Mental Compulsions: Understanding OCD Mental Rituals
There are two core elements that contribute to the cycle of OCD: obsessions and compulsions. Except not all compulsions are visible. Some are ritual-like behaviors that occur in our minds. These are called mental compulsions.
Individuals suffering from obsessive-compulsive disorder find themselves stuck in a cycle that is tricky to break.
Obsessions arise in the form of thoughts, feelings, images, sensations, and urges. And these obsessions cause extreme anxiety, uncertainty, and discomfort. This is what makes them so difficult to shake.
And so of course, the sufferer looks for any way to alleviate those feelings.
This is where compulsions come into play.
The compulsion is our way of finding temporary relief. A compulsion is any behavior an individual feels compelled to perform in an attempt to rid themselves of the anxiety/disgust/frustration/icky feeling that arises from the obsession.
Yet it is only a very short-term fix. In the long term, it only goes to ensure the OCD cycle continues.
Content
What is a mental compulsion?
A mental compulsion is a compulsion that happens in our minds.
Compulsions land in two categories: physical compulsions and mental compulsions. A physical compulsion is one that we can see. For example, we can see someone excessively washing their hands.
We might see someone who needs to turn the lights on and off three times before bed.
We might see someone repeatedly reorganizing their desk space until it’s ‘just so’.
To an onlooker, these behaviors are something we can observe. Yet, with mental compulsions, they are invisible. It is a mental behavior. And this is where some may get confused. We always associate ‘behavior’ with physically doing something.
But we also have cognitive behaviors. Cognitive habits that we can do intentionally, or unintentionally. Mental compulsions are mental behaviors that we do in much the same ways as physical compulsions.
Except they happen between our ears.
We may silently count, or repeat reassuring sentences, we may make lists, or repeatedly review events of the past.
All compulsions are very specific to each individual OCD sufferer, yet they are done for the same reason – to offer a moment of peace and relief from the distress caused by the obsession.
Mental compulsions vs physical compulsions
The unfortunate reality is that OCD is a common disorder and these compulsions greatly affect an individual’s quality of life.
All of us can experience intrusive thoughts, for example, and manage to go on with our lives without giving them a second thought. Certain personality types may dance closer to obsessive-compulsive tendencies, such as the perfectionist who ‘needs’ their house to be in order.
But this still does not have to greatly impact the quality of their day-to-day existence.
When these compulsions become repetitive and ongoing rituals that the sufferer ‘needs’ in order to cope, it can have a dramatic impact on the person’s ability to do even small everyday things.
Because of the nature of mental compulsions (invisible and unnoticeable), those with these particular types of compulsions often feel as though their struggles are less valid.
The family or friends of someone with physical compulsions are able to see what the person is struggling with and respond in a helpful way.
For someone struggling with mental compulsions, it is difficult to try and explain or help their loved ones understand exactly what it is they are struggling with.
It can be very isolating, and often, those with mental compulsions are less likely to speak up and voice their struggles for fear they will be judged negatively.
| Overt or Covert To put it simply, physical compulsions are also known as overt compulsions. These are the observable behaviors that are performed to reduce anxiety and stress. Mental compulsions are also known as covert compulsions. The type that is invisible to those around us and appears as cyclical mental behaviors. |
Examples of mental rituals
There are a vast array of mental rituals and often they present themselves differently depending on the person and their specific subtype.
1. Mental Rehearsal
‘Rehearsal’ as a mental compulsion might look like imagining what you might do or so in a certain situation.
It involves repeatedly going over this in your head as a form of mental preparation. This is in an attempt to create a sense of safety and to feel in control.
By thinking about all the possible ways a scenario could play out, the sufferer believes they can make the uncertain, certain.
2. Mental Reviews/Checking
‘Reviewing’ could either look like replaying an event in your head to make sure you said or did ‘the right thing’, for example.
Or it could look like reviewing (or checking) your surroundings to make sure everything is ‘right’.
With mental reviewing/checking, the sufferer is often looking for confirmation that things were either done correctly or that they are safe.
3. Mental Counting
‘Counting’ as a mental compulsion looks like silently counting in your head.
For people with counting as a compulsion, this may either derive from counting up to a number that has some form of significance or counting until it feels ‘just right’.
