How do obsessive thoughts lead to compulsion?
When there is an obsessive thought, it comes as a distressing image, doubt, lack of certainty, or an urge. Suppose there is an obsessive intrusive thought of an image of someone you love a lot covered with blood, what will be the ensuing reactions? You would start feeling very distressed and start feeling anxious and upset. Typically, a compulsion might look like calling your loved one to check if they are safe, checking their pulse to see if they are ok. It might involve a mental compulsion to neutralising thoughts of an image as if your loved one is happy and safe.
Obsessive thoughts can take several forms. For example, if the thoughts are about doubts about whether you have caused accidental harm (like hurting a dog when driving), this would include repeatedly getting down to check (compulsive behaviour).
If you have the intrusive thought that you might get contaminated by touching someone else’s phone, you might wash your hands repeatedly till your mind registers this as “just right” (compulsive behaviour).
If the thoughts are taboo, such as sexual or violent images which are distressing, you might think of an opposite thought, which is positive or might pray as a form of compulsion.
If the urge is to hoard stuff as you may not know if it will be important in future, then accumulating excess stuff might result in compulsive behaviour.
If you get intrusive swear words in religious places, you might have to do some purifying rituals to undo the distress of the thought.
For example, if you are preoccupied with perfection and symmetry, even a slightly slanted wall hanging might distress you, as you may not be able to remove your focus. Compulsive behaviours might include setting the imperfect object right and ordering rituals.
Pathological, intrusive doubts are a common feature of OCD. You might have repeated doubts about whether you have locked the door or left it unlocked. This might distress you as you might be worried about a burglar robbing the house. Unfortunately, the distress may not be set right by just checking once or twice. The compulsive behaviour might be so that you might have to check the lock 15 or, 20 or a 100 times before your mind can register the certainty and “just right” feeling. This might happen with light switches and gas stoves, too.
Sometimes, your focus might be towards your somatic sensations, such as your breathing. You may not be able to shift your focus away from your breathing. You might have to count your breath or do avoidance strategies to cope. If you understand how the cycle of obsessive thoughts leads to distress, which in turn leads to short-term anxiety-reducing strategies known as compulsions, then you are in a better place to combat this. Obsessive thoughts can sometimes occur independently without compulsions, but the distress will be the same. Please review the blogs, as this is an effective treatment for OCD.
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