Obsessive compulsive disorder - OCD treatment and therapy from NOCD
OCD subtypes
Counting OCD

Counting OCD: Why Do I Always Count?

7 min read
Gary VanDalfsen, PhD
All types of OCD include obsessions and compulsions. Obsessions are unwanted and intrusive thoughts, feelings, urges and doubts, while compulsions are repetitive physical or mental actions performed in an attempt to relieve distress and anxiety.

Counting OCD is a common form of Obsessive-Compulsive Disorder, characterized by counting-based behavior. People with Counting OCD may count to achieve a state of feeling “right” and to avoid the anxiety of something feeling “wrong.”

In some cases, they may feel a responsibility to prevent something bad from happening to themselves or to others and they count to try and guarantee safety – even though they know it doesn’t make sense. 

Examples of Counting OCD

Example 1: A young woman fears that tragedy will strike unless she makes all the right moves.

Annie is in the living room watching television when her father walks by and casually mentions that her mom just called and said that she is on her way home from the airport. Annie’s mind shifts from the television program to a familiar obsessive thought: “What if mom gets into an accident?”

Annie feels the pit of anxiety in her stomach and notices her heart begins to beat faster. In response, she starts her familiar ritual of mentally counting to seven over and over again. She connects her counting to a physical action, like tapping her hand on the armrest of the couch seven times, clicking her heels together seven times, or moving her head to one side and back again seven times.

Annie knows that none of this makes sense rationally, but she somehow feels responsible for making sure that mom gets home safely and seven is the number of movements she must count in order to be certain that this will happen.

Example 2: A man has trouble getting into bed at night, needing to complete a time-consuming counting ritual until “it feels right”.

It’s late at night and Jamal is at the bathroom sink realizing that, once again, it’s going to be a long while before he’ll get to bed. He knows it doesn’t make any sense, but he still feels the need to brush his teeth for a count of 37 – no more, and no less.

But Jamal’s counting doesn’t stop at the sink. Once that is done, he has to count his steps out of the bathroom and into the bed. “Eight. It needs to be eight”, he thinks to himself. 

Once in bed, the ritual continues. Jamal has to look at objects in his room, always in sets of threes. “Window, television, picture”, he thinks to himself. “Light switch, door knob, water glass.” How many times Jamal has to notice these sets of threes in his room can vary from three or four times to 20 times or more. Jamal needs to do this until it feels right.

Jamal knows that this all is excessive and that none of this really makes any sense, yet every night he goes through this elaborate ritual. He knows that if he tries to skip any part of it, or if he does any of it incorrectly, nothing bad will happen but it won’t feel right to him and he’ll need to start all over again, pushing sleep farther and farther away.

Numbers written on locker

Common Reasons for Counting

People with Counting OCD count for a variety of reasons. Sometimes the counting is automatic – without thinking about it, a person finds themselves counting random things around them. Common items counted can include:

  • Floor or ceiling tiles;
  • Road signs;
  • Words in a sentence or on a page;
  • Steps taken.
  • Counting letters in words
  • Counting numbers

The counting is not in response to an obsessive thought. Instead, it can trigger an obsessive fear like: “What if I can’t ever stop counting?” This is similar to obsessive fears people have about being distracted by something like swallowing or blinking, or maybe a ringing in their ears.

More often, counting is a compulsive behavior, meaning that it is in response to an obsession that creates anxiety. The obsessive concern might be that something bad will happen to themselves or to someone they care about. Annie, the girl from the scenario at the beginning of this article was an example of someone with fear-related counting.

Sometimes the obsessive concern is more vague. Instead of fearing that something bad will happen, the person with Counting OCD feels the need for something to be done the “right” amount of times or according to some rigid rules. The concern is that if an action isn’t done in this way they will experience significant distress over the fact that it doesn’t feel “right.” Jamal was an example of this.

Numbers from 1-9

Common Counting Behaviors

Counting OCD can manifest in a variety of ways. Some common types of counting include:

  • Counting to a specific number. This can be done once, or over and over again.
  • Counting to whatever number happens to feel “right” at that moment.
  • Doing actions in sets of a particular number (e.g., looking at things or performing other behaviors in a specified series, like sets of three).
  • Preferring odd or even numbers.
  • Adding to or repeating behavior sets as many times as necessary to avoid “bad” numbers, e.g., having to scratch one’s nose another time because they had just done it twice and two is a “bad” number. This can also take the form of needing to avoid looking at anything that contains a “bad” number, including street signs, house numbers, price tags, clocks, or volume indicators.

