Obsessive compulsive disorder - OCD treatment and therapy from NOCD

What are mental compulsions in OCD?

5 min read
Stacy Quick, LPC

You probably are very familiar with rituals and compulsions in OCD that are visible, such as handwashing or checking things repeatedly. What is far less obvious to most people, even people with OCD, is that OCD can involve just as many compulsions that go unseen. Sometimes a person performing mental compulsions won’t even realize that what they are doing is a compulsion.

In order to understand whether something is a mental compulsion or not you will need to understand your motive for doing it. Ask yourself: “Am I trying to relieve stress or anxiety? Am I trying to somehow make something feel ‘right’? Am I trying to avoid an imagined catastrophic outcome? Am I looking for perfect certainty about my doubts?” These can all warn you that you may be performing mental compulsions when you have OCD. 

It should also be noted that even many mental health professionals fail to identify mental compulsions. That is why it is so important to be open and honest when sharing your symptoms and to ensure that you are seeing someone who has significant experience in diagnosing and treating OCD

What are some common mental compulsions?

Rumination is probably the mental compulsion that people identify with most. Rumination is purposeful thinking directed at a perceived problem or negative material. It can focus on past or present content and brings about emotional distress. This type of thinking will feel uncontrollable and often repetitive. When people are compulsively ruminating, they may genuinely think that they are just trying to solve a problem or that they are doing something. 

There’s a difference, though: in problem-solving, there is an intended goal to reach a decision on a specific matter. Rumination is based on a sense of urgency and a feeling that one needs to figure something out now, with absolute certainty. Problem-solving doesn’t demand certainty and isn’t often accompanied by an intense need to do it immediately. Truly solving problems can make one’s life easier and bring lasting satisfaction, while rumination only increases anxiety in the long term.

Mental reviewing and replaying situations, encounters, and conversations is another common form of mental compulsion. This is usually done in an attempt to feel “certain” about what did or didn’t take place. It can include walking through steps you took, trying to recall where exactly you were, where your hands may have been placed, what you were looking at, and so many other things that relate to your obsessions. This process often involves an attempt to disprove one’s fears and doubts.

This is different from fantasizing or daydreaming. People with OCD do not find these compulsions pleasurable or relaxing, but relive past situations out of a sense of urgency and distress. This can then lead to physical compulsions, as well, such as repeatedly taking pictures of events so they can be sure of what took place.

Self-reassurance can be a healthy thing for people who aren’t using it in response to obsessions in OCD. Again, OCD demands certainty and perfection, and there will never be enough. It only leads to increased anxiety and distress in the long run. Self-reassurance can look like repeating certain phrases over and over in one’s head. It may be something like “you got this” or “I would never do that.” It can be anything that brings about temporary relief from intrusive thoughts, feelings, urges, or images. 

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These may seem like good coping skills or healthy ways to challenge negative thought patterns, and they can be when they are not being used in response to obsessions. With OCD, even if you’re aware that a thought is illogical, OCD makes you feel as if you need to know something with certainty. But no amount of certainty or reassurance is ever enough to keep the doubts from returning, and you end up needing that temporary reassurance more often than before.

Thought replacement is similar to self-reassurance in that the person is trying to replace a negative thought with a positive one. People with OCD may also engage in image replacement, trying to replace a scary or unwanted image with one that is more appealing. Like other compulsions, this is an attempt to avoid sitting with uncomfortable feelings. But we know that by avoiding discomfort, one actually strengthens the idea that obsessions are truly dangerous, when they aren’t.

Distraction is a mental compulsion that people often report being particularly difficult to recognize, as it can feel automatic. When you have OCD and are distracting yourself as a way to avoid feeling hard feelings, then it’s a compulsion. The goal of OCD treatment is to allow uncomfortable feelings to exist, as painful as they may be. By doing this, you retrain your brain to know that you can handle things you thought you couldn’t. By feeling the emotions that intrusive thoughts bring, without engaging in them, you can find long-term relief from symptoms of OCD.

ERP teaches you to identify and resist mental compulsions

By working with a therapist who has experience with OCD and has received specialty training in treating it with exposure and response prevention (ERP), you can learn to identify mental compulsions and resist engaging in them on a consistent basis.

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Your therapist will provide you with a personalized treatment plan designed to meet your unique needs and will teach you the skills needed to begin your OCD recovery journey while supporting you every step of the way. They will guide you in taking small steps to reach your goals. Each one of our therapists at NOCD is passionate about the treatment of this debilitating disorder and is trained by world-renowned experts in OCD treatment. To learn more about working with a NOCD therapist, schedule a free 15-minute call with our care team.

NOCD Therapists specialize in treating OCD

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Taylor Newendorp

Taylor Newendorp

Network Clinical Training Director

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.

Gary Vandalfsen

Gary Vandalfsen

Licensed Therapist, Psychologist

I’ve been practicing as a licensed therapist for over twenty five years. My main area of focus is OCD with specialized training in Exposure and Response Prevention therapy. I use ERP to treat people with all types of OCD themes, including aggressive, taboo, and a range of other unique types.

Madina Alam

Madina Alam

Director of Therapist Engagement

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.

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