Obsessive compulsive disorder - OCD treatment and therapy from NOCD

When Compulsions Backfire

7 min read
Alegra Kastens, M.A., LMFT

This is a guest post by Alegra Kastens, a licensed Marriage and Family Therapist who founded the Center for OCD, Anxiety, and Eating Disorders.

People with obsessive-compulsive disorder (OCD) feel the urge to perform mental or physical compulsions in response to obsessions. These excessive, time-consuming rituals are often carried out to alleviate anxiety or discomfort, seek reassurance about one’s obsessions, and resolve doubt. In theory, the compulsion is supposed to help. In reality, the compulsion often backfires, leaving the person more anxious and triggered than they were before they performed it.

Below are five examples of compulsions and the ways in which they can backfire. Please note, this is not an exhaustive list of compulsions or their impacts.

1. Mental review

This mental compulsion entails recalling and replaying the past (an event, conversation, one’s behavior, etc.) to seek clarity about the past as it relates an obsession and/or resolve uncomfortable feelings associated with it. This could look like a new mom with sexual obsessions mentally reviewing past diaper changes to reassure herself that she didn’t harm her baby. For someone with hit-and-run obsessions, this may look like mentally reviewing past driving experiences to alleviate anxiety related to the fear of having hit someone with their vehicle.

Clarity about the past is most often the desired outcome of this compulsion, but research shows that clarity about a memory dwindles the more often we recall and review it.  The more we turn over a memory in our mind, the more distorted it becomes. We might start to remember things that never happened, which can lead to “false memories” that are perceived as evidence of an obsession being true. The same new mom mentally reviewing the past might remember details that never happened, such as her touching her baby in ways she did not. In trying to obtain clarity, we end up more confused and triggered than when we started. The mental reviewing backfires.

2. Mental checking

Mental checking occurs when a person takes a temperature of their emotions and bodily sensations. This mental compulsion is often performed to make sure that one is feeling the “right” way about something: intrusive thoughts, their partner, intrusive images, a religious figure, a relationship, etc. For example, people with sexual obsessions commonly check their groinal area after having an unwanted sexual thought to make sure they’re not aroused by it. Those with relationship obsessions may check on their feelings about their partner to ensure they’re feeling “enough love” for them. Folks with harm obsessions might look inward after having a violent intrusive thought to check that they’re scared of it and not delighted by it.

We expect to find what we are looking for when checking, but it doesn’t always play out as such. Repeatedly checking on our feelings chips away at, and ultimately erodes, what we are naturally feeling. When a person incessantly checks to see if they love their partner, they may start to feel numb because of the constant checking. This numbness then serves as “evidence” that they must not really love their partner anymore, leaving them far more anxious than before the compulsive checking.

This goes for bodily sensations as well. When a person checks to make sure that they are not experiencing a sensation, such as a tingle in their groinal area, they often end up feeling something because they are placing so much emphasis on a specific body part. By attempting to reassure oneself that they’re not physically aroused by an unwanted sexual thought, they receive what feels like confirmation and evidence that the obsession is true: a genital response.

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3. Compulsive research online

Forums such as Reddit and Quora, as well as search engines like Google, are frequented by people with OCD seeking information that serves as reassurance about their obsessions. Those with relationship obsessions might scroll subreddits to decipher how others know that they love their partner. People with sexual orientation obsessions may search through threads about sexuality on Quora looking for a definitive answer about them. Folks with harm obsessions might research articles about Jeffrey Dahmer, looking for characteristics about this serial killer that differ from their own characteristics.

Instead of trusting what they know, people with OCD commonly look to the internet to quell their obsessional doubts. They desire to find that one piece of information that will satiate the obsession but, because the internet offers endless information from people with varying life histories (that may or may not be true), it’s more likely that they come across information that serves as “evidence” that their obsession is true and exacerbates their anxiety.

It’s important to note that information-seeking is not inherently compulsive. Gathering information about something that you do not know about, and accepting that answer, is commonplace. It becomes compulsive when a person has been provided that information but seeks it out repeatedly for reassurance.

