What Obsessions and Compulsions Look Like

Obsessions and compulsions look different in each person; however, I’d like to provide you with a few examples to help illustrate what they look like, using what we covered in the first post of this series. Each example includes the trigger, the (obsessional) doubt, the feared consequence, the anxiety or distress experienced, and the compulsion.

Contamination Example

• Trigger: Turning a doorknob and noticing a texture that didn’t match the rest of the knob.
• Obsessional Doubt: Oh no! What was that? I could have touched dried blood.
• Feared Consequence: I might have a bloodborne disease now.
• Anxiety/Distress: I cannot risk taking this home and spreading it to my family. They might get sick too. Worry and panic.
• Compulsion: Washing hands seven times and ensuring that at least 14 minutes are spent doing so. If the count or time is lost, handwashing must be restarted.

Checking/Safety Example

• Trigger: Leaving the house and locking the front door.
• Obsessional Doubt: What if the door isn’t locked?
• Feared Consequence: Someone could enter my home and steal something!
• Anxiety/Distress: Fear and panic.
• Compulsion: Unlocking and locking the door 4 times, turning the knob and giving the door a push.

“Just Right” Example

• Trigger: Writing an email to a coworker with feedback.
• Obsessional Doubt: I could have made an error.
• Feared Consequence: If I made an error, they’re going to think I’m incompetent. I may be fired!
• Anxiety/Distress: Feeling like a fraud.
• Compulsion: Rereading the email until the person is certain there are no mistakes and it feels “just right” to send.

Intrusive Thoughts of Harm Example

• Trigger: Seeing a child walking home alone.
• Obsessional Doubt: What if I could be a kidnapper? I’m the only person near them right now.
• Feared Consequence: I could kidnap this child and become a most wanted criminal.
• Anxiety/Distress: Panic and disgust.
• Compulsion: Avoiding places where children may be and frequently checking the trunk of their car.

Notice that in each of these examples, the person doesn’t want the thought and is distressed by it. That’s especially true of intrusive thoughts of harm like the one above. The person finds the thought unwanted and upsetting, and it doesn’t reflect what they actually want. This quality is called ego-dystonic, which means the thought feels foreign and in direct conflict with a person’s core values, beliefs, and self-image. If you’d like more detail, I explain it further in the first post of this series.

Distinguishing Compulsions from Everyday Habits

Compulsions are often mistaken for habits, but they’re fundamentally different. Not wanting to make your bed is a mild preference you can shrug off; a compulsion feels like something you have no choice but to do, even when part of you knows it won’t actually solve the problem it’s meant to fix. That gap between knowing and doing is where much of the powerlessness of OCD lives. And unlike a nighttime routine you’ve simply grown used to, compulsions cost real time and bring real distress every time they’re carried out.

Between habits and compulsions, the key difference is distress and impairment. The distress and impairment caused by compulsions are unlike those caused by everyday habits. To help you consider whether a behavior is compulsive, ask yourself questions like:

• How long do I spend doing this? Is that more than I’d expect to spend on it?
• How often do I do this? Is that more often than I’d expect?
• What have I given up, or what has it cost me, to do this? Was it worth the cost?
• Could I stop myself from doing this if I wanted to? If I could, how distressed would I be?
• Do I plan my day around this behavior, or around the things that trigger it?
• Have other people noticed what I do? What have they said? Have I hidden this behavior from others?

There are certainly other questions you could ask; however, answering these can help you determine whether you should look for a therapist to discuss it further.

Why Telling the Difference Matters

It can be hard to tell a compulsion from a habit, and that’s one of the reasons OCD so often goes unrecognized. Behaviors get written off as normal, as simply being careful, or as just the way you are, and the shame that can come with them makes them easy to hide. The International OCD Foundation reports that it takes more than 7 years, on average, for a person to receive an accurate OCD diagnosis, and Harvard Health notes that it’s common for people to live with symptoms for 5 to 10 years before seeing a psychiatrist.

If the questions in this post gave you pause, that’s worth paying attention to. You don’t need to be certain it’s OCD to reach out and talk it through. And if you’d like a refresher on the basics, the first post covers what OCD actually is.

Don’t Go without Support

OCD is not likely to resolve on its own, and treatment will likely be needed. With treatment, OCD symptoms can improve significantly, and you will be better equipped and prepared to resume life.

When should you consider reaching out for help? On some level, we addressed this in the first post. It’s when the symptoms of OCD are running through your life. You’re late to work and missing meetings, spending more time entertaining compulsions than with your own family, or worse yet, you’re on the brink of losing a job or a relationship. You’ve not seen your friends in months because you’re afraid you won’t be able to stop counting at the dinner table. You doubt whether you’re the kind of person who could lead a normal life.

You now have a name for this, and it’s called Obsessive-Compulsive Disorder, or OCD. You’re not just a particular person or someone preoccupied with neatness. OCD is a debilitating mental health condition, and you may have already gone months or years without help. Now is your time to schedule a consultation with us.

If you’d like to know more about what treatment involves before you reach out, the next post looks at what treatment can look like, beginning with Exposure and Response Prevention (ERP).