If your brain works like mine, you understand things better when you can visualize them. For me, as I write about mental health and healthcare, I like a good metaphor—something recognizable that can make the unfamiliar familiar.
If you’ve taken a middle school science class and studied the water cycle, you can probably picture a cycle easily. Unlike the water cycle, the OCD cycle is not necessary for survival—quite the opposite. Still, the idea is the same: all the elements of it depend on and contribute to one another.
Truly understanding the OCD cycle isn’t easy, but it can help you better identify how OCD shows up for you. This is a critical part of getting on the road to recovery, as it’s difficult to address something before we first acknowledge it.
Let me help explain how we move back and forth from obsessions to compulsions and, ultimately, what we can do to break the cycle, with the help of Dr. Patrick McGrath, Chief Clinical Officer at NOCD.
Part 1: OCD begins with obsession
An obsession entails repeated intrusive thoughts, images, urges, sensations, or feelings. These intrusive triggers are ego-dystonic, meaning they go against one’s values and beliefs. People with OCD do not enjoy, want, or agree with their obsessions—on the contrary, they find them quite distressing.
Everyone gets intrusive thoughts, but these universal mental glitches become obsessions when one is unable to move past them. Someone without OCD recognizes intrusive thoughts as intrusive—unwanted, untrue to who they are, and not meaningful—while people with OCD interpret them as serious threats that demand an immediate response. They trigger alarm bells that say to the sufferer that something is wrong, or even dangerous.
Because they are taken so seriously, they also occur more frequently in the future. You know how if you try not to think something, you’re going to think it? Or if you focus too intently on trying to fall asleep, that makes it harder to fall asleep?
The way obsessions are triggered works similarly. The individual desperately does not want them, and takes action to avoid them or make them go away. Unfortunately, this leads them to persist and even increase, in both frequency and intensity.
Part 2: Obsessions create distress
When obsessions are triggered, they can spark a variety of uncomfortable feelings, broadly categorized as distress.
The nature of intrusive thoughts are not only out of alignment with the individual’s values or beliefs, but they can also be highly taboo. For example, a common theme of OCD is pedophilia OCD.
Obsessions may sound like, What if I inappropriately touch this child? What if that’s my true desire? What if I have acted inappropriately toward a child and don’t remember? Because people with OCD can’t determine completely for certain that these thoughts don’t actually mean anything, and because they of course value not being a pedophile, thoughts like these can be extremely distressing and cause a great deal of anxiety.
Another taboo but common OCD theme is harm OCD. This subtype focuses on fears about harming others or oneself. Intrusive thoughts can sound like, What if I stabbed my partner? What if I pushed this stranger in front of a train? What if I ran over that biker with my car? What if I jumped off of this balcony?
Again, people with OCD want to completely ensure that these thoughts are not true because if they were, it would oppose everything they thought they knew about themselves. They feel unable to write off these thoughts as strange and simply move on with their day—as so many others do who experience the same thoughts.
Even when the focus of OCD isn’t necessarily taboo or inappropriate, it can still be highly distressing. For example, with relationship OCD, or ROCD, one struggles with fears about their relationships—typically romantic or intimate ones, but sometimes even friendships or family relationships.
Obsessions in ROCD can sound like, am I attracted enough to this person? Is this person ‘The One’? What if we break up like our friends did? What if they don’t love me as much as they say they do? When these obsessions are triggered, people feel desperate to “solve” their worries and get rid of those uncomfortable feelings. To do so, they engage in compulsions.
Part 3: Distress leads to compulsions
Compulsions are not limited to touching the dials on the stove or flicking the light on and off. Those absolutely can be compulsions, but a compulsion is anything done to relieve the uncomfortable emotions brought on by obsessions.
Compulsions unfortunately reinforce the mistaken belief that intrusive triggers need to be taken seriously. They communicate to a person’s brain that they cannot tolerate the discomfort and uncertainty that come with their obsessions and triggers.
Compulsions are what really keep you stuck in the OCD cycle, because while everyone experiences intrusive thoughts, not everyone reacts to them. In fact, as I’ll explain in the final section of this article, the goal of OCD treatment is to learn to resist compulsions, disrupting the OCD cycle.
Common mental compulsions, which serve the same purpose as physical compulsions but happen invisibly and internally, include:
- Rumination. To put it simply, rumination is overthinking to an intense degree. It happens when you turn a thought, memory, situation, or question over and over in your mind with the hope of “solving” or “figuring out” something.
