5 ways OCD can impact you at the gym

Working out can be a great stress-reduction tool, a fun challenge, or a rewarding way to feel embodied. If you live with obsessive-compulsive disorder (OCD), you may also find that regular exercise helps alleviate symptoms, alongside specialized OCD treatment. For some people with OCD, however, the gym is a prime venue for distressing obsessions and disruptive compulsions to kick into overdrive.

In fact, OCD may make your workout so stressful and frustrating that you end up avoiding the gym altogether. But you deserve to have the workout you want, without OCD dictating the terms. 

In this article, we’ll dive into five ways OCD can show up at the gym, how these symptoms differ from eating disorders like orthorexia, and how you can learn to navigate your workouts with more ease.

Sexual orientation OCD and sexual themes

Gyms are generally full of sweating, grunting people in often tight or revealing athletic clothing—or even no clothing at all, in the case of changing rooms or saunas. This environment might feel especially difficult if you experience sexual obsessions such as sexual orientation OCD (SO-OCD), a subtype of OCD characterized by egodystonic intrusive thoughts and images, and irrational doubts, about your sexual identity. 

For example, a lesbian with SO-OCD who knows that they are truly gay might start to doubt their sexual orientation because of repetitive, distressing sexual thoughts and images about men. “What if I’m not actually a lesbian and I’m lying to everyone?” might become an all-consuming obsession.

At the gym, this person may find themself worrying about whether they’re secretly attracted to the men around them, scrutinizing their bodily sensations to check for groinal responses, or endlessly ruminating about thoughts about men in an attempt to prove their “true” sexual identity.” This loop of obsessions and compulsions (the OCD cycle) can make visiting the gym so overwhelming that someone with SO-OCD only goes at times they think it won’t be crowded. In some cases, they may avoid the locker room or gym altogether.

Just right OCD

People with just right OCD, also called perfectionism OCD, contend with an unbearable feeling that something is off, incomplete, or “not quite right.” If you struggle with this subtype, you may feel the urge to perform certain workouts in just the right way—for example, by repeating a workout rep until it feels “just right,” or by doing exercises over and over until you feel you’ve achieved perfect form. 

But, these compulsions only keep you stuck in the OCD cycle—intensifying intrusive thoughts and feelings of distress. And repeating an exercise until it feels “perfect” can be dangerous, as you may be more likely to ignore other important physical cues, causing an overuse injury. The need to keep going until your workout feels “just right” can also lead you to spend far more time at the gym than you planned, disrupting your schedule and other activities that are important to you. 

Contamination OCD

If you have contamination OCD, the gym may feel extremely daunting. You might be afraid that you’re going to contaminate yourself or someone else via contact with the machines, weights, water fountain, or just through breath or sweat. You may even feel fears about becoming pregnant or contracting sexually transmitted illnesses through bodily fluids exchanged on surfaces. 

It can be common etiquette to take some precautions around germs at the gym, and seeing other people wipe down machines may make it feel especially hard to determine what’s a compulsive behavior and what’s reasonable. But, if your cleaning rituals feel urgent, elaborate, time-consuming, or are in direct response to distressing intrusive thoughts, these behaviors are probably keeping you stuck in the OCD cycle. 

If you deal with contamination OCD, you may also experience a fear of “emotional contamination.” Maybe someone you aren’t fond of goes to the same gym and you worry that being in their presence will make you develop their personality traits and characteristics. Or, maybe certain areas of the gym where you’ve experienced intrusive thoughts start to feel contaminated, leading you to restrict your activity.  

Magical thinking OCD

The many numbers and metrics involved in a gym workout can also be triggering for those with magical thinking OCD, who erroneously believe that performing a compulsion will prevent an obsession from coming true—even when the compulsion is not logically connected to their feared outcome.

