Obsessive-compulsive disorder (OCD) has two main symptoms: obsessions—intrusive thoughts, sensations, images, feelings, or urges—and compulsive behaviors done to relieve distress brought on by obsessions. These symptoms sometimes get confused, but it’s important to be able to tell them apart to understand your condition and get effective care.
Even if you’re familiar with obsessive-compulsive disorder (OCD), you may experience occasional confusion about what’s an obsession and what’s a compulsion. It can be especially tricky to tell the difference, if your compulsions primarily show up as mental behaviors, rather than physical actions.
Learning to identify and distinguish these symptoms is a crucial part of the OCD recovery process, as you need to be able to identify your compulsions in order to learn how to resist engaging in them. Read on to understand the differences between these two main symptoms, and why understanding them is key for accessing effective treatment.
What is an obsession?
In the context of OCD, an obsession is a repetitive, unwanted intrusive thought, sensation, image, feeling, or urge. Dr. Patrick McGrath, Chief Clinical Officer at NOCD, says they can be “inappropriate or uncomfortable” in nature, and often cause great distress.
While everyone experiences intrusive thoughts sometimes, obsessions are all-encompassing. For example, while someone without OCD might be able to experience a brief intrusive thought about swerving their car off a bridge, and move on, a person with OCD might interpret this same thought as extremely serious, and feel an urgent need to investigate, or respond. Intrusive thoughts can latch onto anything, but typically attack what we value most, causing distress.
Common obsessions include:
- Contamination: “What if I contract a deadly illness from this public restroom?” “What if I am exposed to germs at the concert and then bring them home to my family?”
- Relationships: “Is this person really ‘the one’?” “Am I attracted ‘enough’ to them?”
- Harm: “What if I grabbed a knife from the kitchen and stabbed my partner?” “What if I pushed this stranger in front of the train?”
- Sexual orientation: “What if I’m lying to my partner, and I’m actually straight?” “What if I’ve been repressing my sexuality my whole life, and I’m actually queer?”
- Pedophilia: “What if I am attracted to this child?” “What if I want to molest children?”
- Scrupulosity/Religion: “Am I actually a bad person?” “What if I’m a sinner?”
- Existential: “What if I never know the purpose of my life, and I waste it?” “How do I know I’m not really dead or in a simulation?”
- Sensorimotor: “What if I am not blinking correctly?” “What if I can never stop paying attention to my breathing?”
While these are some of the most common themes for OCD obsessions, the condition can latch onto anything and switch themes at any time. The good news is that the content of your obsessions doesn’t matter for treatment. A therapist who specializes in OCD can help you tackle your intrusive thoughts, no matter what they are.
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What is a compulsion?
A compulsion is a behavior or mental action done to relieve the uncomfortable feelings brought on by obsessions. Compulsions are often performed to try to find certainty, prevent a “bad” thing from happening, or “neutralize the thought,” Dr. McGrath says. If your compulsions are mostly done in your head, they can be especially tricky to recognize.
Common mental compulsions include:
- Seeking reassurance from yourself: For example, repeatedly repeating affirmations like, “I am a good person” or, “My life has purpose.”
- Rumination: You over-examine something in your mind to “get to the bottom” of your intrusive thoughts, or have a desire to “think your way out” of any uncomfortable feelings.
- Thought replacement: You try to replace a “bad” thought with a “good” one. For example, after experiencing an intrusive thought about pushing a stranger in front of a train, you might intentionally force yourself to think, “That person looks really kind.”
- Mental review: You consider prior experiences and situations to look for proof that your intrusive thoughts are true. For example, if you have pedophilia OCD, you might look back on memories you have with children and ask yourself, “Was that creepy?” or, “Was it wrong that I hugged them?”
- Distraction: You try to keep your mind occupied, in order to not leave room for intrusive thoughts. For example, maybe you watch a lot of TV, because you think it will help distract you from any obsessions you may experience.
Physical, visible compulsions are usually more easily identifiable, as they are more difficult to hide from yourself and others.
Common physical compulsions include:
- Excessive washing or cleaning: You might engage in excessive hand washing, showering, or disinfecting of surfaces.
- Checking: You check to make sure the stove is off, the door is locked, or that you didn’t accidentally run over someone with your car.
- Tapping/touching: While there may be no logical connection between the intrusive thought and the action, you feel a need to repeatedly tap or touch to try to relieve distress. For example, you may pick up and put down your coffee mug or tap your arm a certain number of times in order to feel “just right.”
- Repeating actions: Similar to the above compulsion, you may repeat words or sentences until they sound “just right,” or reread a sentence until you understand it “perfectly.”
