Friday, April 1, 2011

Pure O: How do I tell the difference between obsessions and compulsions?

Bacterial capture by Neutrophil NETs

There's been discussions lately on the OCD support lists about how to tell the difference between an obsession and a compulsion, if it's all thoughts, as in "Pure O." My understanding is that the initial thought is the obsession, and the cascade of thoughts afterwards are the compulsion. For me it would be something like, "What if I said the wrong thing?" as the obsession, followed by trying to figure out if I did indeed say the wrong thing, including retracing my words, trying to account for all of them, which is the compulsion.

The irony is that the compulsion is supposed to be what reduces the anxiety produced by the obsessive thought, and yet, when I used to say "I wish I could stop obsessing about this" what I really meant was the whole flood of compulsions. I fly into compulsing so quickly that it seemed quite dubious that the initial thought was causing the anxiety--surely all the retracing, figuring out, analyzing, and research were the obsession right? How could they possibly be a way to lower my anxiety??

But what I learned during exposure therapy was that compulsions only provide short term relief, and in some cases, very very short term, and then they rebound with their own additional suffering, taking up mental space and energy, and that if I challenged myself to refrain from figuring out an obsessive thought, that my anxiety level immediately spiked, and that was a sign that the compulsion was serving its function of a short term hit of relief, even if I couldn't see it as it happened.

My husband had the flu this week, and he gave this analogy--the virus is the obsession, and the immune system response is the compulsion. When we are sick, what makes us feel lousy isn't the virus itself, but the attack of the immune system on the virus. In the case of our bodies, for the flu or other illnesses, we actually want the immune system to attack, but OCD is more like an allergy, where our immune system attacks something harmless like pollen, mistaking it for an invader. I know the things we obsess about don't seem harmless, and that they are often about things important to us, but our full blown compulsions cause us more misery in many cases than the initial obsession.

In the midst of my worst OCD flare ups, I had glimpses of how destructive the compulsions were, but I was so scared by the obsessive thought that I clung to my compulsions. I finally hit a low point with my health anxiety, that even though I was terrified of getting treatment, I knew I couldn't continue on the way I was going and have any kind of life. If you are like me, you probably also spend time trying to figure out if something is an obsession or a compulsion, and wanting to know for sure which it is. Another lovely complication of the OCD! Take your best guess.


  1. ExpWoman - I too spent a lot of time trying to figure this out - especially regarding ROCD. I think in the last few months I have got a better handle on the differences, now the trick for me is to stop the compulsing because for me it is such a habit that it happens instantaneously. I was giving my therapist the following example the other day: I read somewhere that there is a higher proportion of gay people who are left handed. Of course, when I am in a new environment - the first thing I do is scan it for signs of potential danger ie: any lesbians in this room? So what do I do? (Before I even catch myself) I look for signs to see if anyone is left-handed. I do this before I even catch myself! Thanks for this post!!

  2. In coming to terms with some of my OCD tendencies, I am reviewing a lot of my life patterns of behavior. While most OCD symptoms seem quite disruptive in a negative way, I am beginning to wonder about my 'good' obsessions. I have always had a tendency for total absorption into a new project or hobby. I would literally spend 10hours plus a day thinking about it and generating more and more excitement or 'good' feelings. I suspect part of this was avoiding 'bad ' feelings but I wonder whether others report similar tendencies?

  3. Pure O--learning to catch myself was really key! At first I didn't want to, because noticing my ocd set off all my "you are screwing up again" stuff, but if I can't see it, I can't change it.

    Anon--Yes, I can be in the zone with making art, and it seems like a "good" obsession. The difference is that I'm not in the studio to avoid bad feelings, as a compulsion to reduce my anxiety(at least most of the time. . .)I don't believe we have to give up our strengths of focus and passion in order to deal with the negative patterns, but sometimes, I don't realize that the negative stuff is operating, and it's been a journey of discovering all the ways I'm affected by my ocd.

  4. Hello everybody.. I an so afraid that I am alone. I cant find this anywhere. Yesterday my brain locked in on my speech. Everytime i said somethimg i replayed it in my head. I have GAD but never OCD. What is happening in my brain?

  5. Hi KB,
    I'm glad you found my blog. When I go over things in my mind, I call it "retracing"--I have a post on it here--
    Jonathan Grayson has some stuff about it in his book Freedom From OCD. Also, I was earlier diagnosed with GAD, and my current OCD therapist thinks there's a lot in common between the two.

  6. I struggled with that a bit- my compulsion is scalp picking. It took me a while to make the connection that it was an obsession. My psychiatrist was going down the list of common compulsions as she was trying to determine if I had OCD or not, and how severe it was, and sure enough, she came to scalp picking and it all clicked. It's so hard not to do it in public... I feel like I'm being stared at...

  7. Hi cudylant--welcome! I've struggled with hair pulling--the fact that I found it soothing was an obstacle to dealing with it, but working on my OCD with exposure therapy helped reduce my general stress level.

  8. Thanks a lot for the post.