Obsessive-compulsive disorder (OCD) is a mental health condition characterized by two main types of symptoms: obsessions and compulsions. The OCD cycle refers to the continuous loop of these behaviors. It begins with obsession—intrusive thoughts that trigger distress or anxiety. In response to this discomfort, people engage in compulsive behaviors to gain temporary relief. However, this relief is short-lived, and the anxiety soon returns, prompting the cycle to repeat itself.
People with OCD may be aware that they’re in a cycle and feel trapped. However, the urge to perform compulsions can feel overwhelming, making it difficult to resist even when they know the behavior is not rational.
If you have OCD, understanding the cycle can help you recognize how your obsessions and compulsions show up in your life. While breaking the OCD cycle is challenging, it’s possible with persistence, support, and the right form of treatment.
Part 1: OCD begins with obsession
OCD is a chronic mental health condition characterized by obsessions, or recurrent and intrusive thoughts, images, urges, sensations, or feelings. These intrusive triggers are ego-dystonic, meaning they go against your values and beliefs. People with OCD do not enjoy, want, or agree with their obsessions—on the contrary, they find them quite distressing.
“Everyone has intrusive, unwanted thoughts. It’s part of being a human,” explains NOCD therapist Tracie Ibrahim, LMFT, CST. “People with OCD get stuck on intrusive thoughts and end up in a cycle of trying to figure out what is ‘true’ or ‘certain’ by doing physical and mental compulsions. People without OCD can move past the intrusive thoughts much more easily and do not get stuck in compulsions trying to figure them out.”
Because these thoughts are taken so seriously, they also occur more frequently in the future. People with OCD desperately do not want them, and take action to avoid them or make them go away. Unfortunately, this leads them to persist and even increase, in both frequency and intensity.
Part 2: Obsessions create distress
When obsessions are triggered, they can spark a variety of uncomfortable feelings—broadly categorized as distress. The nature of intrusive thoughts are not only out of alignment with your values or beliefs, but they can also be highly taboo.
For example, a common theme of OCD is pedophilia OCD. Obsessions may sound like, What if I inappropriately touch this child? What if that’s my true desire? What if I have acted inappropriately toward a child and don’t remember? Because people with OCD can’t determine completely for certain that these thoughts don’t actually mean anything, it can be extremely distressing and cause a great deal of anxiety.
“Distress is often feelings of fear or anxiety that come up about the obsession being something that might be true, might happen, such as something terrible happening to a loved one, being responsible for harming someone or yourself, or some other obsessional fear,” Ibrahim says.
Another taboo but common OCD theme is harm OCD. This subtype focuses on fears about harming others or oneself. Intrusive thoughts can sound like, What if I stabbed my partner? What if I pushed this stranger in front of a train? What if I ran over that biker with my car? What if I jumped off of this balcony?
Again, people with OCD want to completely ensure that these thoughts are not true because if they were, it would oppose everything they thought they knew about themselves. They feel unable to write off these thoughts as strange and simply move on with their day—as so many others do who experience the same thoughts.
Even when the focus of OCD isn’t necessarily taboo or inappropriate, it can still be highly distressing. For example, relationship OCD typically involves fears about romantic partnerships, but can extend to friendships or family relationships. Obsessions in ROCD can sound like, am I attracted enough to this person? Is this person ‘The One’? What if we stop being friends?
When these obsessions are triggered, people with OCD feel the need to “solve” their worries and get rid of those uncomfortable feelings. When something triggers intrusive thoughts, images, sensations, feelings, and urges, you may engage in compulsions to relieve the anxiety and distress that come as a result.
Part 3: Distress leads to compulsions
Compulsions are not limited to repetitive handwashing, repeatedly touching the dials on the stove, or the other common depictions of OCD in film and television. These rituals can definitely be examples of compulsions, but compulsions can involve anything done to relieve the uncomfortable emotions brought on by obsessions, or to prevent a feared outcome from happening.
Compulsions are what really keep you stuck in the OCD cycle, because while everyone experiences intrusive thoughts, not everyone reacts to them. Compulsions reinforce the mistaken belief that you can’t tolerate the discomfort and uncertainty that happens when your OCD is triggered.
These compulsions can be physical or mental, and both serve the same purpose: to alleviate the anxiety caused by obsessive thoughts, even if only temporarily. Although mental compulsions are less visible, they are just as powerful. These also might be harder to see or notice—even by the person experiencing them.
Common physical compulsions include:
- Tapping/touching: This could look like picking up an object and putting it back down a certain number of times until it feels “just right” or having to close a door exactly the “right way.” This compulsion often has no logical connection to the fear or obsession itself, but rather relieves a sense of discomfort.
