Dealing with obsessions and compulsions

Co-authors: Dr. Leorra Newman & Dr. Kayleigh-Ann Clegg.

Have you ever had random, sometimes unsettling thoughts pop into your head out of nowhere? Things like, “I could push that person into traffic!” or “I could drive right off this bridge!” Or have you ever left the house just to turn right back around to double-check that the oven was off? Are you especially concerned about germs or dirt, or can’t stand when things aren’t in their rightful place?

If so – same! And here’s the thing: all of these experiences are really common. Nearly all of us – studies suggest over 90% – experience intrusive thoughts of all kinds at some point. And although many people can manage these thoughts or shrug them off, it can be much more difficult for people with obsessive-compulsive concerns.

So, what are obsessive-compulsive concerns, and how do you know if you need support to help manage obsessions or compulsions?

What are obsessions and compulsions?
Obsessions are thoughts, images, or urges that are intrusive, unwanted, and persistent. They keep coming back, and when they do, they cause a lot of distress and can trigger feelings like anxiety, disgust, and shame. They tend to involve things that you’re afraid of or things that go against your personality or values. For example, you might have unwanted urges to harm someone you love, fears of being contaminated or getting sick from dirt or germs, or thoughts about being responsible for something terrible happening.

Compulsions, on the other hand, are things that you might feel driven to do, either physically or mentally, often to deal with the anxiety that gets triggered by obsessions. They’re usually things that are out of proportion to the situation (for example, you do them more frequently or intensely, or spend more time on them than the average person might); but they can also be regular acts that are carried out according to really strict rules or until you get a “just right” feeling. For example, you might turn the door handle 10 times every time you leave the house to make sure it’s locked, or you might have a specific, detailed handwashing ritual that takes you a significant amount of time to complete. Or your intrusive fears may lead you to spend a lot of time seeking reassurance or avoiding particular situations. In the short term, compulsions, reassurance, and avoidance can all reduce anxiety and increase feelings of safety. The problem is that in the long term they tend to become more time-consuming and complex, and ultimately increase your distress.

Obsessions and compulsions are most often experienced together, in a vicious cycle. You experience an obsession, which creates anxiety, so you do a compulsion that provides temporary relief from that anxiety… but the obsession, or intrusive thought, pops up again, and the cycle starts all over.

When to seek support?
We all have intrusive thoughts or engage in repetitive behaviors or compulsions from time to time. However, when they’re more severe, obsessive-compulsive concerns don’t tend to go away on their own and can in fact get worse over time.

You may benefit from seeking support if you’re experiencing obsessions and/or compulsions that are:

• More severe or upsetting, and causing you a lot of emotional distress
• Extremely frequent or time-consuming: for example, if a certain ritual takes up hours of your day, or if you wash your hands considerably more often than the average person
• Interfering with your ability to do the things you need or want to do in your day-to-day life

What does support for obsessive-compulsive concerns look like?
Working on your mental health can sometimes feel daunting. If you do take the step to seek support for obsessive-compulsive concerns, it can help to have a sense of what that support might look like. One of the most evidence-based, established treatments for obsessive-compulsive concerns is Cognitive Behavioural Therapy (CBT). CBT focuses on disrupting that vicious obsession-compulsion cycle in two main ways: (1) by teaching you techniques for evaluating obsessions and the way you interpret them, and learning new, different ways of relating to those thoughts and experiences, and (2) by helping you break the obsessive-compulsive cycle with Exposure and Response Prevention (ERP). ERP involves gradually facing your fears and triggers, without using compulsions or rituals. This is done in a slow, structured way that helps you build confidence and lessens the anxiety and distress you feel over time.

If you’re struggling, you can access our therapy programs by visiting our Virtual Mental Health Therapy Clinic. If you are part of our Workplace Mental Health Program, please visit your company page for access to services covered by your workplace. We’re always here for you. 

Selected Resources:

• Abramowitz, J.S. (2021). The family guide to getting over OCD: Reclaim your life and help your loved one. Guilford Press. 
• Abramowitz, J.S. (2018). Getting over OCD: A 10-step workbook for taking back your life (2nd ed.). Guilford Press. 
• Grayson, J. (2014). Freedom from obsessive-compulsive disorder: A personalized recovery program for living with uncertainty (updated edition). Berkley Publishing Group. 
• Hershfield, J., & Corboy, T. (2020). The mindfulness workbook for OCD: A guide to overcoming obsessions and compulsions using mindfulness and cognitive behavioral therapy (2nd ed.). New Harbinger Publications. 
• Purdon, C., & Clark, D.A. (2005). Overcoming obsessive thoughts: How to gain control of your OCD. New Harbinger Publications. 
• Radomsky, A. S., Alcolado, G. M., Abramowitz, J. S., Alonso, P., Belloch, A., Bouvard, M., ... & Wong, W. (2014). Part 1—You can run but you can't hide: Intrusive thoughts on six continents. Journal of Obsessive-Compulsive and Related Disorders, 3(3), 269-279.
• Seif, M.N., & Winston, S.M. (2019). Needing to know for sure: A CBT-based guide to overcoming compulsive checking and reassurance seeking. New Harbinger Publications.