Each of us experiences occasional anxiety as a normal part of life (NIMH, 2021). When we worry or feel anxious, it is common to engage in certain behaviors to help reduce our feelings of concern or uneasiness. Checking our car doors to alleviate our fear of them being unlocked, for example (King, 2012).
For some of us, our worries and anxieties develop into obsessions - recurring and persistent thoughts, images or urges that cause us significant emotional distress. Common themes of obsessions include self-doubt related to doing something incorrectly, contamination, desire for symmetry, exactness and order, or an impulse to act religiously, aggressively or sexually (Weiner, 2010).
Obsessions are typically experienced as unwanted, intrusive, and inconsistent with our self-image, beliefs, personal values and other behaviors (Weiner, 2010). The intrusive nature of obsessions and compulsions is considered to be tied to feeling uncomfortable with our sense of self and with our personal identity (Potter, 2020).
When an obsession occurs, we may attempt to ignore or suppress it by engaging in a compulsion (Wiener, 2010). A compulsion is a repetitive behavior (placing things in order, washing our hands) or a mental act (counting things or repeating words and phrases) that must be performed according to a strict set of personal rules (Potter, 2020). Such rituals are also hallmarks of compulsive disorders such as body dysmorphia and anorexia nervosa (Grant, 2019).
Engaging in compulsions can serve to lower the anxiety caused by obsessions, yet the relief they offer is short lived. This is because the rituals rarely address the root cause of the anxiety, and often manifest as an overreaction to the situation at hand. The rituals can grow to disrupt the flow of life and create interpersonal conflict with friends, family and coworkers, leading to increased distress which then generates more obsessions (Potter, 2020).
Those of us who struggle with such thoughts and behaviors also tend to make a series of overestimations that increase the level of worry and distress we experience. Specifically, we overestimate the likelihood of a specific or general negative outcome, as well as overestimate the influence we have over that outcome occurring or not (Weiner, 2010). These intrusive ideas can be very difficult to ignore or dismiss (King, 2012).
If obsessions, compulsions and overestimations take up more than 1 hour of time each day, they may fall under the diagnostic criteria of obsessive compulsive disorder (Potter, 2020). It is estimated that over 2% of the United States population experiences obsessive compulsive disorder, and that obsessive compulsive personality disorder is the most commonly occurring personality disorder in Europe and the Americas (Grant, 2019).
Origins of Obsessions and Compulsions
One way to think about the way obsessive compulsive behavior (OCB) develops is through behavioral theory. It suggests that in our early development or a time of great stress, we learned to fear something. This fear created feelings of worry or anxiety that were distressing to us and caused us to seek out a behavior that alleviated those uncomfortable emotions. We received temporary relief from that behavior, which reinforced the idea that engaging in that behavior in the future will relieve anxiety and stress in the future. Thus, a cycle is born (Weiner, 2010).
Another model we can use to understand OCB is called executive overload. This model suggests that those of us with obsessions, compulsions and overestimations experience a mental ‘flooding’ of such thoughts when they occur. This condition of mental overload shuts down other functional processes in the brain, which then limits our abilities and behaviors so they become repetitive (Abramovitch, 2013).
Interestingly, it is typical of people who engage in OCB to have a general awareness that their obsessions are not entirely helpful, and understand that the intrusive obsessions originate within. Very few other mental challenges offer this baseline level of self awareness (Wiener, 2010).
Strategies to Reduce Obsessive Compulsive Behaviors
When considering how to approach OCB, it is important to recognize that efforts to suppress such thoughts and behaviors have been proven to result in an increase in their frequency. Meaning, attempts to actively suppress OCB cause us to focus more on them (Weiner, 2010).
Instead, what is most effective in reducing such behavior is increasing our own level of insight into our symptoms. The more insight we have, the lower the burden of our symptoms (Potter, 2020). One way to gain insight is through cognitive behavioral therapy (CBT). Those who engage CBT report up to a 65% reduction in their OCB symptoms, with progress enduring long term. For access to CBT, click here.
Exposure and response prevention is a form of cognitive behavioral therapy that involves prolonged and repeated confrontation with the situations that cause our fear and obsessions. We are then asked to refrain from carrying out our compulsive ritual for as long as possible. This weakens the association between fear, obsession and compulsion and reduces our reliance on the ritual over time. An example of this would be touching something contaminated and waiting to wash our hands (Weiner, 2010). Access exposure and response prevention by clicking here.
Engaging in physicality, specifically deep breathing, can help us to relieve our feelings of worry, create a distraction for us to use instead of a ritual, and enhance our sense of well being through community interaction (Potter, 2020). For more information on the types of physicality, click here.