Some people may engage in mental counting to neutralize negative thoughts with a positive number that they associate with good things.
4. Mental Reassurance seeking
As a physical compulsion, reassurance seeking may look like seeking reassurance from someone else. Perhaps a loved one, peer, or mentor.
As a mental compulsion, reassurance seeking often looks like giving ourselves reassurance.
It may present itself as thoughts such as, “You’re not a bad person” or “You did the right thing”
5. Mental list-making
List-making in OCD can arise for many reasons.
One particular list of words, phrases, or people, for example, may give them comfort and offer relief from anxiety. Other times, the list-making is born from an obsession like ‘I won’t remember important things’
The list is a coping mechanism for this.
6. Praying
Compulsive praying typically arises in association with religious/scrupulosity OCD.
It is entirely possible to have mental prayer as a compulsion in association with other subtypes, but typically compulsive prayer is linked to this particular subtype.
A person may pray to counteract the obsessions that go against their religious beliefs.
7. Rumination
Rumination as a mental compulsion looks like fixating on the obsession. You may repeatedly go over the thoughts or images in your mind. You may think excessively about what the unwanted sensation or feeling must mean. As a compulsion, rumination becomes a habit of trying to ‘figure’ things out by giving it an endless amount of our time and attention.
8. Self-Punishment
Self-punishment as a mental compulsion can often be quite confusing. As compulsions are done to allow a moment of relief from the distressing feelings we experience off the back of obsessions, it can be hard to see how self-punishment is supposed to make us feel better.
But for certain obsessions, especially those that make us feel a great deal of shame or guilt, self-punishment can alleviate those feelings.
It can look like this, “I am having this thought that I shouldn’t be having. If I punish myself for it, at least I’m not letting myself ‘get away with it’ and I’m giving myself what I deserve’
Click here to sign up for our weekly newsletter and receive immediate access to the 6-part mental compulsions audio series to help you resist the urge to engage in mental rituals (PDF worksheets included)
Mental Compulsions and Pure O
The term Pure O stands for Purely Obsessional.
This is a phrase that’s often used for OCD sufferers who experience obsessions without the presence of compulsions.
However, this is often misleading. Just because there is a lack of external compulsions does not mean the person does not experience mental compulsions.
According to OCD UK and NOCD, the term Pure O is imprecise because there is almost always some form of physical rituals alongside mental rituals. Yet it is a phrase that has been incorporated into the OCD world.
The term Pure O is not in fact a clinical term, you cannot receive a diagnosis of Pure O in the way you can for the other OCD subtypes.
It is true, the compulsions may not be obvious to you, but in OCD they are a core factor in keeping the OCD cycle in motion. A study had been conducted to confirm that in the cases of 1,000 participants, all of them had some form of compulsions – even if they were unknown to them.
The obsessions may be a primary focus, but if we dig deep enough, a qualified clinician will help you find how your compulsions are presenting themselves.
Why do mental compulsions make OCD worse?
All compulsions – mental or physical – maintain the cycle of OCD.
The cycle of OCD has those three key components as mentioned above:
- Obsessions
- Feelings (Anxiety/uncertainty/distress/disgust etc)
- Compulsions
Once we find our anxiety rising in response to those obsessions, it is at that moment that we have two options…
We give in to the urge to do a compulsion that we know will greatly relieve our discomfort or, we allow the anxiety and uncertainty, and resist the urge to do compulsions.
The first choice teaches our brain that we cannot tolerate the anxiety and uncertainty without the compulsion.
The second choice teaches our brain that we can tolerate the anxiety and uncertainty, and that we will be able to tolerate it in the future.
In resisting the urge to perform compulsions, we teach ourselves that we do not need to perform these behaviors to manage the anxiety. We teach ourselves that we can allow those feelings to arise and still continue on in our day-to-day lives.
When we do not resist, and we do the compulsion, the OCD cycle continues.
We have taught our brains that we will need that compulsion to manage anxiety and uncertainty in the future.
How can I tell the difference between an obsession and a mental compulsion?
In many cases, as in those mentioned above, the distinction is quite clear. It can still take some time working with a trained professional to truly identify those mental compulsions, as they are often hidden, even from the sufferer.
Even to ourselves, it is easier to notice when we cannot resist the urge to do a repetitive physical behavior.
