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The Sneaky Side of OCD: Understanding Mental Compulsions
When most people think of obsessive-compulsive disorder (OCD), they picture someone washing their hands over and over, checking the door lock repeatedly, or arranging things in a particular way. These are examples of physical compulsions, or visible behaviors done to ease the distress caused by obsessive thoughts.
But there’s another side of OCD that’s often overlooked because it happens entirely in the mind: mental compulsions.
What Are Mental Compulsions?
A mental compulsion is an internal behavior, something you do in your mind, to reduce the anxiety triggered by an obsessive or intrusive thought. Because these actions aren’t visible, they can be harder to recognize, both for the person experiencing them and for others around them.
Some common examples include:
- Replacing a “bad” thought or image with a “good” one
- Reviewing past events to make sure nothing harmful or bad happened
- Mentally counting
- Repeating a prayer or phrase
- Keeping track of “contaminated” objects or people
- Reassuring yourself with thoughts like “It’s okay, I’m okay.”
- Just like physical compulsions, these mental behaviors temporarily relieve anxiety but ultimately keep the OCD cycle going.
Mental Compulsion vs. Obsessive Thought
It can be tricky to tell the difference between an obsessive thought and a mental compulsion, especially since they often occur back-to-back.
Here’s a simple way to think about it:
- Obsessive or intrusive thoughts happen unintentionally. They pop into your mind without your control.
- Mental compulsions, on the other hand, are intentional acts or things you do mentally in response to the distress caused by those intrusive thoughts.
For example, if an unwanted thought about harming someone appears (an obsession), the person might mentally review their past actions to “make sure” they never actually hurt anyone (a mental compulsion). In fact, mental compulsions commonly, but not exclusively, occur in response to “taboo” obsessive thoughts that are sexual or violent in nature making them even more difficult to identify.
Why Mental Compulsions Matter
Because mental compulsions can’t be seen, they often go unnoticed even by therapists or individuals who are otherwise aware of their OCD symptoms. They might even seem “reasonable” at first, like saying “That’s bad” or “I would never do that.”
However, these internal rituals serve the same purpose as physical compulsions: they provide short-term relief but reinforce long-term anxiety. They prevent the brain from learning what would actually happen if the compulsion didn’t occur and that intrusive thoughts don’t need to be controlled or neutralized.
Addressing Mental Compulsions in Treatment
In Exposure and Response Prevention (ExRP), the gold-standard, evidence-based treatment for OCD, learning to resist mental compulsions is just as important as resisting physical ones. The “response prevention” part of ExRP involves not performing the compulsion, even when the urge feels strong.
Since mental compulsions are behaviors that you can consciously choose to do, you can also actively choose to not do them. It’s not easy to do, but it IS possible! While this is absolutely possible, it is not simple. Patterns of rumination and internal checking often feel automatic because they are so well-practiced. Working with a trained clinician provides essential support, structure, and accountability as they begin to shift these responses. That said, there are things you can try right now to help – research supports mindfulness as an effective approach:
- Noticing when the urge to perform a mental compulsion arises
- Refocusing your attention on the present moment rather than your thoughts
- Engaging in an activity aligned with your values instead of the compulsion
Over time, this process helps retrain the brain to tolerate distress and uncertainty and thereby reduce the distress related to OCD symptoms and regain control of your life.
The Takeaway
Mental compulsions may be invisible, but their impact on OCD is very real. Recognizing and addressing them is a key part of treatment. With awareness and evidence-based treatment, it’s possible to break the cycle and reclaim mental space from OCD.
About the Author:
Dr. Paulina Syracuse, PsyD, MS, is a clinical psychologist at the Center for Hope and Health. She specializes in evidence-based treatment for adolescents and young adults, drawing on extensive training in CBT, ERP, Prolonged Exposure, ACT, and DBT-informed approaches. Dr. Syracuse works with clients in person in our Somerville location and also provides virtual services to people living in Pennsylvania and New Jersey.
