Mental Compulsions: Understanding the Hidden Battle of OCD
According to the International OCD Foundation, more than 3 million individuals are living with OCD today, and it takes an average of 14 years for someone to receive an official diagnosis. Many barriers can delay diagnosis, including fear of disclosing unwanted intrusive thoughts, symptom overlap with other anxiety disorders, and the presence of hidden mental compulsions that can make OCD difficult for therapists to identify.
Checking and cleaning rituals have long been viewed as the hallmark compulsions of OCD. Media portrayals often reinforce this narrow understanding by focusing primarily on visible compulsions such as excessive cleaning or checking behaviors. However, there is an entire category of compulsions that often goes unnoticed during both diagnosis and treatment: mental compulsions.
Because they occur internally, mental compulsions can be more difficult for therapists to recognize and easier for individuals to become trapped in. Like physical compulsions, mental compulsions serve as an attempt to reduce the anxiety triggered by unwanted intrusive thoughts. Unfortunately, the more an individual relies on these compulsions for relief, the stronger the OCD cycle becomes.
Mental compulsions can include:
Mental reviewing
Mental checking
Reassurance seeking
Rumination
Repeating phrases or prayers mentally
Making mental lists
Although these compulsions are invisible to others, they reinforce the same cycle of doubt and anxiety. Individuals attempt to reduce their distress by engaging in mental rituals designed to create certainty or relief.
Examples of mental compulsions may sound like:
The anxiety will go away if I keep repeating this phrase in my mind.
The anxiety will go away if I keep analyzing this intrusive thought.
The anxiety will go away if I keep reassuring myself that everything will be fine.
The anxiety will go away if I make a mental list.
The anxiety will go away if I keep reviewing that conversation.
These strategies may provide temporary relief, but when intrusive thoughts return—as they inevitably do—the cycle begins again. Individuals struggling with mental compulsions can spend hours trapped in their own minds, attempting to think their way out of anxiety. Instead, the ongoing rumination strengthens the OCD cycle and reinforces the need for certainty.
Understanding mental compulsions changes the way clinicians approach OCD treatment. Therapists become more aware of how traditional talk therapy can unintentionally reinforce mental rituals and strengthen the OCD doubt cycle. It also changes how therapists engage with clients, encouraging them to avoid providing reassurance solely to reduce anxiety in the moment.
As clinicians, it is essential to recognize how mental compulsions maintain OCD. Traditional talk therapy can sometimes become a breeding ground for these compulsions when sessions focus on helping clients find certainty about their intrusive thoughts. Effective OCD treatment requires helping clients develop a different relationship with uncertainty rather than seeking reassurance or answers that temporarily relieve distress.
By increasing awareness of mental compulsions, we can help individuals receive more accurate diagnoses, access appropriate treatment sooner, and better understand the hidden battle that so many people with OCD face every day.
Resources
For more information on OCD and mental compulsions, consider the following resources:
Overcoming Unwanted Intrusive Thoughts by Sally M. Winston and Martin N. Seif
Needing to Know for Sure by Martin N. Seif and Sally M. Winston
According to the International OCD Foundation, more than 3 million individuals are living with OCD today, and it takes an average of 14 years for someone to receive an official diagnosis. Many barriers can delay diagnosis, including fear of disclosing unwanted intrusive thoughts, symptom overlap with other anxiety disorders, and the presence of hidden mental compulsions that can make OCD difficult for therapists to identify.
Checking and cleaning rituals have long been viewed as the hallmark compulsions of OCD. Media portrayals often reinforce this narrow understanding by focusing primarily on visible compulsions such as excessive cleaning or checking behaviors. However, there is an entire category of compulsions that often goes unnoticed during both diagnosis and treatment: mental compulsions.
Because they occur internally, mental compulsions can be more difficult for therapists to recognize and easier for individuals to become trapped in. Like physical compulsions, mental compulsions serve as an attempt to reduce the anxiety triggered by unwanted intrusive thoughts. Unfortunately, the more an individual relies on these compulsions for relief, the stronger the OCD cycle becomes.
Mental compulsions can include:
Mental reviewing
Mental checking
Reassurance seeking
Rumination
Repeating phrases or prayers mentally
Making mental lists
Although these compulsions are invisible to others, they reinforce the same cycle of doubt and anxiety. Individuals attempt to reduce their distress by engaging in mental rituals designed to create certainty or relief.
Examples of mental compulsions may sound like:
The anxiety will go away if I keep repeating this phrase in my mind.
The anxiety will go away if I keep analyzing this intrusive thought.
The anxiety will go away if I keep reassuring myself that everything will be fine.
The anxiety will go away if I make a mental list.
The anxiety will go away if I keep reviewing that conversation.
These strategies may provide temporary relief, but when intrusive thoughts return—as they inevitably do—the cycle begins again. Individuals struggling with mental compulsions can spend hours trapped in their own minds, attempting to think their way out of anxiety. Instead, the ongoing rumination strengthens the OCD cycle and reinforces the need for certainty.
Understanding mental compulsions changes the way clinicians approach OCD treatment. Therapists become more aware of how traditional talk therapy can unintentionally reinforce mental rituals and strengthen the OCD doubt cycle. It also changes how therapists engage with clients, encouraging them to avoid providing reassurance solely to reduce anxiety in the moment.
As clinicians, it is essential to recognize how mental compulsions maintain OCD. Traditional talk therapy can sometimes become a breeding ground for these compulsions when sessions focus on helping clients find certainty about their intrusive thoughts. Effective OCD treatment requires helping clients develop a different relationship with uncertainty rather than seeking reassurance or answers that temporarily relieve distress.
By increasing awareness of mental compulsions, we can help individuals receive more accurate diagnoses, access appropriate treatment sooner, and better understand the hidden battle that so many people with OCD face every day.
Resources
For more information on OCD and mental compulsions, consider the following resources:
Overcoming Unwanted Intrusive Thoughts by Sally M. Winston and Martin N. Seif
Needing to Know for Sure by Martin N. Seif and Sally M. Winston