It is more difficult to notice when we are performing a mental ritual.
Rumination can become a mental compulsion that may feel like an intrusive thought and be mistaken for an obsession, for example. You may be thinking:
What if I didn’t do X,Y, Z
What if I did say A, B, C
These thoughts could easily be mistaken for intrusive thoughts. But in actuality, they may well be the compulsion. A form of reviewing, for example.
When thoughts are churning through your mind one after another, some born from fear and others designed to relieve that fear… it can be hard to see the wood through the trees.
As a general rule to follow:
- Obsessions induce anxiety and uncertainty
- Mental compulsions are done with urgency and relieve anxiety and uncertainty.
How to treat mental compulsions?
As with any other OCD treatment, ERP (exposure and response prevention) remains the gold standard treatment.
Even though these particular compulsions remain inside your mind, we can take the same approach using ERP.
It is important that the individual goes through the correct diagnostic procedure and works with a qualified OCD specialist. Without working with someone who can identify and recognize mental rituals as compulsions, treatment will be ineffective.
It is just as important to treat mental compulsions as it is to treat physical compulsions.
ERP for mental compulsions
Sometimes it can be confusing for OCD patients to understand how they might approach exposure therapy for mental compulsions.
But the practice is very much the same as it would be for overt/physical compulsions. In all cases, the goal is to resist the urge to do these rituals.
For example, if someone has religious/scrupulosity OCD, they may be triggered by an obsession in the form of an unwanted thought. This thought may take the form of a ‘what if’ thought…
What if I’m not religious?
What if I don’t believe in this God?
What if I do something sinful?
The anxiety and fear that grows from this may inspire the urge to pray. They may find comfort in repeating a religious passage, for example.
In this instance, we would ask them to sit with those thoughts and avoid thinking through that religious passage.
Likewise, someone with harm OCD may indulge in self-reassurance as a compulsion. Obsessions like, ‘what if I harm myself’ or ‘what if I harm my children’ might arise on seeing a knife in the kitchen.
They may then go on to tell reassure themselves by thinking –
I am a good person
I am not going to hurt anyone
I am in control
In ERP therapy, we would ask that you resist the urge to engage in this mental reassurance seeking. Do not avoid the knife, but approach the knife. Allow the thoughts to arise and resist the urge to do those mental compulsions.
The difficulty in ERP for mental compulsions
The challenge for most in doing ERP for mental compulsions is that they can very easily become an automatic habit that we do without even realizing we’re doing them.
And so it isn’t uncommon for a client to say that they aren’t even aware that they are engaging in these compulsions.
It does not mean that they cannot be treated, it just means that you want to work with an OCD specialist who can help you identify the familiar cycle of obsessions and compulsions, and how they pop up for you individually.
It will be a case of finding ways to interrupt those mental rituals and redirect your focus and attention elsewhere.
ERP School – An Online Resource For You
Online programs can be an incredibly effective way of helping yourself manage compulsions when you don’t have access to private therapy.
Kimberley Quinlan founded ERP School after noticing a lack of support available to those who don’t have access to 1:1 therapy. As a highly qualified OCD specialist, Kimberley created an online self-paced program that is accessible to all.
Throughout the program, you will be taken through the exact process Kimberley guides her 1:1 clients through. You will be given the same tools and techniques she uses with her private clients to help you resist the urge to do compulsions and change your relationships with your obsessions.
So you can finally stop letting intrusive thoughts control your day-to-day experiences and drastically improve your quality of life.
You can join the program HERE.
Private Therapy
If you are based in the state of California and are seeking 1:1 therapy with a qualified OCD specialist, please get in touch with us using the form below or submit an application HERE.
We have an elite team of 10 warm, compassionate, and highly qualified mental health professionals who are ready to guide you through your OCD recovery.
Each our of clinicians are highly qualified, licensed therapists who work under Kimberley Quinlan’s supervision and follow her specific OCD treatment plan. You can rest assured that under their guidance you will receive the specialist support you need to take your life back from OCD.
Your Anxiety Toolkit Podcast Episodes
If you’re interested in learning more about mental compulsions, please visit this list of podcast episodes dedicated to this particular topic.
We had the pleasure of taking a deep dive into these particular compulsion types in our 6-part series.
If you’re curious to understand more, these episodes are for you.