4. Confession

People with OCD may feel the urge to confess unwanted thoughts to others to alleviate uncomfortable feelings associated with them (such as guilt or anxiety). The release of that thought into the world, instead of keeping it within, may provide momentary relief. Those with OCD often (wrongly) believe that they did something bad by having a thought, leading them to confess that thought to receive reassurance that they’re not a bad person or to seek forgiveness for the “crime” of having that thought. Confession is also carried out under the (false) assumption that withholding intrusive thoughts and feelings from someone is lying to them. People with OCD may (falsely) believe that for a person to “truly know” them, they must know about their obsessional content.

While some relief might be obtained through confession, it doesn’t last for long. Following the confession often comes guilt about the confession’s impact on the person receiving it. Someone confessing intrusive thoughts about their partner, such as “I don’t really love you,” may feel immense guilt about their partner having to hold that thought. Fear of judgment is also common after confession. Instead of alleviating anxiety for good, the person feels heightened anxiety about the content of thoughts shared with another person. A new cycle starts: Do they think I’m weird? They know I wouldn’t actually do that, right? Do they understand that I don’t like the thought? Do they think differently of me?

5. Hypothesizing

This mental compulsion entails imagining a scenario related to an obsession to test one’s reaction to that scenario. You purposely carry out a hypothetical scenario in your mind as a checking mechanism to seek “clarity” about the obsessional fear: If this thing happened, what would I do? How would I respond? How would I feel?

For example, someone with bestiality obsessions might play out a sexual act with a dog in their mind to make sure they are disgusted by it. As previously mentioned, this tends to backfire because we often experience a physical response to sexual thoughts. Our bodies respond to what is sexually relevant and not always what we sexually desire. If the person does feel the disgust they’re looking for, guilt and shame about purposely thinking the thoughts tend to arise. They (wrongly) believe that they are a monster because they brought the thought on instead of it popping in intrusively and now must deal with the added layers of guilt and shame.

It’s important to note that whether you purposely bring on a thought or it pops into your head, it is still a thought. Purposely thinking it doesn’t suddenly make it true or mean that you actually align with the thought.

Learning to resist compulsions

Compulsions create confusion, not clarity. They keep you stuck, not safe. It’s difficult to believe this when the urge to carry out the compulsion is strong. The pull is akin to not scratching a very itchy itch, but it’s worth resisting for long-term symptom relief.

Exposure and response prevention (ERP) therapy, the most evidence-based treatment for OCD, can help eliminate compulsive rituals. Inference-based cognitive behavioral therapy (I-CBT), another evidence-based treatment for OCD, can help you understand why you’re buying into the obsession in the first place, making compulsions easier to resist.

If you’re struggling with compulsions like these, NOCD can help. Our licensed therapists deeply understand OCD and are specialty-trained in treating OCD with ERP. They’ll work with you to create a treatment plan personalized to your unique needs and help you regain your life from OCD. You can book a free 15-minute call with our team to learn more about getting started with OCD treatment.

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ERP therapy was developed specifically to treat OCD and has helped many people who struggled with the condition regain their lives. All therapists at NOCD have specialty training in OCD and ERP.

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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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Alegra Kastens, M.A., LMFT

Alegra Kastens is a Licensed Marriage and Family Therapist and received her master’s degree in clinical psychology from Pepperdine University. She is the founder of The Center for OCD, Anxiety, and Eating Disorders, and practices in CA and NY, and specializes in the treatment of obsessive-compulsive disorder (OCD), anxiety disorders, eating disorders, body-focused repetitive behaviors (BFRBs), and body dysmorphic disorder (BDD). Her passion for OCD treatment, education, and advocacy comes from her own personal experience with the disorder. She understands firsthand the relentlessness of OCD and how painfully it holds one’s life captive. She also understands that relief and recovery are real with a large dose of evidence-based treatment and an equally large dose of willingness.