Obsessive-compulsive disorder (OCD) can be hard to talk about. OCD has a habit of creating doubt, fear, and shame that can make it feel extremely difficult and scary to discuss your experiences. Pop culture portrayals ranging from simply inaccurate to outright offensive have also contributed to a sense of what is and is not “normal” when it comes to OCD, leading to confusion not only amongst the general public, but also those who have OCD themselves.
Even when a portrayal of OCD rings true overall, some themes, symptoms, and types of compulsions may seem to be discussed more commonly and more easily than others. And when compulsions stray outside what you might expect, or feel especially embarrassing, taboo, or personal, it can be deeply isolating. You might feel like you’re the only person in the world dealing with a specific compulsion—which can make it harder to notice when the behavior is showing up, and make it feel even more all-consuming and upsetting. For instance, while you may be familiar with compulsive cleaning as a result of contamination OCD, limited portrayal and conversation mean you could be forgiven for thinking that you’re the only person in the whole world whose OCD creates a persistent fear of peeing your pants.
But in reality, compulsions that you may think are uncommon, unsettling, and taboo are experienced by many. OCD can latch onto almost any fear, doubt, sensation, thought, or urge and convince you that you need to achieve a sense of perfect certainty via all kinds of compulsive behaviors. You are not the only person constantly checking if your bladder is full or if your pants dry. Many people share this experience—including those who have been able to stop performing this compulsion, and others, thanks to specialized OCD treatment.
What are some less commonly discussed OCD compulsions?
These compulsions are less likely than others to be part of a character’s arc in a TV show or movie, or even a mainstream discussion of OCD on social media—but they are still manifestations of OCD, and you shouldn’t be ashamed to discuss them with a trained, specialized therapist. Some compulsions you may not have heard of, or that you may think you’re alone in experiencing, include:
- Repeatedly checking your pants or underwear to make sure that you haven’t urinated. This behavior can be a common response to the OCD fear of peeing yourself. When the intrusive thought arises that you might have accidentally urinated, OCD might cause feelings of urgency, alarm, and distress—making a person want to immediately check if the fear is real. This sort of fear can also lead to hyper-focusing on or monitoring the physical sensations of your bladder in an attempt to discern whether you have to pee.
- Monitoring your feelings and physical response during sex to check whether you’re attracted to your partner. This could be the result of fears related to relationship OCD, which is typically characterized by intrusive doubts about your relationship, or sexual orientation OCD which can lead you to question whether the way you identify is truly accurate. If you’re afraid that you might not actually love your partner, or that you’re not truly attracted to them, obsessively scrutinizing and analyzing your reactions during sex can be a way of trying to uncover “the truth” and achieve certainty.
- Compulsively watching porn or imagining sexual scenarios. It’s important to note that this compulsion is not done to gain pleasure, but rather out of a desire to gain certainty about intrusive thoughts around sexuality or morality. A person engaging in this compulsion might watch porn or imagine sexual scenarios in order to scrutinize their reaction as a sort of “litmus test” for whether their sexual orientation may be different from how you’ve historically identified, or whether they are secretly aroused by something they find morally upsetting. All compulsions that involve monitoring physical sensations can be especially stressful, because hyper-focusing on what your body is feeling often distorts and magnifies those feelings, convincing you that you’re having a response you are not, driving sensations you might not otherwise have, or ascribing disproportionate meaning to bodily experiences that are actually totally benign.
- Compulsively “confessing” alarming thoughts or actions you’re worried were “bad” in an attempt to receive reassurance, punish yourself, or absolve yourself of an act you’re scared was “wrong.” This can be a manifestation of moral OCD, which is characterized by unceasing doubt about one’s own morality, and it’s often a specific form of the extremely common compulsion of reassurance-seeking. Intrusive fears and doubts about whether you’re a good person can drive you to constantly seek feedback and reassurance from others about your thoughts and actions.
- Excessively researching or reading about the experiences of those with psychosis or other mental health conditions you are scared of. This compulsion usually stems from fears about experiencing a frightening-seeming mental health condition. Someone performing this compulsion may do so in order to compare their own experiences with those of others and try to determine if they have those conditions. This can also show up as continually “monitoring” yourself for symptoms, or analyzing your thoughts to try to determine if you’re becoming detached from reality.
- Avoiding holding knives or other potentially dangerous objects near loved ones. If you experience intrusive thoughts about being violent toward people you care about—a common symptom of harm OCD—you might begin compulsively avoiding anything that could be used as a weapon, or even steering clear of the very people you worry you might hurt. You might also engage in compulsive rumination about whether the disturbing thoughts and urges OCD creates mean you secretly want to hurt people.
- Checking whether the world feels real by fixating on the objects or people around you. This can be a manifestation of existential OCD, which causes a person to obsess over unanswerable, abstract, or philosophical questions that often center around the meaning of life, what happens after death, or the nature of the universe. If you experience intrusive fears that you or the world around you aren’t truly “real,” this kind of checking—which might look like analyzing your own sensory input or examining the objects around you for hours on end—is created by a drive for an impossible level of certainty about existential questions.
Ultimately, all compulsions are part of the OCD-driven pursuit of an impossible level of reassurance and certainty. And if your specific experience isn’t on this list, that still doesn’t mean you’re alone. No matter the nature of your compulsions, OCD is highly treatable, and specialized treatment can help you break free from the cycle of obsessions and compulsions.
No matter the specific compulsion, ERP can help
Talking about your “taboo” compulsions can feel extremely scary, but it’s also a crucial part of OCD treatment. Exposure and response prevention (ERP) therapy is the most evidence-based form of treatment for OCD, and it works for all subtypes, themes, and compulsions. That means that even if you were the only person in the world with your specific compulsion—which you almost definitely are not—the principles of ERP would remain the same, and they would still be highly effective.
ERP works by helping you learn to handle the fear, anxiety, and uncertainty that your OCD creates, without resorting to compulsive behaviors and coping tactics that compound your stress, interfere with your life, and negatively impact your relationships. An ERP therapist who specializes in treating OCD will work with you to identify your values, which can serve as a framework that reminds you who you are and what matters to you when obsessive and intrusive thoughts try to take the reins.
For example, if you have intrusive thoughts and worries about peeing your pants that lead you to compulsively check whether your pants and underwear are dry by feeling them or taking multiple trips to the bathroom, an ERP therapist might suggest reducing the number of times you check or visit the bathroom, and working toward eliminating the action altogether.
Your ERP therapist will also encourage you to treat yourself with compassion, especially if you feel ashamed of your compulsions because they seem uncommon or taboo. No matter what your compulsions are, you can seek help for OCD, and you deserve to.
