13 Mental Compulsions And What To Do About Them
We all know what Obsessive Compulsive Disorder (OCD) is, right? Handwashing. Cleaning a lot. Checking the stove. Organizing your books by color, or size, or topic, or author. Of course, if you have a really exotic manifestation, you circle back when you drive just to make sure you didn’t run over a pedestrian or cat that didn’t deserve it. That’s pretty much it, right?
By now, hopefully, you’ll hear my sarcasm.
If you have lived experience with OCD, or know someone who does, you may know that OCD goes well beyond the external behaviors and also include hidden actions that are as tricky as they are sinister.
Mental compulsions, also known as covert compulsions, are compulsive behaviors, actions, or efforts that occur inside the mind and body. Just because you can’t see them does not mean they are easier to deal with, have less of an impact on your life, or are in any other way “less than” the outward compulsions that people see and are really easy to overlay on a TV show or movie character.
What is OCD?
For the uninitiated, let me briefly go over what the OCD cycle is.
It all starts with a trigger. This can be literally anything! Something outside of you, like seeing children play, hearing a song, or seeing a random scene in a movie. Triggers can also be inside of you, like having a random mental image of boat pop into mind, feeling your heart flutter, or even that abstract feeling of being “nudged or drawn” toward or away from something.
This starts an obsession that leads to a doubt, uncertainty, and an anxious feeling. “Oh no, does that mean I want to do _______?” Or, “If that were to happen, that would be terrible!” These doubts raise questions about who you are, what you want, and what will happen to you, and usually it goes against something you intrinsically know or believe to be true. Yuk.
To feel better, safe, and confident again, or to feel sure that the obsession won’t happen, you do a compulsion, which means a reassurance, avoidance, ritual, or routine that somehow works to quell the thought or feeling. Usually, the compulsion works, until it doesn’t, but that is a different conversation.
For example:
Trigger: Touching a door knob
Obsession: Oh no, what if it wasn’t clean and I could get sick!
Compulsion: Wash hands
What Are Mental Compulsions?
Alongside the myriad of external compulsions, you can also be experiencing and engaging with internal compulsions that are just as problematic to your recovery. While this list may be limited, and may not describe all examples of these mental compulsions, let’s go over a few of them, then see them in action.
Mental Avoidance- Trying to prevent a topic from coming in mind. “Don’t think about the white elephant.”
Thought Suppression– Working to force a thought out of your head.
Counting– Performing acts in a in a certain amount due to a belief that certain numbers hold special significance. Can also be counting up to a certain number, by certain intervals, or in sets of numbers.
Tracking– Keeping track of items or peoples’ location, orientation, quantity, qualities etc.
Mental Review– Going over a previous interaction to evaluate your actions, the actions of others, or for “right/ wrong” events.
Emotional Checking– Evaluating your feelings, bodily sensations, or emotional states for the presence or absence of good, bad, right, or wrong feeling. “Do I feel love? How much? Enough love?”
Rumination– Seemingly never-ending mental evaluation and comparison. Thinking about something that leads to more thinking but never any real action.
Mental Rehearsal– Trying to play out all possible scenarios of a future event in your head. Usually done to plan out the right thing to do, or get certainty that you won’t do the wrong thing.
Mental Checking– Mentally looking for something. “Am I thinking it? Do I feel that sensation? Is it still there, or did it go away?”
Memory Hoarding– Effortfully working to hold on to thoughts, memories, or experiences.
Compulsive Prayer– Engaging with or repeating prayers until they are done completely, “right,” or elicit the “appropriate and adequate” feeling.
Scenario Twisting– Mentally changing a few details of a previous event to see how they would change your current situation or feeling, and how those changes would change, improve, or worsen your imagined future.
Self-Reassurance– Assuring yourself that you are “Ok,” “Safe,” and that everything is as it should be.
Mental Compulsions and OCD
Now, let’s see a few of these in action:
Relationship OCD (ROCD)
Trigger (external)– seeing your partner
Trigger (internal)– remembering a past interaction with your partner
Obsession– “Do I really love my partner?” “Do they really love me?” “If I don’t love my partner more than I loved previous partners, I’ll be wasting our time!”
Compulsion– Evaluate current feelings for the amount of love you have when thinking about or around your partner, compare levels of affection or arousal when conjuring thoughts about your current and past romantic partners.
Contamination Obsessions
Trigger (external)– seeing a door knob
Trigger (internal)– feeling “dirty”
Obsession– “What if I just touched something that could infect me and get me sick?” “This feels gross!” “I just touched something that might have germs on it that I could infect someone I love!”
Compulsion– Mentally keep track of everything you touch after it so you can go back and wash it, repeat “it’s ok, germs are ok, I’m fine,” think about all the things you could touch and evaluate whether it’s worth it to keep going or wash hands now.
Harm OCD
Trigger (external)– seeing a knife on the counter
Trigger (internal)– imagining blood on objects or people
Obsession– “I might take that knife and harm someone!” “If I hurt someone with that knife, I’ll be arrested, thrown in jail, and my life will be over!” “If I have a violent thought, that could mean I’m a violent person and hurt someone.”
Compulsion– Think of doing nice and kind things for people to neutralize the violent thought, intentionally look at the knife three times to symbolize “Father, Son, Holy Spirit.” Monitor your body’s movements and ensure that no actions are aggressive or “too close” to a knife.
None of the above examples reflect any external compulsions. The casual observer would have no idea the person they are around has OCD or is eye-balls deep in compulsive acts. While they cannot be seen, these thoughts are actions, effortful, and intentional.
Wait, So What is Pure-O?
Pure Obsession, or Pure O, or Pure OCD, is a term used to describe an Obsessive Compulsive Disorder manifestation where the obsessions take place covertly inside your mind or body. The term originally was used to describe someone who seemingly does not have any compulsions. Instead, they reported only excessive or continuous rumination or only “obsessions.”