This can lead to a fixation on numbers. For example, someone with magical thinking OCD might be running on the treadmill and feel the need to set the pace or incline to a specific “lucky” number to prevent someone from dying. Or, maybe they worry that something bad will happen if they end your workout on a “bad” or “unlucky” number of reps. This can become dangerous if the numbers that OCD decides are “right,” “good,” or “lucky” lead to a workout that’s painful, or more taxing than your body can handle on a given day.

Health OCD

Have you ever gone to the gym hoping it will have a positive impact on your health, only to find yourself fixating on every heartbeat, ache or sensation once you get there? Health OCD is a subtype of OCD marked by intrusive thoughts about developing or living with a serious medical condition, and it can be triggered by worries about the potential negative health consequences of exercise. 

For example, you might fear that a strenuous run on the treadmill has triggered a medical emergency, like a heart attack, because your heart rate is up when, in reality, your body is merely responding to physical activity Or, maybe the very sensation of breathlessness or increased heart rate makes you so worried that you stop exercising entirely—a form of compulsive avoidance. On a similar note, sensorimotor obsessions can make it difficult to navigate bodily sensations at the gym, as you may find yourself fixating on every small change.

OCD vs. eating disorders and over-exercising

If OCD is keeping you at the gym for long hours, or making you perform your workout in highly specific or repetitive ways, it’s possible you may have noticed some similarities between the ways you behave and some symptoms of eating disorders like orthorexia, body dysmorphic disorder (BDD), muscle dysphoria, and anorexia. While these mental health conditions can look similar, they are distinct.

Conditions like orthorexia can lead a person to exercise more than is healthy, and may cause increased anxiety or fear when visiting the gym. BDD and muscle dysphoria can both cause people to excessively focus on their outward appearance—fixating on small flaws or the idea that their body isn’t muscular enough, and spending extra time at the gym to try to “fix” these perceived issues. It’s important to understand that the motivation behind these behaviors is typically different from what a person with OCD experiences. For people with eating disorders, over-exercise usually stems from concerns related to body shape, weight, and size.

For example, someone with an eating disorder might spend four hours in the gym because they’re focused on trying to lose weight, or afraid of gaining weight. Someone with OCD, on the other hand, might be at their gym for the same amount of time due to excessive sanitizing rituals, or because four hours was the amount of time that felt “perfect.” While it can be common to have both an eating disorder and OCD, it’s important to know that these conditions are different, and require specialized treatment. 

Breaking the OCD cycle at the gym

OCD can make working out feel like a minefield, but it’s absolutely possible to break the cycle of obsessions and compulsions in order to navigate the gym with more ease—and even enjoy your workouts. 

Exposure response prevention (ERP) therapy can be a very helpful tool to utilize when OCD shows up at the gym. By gradually facing your fears while resisting compulsive rituals, you can learn that OCD is lying to you, your obsessions are unfounded, and you can cope without performing compulsive rituals. Repeated exposure can also facilitate desensitization, meaning the more that you are exposed to a stimulus (like touching weights at the gym), the less anxiety-inducing that stimulus becomes over time. 

For example, if “just right” OCD leads to endless reps in an attempt to achieve the “right” feeling before stopping an exercise, your ERP therapist may recommend that you stop the exercise when it feels “wrong” to learn to tolerate that feeling. Over time, it’s likely that this will become less bothersome. 

Or, if you want to run on the treadmill but health-related obsessions are causing you to misinterpret a racing heart as a heart attack, ERP exercises might start by walking on the treadmill.

If contamination obsessions lead you to sanitize equipment four times before using it, response prevention would include a gradual reduction of sanitizing.

Those with sexual obsessions who would like to use locker room showers might try entering the locker room while simultaneously resisting the urge to check their bodily responses and feelings.
ERP is tailored to each person and their symptoms. Learning to experience distress without engaging in compulsions can be empowering. And over time, you may find that you feel less anxiety when confronted with the same triggers. With ERP skills in hand, visiting the gym can become a meaningful way to care for yourself, even and especially if you have OCD.