- Reassurance-seeking from others: You may ask a loved one, “Do you think I’m going to be okay?” or, “Did I hit that person on the bike back there?”
- Avoidance: You may refuse to go to places, be in situations, or be exposed to stimuli that trigger your intrusive thoughts.
Compulsions tend to bring temporary relief, but they ultimately feed the OCD cycle. These behaviors end up reinforcing the idea that intrusive triggers and obsessions are serious threats, that compulsions are keeping you safe, and that you cannot tolerate the uncertainty and discomfort that OCD causes.
Community discussions:
Are obsessions and compulsions symptoms of any other mental health conditions?
OCD is commonly misunderstood and misdiagnosed—partly because it shares some symptoms with other conditions. However, what makes OCD distinct is the act of performing compulsions in order to relieve distress brought on by intrusive triggers. While there are various conditions that are characterized by either excessive fixation or compulsive behavior, people don’t typically enact these behaviors in the same ways they do with OCD. It’s important to be able to understand the difference because, “you don’t want to treat the wrong thing,” according to NOCD therapist Heather Brasseur, LMC, LPC. ”Obsessions and compulsions might look like tics, body-focused repetitive behaviors, or food concerns, but they come from different places and need different treatment approaches.”
Other conditions that may look like OCD:
- Anxiety: Anxiety disorders, such as generalized anxiety, social anxiety, and panic disorder, are a common misdiagnosis for people with OCD. While anxiety is a common feature of OCD, people who are dealing with anxiety and not OCD won’t typically engage in compulsions.
- Specific phobias: With specific phobias, you may experience intrusive fears, but typically only when presented with the subject of your phobia. OCD, on the other hand, tends to present intrusive thoughts regardless of the context. People with phobias don’t generally perform compulsions.
- Body-focused repetitive behaviors (BFRBs): A BFRB is a repetitive behavior focused on your body, such as skin picking and hair pulling. Unlike OCD, these behaviors tend to bring pleasure or satisfaction (even if it causes damage later on). The behavior can be compulsive, but they’re not typically done in order to relieve distress from intrusive thoughts.
- Body fixations: People with body dysmorphic disorder (BDD) spend an excessive amount of time thinking about specific perceived flaws and looking in a mirror—or, conversely, avoiding mirrors. They may engage in compulsive “body checking” or reassurance-seeking about their appearance. While these behaviors can be common in people with OCD, compulsive behaviors associated with BDD are usually a response to negative feelings about your body—not an attempt to alleviate uncertainty or prevent something bad from happening.
- Disordered eating habits: Eating disorders like anorexia, bulimia, orthorexia, binge eating, and avoidant restrictive food intake disorder (AFRID) are characterized by a fixation on body weight, shape, and/or food. They also often involve compulsive behavior surrounding food and the body. However, people with eating disorders often are not aware that their compulsive food behaviors are wrong, while people with OCD often experience significant distress about these behaviors.
- Tics or stims: Tics are sudden, repetitive movements or sounds that your body makes involuntarily—these may appear as twitching, excessive blinking or persistent throat clearing. Stims are physical behaviors, including humming, drumming fingers, and hair-twirling, which people engage in to regulate sensory systems or deal with anxiety. Both of these behaviors may look like compulsions, but the key difference is that stims and tics are largely involuntary and are not done with a specific goal in mind. Compulsions, on the other hand, are generally performed to try to neutralize feelings of distress or prevent something from happening.
How do you treat obsessions and compulsions?
All themes of OCD are treated the same way: with exposure and response prevention (ERP) therapy. ERP was specially designed to treat OCD—and research shows it is highly effective.
Your ERP therapist will begin by working with you to identify all your intrusive triggers, obsessive thought patterns, and compulsive responses. From there, you’ll create a plan to address your fears gradually—starting with the ones that cause the least distress, and working your way up. Your therapist will teach you tools to resist compulsions before, during, and after these exposures.
Over time, you’ll learn to tolerate discomfort and accept uncertainty outside of therapy. In doing so, you can learn to feel less distress over time—and find healthier ways to respond to the tough moments in life. OCD symptoms don’t have to rule your life. With ERP, you can begin the rewarding journey toward long-term recovery.
Key takeaways
- Obsessions are intrusive thoughts, sensations, images, feelings, or urges that cause discomfort or anxiety and are often taboo or go against your values.
- Compulsions are physical actions or mental behaviors done in effort to relieve distress brought on by obsessions, prevent “something bad” from happening, or neutralize intrusive thoughts.
- There are many symptoms that get misidentified as obsessions or compulsions, including tics, bodily fixations, and disordered eating habits.
- No matter what your obsessions and compulsions are, ERP therapy can help you learn to resist compulsions and feel less distress over time.