- Washing/cleaning: This is a common compulsion for people with contamination OCD, the theme of OCD that focuses on fears about spreading or contracting an illness. People may wash their hands, shower, or clean surfaces and objects for hours every day.
- Checking: This can look like checking to make sure the stove is off, the door is locked, or that you didn’t hit someone with your car.
- Redoing: This looks like redoing any action until it feels perfect, safe, or “just right,” such as walking down the stairs again or repeating a certain word or phrase.
- Avoidance: You may avoid places, people, or situations that might potentially cause you distress.
Common mental compulsions include:
- Rumination: To put it simply, rumination is overthinking to an intense degree. It happens when you turn a thought, memory, situation, or question over and over in your mind with the hope of “solving” or “figuring out” something.
- Mental reviewing: This looks like combing through past events or situations to look for proof that your worries are or are not true.
- Seeking reassurance: This can sound like, I’m a really good person, I would never do something like that, Everything will be fine, and other reassurances that are a direct response to the fear or worry caused by obsessions, promising a false sense of certainty.
- Distraction: This looks like intentionally keeping your mind occupied in the hopes that the distraction keeps your intrusive thoughts and other obsessive triggers at bay.
- Thought neutralization: Similar to seeking reassurance, you may try to replace your negative thoughts with positive ones or ones that can “neutralize” them. The same goes for images. You might replace a scary or unwanted image in your mind with one that is more appealing.
These are only a few common examples among endless possible compulsions—the mental and physical behaviors that people perform to find short-term relief from their obsessions are unique to each individual.
Part 4: Compulsions bring temporary relief
People with OCD continue to perform compulsions because they bring temporary relief. For some amount of time, perhaps a few seconds, a few minutes, or even a few hours, you might feel better after engaging in compulsions—but it won’t last. Rather than solving the underlying issue, compulsions reinforce the belief that something is wrong and must be fixed immediately, trapping you in an endless loop of obsessions and compulsions.
The more you give in to the compulsive behaviors, the more you reinforce the OCD cycle, making it increasingly difficult to resist and eventually leading to more frequent and intense obsessions.
Dr. Patrick McGrath, Chief Clinical Officer at NOCD describes this dependence on compulsions, saying, “Now we’re stuck in the cycle because we figure the only reason the bad things—our fears, worries, or discomfort—aren’t happening is because of the compulsion. It becomes very ingrained that way in our minds. But compulsions don’t actually solve anything.”
How to break the OCD cycle
Exposure and response prevention (ERP) is a specialized form of therapy created to treat OCD. This specialized form of treatment breaks the OCD cycle by teaching people to recognize and resist compulsions. “It allows people to learn they can handle intrusive thoughts,” Dr. McGrath says.
To start, you and a trained therapist will work together to identify your obsessions, as well as the places, situations, thoughts, feelings, and other stimuli that trigger them. You’ll also take note of every behavior, mental or physical, that you do in response to the distressing feelings that your obsessions cause—that is, your compulsions.
Once you have identified what your OCD looks like, you’ll come up with a hierarchy of exposure exercises. This means that you’ll intentionally face the things that trigger your obsessions and distress. You’ll start with exposures that bring a small amount of discomfort, working your way up to the ones that are more difficult.
Your therapist will give you tools before, during, and after exposures to resist compulsions—this is the key to lasting recovery from OCD. Over time, you’ll build up tolerance to discomfort and uncertainty, and you’ll begin to take intrusive thoughts less and less seriously. Before long, you’ll find that your former triggers are far less distressing, and that you’re much better equipped to handle them whenever they occur.
For example, you might begin by confronting a mild obsession during ERP, such as worrying about whether you locked the door. At first, it may feel incredibly uncomfortable to resist checking the lock, but with guidance from your therapist, you’ll learn to sit with the anxiety without doing a compulsion. As you practice tolerating this discomfort, you’ll gradually expose yourself to more challenging triggers.
The goal of ERP isn’t to completely eradicate intrusive thoughts, images, feelings, sensations, or urges. Rather, the goal is to change your response to intrusive triggers, so they don’t end up causing as much distress and impacting your life. We want to disrupt the OCD cycle, which cannot continue without its crucial third stage: compulsions.
Bottom line
We understand that breaking the OCD cycle can be difficult, and it may feel overwhelming at times. The constant tug-of-war between obsessive thoughts and the urge to perform compulsions can create a sense of being trapped.
Observing how the OCD cycle shows up in your own life is something that you can begin to do on your own. And with the help of a trained therapist, exposure and response prevention therapy is a way to break the OCD cycle and drastically reduce the effect that your symptoms have over your life.