Mental Compulsions with ocd and pure-o ocd
Obsessive-Compulsive Disorder (OCD) is often associated with physical compulsions, such as washing hands repeatedly or checking locks. However, many people with OCD also experience mental compulsions, which can be just as distressing, though less visible to others. Some people may experience ONLY mental compulsions with OCD and not engage in any physical rituals or behaviors. This is often referred to as “Pure-O OCD”. While sometimes this can make diagnosis more difficult as many therapists and doctors are less aware of mental compulsions, having only or primarily mental compulsions does not change OCD treatment or outcomes.
What Are Mental Compulsions?
Mental compulsions are internal, cognitive behaviors performed to reduce the anxiety or distress caused by obsessive thoughts. Unlike physical compulsions, mental compulsions are invisible to others, but they are just as impactful on the person experiencing them.
Mental compulsions often arise in response to intrusive, obsessive thoughts or fears. These compulsions might include:
Repetitive mental counting: Repeating certain numbers or phrases in one's mind to feel "safe" or to prevent something bad from happening.
Mental checking: Ruminating or mentally reviewing events, thoughts, or situations to make sure nothing bad happened or to confirm that something was done “correctly.” This could include reviewing conversations, actions, or decisions.
Reassurance-seeking thoughts: Continuously asking oneself, "Am I sure everything is okay?" or mentally reassuring oneself that a situation is under control, even when there’s no evidence to suggest otherwise.
Prayer or mantra repetition: Repeating prayers or specific phrases in the mind to prevent harm or neutralize a bad thought.
Undoing or neutralizing thoughts: Trying to mentally "counteract" or "cancel out" bad thoughts or images, often by thinking a good or neutral thought, in hopes of preventing something negative from occurring.
Imagining safe outcomes: Mentally visualizing a scenario or outcome to avoid disaster or prevent harm (e.g., imagining the road being clear when driving or mentally picturing an event unfolding perfectly).
How Mental Compulsions Work
Mental compulsions, like their physical counterparts, are performed to reduce the anxiety triggered by obsessive thoughts. In OCD, the individual is often caught in a cycle of obsession and compulsion:
Obsession: An intrusive, unwanted, and often disturbing thought or image. This could be a fear of harm, a worry about causing offense, or a thought about something immoral or dangerous.
Anxiety: The obsession causes significant distress or anxiety. The individual becomes consumed with the need to alleviate this discomfort.
Mental Compulsion: To neutralize or "undo" the obsession, the person engages in a mental ritual (such as counting, repeating a phrase, or checking something mentally).
Temporary Relief: The mental compulsion provides short-term relief from the anxiety caused by the obsession, which reinforces the mental compulsion as a "solution."
Unfortunately, this relief is short-lived, and the cycle repeats itself. Over time, the individual may feel trapped, as the mental compulsion becomes a deeply ingrained response to nearly every intrusive thought or worry.
Examples of Mental Compulsions
Here are a few examples to help illustrate what mental compulsions might look like:
Example 1: A person with OCD may worry that they’ll accidentally harm someone. In response, they may mentally review their actions all day, thinking through every moment to reassure themselves they didn't cause harm, even if there is no evidence to suggest that harm occurred.
Example 2: Someone may have obsessive thoughts about blasphemous or inappropriate images or ideas (e.g., religious sacrilege). To neutralize these thoughts, they may repeatedly mentally pray or counter the image with a positive or neutral thought.
Example 3: A person who has obsessive fears of contamination may mentally count the number of times they've touched something they believe to be dirty, in an attempt to make sure that the total is "safe" or within an acceptable range.
Example 4: A person may have a mental "ritual" of repeating the phrase “I am safe” multiple times in their mind to ease the distress of a harmful thought, like imagining an accident happening.
Why Are Mental Compulsions So Difficult to Detect?
Mental compulsions are challenging to detect because they don’t involve observable physical behaviors, making them less noticeable to others. A person with OCD might appear calm on the outside, but internally, they could be experiencing significant distress and engaging in complex mental rituals to cope. This can also make it harder for people with OCD to recognize that they are engaging in a compulsive behavior, as it’s harder to recognize mental rituals as problematic compared to physical ones.
The Cycle of Mental Compulsions
The cycle of mental compulsions mirrors the cycle of physical compulsions:
Intrusive Obsessive Thought: A distressing thought or image arises, which could be related to fears of harm, contamination, morality, or other themes.
Anxiety or Distress: The person feels intense anxiety because they cannot dismiss the obsessive thought.
Engagement in Mental Compulsion: The individual begins a mental ritual to neutralize or reduce anxiety (such as counting, repeating mantras, or mentally checking).
Temporary Relief: The mental compulsion provides brief comfort, reducing anxiety for a short time.
Reinforcement: Because the mental compulsion provides temporary relief, the person is more likely to repeat the behavior when the next obsessive thought arises, reinforcing the cycle.
Why Do People With OCD Use Mental Compulsions?
Mental compulsions serve the same purpose as physical compulsions: to alleviate the anxiety caused by obsessive thoughts. They often stem from an irrational belief that by performing these mental rituals, the person can prevent something bad from happening or "undo" a potentially harmful or immoral thought.
However, while mental compulsions provide short-term relief, they only strengthen the OCD cycle in the long run. The individual becomes more dependent on these mental rituals, and the anxiety is likely to return, prompting further compulsive behavior.
How to Treat Mental Compulsions
Treatment for mental compulsions is often based on the same principles used to treat physical compulsions. The most effective treatment is Exposure and Response Prevention (ERP), a form of Cognitive Behavioral Therapy (CBT). Here's how ERP works with mental compulsions:
Exposure: The therapist might ask the individual to confront their intrusive thoughts or images directly, without performing any mental rituals. For example, they may deliberately think about the feared or distressing thought without trying to neutralize it.
Response Prevention: The person is encouraged to refrain from engaging in the mental compulsion (such as mentally counting, repeating a phrase, or reviewing events). Instead, they learn to tolerate the anxiety and discomfort without performing the ritual.
Cognitive Restructuring: The therapist may help the individual identify and challenge the irrational beliefs that fuel the compulsive behaviors. This might involve exploring the unrealistic nature of the fears and helping the person develop healthier ways of responding to intrusive thoughts.
Mindfulness: Mindfulness techniques may be used to help the individual observe their thoughts without becoming overwhelmed by them. This can help them become more aware of when mental compulsions are taking place and gradually reduce their reliance on them.
Conclusion
Mental compulsions in OCD are internal rituals that individuals use to reduce the anxiety caused by obsessive thoughts. These compulsions can be just as disruptive as physical compulsions, often leading to a cycle of increased anxiety and repeated rituals. While mental compulsions are harder to spot than physical ones, they can be treated effectively with therapies like Exposure and Response Prevention (ERP), helping individuals break free from the cycle and regain control over their lives. If you or someone you know struggles with OCD, it's important to seek support from a mental health professional who can guide you through the process of recovery.
Meghan Cromie LPC is an OCD specialist who has helped many people overcome OCD. If you believe you have Pure-O OCD or any other form of OCD reach out for a free 15 minute consultation to start the journey to a still mind.
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