Purely Obsessional OCD (Pure-O) is not a diagnosis unto itself. It is simply one way OCD manifests itself and generally outlines the ways in which the individual will exhibit symptoms or interact with their feared stories (i.e. obsessions). Any broader subtype of OCD can either be or include Pure-O traits. These can include SO-OCD with mental or emotional checking, Religious Scrupulosity with compulsive prayer, and contamination obsessions with mental checking or neutralization, just to name a few.
The Diagnostic and Statistical Manual, 5th edition, describes compulsions as “Repetitive behaviors (e.g., hand washing, ordering checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels drive to perform in response to an obsession, or according to the rules that must be applied rigidly.”
“Pure-O” is, therefore, a misnomer. While the person with Pure-O does not have external or overt compulsions, they are still engaging in internal compulsions, actions, efforts, or processes to neutralize, negate, undermine, or eliminate the uncertainty, doubt, and unwanted feelings. In other words- compulsions.
Why Mental Compulsions Are A Problem
As people who are faced with decisions and the complexities of life, we should think, weigh the options, and consider the pros and cons when making decisions for the future or evaluating how to improve. But OCD hijacks this process creates an endless, self-reinforcing, feedback loop. People doing mental compulsions often feel like they are doing the right thing by reviewing or planning ahead. They feel like they will discover a mistake so they can atone for mistakes or mend a relationship. Or, at the very least, it makes them feel better temporarily.
But, it is all just another compulsive trap! It may not be washing your hands, or putting things in alphabetical order, but it is still an intentional, effortful action to eliminate anxiety, exorcise uncertainty, and restore a sense of safety.
Know Thyself!
In order to stop mental compulsions, you have to be aware that you are doing them. Reviewing the list above should be a good primer to recognizing types of compulsive thought patterns. Go back and review the list and make a note which one(s) you do. For bonus points, write down how that specific mental compulsion shows up in your life, when it’s most likely to show up, and what you are hoping to accomplish by doing them. Most importantly in this exercise, be honest with yourself.
How Can I Stop Mental Compulsions?
Stopping mental compulsions can be a tricky business, especially since these mental behaviors mask themselves as the typical thought process. To that end, If we are being honest, it is a typical thought process inasmuch as a hammer is good for a nail; a few whacks and you’re typically good to go, but when a few whacks lead to more whacks followed by a lot more whacks you are left exhausted and with nothing to show for it.
However, we always have a choice with where and how much we invest our mental energy. Granted, sometimes the choice is hard to recognize, especially when OCD’s voice is loud! However, you have control over whether you orient your thoughts toward meaningful activity, or whether you intentionally engage in compulsive thought processes that feed the OCD monster.
Attention Training Is Not Thought Suppression
Attention training is a great way to build the “focus-shifting muscle.” Some confuse this with thought suppression or mental avoidance, however there are key differences. Attention shifting is about gently turning your attention toward a more preferred topic, thought, or activity, whereas thought suppression aims to eliminate the non-preferred thought.
In dealing with mental compulsions, once you become aware that you are engaging in mental compulsions, acknowledge the thought (for example, by saying, “Oh, I’m doing that thing again,” or “thinking”) and gently redirect your focus elsewhere (i.e. back to your conversation, the actions involved in washing your dog, or your psych 101 lecture).
Attention Training… Training
Here is a simple way to practice this. Put on a set of headphones and play Bohemian Rhapsody by Queen. As you’re listening, focus on Freddy’s singing. Just his singing. Notice the rasp, the punch, the gentle glissando fall at the end of his phrases. Now, shift and listen to the guitar. Only the guitar. The note’s crisp attack, how notes are played after or before the beat for emphasis, the smooth vibrato. If you did this and got distracted by listening to the bass for a moment, don’t get upset. Sure, John Deacon’s playing is immaculate, but not the focus of the exercise. For now, ignore his playing like most people usually do, and gently bring your focus back to the guitar.
Did you notice how you were able to selectively refocus your attention. Did you also notice that sometimes, despite your best efforts, you got distracted? That’s expected, normal, and human. Did you also notice that when you focused on the guitar, you still heard the other instruments and the singer? Right! You weren’t trying to pretend as if the other sounds weren’t there because they were there! Same with the thoughts. Your goal with this exercise was to build your skill, confidence, and self-compassion in willfully and nonjudgmentally focusing on a thought or stimulus of your choice and gently shift back to it when you were distracted.
Acceptance and Exposure and Response Prevention
If you are tired of repetitive mental compulsions and are ready to take the risk to cut them out, you are effective doing your own Exposure and Response Prevention (ERP). ERP is the primary therapeutic focus for all types of OCD and is most commonly used to break the obsessive-compulsive cycle. When you recognize you have fallen back into a mental compulsion, that’s ok. Compassionately acknowledge that you did it, recognize you were aware of it, and redirect your attention and mental energy elsewhere.
When you do disrupt the mental compulsion and resist giving into the obsessive doubt, you leave the obsession unanswered and allow the uncertainty/ anxiety to linger. You accept a temporary discomfort. But, it will go away. It always does. And always will. Eventually. When you commit to interrupting your compulsive thoughts and behaviors, you build confidence that the anxiety goes away, all on its own, without compulsions.
If you are ready to take this leap, there are a ton of resources out there that discuss ERP and acceptance in greater detail. Better yet, you can reach out to a therapist and begin working with them to directly face your feared thoughts and feelings through structured ERP, and with the tools that you’ve learned in this article you will be prepared to disengage with mental compulsions, redirect your focus back on your life, and take control over your relationship with OCD ridden thoughts and feelings!