OCD include:

• Repeatedly checking that a door is locked or a switch is turned off
• Counting in certain patterns or precisely performing tasks a certain number of times
• Precisely ordering or arranging items
• Repeating words, phrases, or prayers over and over again in your head
• Attempting to replace a bad thought with a good thought
• Excessive cleaning or bathing
• Constant checking and reassurance-seeking that you haven't harmed someone

Treatment and Management of OCD

If you think you may have this condition, it's important to seek professional help for it. While OCD is a chronic condition, proper treatment can help manage symptoms and improve quality of life, Hershfield says.

Healthcare providers use psychotherapy , medication, or a combination of both to treat common OCD symptoms. "Medication and [psychotherapies like cognitive behavioral therapy (CBT) ] work well together, and both in combination are always recommended for more severe OCD," says Phillips. "They can give someone their life back."

CBT - particularly a type of CBT called exposure and response prevention (ERP) - is the top recommended treatment for OCD.

CBT teaches practical skills to overcome obsessions and compulsions, says Phillips. ERP involves strategic, gradual, and intentional exposure to a trigger and practicing resisting compulsions. This therapy helps your brain "unpair the obsessions from the compulsions" and recognize that you can tolerate triggers, Hershfield says.

Doctors may also treat OCD with selective serotonin reuptake inhibitors (SSRIs) , a class of antidepressant medications commonly prescribed for OCD. With the right dose - typically higher than what's required to treat depression - SSRIs can help ease OCD symptoms.

In certain cases or severe OCD, you may need a higher level of care, such as intensive outpatient therapy or residential treatment. If your OCD does not respond to medication and therapy, your doctor may recommend an FDA-approved treatment called transcranial magnetic stimulation (TMS) . This noninvasive therapy uses a magnet to stimulate areas of the brain associated with OCD.

The Takeaway

OCD is a serious mental health condition characterized by unwanted, distressing thoughts (obsessions) and repetitive behaviors (compulsions) aimed at reducing the anxiety caused by these thoughts. OCD significantly disrupts daily life, with individuals often spending hours each day trying to manage their obsessive thoughts with compulsive behaviors. If you think you may have OCD, reach out to your doctor for help. Effective treatments, such as psychotherapy and medication, can help you regain control and improve your quality of life.

Resources We Trust

• Mayo Clinic: Obsessive-Compulsive Disorder (OCD)
• Cleveland Clinic: What's the Difference Between Perfectionism and OCD?
• National Institute of Mental Health: Obsessive-Compulsive Disorder: When Unwanted Thoughts or Repetitive Behaviors Take Over
• International OCD Foundation: What Is OCD?
• National Alliance on Mental Illness: How Can I Get Help/Support for Obsessive-Compulsive Disorder (OCD)?

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Sources

1. Obsessive-Compulsive Disorder. National Institute of Mental Health . September 2022.
2. Obsessive-Compulsive Disorder (OCD). Mayo Clinic . December 21, 2023.
3. Obsessive-Compulsive Disorder (OCD). Cleveland Clinic . December 14, 2022.