Mental compulsions

The nature of obsessive thoughts is that they are unwanted and intrusive. They arrive with a spike of anxiety or uncertainty and the urge to do something that makes them stop. Behavior that you feel compelled to perform, against your conscious wishes, with the sole intention of ending a thought, feeling or sensation is a compulsion.

Let’s discuss the nature of compulsions in greater detail so that we have shared language to understand mental compulsions.

Here is a list of common physical compulsions: 

  • Excessive hand washing or bathing
  • Checking locks or appliances
  • Checking that you haven’t made a mistake
  • Checking that you did not or will not harm yourself or others
  • Checking your body for sensations or your mind for thoughts and feelings
  • Rereading or rewriting
  • Repeating routine activities like moving a chair up and down
  • Counting
  • Excessive list making
  • Needing to tell, ask, or confess what you are thinking
  • Needing to touch or tap
  • Needing to arrange or order objects

Hand washing and all other behaviors listed above becomes excessive and problematic when the function of the behavior transitions from problem-solving to anxiety reduction. When your hands are visibly dirty or your body is sweaty or smelly, washing is problem-solving. When you have the thought that you are contaminated and the feeling of anxiety and you feel compelled to wash until the anxiety is gone, washing is a compulsion. Some people follow rules like “It’s okay for me to stop washing after I repeat my ritual 3 times or after a certain amount of time.” Other people wait for the just-right feeling to stop washing. Many people who engage in compulsive behavior have rules for some situations and use their feelings as criteria for when to stop in other situations.

Here are some common misunderstandings about obsessions and compulsions:

How do I know I’m having an unwanted thought? 

If you have been stuck in a particular content for a long time, you may feel confused by the “unwanted” part of the definition of an obsession. For instance, those suffering from OCD with sexual orientation content might think, “how do I know if this is unwanted? What if I want to be having this sexual thought and that’s why it’s so frequent?” This can make it challenging to take the leap of faith and label the thinking pattern as OCD. If you are stuck wondering whether or not your thought is unwanted (and what it means about you if the thought is or isn’t unwanted), try asking yourself, “Did I choose to think about this? If I could think about anything in the world right now, would I direct my attention at this? Would I purposely choose to talk about it and google this rather than all other things that interest me?” If your answer is no, you wouldn’t choose to think about it, then you are suffering from unwanted thoughts. Everybody sometimes has unwanted thoughts, but not everyone has unwanted thoughts that trigger anxious sensations, create preoccupation, steal time and energy, and compel them to act in ways to make the thoughts go away. It’s really challenging to get out of this type of mental trap. I hope you don’t feel self-pity, but you do feel self-compassion about suffering in this way.

What is problematic about rule-based or feeling-based compulsive behavior? 

We talk a lot about flexible behavior in Huddle.care. People who don’t engage in compulsive behavior have “flexible” behavior in the sense that the function of their behaviors are problem-solving and the solution is different every time. As an example, in some bathrooms, you have access to soap and paper towels. At other times, you don’t. Can you problem solve with whatever the situation calls for and redirect your attention to the present moment if you aren’t able to use your rules for getting clean? The problem with using rules or just-right feelings to make decisions is that unless you rigidly narrow your life options, you will face situations where your rules don’t apply or your just-right feelings feel more and more elusive. You also miss out on the opportunity to become confident in yourself and your ability to adaptively problem solve, if you are drawing your sense of security from rules.

What’s the difference between compulsive feeling-based behavior and intuition? 

Some people believe strongly in making decisions based on feelings and intuition and don’t like the idea of giving up “feeling-based” decisions. The problematic form of feeling-based decisions is when you are rigidly trying to achieve a certain feeling state, specifically the certainty feeling state. When you are open and accepting to all feeling states, then your feelings can actually be data and you can make intuitive decisions based on the information you receive from your feelings. If you are trying to control your behavior to achieve certain feeling states and calling that intuition, it will be hard for you to develop a deep confidence in your ability to respond well to all feeling states.

What’s the difference between addictive behavior and compulsive behavior? 

Compulsive behavior is differentiated from addictive behavior based on its function. Addictive behavior may also eliminate or reduce thoughts, feelings, or sensations, but its primary function is to achieve the state to which you are addicted. Just like compulsive behavior, addictive behavior is defined by impairment and distress. Washing your hands is workable until your hands are dry and sore. Eating sugar or drinking alcohol can also workable behaviors, until they are not. In both compulsive behavior and addictive behavior cycles, you will feel an urge to engage in the behavior. When you have an addictive urge, you typically want to engage in the behavior, although you might not want the consequences of the behavior. For example, you want the drink or the cigarette, but you don’t want the health or social consequences of drinking and smoking. Comparatively, when you have the urge to compulse, you don’t want to engage in the compulsion. You feel compelled to either out of fear of the potential consequences of not compulsing or because of the anxiety you’d have if you didn’t compulse.

What do you mean by flexible, adaptive problem solving, rather than compulsing

How do you know when to stop washing your hands? Stop washing your hands when your hands aren’t dirty, as opposed to when your anxiety is gone or after you followed your rule. Fear of contamination is an easy example to explain. Can you see the parallels to other content areas like fear of harm to self or others or perfectionism about performance, emotions, relationships, and life choices? In all cases, we’re trying to problem solve, rather than reduce anxiety.

How do you know whether you made a mistake or hurt someone? Well, did you hurt someone? Make a decision about this question and live in it, rather than replaying it until you have certainty.

How do you know whether you are spending your time, energy, and resources correctly or with the right person or people? First, there isn’t a right answer to this question. Second, any answer can be workable. Are you willing to accept your actual life choices in the presence of uncertainty? Notice how many opportunities for happiness open up when you give yourself permission be present in your actual life rather than trying to figure out whether that is the right decision.

Mental compulsions

Now that we’re on the same page about compulsions overall, a mental compulsion is a compulsive thought pattern that you feel compelled to engage in with the function of reducing your anxiety or uncertainty, just like physically counting or checking.

The texture of mental compulsions is uncomfortable, sticky, and anxiety-provoking. You don’t really choose to think like this, although it may feel like you want to keep doing it, because of how you’ll feel if you don’t do it. It’s different than worrying, where you’ll notice more what-if thinking about the future. It’s different than ruminating, where you’ll notice negative self-beliefs, self-criticism, and guilt and shame. It sounds more like, “I’m afraid of this very specific possibility and I’m going to think about it in a really specific way to make my fear and uncertainty go away.”

If you mentally compulse a lot, you probably have rules for it to cut it short. An example is replaying your drive or some other experience quickly and in a certain way to get the feeling of certainty that you didn’t hurt anyone. Even if this doesn’t take up a lot of time or energy, every time you engage in this type of compulsive thinking, you miss an opportunity for more flexible problem solving and you miss an opportunity for an increase in self-confidence. Plus, you reinforce the idea that you have to think like this in similar situations in the future.

To overcome it, go back to the basics with exposure and response prevention. Once you figure out what triggers your mental compulsions, you’ll want to expose yourself to that trigger on purpose and then specifically refrain from your mental compulsion by redirecting your attention. If it feels anxiety-provoking to distract yourself away from your mental compulsion, you’re doing the exposure correctly.

In Community Time this week, we’ll discuss your examples of mental compulsions and how to design an exposure and response prevention strategy to overcome it.