Obsessions and compulsions: A dynamic duo

This post is for informational purposes only, and should not be considered professional psychological advice

I love to work with clients who have Obsessive-Compulsive Disorder. One reason this work is so rewarding is that people often don’t know they have OCD in the first place. Talking to them about what OCD is and the many ways it can manifest can offer some immediate relief and insight. Of course, insight isn’t enough to produce long-lasting change, but for many people, learning to recognize the patterns of OCD and name them is a helpful start. And, once we have correctly identified the nature of their struggles, we can apply the treatment that is going to be most effective.

To get better at recognizing OCD, it is important to know the difference between obsessions and compulsions. Obsessions are intrusive thoughts, images, or urges that pop into our heads and feel unwanted, uncomfortable, and even frightening, taboo, or disgusting. Surprisingly, obsessions aren’t the problem. Everyone has intrusive thoughts that are not intentionally conjured up, and one could argue that this ability is important and allows for creativity, problem-solving, and innovation. People who don’t have OCD can typically notice when they have uncomfortable or odd thoughts and think to themselves, “Huh, that was weird” before moving on with their day. In contrast, people who have OCD are more likely to respond internally with something like, “Oh no, why did I just think that? What kind of person thinks things like that?!” They experience such a high degree of discomfort with the thought that they are compelled to do something about it, whether that means trying to suppress the thought itself, distract from it, or do another action to soothe their discomfort or try to prevent something bad from happening.

Which brings us to compulsions. These are the behaviours done to make the thoughts and discomfort go away, or to neutralize superstitious fears. Compulsions may or may not be logically connected to the fear (e.g., checking that the stove is off versus knocking on wood). Just as obsessions are common in people without OCD, we also see compulsions in the general population. Someone who feels they need to wear their “lucky” shirt while watching their favourite hockey team play is technically engaging in a compulsion by wearing the shirt “just in case”. A key difference is that they likely are not having distress and impairment from this behaviour, and could cope well even if their lucky shirt was lost.  

This isn’t the case for someone who has OCD. Distress often means frequent and intense feelings of anxiety, disgust, or discomfort, and impairment can include struggling to meet social, familial, personal, financial, or occupational needs and responsibilities. These impacts often occur when the pattern of having an obsession and responding with a compulsion snowballs. The more the person engages in compulsions (or avoidance, which is also problematic), the more they are going to believe that they need to engage in these behaviours, and that they can’t tolerate the discomfort of the thoughts themselves.

So this is the basic pattern: someone has an obsession, interprets the thought or resulting discomfort as dangerous, and then engages in compulsions and/or avoidance to try to make the discomfort go away or prevent something bad from happening. Many people with OCD notice that the content of their obsessions can shift over time, almost like a game of whack-a-mole, in which one obsession seems to be resolved right as a new one pops up. Luckily, when people are able to understand the underlying pattern of obsessions and compulsions, they get better and quicker at recognizing a new obsession and can apply the tools they learn in therapy sooner to keep the symptoms from snowballing.

Next time, I will discuss common and less common themes that often are the focus of obsessions, along with the variety of compulsions that might accompany them.