When you think about obsessive-compulsive disorder (OCD), chances are you’re picturing certain behaviors, such as checking locks or lining up items in perfect symmetry.
But not all OCD-related behaviors, called compulsions, are easy to see. Some happen in a person’s mind.
Rogers Behavioral Health’s Dr. Martin Franklin, PhD, principal research psychologist at Rogers Research Center, explains what mental compulsions can look like and why they keep the OCD cycle going.
What are OCD mental compulsions?
First, let’s start by explaining what OCD is. OCD is a cycle of obsessions, which create a lot of anxiety or other negative emotions such as disgust or discomfort, and compulsive behaviors that are designed to reduce those emotions.
Obsessions are unwanted and intrusive thoughts or images. Compulsions are what people do in response to the obsessions. Some compulsions, called behavioral compulsions, can be observed, such as washing hands. Others, called mental compulsions, aren’t visible because they happen in a person’s mind.
Examples of mental compulsions include:
- Repeating certain words or phrases in the mind
- Saying special prayers in the mind
- Replaying or reviewing events mentally, such as “Did I really lock the door?”
- Seeking assurance by replaying conversations to make sure nothing bad happened
Why can mental compulsions be hard to recognize?
Because mental compulsions happen in the mind, they can be easy to miss, even for the person experiencing them.
Someone may look distracted or like they’re staring off into space. We see a lot of this with kids. A teacher may think a child isn’t paying attention or wonder if they have ADHD because they’re always looking out the window.
Sometimes, they’re paying perfectly good attention, just not to the teacher. They may be focused on their obsessions and trying to “fix” them in their mind to reduce the likelihood of a feared outcome or reduce their discomfort.
This is not an attention problem. This is an OCD problem.
How do mental compulsions keep the OCD cycle going?
The irony of OCD is that it makes perfect sense that someone would want to get rid of recurrent and uncomfortable thoughts. And it makes perfect sense that they would want to get away from negative emotions if they can.
The trouble with OCD is that you can wind up on a treadmill pretty quickly. If saying a prayer in your head or repeating a phrase brings you some relief, even if it’s only temporary, you’re going to want to do it over and over again.
I’ll give you an example. My son does not have OCD. He was about seven years old when he was sitting in the back of the car complaining that he had a song stuck in his head. He kept trying to think of another song to get rid of it. That would work for a little while, and then it would come back.
So, I suggested: Let it play.
The more you’re pushing the recurrent and intrusive thought out the door, like the song stuck in my son’s head, the more it’s going to come in through the window. It becomes a loop. If I try to get temporary relief, I’m going to pay for that in the form of more frequent and more intense obsessions. You unintentionally reinforce the whole pattern, and you may start responding that way automatically.
My goal is to help people understand that they can’t control which thoughts enter their minds. What they can learn to change is how they respond to those thoughts.
What does it feel like to experience mental compulsions?
For someone with OCD, a mental compulsion can feel like something they must complete to feel better or prevent dreaded outcomes. They may not initially feel like they are voluntary. Our job in treatment is to help patients understand the OCD cycle, and to not reinforce it by engaging in compulsions, whether behavioral or mental.
What would it feel like to not do the mental compulsion and why? Patients will likely feel an increase in the negative emotions they’re trying to squelch. But by refraining from doing the compulsion, they may experience reductions in distress over time, which takes the wind out of OCD’s sails and allows them to get back to engaging fully in their lives, regardless of whether they’re having obsessions. And when they do that, of course, the frequency and intensity of obsessions typically goes down further.
What role do education and stigma play?
We’ve got to make more people aware of OCD, both those who have it and those who don’t. People may feel uncomfortable talking about it or seeking help, and it’s our job to help reduce such concerns through psychoeducation and improving understanding in the medical context, in schools, and in the community. OCD is not a character flaw. We’ve made a lot of strides in the past decade or so with celebrities sharing their experiences. But we still have a long way to go.
I think increasing knowledge about OCD is especially important for people who work with kids in schools. I’m not asking them to treat OCD. I’m just asking them to be able to catch it. That can look like telling a parent they noticed their child is having trouble repeating themselves unnecessarily at practice.
My work has always been about prevention. Working with kids is about helping kids of course, but it’s also about trying to prevent OCD in adulthood.
I know what adult OCD looks like. If I can work with someone when they’re nine and educate them about how to manage OCD so they know what they should and shouldn’t do, maybe they won’t be coming into my clinic at 48.
How are mental compulsions treated?
A mental health professional trained in treating OCD will use exposure and response prevention (ERP). ERP helps people gradually face unwanted thoughts, images, or urges while learning not to respond with compulsions, whether those are behavioral or mental.
Treatment helps people practice allowing the thought to be there without engaging in a ritual to get rid of it.
It doesn’t mean that a person likes the thought or that it reflects who they are. It means learning that they don’t have to respond to every intrusive thought that enters their mind. Remember, the obsession may be the part that happens automatically. The response, which is the compulsion, is the part a person can learn to change.
Rogers offers OCD treatment
Mental compulsions can be easy to miss, but they can have just as much impact on a person’s life as compulsions that are visible.
If you or someone you love feels stuck in a cycle of unwanted thoughts and repeated mental efforts to make those thoughts go away, recognizing the pattern is an important first step.
When you’re ready, our OCD experts are ready to help.
For a free, confidential screening, call 833-308-5887.
Mental compulsions are behaviors that happen in a person’s mind in response to unwanted thoughts, images, or urges. They may include repeating phrases, saying prayers, mentally reviewing events, or seeking reassurance.
Mental compulsions happen internally, so they aren’t visible to other people and may even be difficult for the person experiencing OCD to recognize.
Mental compulsions can provide temporary relief from anxiety or uncomfortable thoughts, but repeatedly using them can reinforce the OCD cycle and lead to more frequent or intense obsessions.
Exposure and response prevention (ERP) can help people with OCD face unwanted thoughts, images, or urges while learning not to respond with mental or behavioral compulsions.
Yes. Mental compulsions can be particularly difficult to recognize in children because they may look distracted or as though they aren’t paying attention when they are actually focused on obsessions and trying to manage them internally.