- Mental reviewing. This looks like combing through past events or situations to look for proof that your worries are or are not true.
- Seeking reassurance from yourself. This can sound like, I’m a really good person, I would never do something like that, Everything will be fine, and other reassurances that are a direct response to the fear or worry caused by obsessions, promising a false sense of certainty.
- Distraction. This looks like intentionally keeping your mind occupied in the hopes that the distraction keeps your intrusive thoughts and other obsessive triggers at bay.
Common physical compulsions include:
- Tapping/touching. This could look like picking up an object and putting it back down a certain number of times until it feels “just right” or having to close a door exactly the “right way.” This compulsion typically has no logical connection to the fear or obsession itself, but rather relieves a sense of discomfort.
- Washing/cleaning. This is a common compulsion for people with contamination OCD, the theme of OCD that focuses on fears about spreading or contracting an illness. People may wash their hands, shower, or clean surfaces and objects for hours every day.
- Checking. This can look like checking to make sure the stove is off, the door is locked, or that you didn’t hit someone with your car.
- Redoing. This looks like redoing any action until it feels perfect or safe, such as walking down the stairs again or repeating a certain word or phrase.
These are only a few common examples among endless possible compulsions—the mental and physical behaviors that people perform to find short-term relief from their obsessions are as unique as the sufferers themselves.
Part 4: Compulsions bring temporary relief
One continues to do compulsions because they bring temporary relief. For some amount of time, perhaps a few minutes, or even a few hours, you will feel better after engaging in compulsions—but it won’t last.
When my OCD was at its worst, I spent much of my time ruminating. I searched my brain for evidence that my intrusive thoughts were not true. If I came up with a particularly convincing piece of “evidence,” my intrusive thoughts and doubts would be quiet for a while.
I’d think I solved it. Then, inevitably, OCD would throw an even more convincing piece of “counter-evidence” at me in the form of more intrusive thoughts, doubts, and worries. OCD seeks 100% uncertainty, and because no compulsions can ever give us that, OCD is never satisfied, and compulsions suck us further into OCD’s trap.
In a moment, I would be back at square one. To get back to that place of peace I was in, it seemed the only answer was to start ruminating again—that’s what brought me peace last time, after all. I didn’t realize that I could never feel better long-term as long as I was doing compulsions.
Dr. Patrick McGrath, Chief Clinical Officer at NOCD describes this dependence on compulsions, saying, “Now we’re stuck in the cycle because we figure the only reason the bad things—our fears, worries, or discomfort—aren’t happening is because of the compulsion. It becomes very ingrained that way in our minds.”
How effective treatment breaks the OCD cycle
OCD is treated with exposure and response prevention therapy, or ERP. This specialized form of treatment breaks the OCD cycle by teaching people to recognize and resist compulsions. “It allows people to learn they can handle the intrusive thought,” Dr. McGrath says.
To start, you and a trained therapist will work together to identify your obsessions, as well as the places, situations, thoughts, feelings, and other stimuli that trigger them. You’ll also take note of every behavior, mental or physical, that you do in response to the distressing feelings that your obsessions cause—your compulsions.
Once you have identified what your OCD looks like, you’ll come up with a hierarchy of exposure exercises. You’ll intentionally face the things that trigger your obsessions and distress. You’ll start with exposures that bring a small amount of discomfort, working your way up to the ones that are more difficult.
Your therapist will give you tools before, during, and after exposures to resist compulsions—this is the key to lasting recovery from OCD. Over time, you’ll build up tolerance to discomfort and uncertainty, and you’ll begin to take intrusive thoughts less and less seriously. Before long, you’ll find that your former triggers are far less distressing, and that you’re much better equipped to handle them whenever they occur.
The goal is not to never have intrusive thoughts, images, feelings, sensations, or urges—as we learned before, everyone has them. Rather, the goal is to change your response to intrusive thoughts, so they don’t end up causing as much distress and impacting your life. The goal is to disrupt the OCD cycle, which cannot continue without its crucial third stage: compulsions. We can’t control our thoughts or the world around us, but we can control our behavior. We can behave our way out of OCD.
How to find qualified, effective help for OCD
I find that having images, language, and visual tools for our experiences is helpful in addressing them. It can make debilitating symptoms a bit less terrifying and mysterious.
If you’re interested in working with a specialty-trained therapist to break the OCD cycle for lasting relief, I encourage you to learn more about NOCD’s evidence-based, accessible approach to ERP therapy. By understanding how the OCD cycle works in your own life, you’re that much closer to a life-changing recovery journey.