Most people think of hand washing or checking compulsions when they imagine someone with OCD, but there are many other compulsions that are actually quite common that are not so obvious. Even therapists and doctors often miss these subtle signs of OCD, and misdiagnose the patient with an anxiety disorder. While OCD does often involve anxiety, the diagnosis of OCD is important when OCD is present because the treatment differs significantly, and most often people with OCD who are misdiagnosed with anxiety do not get better.
So what are these subtle or hidden compulsions and how do we miss them?
There’s a mistaken belief that a compulsion must be a behavior that is done over and over, but compulsions can often be done mentally. Here are a few examples of mental compulsions:
Overthinking / Figuring out
We all think a lot, and many of us worry or think through things too much. This overthinking can become a compulsion when it is done in an effort to gain certainty about something that you are obsessing about. For instance, someone with OCD may fear that they accidentally hurt someone. Some compulsions that are behaviors include asking the person if they’re okay over and over, seeking reassurance from others to determine if the person looks okay, or even checking the news and hospitals to make sure that the person isn’t hurt. These behaviors rise to the level of compulsions if they are done repeatedly to try to gain certainty that the person is not hurt, in order to reduce the anxiety that the OCD sufferer feels about the possibility that this person might be hurt. If the person with OCD is also going over and over in their mind all of the things that they did that day to try to figure out if they hurt the person or not, this is likely a mental compulsion.
Compulsions usually give the OCD sufferer some temporary relief of their anxiety, but then the doubt inevitably creeps back in because they can never be 100% certain that they didn’t hurt this person. “Maybe the person was lying when he said he was okay? Maybe he later discovered he was hurt and didn’t tell me?” These thoughts or obsessions continue to haunt the OCD sufferer and make them feel like they have to keep doing the compulsions in order to feel a fleeting sense of relief, only to then have the doubts come back and the endless cycle of obsessions and compulsions continue. Therefore these compulsions are actually fueling the OCD, making it stronger and harder to resist engaging in them the next time they are triggered.
In order for treatment to be successful, all of these compulsions must be identified and gradually stopped so that the OCD sufferer can learn to live with the uncertainty that he can never know for sure if he hurt someone or not. For those of us without OCD, this may sound easy to do, but for someone with OCD it is extremely difficult, and often requires a type of Cognitive Behavioral Therapy (CBT) called Exposure and Response Prevention (ERP).
Reassuring Themselves
Another common mental compulsion involves the OCD sufferer reassuring themselves that the bad thing they are worried about did not occur or will not occur. For instance, it’s common for mothers with OCD to become obsessed with the idea that they might harm their baby, either physically or sexually. Once this thought comes into their minds, they become terrified that they will act on it, and/or that they’re a terrible person just for having the thought. Interestingly, these women are the least likely people to ever harm their children, and the thought usually pops into their head because of how much they love their child and how worried they are about anything happening to the child. It’s common for anyone to have a random thought of how easy it would be to accidentally harm a new baby, but most of us can just let that thought go without much, if any, worry. However, someone with OCD of this type may obsess about this, and then use the compulsion of reassuring themselves that they would never do anything like this, in order to try to feel better. Just like other compulsions, this may bring temporary relief of anxiety, but inevitably the worries will return and they will have learned that the only way to make the anxiety go away is to reassure themselves, and so the endless cycle of OCD is strengthened.
In order to break free from this cycle, the OCD sufferer will have to accept that there is a minuscule chance that they could harm their child or be a terrible person. They must learn to accept some degree of uncertainty, that we all accept without realizing it, in order to stop worrying about it.
Arguing With The OCD
Using the same example as above, the OCD sufferer may try to argue with their OCD thoughts in an effort to feel better, which can turn into a compulsion. So if the mother has the thought, “I might hurt my baby,” this is an obsession or an OCD thought. The mother may start to argue with the OCD in her mind by saying, “no I won’t! I would never do that to my baby!” To which the OCD will likely respond, “but you never know, you could do it,” which will cause the mother to become more anxious and resort to even more arguing, going back and forth with no real relief. This arguing with the OCD compulsion does the same thing as the others as far as strengthening the OCD, so like any other compulsion it must be stopped in order to get better.
Because these compulsions can be so subtle and hard to detect, it is important to find an OCD specialist for treatment. The good news is that OCD is very treatable, and while there isn’t a cure for it, with appropriate treatment it is common to experience a complete remission of symptoms and a return to normal functioning. Once the OCD sufferer has completed treatment, which usually lasts about two to three months, they will have learned how to be aware of compulsions sneaking their way back in, and how to stop them before the OCD spirals out of control again.
If you have any questions about whether you or a family member has OCD, feel free to make an appointment with one of our OCD specialists. We can easily tell if you have it or not, and let you know how treatment will look. There is no need to suffer with OCD or become disabled by it, as many who do not receive treatment unfortunately do, but it is important to get help as soon as possible because the longer it goes untreated the worse it will usually get.