Is Counting OCD Treatable?

The good news is that Counting OCD is really no different than any other form of OCD and that it can all be effectively treated with Exposure and Response Prevention (ERP) therapy.

ERP therapy encourages people to face their fears and teaches them how to respond to OCD thoughts, images, and urges in an effective way. Over time, these obsessions and compulsions can fade in intensity and frequency, allowing the person to regain their life.

ERP can help people like Jamal stop believing that he won’t be able to tolerate things not feeling right or Annie believing that her mom’s safety is all up to her. When people with Counting OCD are willing to face their fears without giving in to the counting they have the chance to experientially learn some very important things:

  • What they fear is very unlikely to happen;
  • The anxiety that they feel is likely to eventually go down on its own, without counting;
  • They are stronger than they thought – they can tolerate anxiety and uncertainty without having to give in to compulsions.

Examples of ERP for Counting OCD

Example 1: Jamal challenges his nighttime rituals.

In working with a trained ERP therapist, Jamal would face the challenge of getting ready for bed (exposure) without giving in to his counting rituals (response prevention). He could do this a variety of ways including not counting at all, counting to the “wrong” number(s) or maybe singing a song to himself instead of counting.

Refusing to give in to his counting compulsion would certainly bother Jamal but, if he committed to the response prevention, he would have the chance to realize that he actually could tolerate things not feeling right and that, eventually, his anxiety would diminish and he’d fall asleep.

Example 2: Annie learns that she’s not in charge of her mother’s safety.

An ERP-trained therapist working with Annie would have her trigger her obsessive thoughts about her mom driving home from anywhere (exposure). Annie would then feel that familiar anxiety but would be instructed not to engage in her counting ritual (response prevention). As with Jamal, this could take various forms, such as not counting at all, counting to the “wrong” number or even replacing the mental counting with thoughts like “It’s possible that mom might get into an accident on the way home.”

Were Annie to refrain from her counting ritual, she would have the chance to learn that it really wasn’t the thing that was keeping mom safe. She would also have the chance to learn that her anxiety would go down on its own and that she could tolerate the anxiety and feelings of uncertainty without having to give in to her counting rituals.

How to Find Treatment

If you are struggling with Counting OCD, there is hope! The first step is finding the right help by seeking out a provider trained in treating OCD with Exposure and Response Prevention (ERP) Therapy.

NOCD has trained ERP specialists who can work with you to reduce your OCD symptoms within just a few weeks of live one-on-one video therapy. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP. If you’d like to get started with a licensed therapist, you can schedule a free call with the NOCD team.

You’ll also be welcomed into our supportive peer community, with 24/7 access to personalized self-management tools built by people who have struggled with OCD and successfully recovered using ERP.

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NOCD Therapists specialize in treating Counting OCD

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Taylor Newendorp

Taylor Newendorp

Licensed Therapist, MA

I started as a therapist over 14 years ago, working in different mental health environments. Many people with OCD that weren't being treated for it crossed my path and weren't getting better. I decided that I wanted to help people with OCD, so I became an OCD therapist, and eventually, a clinical supervisor. I treated people using Exposure and Response Prevention (ERP) and saw people get better day in and day out. I continue to use ERP because nothing is more effective in treating OCD.

Madina Alam

Madina Alam

Licensed Therapist, LCMHC

When I started treating OCD, I quickly realized how much this type of work means to me because I had to learn how to be okay with discomfort and uncertainty myself. I’ve been practicing as a licensed therapist since 2016. My graduate work is in mental health counseling, and I use Exposure and Response Prevention (ERP) therapy because it’s the gold standard of OCD treatment.

Andrew Moeller

Andrew Moeller

Licensed Therapy, LMHC

I've been a licensed counselor since 2013, having run my private practice with a steady influx of OCD cases for several years. Out of all the approaches to OCD treatment that I've used, I find Exposure and Response Prevention (ERP) therapy to be the most effective. ERP goes beyond other methods and tackles the problem head-on. By using ERP in our sessions, you can look forward to better days ahead.

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