Obsessive-compulsive disorder (OCD) is a complex mental health condition with two main components: obsessions and compulsions.
Obsessions are what sets the OCD cycle in motion. They cause distress, which leads to compulsions, which are the physical or mental actions performed in an attempt to find relief. However, the relief is only temporary, keeping the OCD cycle going.
Read on to get deeper insights into obsessions and what you can do to manage OCD symptoms.
How do obsessions work in OCD?
Obsessions may appear as intrusive thoughts, but they can also be intrusive images, urges, feelings, sensations, memories, and even dreams that cause fear and anxiety. “People that experience obsessions find them to be unwanted, inappropriate, and intrusive, so they respond to them with something to neutralize them—which is where a compulsion comes in,” says Patrick McGrath, PhD, Chief Clinical Officer at NOCD.
OCD obsessions can center around specific themes, such as a fear of harming yourself or others, persistent concerns about your sexual identity, or excessive worry about germs and contamination.
Regardless of how your obsessions manifest, it’s essential to understand that they’re typically ego-dystonic, meaning they don’t align with your values, morals, or beliefs. While everyone experiences ego-dystonic thoughts from time to time, most people can move on from them, understanding that they don’t have any meaning. However, if you have OCD, obsessions can make you believe that your fears could potentially come true, which can lead you to do compulsions.
“Let’s say that you’ve run over a bump, but you’re afraid it’s a person,” explains Dr. McGrath. “You start thinking that you’re this terrible person who runs people over and then leaves them at the side of the road. What do you do? You go back and check to try to eliminate that ego-dystonic feeling or experience from being there. That’s where OCD really gets you by pulling on your emotions—leading you to do these behaviors over and over again.”
How are obsessions different from everyday worries?
Let’s be honest—it’s common to worry about things like locking your door or making sure the stove is turned off after cooking. But the difference between normal worry and extreme worry is the presence of an actual threat or danger, notes Tracie Ibrahim, LMFT, CST, NOCD’s Chief Compliance Officer.
“If your neighbor’s house was on fire, you may worry your house might catch fire, which makes sense at the moment,” she explains. “But, there are people who do things like [repeatedly] checking the stove knobs, electrical cords, and sockets because they’re afraid of starting a fire. You can see where one fear is disproportionate over the other.”
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Common themes of OCD obsessions
OCD obsessions can be grouped into themes or subtypes that usually fall under the four main categories: contamination, harm, “just right,” and taboo topics.
Common OCD obsessions include:
- Fear of harming yourself or others
- Fear of being contaminated or contaminating others physically, mentally, or emotionally
- Doubts about your sexual orientation
- Excessive worry about romantic and/or platonic relationships
- Fear of going against ethical, moral, or religious beliefs
- Need for things to be “just right” or symmetrical
- Preoccupations with unanswerable philosophical questions
- Fear of losing control of bodily functions or sensations
- Fear of accidentally cursing yourself or others
- Excessive concern about things that happened in the past
- Fear of being an unfit parent or making a mistake that will harm your baby
- Unwanted sexual thoughts
Examples of OCD obsessions
- I did something really bad in the past, and now I might be cursed.
- Am I actually attracted to my partner?
- What if I actually die in my dreams?
- Will I become a pedophile in the future?
- What if I leave the stove on and the house burns down?
- Did I hit someone while driving?
- Someone sneezed near me. What if I get sick?
- I had a sinful thought, and therefore, I have sinned.
- Why is my swallowing so loud?
If you have OCD, the distress caused by obsessions can take a toll on your emotions, which is why you may resort to doing compulsions like checking, seeking reassurance, and rumination.
What triggers OCD obsessions?
Anything could be a trigger for your obsessions, says Ibrahim. “It could be feeling like you’re going to harm somebody you love, or a pet you care about, or saying that you like things that you don’t,” she explains. “But we really don’t know why we get specific obsessions.”
Ibrahim believes she developed contamination-related obsessions and compulsions from her grandmother. “Some of my contamination OCD is an exact mirror of how I was raised by my grandmother, who had undiagnosed contamination OCD,” she says. “I do the exact same things that I remember her telling me to do to be safe. Some of that is learned versus other compulsions I just started doing because I have OCD, and there’s no reason behind them.”
While we don’t know what exactly causes OCD obsessions, situations that might trigger them include:
- Significant life changes (e.g., getting married, a new job, having a baby, losing a loved one, etc.)
- Lifestyle disruptions, such as a lack of sleep or not eating enough
- Engaging in compulsions
- Trauma
- Co-occurring mental health conditions, such as anxiety and depression
When to seek help
While it’s normal to have intrusive thoughts, if they’re recurring, feel upsetting, and you’re going out of your way to avoid them or make them go away, it could be a sign of OCD. If these thoughts are causing distress, your best bet for getting help is to seek a mental health professional. An OCD specialist can help you make sense of your experiences and help you manage your symptoms so you can start feeling more like yourself again.
How do you manage obsessions?
While there’s no way to stop obsessive thoughts, getting treatment can help you stop engaging in compulsions and escape the OCD cycle. The first-line treatment for OCD is a specialized form of cognitive behavioral therapy (CBT) known as exposure and response prevention (ERP) therapy.
During ERP, you’ll work with a therapist who will guide you through exposures, which are situations where you’ll confront your fears head-on, and response prevention techniques, which are exercises that teach you how to resist engaging in compulsions.
While ERP can be successful for many people, it is not a quick and easy process. You’ll need to be patient and consistent with your therapy sessions and homework to see any change in your symptoms.
Bottom line
Obsessions start the cycle of OCD, leading to recurring distress and compulsive behaviors that can be hard to escape if left unmanaged. If your obsessions are impacting your life, consider seeking professional help—preferably from a therapist who specializes in OCD and ERP. They can work with you to create a personalized treatment plan that addresses your specific triggers, obsessions, and compulsions.
