Obsessive-compulsive disorder (OCD) is a complex mental health condition that affects 1 in 40 people. OCD has two main components: obsessions and compulsions (also known as safety behaviors).
Obsessions are what sets the OCD cycle in motion. The distress they cause leads to compulsions, which are the physical or mental actions performed in an attempt to find relief. Compulsions may also be done to prevent something bad from happening. However, the relief is only temporary, keeping the OCD cycle going. Knowing what obsessions are, including their different types and causes, is important in finding the right treatment to manage symptoms.
Read on to get deeper insights into OCD obsessions and how you can start your treatment journey.
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 identity or 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 or dooming 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?
- Why did I have a dream where I was attracted to a man? Does that mean I’m gay?
- 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 against Allah.
- Why is my swallowing so loud?
- I need to replay or rethink what exactly happened or what was said.
- If I don’t digest all the information in my text perfectly, I’ll fail my test.
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
How are obsessions different from impulsive thoughts and hyperfixation?
Obsessions can be confused with impulsive thoughts and hyperfixation, so it’s crucial to understand the differences between the three symptoms. As we discussed, obsessions are unwanted and intrusive thoughts and other manifestations that can be extremely distressing.
Impulsive thoughts, on the other hand, are sudden, intense urges or desires to act on something spontaneously—often without thinking about the potentially undesirable consequences.
The difference between impulsive thoughts and intrusive thoughts are the motivational drives behind them. Typically, impulsive thoughts are things you want to do—like buying something expensive on a whim. It may not be a great decision in the long term, but the impulsive action makes you feel good in the moment. Intrusive thoughts, however, are things you do not want and will go to great lengths to push away or prevent from happening.
Hyperfixation is usually a deep focus on a specific activity or topic that brings enjoyment rather than distress. While hyperfixation is commonly linked with autism and ADHD, it is possible to experience it as a type of OCD compulsion. “If you have OCD, then hyperfixation can usually turn into rumination,” explains Ibrahim. “Even if you find something that you feel good about for a tiny bit, doubt comes back. That’s because that’s the whole point of OCD–it’s this hyperfixation on something that tells you it’s scary or a problem.”
How are OCD obsessions treated?
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. ERP is supported by decades of research and has been found to significantly reduce symptoms in 80% of people with OCD.
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.
ERP is not the only treatment that can be effective for managing obsessions and compulsions. Certain medications, such as selective serotonin reuptake inhibitors (SSRIs), can be paired with ERP to reduce OCD symptoms. This treatment combination can be especially helpful if you’re managing other mental health conditions (such as anxiety and depression) or dealing with severe OCD symptoms.
Other treatments for OCD include acceptance and commitment therapy (ACT), a form of talk therapy that involves changing your relationship with your obsessions, as well as incorporating mindfulness practices into your routine. Both ACT and mindfulness can be used alongside ERP.
Bottom line
Obsessions start the cycle of OCD, leading to re-curring 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.
Although OCD is a complex mental health condition, know that it’s possible to get your life back from your obsessions.
Key takeaways
- Obsessions are intrusive thoughts, images, ideas, feelings, sensations, and/or urges that cause fear and anxiety.
- The main themes of obsessions are harm, contamination, “just right” (or perfectionism), and taboo topics.
- While it’s unknown what can trigger specific obsessions, they could potentially arise due to significant life changes, trauma, a family history of OCD, compulsions, and co-occurring mental health conditions.
- The best treatment for addressing obsessions and compulsions is exposure and response prevention (ERP) therapy.
